PainRelief.com Interview with: Jeungchan Lee, PhD Department of Radiology Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School Charlestown, MA
PainRelief.com: What is the background for this study?
Response: Fibromyalgia is a centralized chronic pain syndrome, characterized by multidimensional symptoms. The underlying mechanism, however, in the brain is not well understood. Plus, the application of neuro-metabolic imaging has been limited to a preselected single brain region, which has a potential bias in single region-preselection, and is time-consuming if data collection is needed from multiple brain regions.
Thus, we tried to understand its mechanism with a better spatial resolution and brain coverage using an advanced neuro-metabolic imaging technique (3D proton magnetic resonance spectroscopy, 1H-MRS) by linking metabolic levels to multidimensional clinical/behavioral variables in fibromyalgia patients.
PainRelief.com Interview with: Benjamin W. Friedman, MD, MS, FAAEM, FACEP, FAHS Professor of Emergency Medicine Vice-chair for Clinical Investigation Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx, NY 10467
PainRelief.com: What is the background for this study? What are the main findings?
Response:A very large number of patients present to US EDs annually with back pain. No medications have proven more effective than NSAIDs for low back pain. Similarly, combining other medications such as skeletal muscle relaxants or opioids with NSAIDs does not improve outcomes more than NSAIDs alone.
Prior to our study, little was known about which NSAIDs were most efficacious for acute low back pain.
The main finding of our study is that ketorolac was more efficacious than ibuprofen for some two and five day outcomes that are important for patients.
PainRelief.com Interview with: Roger Cady, MD VP Neurology Lundbeck Pharmaceutical La Jolla Research Center San Diego, CA 92121
PainRelief.com: What is the background for this study?
Response: The RELIEF study evaluated how preventive migraine candidates may benefit from a VYEPTI infusion during an active migraine attack when administered within 1 to 6 hours of a moderate to severe migraine attack. VYEPTI is the first and only intravenous (IV) infusion approved for the preventive treatment of migraine in adults.
PainRelief.com Interview with: Hanna Grol-Prokopczyk PhD Associate Professor Department of Sociology University at Buffalo, SUNY
PainRelief.com: What is the background for this study?
Response: Although chronic pain is recognized as an extremely common and costly health problem, little research has explored temporal trends in pain prevalence. Indeed, as recently as 5-6 years ago, there was no published research using general population data examining whether pain prevalence in the U.S. was going up, going down, or staying constant. (This can be contrasted to conditions such as diabetes and cancer, for which information about long-term trends is readily available. Of note, chronic pain affects more Americans than diabetes, cancer, and heart disease combined.) In recent years, a few studies have documented rising pain prevalence in the U.S., but most have used data on middle-aged or older adults.
PainRelief.com Interview with: Sophie Bergeron, Ph.D. Canada Research Chair in Intimate Relationships and Sexual Wellbeing Past-President, Society for Sex Therapy and Research Professeure titulaire/Professor Département de psychologie Université de Montréal
Dr.Bergeron
PainRelief.com: What is the background for this study?
Response: Chronic pain problems involving the female reproductive system are major health concerns in women of all ages. As conditions which are poorly understood and often misdiagnosed or ignored, they entail a great personal cost to patients and a significant financial cost to society.
One such condition is vulvodynia, or chronic unexplained vulvar pain. Up to 8% of women under 40 may experience idiopathic vulvar pain during their lifetimes. Provoked vestibulodynia (PVD) – an acute recurrent pain localized within the vulvar vestibule and experienced primarily during sexual intercourse – is suspected to be the most frequent cause of vulvodynia in premenopausal women.
Despite its high prevalence and negative impact on psychosexual functioning of both affected women and their partners, there has been a paucity of controlled research to provide empirically validated treatments for afflicted couples. This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for PVD.
PainRelief.com Interview with: Bruce J. Sangeorzan, M.D., Professor Director, RR&D Center for Excellence in Limb Loss Prevention and Prosthetic Engineering Veterans Affairs University of Washington
PainRelief.com: What is the background for this study?
Response: We began a series of studies in the early 2000’s when ankle replacement was limited to a few centers like our own. We knew that ankle arthrodesis– or fusion—was an effective treatment for ankle arthritis. But ankle fusion is not appropriate for some people and it also results in loss of ankle motion. There were a growing number of ankle replacements being done but little was known about their effectiveness or how long they last.
We wanted to study whether replacement and fusion were comparable for pain relief and activity and wanted to know if maintaining motion of the ankle (by using a replacement) would have an advantage without additional risk. Three studies were done involving more than 800 patients from 6 centers.
This most recent study compared two groups of patients who had similar amount of pain and activity before treatment. All of the patients had already tried non -surgical solutions such as activity modification, bracing and injections with out improvement. One group had fusion of the ankle and the other had replacement of the ankle. Patients were questioned and examined four years or more after surgery and compared to their condition before treatment.
PainRelief.com Interview with: Lingxiao Chen | MBBS, MMed, PhD Candidate The University of Sydney Institute of Bone and Joint Research | The Kolling Institute Sydney Medical School | Faculty of Medicine and Health Statistical Editor of BMJ Open Sport & Exercise Medicine
PainRelief.com: What is the background for this study?
Response: Current guidelines for treatment of low back pain (LBP) do not recommend routinely using diagnostic imaging, except when patients either present with severe, progressive neurologic deficits or with signs or symptoms indicative of a serious or specific underlying condition (eg, fracture or cancer). Nonetheless, diagnostic imaging is still widely used in clinical practice for low back pain. Previous studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain–related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine.
PainRelief.com Interview with: Christina Abdel Shaheed PhD Researcher and Academic University of Sydney
Dr. Abdel Shaheed
PainRelief.com: What is the background for this study? What are the main findings?
Response:Paracetamol (acetaminophen) is one of the most widely used drugs for pain relief globally. Our study (https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50992) examined the evidence on the efficacy of paracetamol versus placebo for 44 different pain conditions. There is strong evidence paracetamol provides greater pain relief than placebo for four conditions: craniotomy, knee or hip osteoarthritis, tension headache and perineal pain following childbirth, however sometimes the effects were very small.
Paracetamol was no more effective than placebo for acute low back pain. There is uncertainty regarding the benefits of paracetamol for the remaining 39 pain conditions. To note, most studies evaluated single doses of the pain reliever, which does not reflect typical use of the medicine.
PainRelief.com: What should readers take away from your report?
Response: If people are considering paracetamol for their pain, the recommendation is to:
Stick within the safe limits for using paracetamol (maximum 4 g daily for adults, which will vary depending on the formulation used).
Bear in mind there are different types of paracetamol products (long-acting, which should be taken less frequently, versus short-acting); and cold and flu preparations (including decongestant) and popular over-the-counter products for pain relief (including ibuprofen) can also contain paracetamol.
Do not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
Consider combining the medicine with other non-drug strategies to optimise pain relief, particularly for conditions like osteoarthritis e.g. exercise and healthy eating.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response:High quality clinical trials evaluating typical use of paracetamol are needed to resolve the uncertainty around its effectiveness for the majority of pain conditions.
Disclosures: Some of the authors on this study were also involved in the PACE trial which evaluated the efficacy of paracetamol vs placebo for acute low back pain.
Citation:
Abdel Shaheed, C., Ferreira, G.E., Dmitritchenko, A., McLachlan, A.J., Day, R.O., Saragiotto, B., Lin, C., Langendyk, V., Stanaway, F., Latimer, J., Kamper, S., McLachlan, H., Ahedi, H. and Maher, C.G. (2021), The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Med J Aust, 214: 324-331. https://doi.org/10.5694/mja2.50992
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: Martin De Vita, CPT, MS, USA Doctoral Candidate Clinical Psychology Department Syracuse University
PainRelief.com: What is the background for this study? What are the main findings?
Response: Seemingly out of nowhere, cannabidiol (CBD) products became immensely popular. Cross-sectional studies showed widespread use among the public for various clinical conditions. Pain was by far the most commonly reason cited for using CBD. However, no human experimental pain studies had been conducted to evaluate the analgesic effects of CBD. A lot of people questioned whether CBD effects on pain were just a placebo.
To answer this question, we tested people’s baseline pain responding using sophisticated equipment capable of delivering safe, but painful stimulation that activates and evaluates human nervous system processes. Then we administered either CBD or a placebo and re-tested these pain outcomes to see how they changed. We took it a step further and manipulated the information that participants were given about which substance they received. So in some conditions, participants were told they got CBD, even though it was just a placebo. In other conditions, participants were told they got an inactive substance, despite actually receiving CBD. This way, we could test whether simply telling someone that they had received CBD would have an effect on their pain. These are called expectancy effects and there is a large body of literature that supports this phenomenon.
When we looked at the data, we found that CBD analgesia was actually driven by both expectancies (placebo analgesia) and pharmacological action. We also found that these manipulations affected different pain outcomes. We found that both CBD and expectancies reduced pain unpleasantness but not pain intensity. The results were complex in that CBD and expectancies for receiving CBD differentially affected various outcomes. This was exciting because we are left with even more questions to investigate in future research.
PainRelief.com Interview with: Dr Renato Vellucci Contract Professor University of Florence Pain and Palliative care Clinic University Hospital of Careggi Florence, Italy
Dr. Vellucci
PainRelief.com: What is the background for this study? What are the main findings?
Response: Chronic low back pain (CLBP) is the most prevalent chronic pain (CP) condition and the leading global cause of years lived with disability. According to the axiom pain as a biopsychosocial issue, mood and sleep disturbances represent key issues. However, the impact of different analgesic therapies on quality of life (QoL) and functional recovery has been poorly assessed to date. Focusing on combination of chronic pain and sleep, they both perform a mutual reinforcement.
Pain disorganizes the sleep architecture, and disturbed and unrefreshed sleep increases spontaneous pain and lowers pain thresholds. Sleep disorders may augment stress levels, thus making it difficult for patients to perform simple tasks impairing their cognitive ability. Poor sleep may predict the growth and intensification of pain over time, with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. Epidemiology of chronic pain unequivocally demonstrates the role of sleep quality in the development of chronic pain.
Notwithstanding this strong two-way relationship between chronic pain and sleep, little knowledge is available about the neurochemical determinants of this interplay and therapeutical strategies to break this vicious circle. Fifty percent of people with chronic low back pain have sleeping disturbances, with an 18-fold increase in insomnia versus healthy people. A recent study investigated the relationship between sleep disturbances and back pain and found that it is two sided with sleep disturbance being associated with risk of back pain whilst back pain can also lead to sleep disturbances. Thus, it can be hypothesized that, by reducing pain and physical dysfunction, sleep quality could be improved, thus enriching the QoL of people with CLBP.
Similarly, improvements in sleep after cognitive behavioral therapy in patients with chronic pain due to osteoarthritis were associated with reduced pain. Earlier evidence suggested that tapentadol prolonged-release treatment ameliorate in parallel QoL and sleep quality in a greater proportion of patients compared to that of patients following oxycodone/naloxone prolonged- release treatment (50% versus 37.7%). Other tapentadol studies conducted in a real-life context documented, along with effective pain control, similar improvements in mental and physical health and suggested beneficial effects in terms of less night awakenings and greater percentages of patients reporting restful sleep.
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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