Back Pain: Advice and Education Provide Small Short-Term Improvements in Pain and Disability

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PainRelief.com Interview with:
Caitlin Jones PhD Candidate
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospita
Australia

PainRelief.com:  What is the background for this study? What are the main findings?

Response: Despite advice being recommended internationally as a treatment for spinal pain, the evidence behind that was uncertain and out of date. We didn’t think that the strong and widespread recommendation to provide advice was reflective of the available evidence. There have been multiple, more recent, trials of advice and education with varying results, so it was a good time to collate and summarise these with a systematic review.

Our main findings were that advice and education had a small effect on pain and disability compared to no advice and education, or placebo in the short term. The effects were around 10 points of improvement for pain and 5 points for disability on a 0 to 100-point scale. There was evidence of no effect at all other time points (immediate, intermediate and long term). The specific content of the advice didn’t seem to make much difference.

We compared simple contemporary advice (such as advice to keep active and to avoid bed rest and reassurance about the positive prognosis) to more comprehensive advice, such as ergonomic advice (specific postural and biomechanical information) or pain neuroscience education, and found them all to be about equally effective. Whether the participants’ symptoms were acute or chronic, the intensity of the intervention in terms of time spent with a therapist, how the intervention was delivered and the depth and type of the content didn’t impact outcomes.

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Chronic Migraine: TOP-PRO Study Compares Propranolol and Topiramate for Pain Relief

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PainRelief.com Interview with:

Dr. Debashish Chowdhury
MBBS; DTCD; MD (Medicine); DM (Neurology); FIAN
Commonwealth Fellow in Stroke Medicine (Edinburg, UK)
Director – Professor and HOD
Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research,
New Delhi, India

Dr. Chowdhury

PainRelief.com:  What is the background for this study?

Response: Chronic migraine is a highly disabling headache disorder affecting about 2% of the global population. Oral preventive treatment options for chronic migraine are limited. Only topiramate has good evidence of efficacy. Although propranolol has class I evidence of efficacy for the prevention of episodic migraine, it has not been tested for chronic migraine with a robust clinical trial. Hence, we conducted an RCT, called the TOP-PRO study assessing the efficacy and tolerability of propranolol against topiramate for the prevention of chronic migraine using a non-inferiority design.

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Pronounced Declines, but Regional Differences, in Hospital Use of Prescription Opioids

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Sarah A. Eidbo, MS
MD Candidate
Geisinger Commonwealth School of Medicine Class of 2023
Scranton, Pennsylvania

Sarah A. Eidbo

MedicalResearch.com: What is the background for this study?

Response: The United States is still witnessing the fallout from years of a devastating, multifaceted opioid crisis. However, in the wake of this situation, healthcare providers and systems across the nation have implemented many strategies to curb the damage where they can. This study1 used reports from the Drug Enforcement Administration (DEA)2 to quantify the changes and trends in prescription opioid distribution to hospitals in the U.S .over the past two decades.

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Study Addresses How Weather Affects Pain Tolerance

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PainRelief.com Interview with:
Erlend Hoftun Farbu, PhD student
Department of Community Medicine
The Arctic University of Norway
Tromsø, Norway

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Many report that weather affect their pain condition. Some studies confirm this, others do no. However, these studies have asked “How much pain do you have today?”

We used two tests to assess how much pain a person can tolerate. We then looked at how pain tolerance vary over time and if they are associated with weather.

The results show quite clearly that people can tolerate more pain caused by intense cold temperature in the colder months of the year. There was no such seasonal variation in pain caused by pressure to the leg. On the other hand, we found that both pressure pain tolerance and weather at one day was associated with the next days, but not the next month. When we further linked the weather and pain tolerance, we found that, for example, in some periods a rise in temperature happened at the same time as a rise in pain tolerance. While in other periods, there were no such association. We mean that this is because we adapt to the weather. For example, how we experience 5 °C (41°F) is different in autumn and spring..

Finally, temperature and barometric pressure could predict future values of pressure pain tolerance

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Acetaminophen (paracetamol) During Pregnancy May Alter Fetal Development

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PainRelief.com Interview with:
Ann Z. Bauer ScD
Department of Work Environment
University of Massachusetts Lowell | UML 

PainRelief.com:  What is the background for this study?  What are the main findings of the underlying studies?

Response: Acetaminophen (paracetamol, brand name Tylenol) is an over-the-counter medication used to relieve pain and reduce fever. It is an active ingredient in over 600 medications and used by more than 50% of pregnant women worldwide and up to 65% of pregnant women in the US.

Current guidance recommends acetaminophen as the pain reliever of choice during pregnancy, as other pain relievers such as ibuprofen and aspirin are contraindicated during pregnancy, particularly after 20 weeks.

In this consensus statement the authors reviewed the research on acetaminophen use during pregnancy from 1995 through 2020 and found a growing body of evidence that suggests prenatal acetaminophen exposure may alter fetal development increasing the risk of neurodevelopmental, reproductive and urogenital disorders. Importantly, this review identifies a convergence of evidence from the trifecta of research areas -human cohort studies, in vitro and animal models. This statement asking for precaution and more research was supported by a total of 91 clinicians and researchers (13 authors and 78 signatories) from around the world.

Research suggests acetaminophen is an endocrine disruptor meaning it interferes with the proper functioning of hormones, specifically it is an anti-androgen that can significantly reduce testosterone production.  Acetaminophen exposure during pregnancy has been suggested to increase the risk of male undescended testicles (cryptorchidism) and shorter anogenital distance (ADG) a marker of sub-fertility.  Additionally, research suggests increased risk of neurodevelopmental disorders primarily attention deficit hyperactivity disorder (ADHD) and related behavioral abnormalities, but also autism spectrum disorder (ASD), language delays, decreased IQ, and conduct disorders.

Many users do not consider acetaminophen to be a medication with potential side effects. There is high usage, in part, because of a perception  that use is of negligible risk.  However, because use is so common, if acetaminophen is responsible for even a small increase in individual risk it could contribute substantially to these disorders in the overall population.

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Migraine Pain Linked to Stress Varies by Individual

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PainRelief.com Interview with:

Serena L. Orr, MD, MSc, FRCPC, FAHS
Assistant Professor
Depts of Pediatrics, Clinical Neurosciences and Community Health Sciences 
Cumming School of Medicine, University of Calgary
Director, Pediatric Headache Program
Alberta Children’s Hospital

Dr. Orr

PainRelief.com:  What is the background for this study?

Response: Stress has long been felt to be one of the most common trigger factors for migraine. However, there is very little data on the relationship between stress and pain severity in individuals with migraine on a day-to-day basis, and this relationship is even more poorly understood among individuals with more frequent attacks, such as those with chronic migraine (who have at least 15 days/month of headache, 8 or more of which meet criteria for migraine attacks).

This was a study that looked at daily electronic headache diary data for 136 adults with chronic migraine, using data from the N1-Headache application. In this study, we aimed to understand the relationship between perceived stress and pain severity in individuals with chronic migraine. Individuals completed 90 days of daily diary entries where they reported on their headache characteristics, and their perceived stress levels, measured on a scale of 0-10.

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Caution Should Be Taken with Hip Steroid Injections For Arthritis Pain Relief

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PainRelief.com Interview with:
Kanu M. Okike, MD
Orthopedic Surgeon
The Hawaii Permanente Medical Group

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Hip corticosteroid injections are a common treatment for osteoarthritis and other hip conditions.  Recently, isolated case reports have raised the question of whether hip corticosteroid injections could be associated with rapid progression of the arthritis process – a condition known as rapidly destructive hip disease (RDHD).

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Pain Relief Study of Low Carb Ketogenic Diet

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PainRelief.com Interview with:
Rowena Field
B.App.Sc (phty) M.Physio. APAM
Physiotherapist/Director
PhD research candidate Sydney University
STEPP (solutions tools and education for persistent pain)

PainRelief.com:  What is the background for this study?

Response: Chronic pain is a difficult problem to treat because it is multifactorial, driven by the brain continuing to arrive at the conclusion that protection is required. Turning up the sensitivity in the nervous system results in ongoing pain as a protector even though there is no new tissue damage. Other protection mechanisms such as increased inflammation, and increased sympathetic ‘fight or flight’ also occur.

Chronic pain becomes part of a whole system protective response, so looking at other treatment options that alter the system (such as diet) are useful additions to pain management. A ketogenic diet restricts carbohydrate to below 50g/day producing ketones for energy from fat. It has been used to treat epilepsy over the last two centuries and successfully reduces nervous system excitability. Many of the drugs used for chronic pain (such as Lyrica) are also anti-epileptic medications, suggesting common pathways. As well as these impacts on the nervous system, pre-clinical research has also shown ketones to be signalling molecules that reduce inflammation.

Combined with the clinical reports that pain reduction occurred when people were on ketogenic diets, it seemed reasonable to test the diet specifically in a chronic pain population.

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Switching to Buprenorphine Might Provide Pain Relief for Poorly Controlled Pain

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PainRelief.com Interview with:
Victoria D. Powell, MD, FACP
Clinical Lecturer – Geriatric and Palliative Medicine
University of Michigan
Staff Physician, Palliative Care
LTC Charles S. Kettles VA Medical Center
Ann Arbor, MI

Dr. Powell

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: People with chronic pain who use long-term opioids face a number of health risks, and often do not have optimally controlled pain.

Buprenorphine acts on the opioid receptor with a different effect than drugs like morphine or oxycodone, and as a result is less associated with the risks of long-term opioid use, such as accidental overdose. While buprenorphine has been successfully used in patients with opioid use disorder for several years, certain experts have proposed using buprenorphine for pain management in people with chronic pain. We found low quality evidence supporting pain control that may be superior to traditional opioids, but much more research is needed to confirm.

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Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

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PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

PainRelief.com:  What is the background for this study?

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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