Clinical Psychologist | VA Puget Sound, Seattle Staff Psychologist | TelePain Clinic | VISN 20 Pain Medicine & Functional Restoration Center Core Investigator | Health Services Research & Development | Seattle-Denver Center of Innovation Assistant Professor | Department of Psychiatry & Behavioral Sciences University of Washington School of Medicine Seattle, WA 98108
PainRelief.com: What is the background for this study?
Response: Chronic pain affects two-thirds of U.S. military veterans, and nearly 10% of veterans report severe pain that leads to significant distress or impairment. Within the Veterans Health Administration (VHA), interdisciplinary pain management has been the standard of care for high-impact, complex chronic pain, but rural patients are less likely to receive these services.
Telehealth provides an opportunity to address problems with accessing care in rural communities. In 2018, VA Puget Sound launched a regional pain telehealth program, TelePain, to bring interdisciplinary pain care using video telehealth to rural veterans in the Northwest.
In this study, we examined the impact of implementing TelePain on access to pain care among rural patients living in Washington state from 2015-2019 and compared their access to urban patients. All patients had moderate to severe chronic pain, and we included patients with any type of pain (e.g., back, neck, migraines, fibromyalgia, etc.). This study is a retrospective cohort analysis of VA data.
PainRelief.com Interview with: Andrew D. Hershey, MD, PhD, FAAN, FAHS Endowed Chair and Director of Neurology Professor of Pediatrics and Neurology Director, Headache Center Cincinnati Children’s Hospital Medical Center Cincinnati, OH 45229 University of Cincinnati, College of Medicine
PainRelief.com: What is the background for this study?
Response: Migraine is a common and debilitating disease, affecting 1 in 10 children and adolescents worldwide. Refractory migraine in adolescents may be associated with poorer academic performance, reduced school attendance, and a negative effect on social interactions. Current acute treatments for adolescents with migraine are mostly pharmacological. These treatments may cause side effects, and their frequent use may potentially lead to medication overuse headache. Additionally, their efficacy may be variable or inadequate. Thus, there is a great unmet need for new safe and effective acute treatments for adolescents with migraine headaches.
Remote Electrical Neuromodulation (REN) is a non-pharmacological, non-invasive neuromodulatory treatment that has been approved by the US FDA for acute treatment of the headache attacks of migraine in patients 12 years of age or older. The REN device (Nerivio®) is a small stimulator controlled by the user via a smartphone application and activates one of the body’s own pain suppression system by inducing weak electrical currents. These currents stimulate nerve fibers in the upper arm to activate an endogenous descending pain inhibition mechanism termed Conditioned Pain Modulation (CPM). Clinical trials of REN have shown efficacy and safety of the treatment in adolescents 12 and older, as well as in adults.
The current study is the first to compare REN and standard-care treatments (over the counter medications and triptans) in adolescents.
Joseph Albert Karam, MD Assistant Professor of Clinical Orthopaedic Surgery Associate Program Director, Orthopaedic Surgery Residency The University of Illinois at Chicago
Dr. Karam
PainRelief.com: What is the background for this study?Would you describe the multimodal pain plan?
Response: Pain after joint replacement surgery has been historically managed by protocols centered on opioid medication. Given the side effects associated with these medications, the risk for long term addiction and evidence showing that opioids are not necessarily the best at treating pain perioperatively in joint replacement, multimodal pain management protocols have been established. These protocols utilize different families of medications that target pain at different steps in the pain pathway.
The exact protocol varies from one institution to the other but typically include systemic agents such as acetaminophen, non-steroidal anti-inflammatories/COX-2 inhibitors, gabapentinoids, corticosteroids, as well as loco-regional interventions such as local infiltration analgesia and regional nerve blocks. ‘Pre-emptive analgesia’ which most commonly uses a nonsteroidal anti-inflammatory, acetaminophen and/or a gabapentinoid has also been demonstrated to play a key role. Additional measures such as NMDA antagonists and epidural catheters can also be used in select cases. Non-pharmacological treatments such as cryotherapy, cryoneurolysis and electrical nerve stimulation have also been described. Our preferred institutional protocol is detailed in the paper.
PainRelief.com: What is the background for this study?
Response: We became interested in looking at trunk position during running because one of us (Daniel Lieberman) had anecdotally observed people running with a variety of trunk positions, and when we went looking for academic literature on the topic, we found it was fairly scarce. We suspected that trunk position could have a major impact on the forces experienced by the lower limbs during running and even affect aspects of gait (stride length and time). So we developed a model predicting how these forces and movements might change as trunk flexion/forward leaning increased.
Our primary predictions were that more forward lean would increase “overstride” which is the distance in side view between the hip and the heel as it contacts the ground (a measure of how far your are extending your leg when you step). This in turn would increase the impact forces experienced by the lower limb at initial contact which have previously been shown to increase the risk of repetitive stress injuries. We also predicted that stride would get longer and take more time because extending the leading leg out farther forward (overstriding) would be necessary to keep the body center of mass within a base of support above the limbs. This more extended limb, we predicted, would change the angles and forces about the ankle, knee and hip joints.
PainRelief.com Interview with: Richard L. Nahin, Ph.D., M.P.H Lead Epidemiologist National Center for Complementary and Integrative Health (NCCIH) National Institutes of Health Bethesda, Maryland
Dr. Nahin
PainRelief.com: What is the background for this study?
Response: Individuals of Hispanic ancestry living in the U.S. include numerous subpopulations that vary in the prevalence of chronic disabling conditions, as well as exhibit differences in socioeconomic status, health behaviors, global health status, health care utilization, and genetic profiles.
Despite this evidence, there are few nationally representative studies examining the epidemiology of pain in these Hispanic subpopulations, and none that compared global measures of pain chronicity, severity, nor examined the influence of race on potential associations with pain in Hispanics.
Madeline H. Renny, MD Postdoctoral Fellow, Department of Population Health Clinical Instructor, Department of Emergency Medicine and Pediatrics New York University Grossman School of Medicine New York, New York
Dr. Renny
PainRelief.com: What is the background for this study?
Response: Prescription opioids are involved in over half of opioid overdoses among youth. Additionally, prescription opioid use is associated with risks of future misuse, adverse events, and unintentional exposures by young children. While there are several studies on opioid prescribing in adults, few studies have focused on the pediatric and adolescent population. In the last year, postoperative guidelines for opioid prescribing for children and adolescents were released, but there remain no national guidelines on general opioid prescribing for youth.
To our knowledge, no prior national studies have examined trends in important opioid prescribing practices, including amount prescribed, duration, high-dosage, and extended-release/long-acting (ER/LA) opioid prescriptions, in this subset of the population; a necessary step in understanding the opioid epidemic and in developing targeted interventions for youth.
Therefore, we performed a cross-sectional analysis of U.S. opioid prescription data to investigate temporal trends in several key opioid prescribing practices in children, adolescents, and younger adults in the U.S. from 2006-2018.
PainRelief.com: What are the main findings?
Response: We found that opioid dispensing rates declined significantly for children, adolescents, and younger adults since 2013. When examining trends in opioid prescribing practices, there were differences based on age group. For adolescents and young adults, rates of long-duration and high-dosage opioid prescriptions decreased during the study period, whereas there were increases in these rates for younger children.
PainRelief.com: What should readers take away from your report?
Response: Dispensed opioid prescriptions for youth have significantly decreased in recent years. These findings are consistent with prior studies in children and adults, suggesting that opioid prescribing practices may be improving. Additionally, the decrease in rates of high-dosage and long-duration prescriptions in adolescents and young adults is encouraging in the context of research showing associations with these prescribing practices and opioid use disorder and overdose. However, opioids remain commonly dispensed to youth and potential high-risk prescribing practices (long-duration, high-dosage, and ER/LA prescriptions) appear to be common, especially in younger children.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The increase in rates of potential high-risk prescribing practices in young children was an unexpected finding and warrants future study. Due to the limitations of our database (no clinical information, including diagnoses or indications for prescription), we were unable to determine the appropriateness of opioid prescribing practices (e.g., whether a prescription was for a child with cancer or for a child with an acute injury). Our two sensitivity analyses were performed to try to identify a subset of patients with chronic illness and both showed no differences in trends. However, it will be important to further investigate these opioid prescribing practices using a database with clinical information to better understand these findings in young children.
Further research investigating specific opioid prescribing practices may inform targeted interventions, including pediatric and adolescent-specific opioid prescribing guidelines, to ensure appropriate opioid prescribing in this population.
No disclosures
Citation:
Renny MH, Yin HS, Jent V, Hadland SE, Cerdá M. Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA Pediatr. Published online June 28, 2021. doi:10.1001/jamapediatrics.2021.1832
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Jing Wang MD PhD Department of Anesthesiology, Perioperative Care and Pain Department of Neuroscience & Physiology NYU Langone Neuroscience Institute, New York University School of Medicine New York, NY
PainRelief.com: What is the background for this study? What are the main findings?
Response: The motivation for this study is three fold.
First, there are no objective ways to measure pain in preclinical models that could facilitate study of pain mechanisms and analgesic screening.
Secondly, while pain is assessed by patient report, a lack of alternative pain measures in humans hinders clinical treatment of pain in patients whom we cannot assess pain readily, such as patients who suffer from dementia or very young children.
Thirdly, chronic pain patients often complain of spontaneously occurring pain episodes which are unpredictable, and we currently do have a way to target specific pain episodes, and so we treat pain with scheduled drugs, leading to under- or over-treatment. We designed a prototype closed-loop neural interface, employing computerized brain implants, to address these challenges. We found that this interface quite effectively relieves short-term and chronic pain in rodents. In this study, we designed a computerized brain implant to detect and relieve bursts of pain in real time. We implanted electrodes in a region of the brain called anterior cingulate cortex, an important area for the processing the emotional component of pain. We used these implanted electrodes to measure neural activity in this brain region, and then applied machine learning algorithm to detect a change in neural activity in this region which signals the onset of pain experience. The detected pain signal then triggered stimulation of another brain region, called prefrontal cortex, which is known to suppress pain. In this way, our device automatically detected and treated pain with minimal delay, as shown by a number of pain behavior assays in rats. The device is also the first of its kind to target chronic pain, which often occurs without being prompted by a known trigger.
PainRelief.com: What should readers take away from your report?
Response: Our experiments offer a blueprint for the development of brain implants to treat pain syndromes and other brain-based disorders, such as anxiety, depression, and panic attacks. The advantage of our approach is that it targets symptoms in a time-sensitive manner. Our approach can detect pain as it occurs in real time. In its current form, it already becomes a powerful tool to screen drugs. In our current system, pain detection is coupled with neurostimulation treatment. But it can also be coupled with drug delivery. In this way, our system can be used to screen new analgesic drugs. It can also be used to screen other neurostimulation techniques.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: We are already working on modifications of our system to move it closer to translation to the bedside.
First, we would like to improve pain decoding accuracy. We are doing that be recording from multiple brain regions.
Second, the current treatment requires injection of viral vectors and foreign proteins, which are not realistic in human use, and thus we are working to use more clinically feasible approaches to treat pain in our closed-loop device.
Finally, we are working on making the device non-invasive – free of brain implants.
Citation:
Zhang, Q., Hu, S., Talay, R. et al. A prototype closed-loop brain–machine interface for the study and treatment of pain. Nat Biomed Eng (2021). https://doi.org/10.1038/s41551-021-00736-7
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Christopher M Proctor, PhD Group Leader, Bionic Systems Group BBSRC David Phillips Fellow Electrical Engineering Division University of Cambridge United Kingdom
Dr. Proctor
PainRelief.com: What is the background for this study? What types of pain might be amenable to treatment with this device?
Response: Spinal cord stimulation has been shown to be effective for patients with severe neuropathic pain. However, the most effective devices that are clinically available today require a rather invasive surgical procedure. Our innovation aims to reduce the surgical burden while providing the best possible treatment.
PainRelief.com: Would you describe the technology?
Spinal Implant – Unrolling
Response: Our minimally invasive spinal cord stimulator is an ultra thin implant that can be inserted into the epidural space within the spinal column through a needle. Once in place, the device can be expanded in a controlled way to cover a large area along the spinal cord. Covering a large area allows for more precise targeting of the nerves that cause you to feel pain.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: We believe that this technology could vastly expand the use of spinal cord stimulation for patients with chronic pain conditions. We are currently fundraising to conduct further pre-clinical testing with an aim to be ready for clinical testing within 3 years.
Any disclosures? The main authors of this study are co-inventors on a related patent application.
BY BEN J. WOODINGTON, VINCENZO F. CURTO, YI-LIN YU, HÉCTOR MARTÍNEZ-DOMÍNGUEZ, LAWRENCE COLES, GEORGE G. MALLIARAS, CHRISTOPHER M. PROCTOR, DAMIANO G. BARONE
SCIENCE ADVANCES 25 JUN 2021 : EABG7833
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Dr. Siddharth A. Padia, MD Interventional Radiology Ronald Reagan UCLA Medical Center UCLA Santa Monica Medical Center
Dr. Padia, MD
PainRelief.com: What is the background for this study?
Response: Osteoarthritis (OA) of the knee can be a debilitating condition with significant impact on a person’s overall quality of life. OA has historically been considered a “wear-and-tear” disease, resulting from years of stress induced cartilage degeneration. Recent data suggests that inflammation plays a role not only in the experience of pain secondary to osteoarthritis, but is a driver of OA itself.
Genicular artery embolization (GAE) is a minimally invasive procedure where the arteries supplying the lining of the knee are selectively catheterized during an angiogram to target abnormally increased blood flow associated with knee osteoarthritis. Injection of small, microspheres results in a reduction in arterial flow, which may in turn reduce the synovial inflammation.
PainRelief.com: What are the main findings?
Response: 40 subjects were enrolled in this trial. Technical success was achieved in 100% of subjects. Transient skin discoloration and transient mild post-procedure knee pain were common and expected. Pain scores decreased from a 8 (out of 10) at baseline to 3/10 (63% decrease) at 12 months. Twenty-seven patients (67.5%) had greater than a 50% reduction in pain scores.
PainRelief.com: What should readers take away from your report?
Response: Genicular artery embolization is a highly promising therapy for people with knee arthritis, who are not surgical candidates or which to defer surgery. It is the first non-surgical treatment that has shown to have a significant reduction in pain with a duration of at least one year. It is minimally invasive, and most people can resume their everyday activities the evening after their procedure.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: This was a single arm trial, in that genicular artery embolization was not compared to other treatments. Future research needs to show a comparison to other treatments or placebo in order to prove its efficacy. Additionally, long-term result (2 and 4 years) would be beneficial to show the durability of GAE over time.
Citation:
Abstract No. 16 Genicular artery embolization for the treatment of knee osteoarthritis: final results from a prospective investigational device exemption trial Padia, S. et al. Journal of Vascular and Interventional Radiology, Volume 32, Issue 5, S8
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Ken M. Hargreaves, DDS, PhD Professor and Chair Department of Endodontics The University of Texas Health Science Center at San Antonio
Dr. Hargreaves
PainRelief.com: What is the background for this study? What are the main findings?
About ten years ago our lab found that the omega-6 lipids can generate pain-producing lipids by activating the capsaicin (found in red hot chili) receptor. At about that time, other scientists reported that a related lipid, the omega-3, can generate pain-relieving lipids.
Scientists have known for a long time that both omega-6 and omega-3 lipids are “essential fatty acids”, meaning that our body does not make them so they must come in our diet.
So, we tested the idea that a high omega-6 diet would be a risk factor for pain. That is exactly what we found: mice fed a high omega-6 diet had greater pain-like responses after inflammatory or neuropathic injury.
Mice with diabetic neuropathy actually had worsening of symptoms after a high-6 diet. Importantly, this was largely reversed in mice fed a high omega-3 diet.
We also found a drug that blocked the release of the omega-6 lipids from cell membranes and this drug significantly reduced diabetic neuropathy pain in mice.
We then transitioned to clinical research. We collected ankle skin biopsies from participants with type II diabetic neuropathy and from age- and sex-matched controls. The tissue levels of omega-6 lipids predicted pain levels, with higher omega-6 lipids associated with higher reports of pain.
PainRelief.com: What should readers take away from your report?
Dietary recommendations have been made for patients with many disorders such as cardiovascular disease, diabetes and autoimmune disease. Our findings suggest that pain should be added to this list and that a diet enriched with a higher ratio of omega-3 to omega-6 lipids may help to reduce pain.
Examples of foods with a high omega 3:6 ratio are tune (25:1 of omega 3:6), broccoli (6:1), flax seeds (4:1), mango (3:1), spinach (5:1) and lettuce (2:1). Examples of foods with excessive omega-6:3 would include many processed foods cooked in vegetable oils such as French fries, hamburgers and the like.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: Our study has identified several paths for future research including a clinical trial evaluating the effects of a high omega 3:6 diet on pain, development of new drugs to block omega-6 release and the possible development of lipids as a biomarker for pain.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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