Mindfulness-Based Stress Reduction For Chronic Pain Relief

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PainRelief.com Interview with:
Cynthia Marske DO
Good Samaritan Regional Medical Center
Corvallis OR

Cynthia Marske DO Good Samaritan Regional Medical Center Corvallis OR

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

Response:  The background for this study is to explore if there are ways to retrain the brain of those suffering from conditions of chronic pain, with associated anxiety and depression. Since those conditions are common now, have lead to an opioid crisis of misuse and abuse, and treatment for these conditions are often limited.

PainRelief.com: What are the main findings?

Response: The main findings are that self healing is possible, we are often misinformed that the brain and body cannot self heal but we all have the inherent ability to heal ourselves if we believe. One modality of self healing is called mindfulness based stress reduction. First started by Dr John Khabat Zinn in the 1980s at the Massachusetts Hospital. This is a combination of practice of mindfulness, meditation and yoga.

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Mindfulness-Based Stress Reduction Can Provide Pain Relief from Episodic Migraine

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PainRelief.com Interview with:
Neda Gould, PhD
Assistant Professor
Director, Mindfulness Program at Johns Hopkins
Associate Director, Bayview Anxiety Disorders Clinic
Department of Psychiatry and Behavioral Sciences
Johns Hopkins School of Medicine

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

Response: Migraines can be severe and debilitating and many of the current pharmacological treatments have side effects. We were interested in studying the effect of a non-pharmacological intervention (mindfulness meditation) on migraines using various outcomes including brain imaging.

Mindfulness-Based Stress Reduction (MBSR) is a program that has been shown to improve chronic pain. However, the benefits of this program have been modest in migraine patients. We sought to determine if a longer period of mindfulness training and home practice would yield better outcomes in migraine patients.

The traditional MBSR course consists of 8 weekly sessions and a retreat. We enhanced this course to include the 8 weekly sessions and retreat followed by 4 additional biweekly sessions (MBSR +).

We randomized 98 adults with episodic migraine to the MBSR+ group (50 participants) or to a stress management for headache group (SMH, 48 participants). The SMH group included didactic content on stress and other triggers in headaches. Both groups followed a similar format and timing.

All participants completed questionnaires an also underwent magnetic resonance imaging (MRI) to look at changes in brain structure and function.

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Pain Relief Specialist Discusses Benefits and Barriers to Telehealth for Pain Patients

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PainRelief.com Interview with:
Sharon M Weinstein, MD, FAAHPM
Neurology; Pain Medicine; Hospice and Palliative Medicine
Professor of Anesthesiology and Adjunct Professor of Pediatrics
University of Utah, Salt Lake City, Utah

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

Response: I’ve been practicing pain medicine and palliative care for over 30 years. In the past several months since the onset of the coronavirus pandemic, I have learned a lot implementing telemedicine in different practice settings.

From the clinician’s perspective, the experience implementing telemedicine varies widely depending on tangible support provided. For example, having dedicated staff to instruct patients in the mechanics of telemedicine and having staff to “room” patients has been critical to my success. Having the health care system prepared with EHR infrastructures has also been essential to smooth operations.

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New Model Helps Clinicians Predict Which Patients Require Highest Doses of Opioids for Pain Relief

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PainRelief.com Interview with:
Dr. Mieke Soens, MD
Anesthesiology Specialist 
Brigham and Women’s Hospital

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

Response: Opioid use worldwide has doubled in the last two decades and several countries, including the US, are struggling with a real opioid epidemic. Higher opioid doses after surgery are associated with prolonged opioid use and misuse. For example, in a study of more than 30,000 patients undergoing minor surgery such as appendectomy or gallbladder surgery, the risk to become a chronic opioid user was around 6% compared to 0.4% in the non-surgical population.

Many of our colleagues have previously identified predictors associated with more severe pain and opioid use after surgery, however, to assess those predictors, they had to use lengthy questionnaires. This approach is very time-consuming and impractical for use in daily clinical practice. The machine learning models that we have developed can work quickly and in real-time prior to surgery to mine data from patient’s electronic medical records and without the need for cumbersome questionnaires, in order to selectively identify those patients who will need high doses of opioids after surgery.

This can help reduce postoperative opioid use, by allowing the care team to maximize non-opioid analgesic strategies in these patients. Examples of non-opioid strategies include nerve blocks and epidurals and different types of non-opioid medications. We know that these alternatives can be very costly and sometimes risky. Therefore, being able to target the right treatment to the right patient is important to not only to reduce opioid use, but also to ensure that patients receive the treatment that is right for them.

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Opioid Epidemic for Pain Relief Has Waned But is Not Over

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PainRelief.com Interview with:
Mario Moric M.S.
Department of Anesthesiology
Rush University Medical
Center Department of Anesthesiology

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

  • Prescription Pain Medicine (PPM) abuse has become a national problem and is now consider an epidemic. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication; enough for every American adult to have a bottle of opioids. 
  • With the recent public information campaign about the epidemic and the possible addictive nature of opioid prescription pain medications, the abuse rates have declined.  We examined data from the National Survey on Drug Use and Health (NSDUH) public data derived from a national survey. 
  • We have raw data (actual reported rates of PPM abuse, see attached image) and weighted data (corrected for the sampling design).  Looking at the raw data you can see that abuse rates for lifetime use (highest line), past year use (middle red line) and past month use (bottom green line) are all more or less stable until 1998 after which we saw huge increase. From 1998 to 2004 the lifetime use increased 186%, the past year use increased 193% and the past month use increased 183%.  Then the decrease, from 2009 to 2018 the lifetime use decreased 72%, the past year use decreased 90% and the past month use decreased 185%.
  • Using the weighted data, the past year use decreases 26% and was statistically significant, indicating a real world decrease in prescription pain medication abuse.
Prescription Pain Medicine
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COVID-19 Protein Provides Pain Relief, Opening Up Targets for Future Pain Treatments

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PainRelief.com Interview with:
Rajesh Khanna, PhD
Professor of Pharmacology, Anesthesiology and Neuroscience
University of Arizona 
Tucson, AZ 85724

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

Response: SARS-COV-2 infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. Transmission of SARS-CoV-2 by asymptomatic or presymptomatic individuals may account for half of the spread, which may be why the virus has been so difficult to contain. The data from our study shows that the Spike protein, the major surface antigen of SARS-CoV-2, is analgesic. Therefore, an explanation for the unabated spread may be that asymptomatic or presymptomatic individuals do not experience the pain and discomfort that act as early warning signs of infection.

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How Do Primary Care Physicians Handle Opioids For Patients Seeking Chronic Pain Relief?

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PainRelief.com Interview with:
Laura Militello
Unveil, LLC
Applied Decision Science, LLC

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

Response: Little is known about how primary care clinicians’ (PCC) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. When it comes to pain management, primary care clinicians (PCCs) find themselves in a somewhat unexpected role. Few conditions intersect with a range of specialties (i.e. mental health, orthopedics, endocrinology, etc.), disability, and aberrant behavior in the way that chronic pain does. PCCs find themselves in a position where they are asked to assess and diagnose sometimes vague and diffuse pain, and determine appropriate treatment often before the underlying cause of the pain is well-understood.

A recent cultural shift in the U.S. has created a situation in which a formerly default treatment, prescription opioid therapy, is no longer considered safe or appropriate for many patients with chronic pain. The addictive qualities and overall safety profile of opioid medications have come into sharp focus in recent years, leading to a push to reduce opioid use while also trying to achieve pain relief with little guidance for PCCs about how to manage this change in treatment plans. Others have documented the uneasiness many experience in managing patients with chronic pain. One participant in our study described the sense that opioid prescribing sometimes extends into unexpected and disconcerting territory in this way: “I never signed up to be an enforcer.” The complexity and moral uncertainty (6) associated with managing patients with chronic pain is an important backdrop for the findings from this study.

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Cognition in Adults Who Use Medical Marijuana for Chronic Pain Relief

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PainRelief.com Interview with:
Dr. Sharon R. Sznitman PhD and
Dr. Galit Weinstein, PhD
School of Public Health,
University of Haifa, Haifa, Israel

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

Response: Due to increased media attention related to the topic of medical cannabis and increasing public demand for the treatment, physicians often find themselves in situations where patients and caregivers request medical cannabis treatment. When this demand is from older patients, there is a dearth of studies of effectiveness and risk-benefit ratio as almost no studies have examined the potential therapeutic effects and potential risks of the treatment in this specific group. One of the main implications of cannabis use that researchers have grappled with is its long-term effect on cognitive function. It is well established that cannabis use has detrimental effects on the developing brain when consumed in early life, but detrimental effects of early-life cannabis use may not translate to use in older ages. Use of cannabis in old ages may have adverse effects on cognition but some evidence also exists showing beneficial effects.

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Mt. Sinai Study Identifies Lifestyle Changes That Provide Some Knee Pain Relief

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PainRelief.com Interview with:
Daniel A Charen MD
Leni and Peter May Department of Orthopaedic Surgery
Icahn School of Medicine at Mount Sinai, New York

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

Response: There is a well-established link between obesity and knee osteoarthritis, and recent research has implicated diabetes as a potential cause of cartilage degeneration. This study uses the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors.

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Are Invasive Procedures Effective for Chronic Pain Relief? A Systematic Review

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PainRelief.com Interview with:
Wayne B. Jonas, MD
Executive Director
Samueli Integrative Health Programs, H&S Ventures,
Alexandria, VA

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

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo-controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

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