Mindfulness Meditation for Migraine Pain Relief

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PainRelief.com Interview with:
Rebecca Erwin Wells, MD, MPH
Associate Professor, Department of Neurology
UCNS Certified Headache Specialist
Founder and Director of the Comprehensive Headache Program at Wake Forest Baptist
Wake Forest School of Medicine

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

  • Migraine is the second leading cause of disability worldwide.
  • Many patients with migraine stop medications because of side effects or ineffectiveness.
  • Many patients with migraine still use opioids despite recommendations against them for headache treatment. 
  • Mindfulness is helpful for many clinical pain conditions.
  • We conducted a pilot study of mindfulness for migraine that demonstrated benefit, so we conducted this larger randomized controlled trial to understand further potential benefit.
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Recorded Music plus Text During Anesthesia Reduced Need for Pain Medication

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PainRelief.com Interview with:
Prof. Dr. Ernil Hansen
Department of Anesthesiology
University Hospital Regensburg
Regensburg, Germany

Prof. Dr. Hansen

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

Response: It is becoming more and more clear that besides drugs and surgery it is communication that makes therapy effective. A meta-analysis we had conducted recently, suggested some beneficial effects of taped words played during surgery in older studies.

Our current study on 385 patients showed evidence that a text based on hypnotherapeutic principles an reduce postoperative pain and use of opioids. Pain within the first 24h after surgery decreased by 25%, opioid requirement by 34%. Six patients needed to be treated to save one patient from opioid exposure at all. High demand for analgesics was reduced by 41%. 

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5-Year Follow-Up of Open-Label Placebo Trial for Chronic Low Back Pain Relief

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PainRelief.com Interview with:
Claudia Carvalho, PhD
Instituto Universitário de Ciências Psicológicas
Social e da Vida
Lisbon, Portugal

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

Response:  Some clinical trials on chronic pain have shown placebo responses that rival those of commonly prescribed first-line therapies for low back pain (LBP).  However, prescribing placebos would pose ethical problems in clinical practice.  One solution to this problem is the use of open label placebos (OLP), which are presented to patients openly as pills without active ingredients, along with a rationale indicating that because of classical conditioning of relief with active medications, the pills themselves might reduce pain. OLP has been shown effective compared to treatment-as-usual for a number of clinical conditions, including chronic LBP.  Having conducted the first clinical trial on OLP on back pain, my colleagues and I wondered whether the effects were long-lasting. To answer that question, we conducted a five-year follow-up on the patients who had received OLP for their back pain.

In our original study, patients who took OLP pills for three weeks experienced greater reduction in back pain intensity and in back pain related disability than patients that simply continued their usual treatment. Additionally, after this phase of the trial, we offered OLP to participants  in the treatment as usual group) and they also reported a significant reductions in pain and disability, together with a spontaneous decrease in the use of pain medication by participants.

In our current follow-up, we found that patients who had taken OLP for three weeks had maintained their reductions in pain and disability 5 years later. In addition, pain medication usage was reduced by 49%. This follow-up study is currently in press (https://journals.lww.com/pain/Fulltext/9000/Open_label_placebo_for_chronic_low_back_pain__a.98186.aspx)

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Guided Radiofrequency Ablation Can Provide Pain Relief for Patients with Moderate to Severe Osteoarthritis of the Shoulder and Hip

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PainRelief.com Interview with:
Felix M. Gonzalez, M.D.
Radiology Department at Emory University School of Medicine
Atlanta, Georgia

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

Response: Arthritis afflicts 30 million Americans yearly with the most common form being degenerative arthritis. The main joints affected are the knee, hip and shoulder joints.  

Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention. The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion. People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks: Prolonged use is linked to increased risks of heart disease and kidney damage. Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time and there are long-term safety issues, including a risk of cartilage damage.  

Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections — two standard treatments — were no longer helping.  

Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.  

In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%. 

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Pain Suppresses the Activity Of the Brain Reward System

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Stéphane Potvin, PhD
Centre de recherche
Institut Universitaire en Santé Mentale de Montréal
Full professor; Department of psychiatry and addiction
University of Montreal

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

Dr. Potvin: Let’s begin by using a concrete example. First, imagine that you are taking a walk and it is really cold outside; so cold, in fact, that you can no longer enjoy the experience. Upon returning home, you realize that you no longer feel the pain, and you now have a smile on your face. During this sequence of events, what happened in your brain? To figure it out, we performed a functional neuroimaging study during which a painful cold gel was applied on the right foot of a group of healthy volunteers. What we discovered is that during pain stimulation, there was a clear de-activation of the medial orbito-frontal cortex, which is one of the main “pleasure” centers in the brain. Intriguingly, we observed that after the cold pain stimulation was discontinued, participants experienced significant levels of pleasant emotions that lasted for approximately 4 minutes.

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A Systematic Review of Cannabis-Based Medications for Pain Relief

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PainRelief.com Interview with:
Joshua (Shuki) Aviram PhD, R.N
Prof. Meiri’s Laboratory of Cancer Biology and Cannabinoid Research
Post doc Fellow Faculty of Biology
Technion Institute of Technology – Haifa, Israel

Dr. Aviram

PainRelief.com:  What is the background for this study?
Response: I am a RN by profession, and treating patients with opioids as the main solution to alleviate their pain, with many adverse effects, such as severe constipation made me looking for another solution.

In the course of my PhD thesis, from which I recently published results in the European Journal of Pain (link:https://www.researchgate.net/publication/344739061_Medical_Cannabis_Treatment_for_Chronic_Pain_Outcomes_and_Prediction_of_Response),

I reviewed the literature and I noticed that there were few reviews that used the same clinical trials as their basis, reaching somewhat different conclusions. Therefore, I decided to conduct a systematic review and meta-analysis of all available randomized controlled trials (RCTs) at that time.

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Stimulation of Nerves in Ear May Provide Pain Relief for Fibromyalgia Patients

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PainRelief.com Interview with:
Anna Woodbury, MD, C.Ac
Associate Professor | Anesthesiology
Associate Program Director | Emory Pain Fellowship
Emory University School of Medicine

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

Response: I have long been interested in non-pharmacologic and minimally invasive therapies for my pain patients.  Unfortunately, there are not a lot of non-pharmacologic options available, particularly for those suffering from fibromyalgia, a poorly understood condition that leads to widespread pain among a constellation of disturbing symptoms.  I observed that many fibromyalgia patients are stigmatized and often dismissed without suitable treatments, and I wanted to find a way to better help them.  

Working in the VA, I learned that gulf war syndrome and fibromyalgia seemed to overlap in terms of their clinical manifestations, and I was presented with an interesting option for pain treatment – the “Military Field Stimulator,” a stimulator that goes on the ear to treat pain using percutaneous electrical nerve field stimulation (PENFS).  I tried it on a few of my difficult to treat pain patients with positive results.  However, the stimulator had not yet been rigorously tested in a clinical trial.  We therefore conducted a small trial to examine the clinical effects of the ear stimulator in veterans with fibromyalgia and examined brain changes that may result from use of the stimulator us a special kind of MRI known as resting state functional connectivity MRI.  

All veterans in the study received standard therapy, including medication management, physical therapy, etc., but some were randomized to standard therapy alone, while others received standard therapy in addition to PENFS.  We found that there was pain relief in both groups immediately following a 4 week treatment period, but the PENFS group seemed to have longer term pain relief (12 weeks), and the changes in the brain differed between the groups.  Further, pain interference measures (the level pain interferes with activity, mood, stress, and sleep) were significantly improved in the PENFS group at some of the timepoints.

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Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

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PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

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

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

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Stronger Pain Relief When Patient and Provider Demonstrate Facial Mirroring

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PainRelief.com Interview with:
Dan-Mikael Ellingsen PhD
Department of Psychology, University of Oslo
Norwegian Centre for Mental Disorders Research (NORMENT),
Division of Mental Health and Addiction
Oslo University Hospital, Oslo, Norway.

Dr. Ellingsen

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

Response: We know that the patient-clinician relationship can have an important impact on clinical outcomes, but we know relatively little about how this works. A better understanding of the behavioral, physiological, and brain mechanisms behind the patient-clinician interaction may help demystifying the therapeutic relationship and how it influences treatment outcomes.

In order to investigate the behavioral and brain mechanisms involved when patients and clinicians interact, we simultaneously recorded brain activity (using functional MRI) in clinicians and patients with chronic pain, while they underwent a pain treatment session. We also recorded and analyzed non-verbal communication – facial expressions – during the interaction. We found that when the patient and clinician had first established a level of rapport – or therapeutic alliance – through a clinical intake and consultation, they showed stronger concordance in brain activity in brain areas involved in empathy and “theory of mind” (the process of trying to understand other people’s mental states) when they engaged during treatment. We also found that in interactions where the patient and clinician showed more mirroring in facial expressions, the patient also reported higher therapeutic alliance and stronger pain relief from the treatment.

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High Dose Pain Reliever Paracetamol -Acetaminophen Linked to Increase in Overdoses

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PainRelief.com Interview with:
Andrea Burden, Ph.D.
Assistant Professor of Pharmacoepidemiology
Institute of Pharmaceutical Sciences
Zurich Switzerland

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

Response: Paracetamol (also known as acetaminophen) is one of the most commonly used medications in the world. While the drug is generally safe, daily intake exceeding 4,000 milligrams (4 grams) can lead to irreversible liver injury and even death. Traditionally in Europe, paracetamol is available in two dose formulations, the 500 and 1,000 milligram tablets. The lower dose formulation is often available over-the-counter (without a prescription), while the high-dose formulation requires a medical prescription. In the last decade, there has been accumulating evidence that both the availability of high-doses of paracetamol, and the quantity of paracetamol available to patients, are associated with the risk of overdose. Therefore, in this study, we aimed to identify if there was an increase in the number of calls to the National Poison Information Centre in Switzerland for paracetamol-related overdoses after the high-dose 1,000 milligram (1 gram) paracetamol tablets became available in October of 2003. We also examined if there were differences in the circumstances of the overdose and severity between the 500 milligram or 1,000 milligram tablets.

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