CAMH Study Finds Potential Risks to Baby from Cannabis Exposure During Pregnancy

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PainRelief.com Interview with:
Maryam Sorkhou
PhD student at the Institute of Medical Sciences
University of Toronto

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

Response: While studies on animals strongly suggest that exposure to cannabis during pregnancy can affect brain development, the impact of using cannabis during pregnancy in humans is not yet clear. Some studies suggest potential negative effects, while others find no impairments.

In light of increasing trends towards legalization and potentially decreased perceptions about the risks of cannabis, our meta-analysis of 57 studies aimed to fill this gap by exploring the associations between prenatal cannabis use and birth and childhood outcomes.

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Study Finds Any Physical Activity, Even Sleeping, Is Better than Sitting for Cardiovascular Health

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PainRelief.com Interview with:
MARK HAMER, PhD
PROFESSOR OF SPORT AND EXERCISE MEDICINE
DIVISION OF SURGERY & INTERVENTIONAL SCIENCE
UNIVERSITY COLLEGE LONDON

PainRelief.com: Can you provide more insight into how much more beneficial moderate to vigorous activities are compared to light activities or standing, in terms of measurable health outcomes?

Response: Our study suggests that the best activity that you can do for your heart is moderate-vigorous activity, followed by a trio of common daily activities: lighter activity, standing and sleeping, with sedentary behaviour being the most harmful. There was a very large and strong association between spending more time in moderate to vigorous activities and better heart health outcomes (outcomes included: BMI, waist circumference, HDL cholesterol, HDL: total cholesterol ratio, triglycerides and blood glucose levels).

For example, replacing 30 min of sedentary behaviour with moderate to vigorous activity was associated with 0.63kg/m2 lower BMI (or –2.4cm lower waist circumference). If an individual were to replace the sedentary time with 30 minutes of light activity instead, we would expect to see a ~0.5 kg/m2 lower BMI. And if an individual replaced their sedentary time with 30 min of either standing or sleep, we would expect to see a ~0.4kg/m2 decrease.  These difference in benefits was much larger when considering cholesterol and triglyceride outcomes.

It was notable that heart health benefits are likely to be observed after replacing just a few minutes of sedentary/sitting time with moderate to vigorous activity. However, to achieve comparable benefits with standing or light activity, it could require 1-3 hours of replacement depending on the outcome (slightly less for measures of obesity such as BMI, much more for cardiometabolic blood biomarkers like cholesterol or triglycerides).

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Study Finds False or Misleading Claims Not Uncommon Among Ketamine Prescribers

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PainRelief.com Interview with:
Michael J. DiStefano, PhD
Department of Clinical Pharmacy
Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus, Aurora

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

Response: Ketamine has been an FDA-approved anesthetic since 1970. However, it is increasingly used off-label to treat a variety of mental health and pain conditions. Some providers also offer oral formulations of ketamine, which do not have FDA approval for any indication. Esketamine, an enantiomer of ketamine, is a nasal spray that recently received FDA approval and is narrowly indicated for people with treatment-resistant depression. Esketamine has an extensive FDA REMS (Risk Evaluation and Mitigation Strategies) protocol in place to promote safe use. There is no analogous safety protocol in place for the off-label or unapproved use of ketamine.

Given increasing interest in using ketamine to treat a variety of conditions, we were interested to see how the drug is being promoted to potential patients. The FDA typically regulates consumer advertising for prescription drugs, but only for manufacturers, packers, and distributors of these drugs, designations which don’t seem to include these clinics. The FDA requires that consumer drugs ads are accurate and provide balanced information on both benefits and risks.

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Osteoarthritis: Emory Study Compares Cell-based vs Corticosteroid Injections

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PainRelief.com Interview with:
Dr. Ken Mautner, MD
Associate Professor, Department of Physical Medicine and Rehabilitation and
Department of Orthopedic Surgery
Emory University
Atlanta, GA

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

Response: With so much talk about “stem cell” therapy in orthopedics today and with the burden of pain from millions who suffer from knee osteoarthritis,  we wanted to conduct a well designed study that would allow us to see if there is a superior source of cellular treatments for knee osteoarthritis.  We were fortunate to receive a large grant from the Marcus Foundation to conduct this study.  

While there are some studies out there on the topic, very few have the scientific rigor that our study had including patients being blinded to whether they were getting a steroid injection or a cellular treatment.  

Our study included four different treatment options: an injection of bone marrow concentrate, stroll vascular fraction, umbilical cord tissue, and corticosteroids.  

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Dental Pain: Progress Toward Reducing Opioids for Pain Relief Slowed During Pandemic

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PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua

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

Response: Using national data, we show that U.S. dental opioid prescribing decreased 45% between 2016-2022, but this decrease slowed during the COVID-19 pandemic.

If pre-pandemic trends had continued, we estimated that 6.1 million fewer opioid prescriptions from dentists would have been dispensed between June 2020 and December 2022.

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Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain

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PainRelief.com Interview with:
Satya Surbhi, PhD
Assistant Professor, Division of General Internal Medicine, Department of Medicine
and Center for Health System Improvement, College of Medicine
Director of Measurement and Reporting, Tennessee Population Health Consortium
University of Tennessee Health Science Center

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

Response: Pain is highly prevalent among individuals with chronic kidney disease (CKD), in whom commonly utilized analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are often contraindicated. Opioids can be an alternative means of analgesia in patients with CKD, but they are associated with numerous unwanted adverse effects and current efforts are aimed at curbing opioid use in general, which leaves patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD compared to opioids are unknown.    

The objectives of this study were to

1) compare the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain and

2) to examine the heterogeneity of treatment effects on outcomes by factors including age, sex, race, smoking status, BMI, cancer, eGFR and UACR levels, benzodiazepine use, and opioid/non-opioid prescription year. 

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Mass General Studies Molecule Linking Sleep Deprivation with Increased Pain Sensitivity

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PainRelief.com Interview with:
Shiqian Shen, M.D.
Assistant Anesthetist
–Anesthesia & Crit. Care, Massachusetts General Hospital
Associate Professor of Anaesthesia
–Harvard Medical School
Physician Investigator (Cl)
–Anesthesia, Critical Care and Pain Medicine, Mass General Research Institute

PainRelief.com: What is the background for this study? Would you describe the function of NADA?

Response:  Both sleep disorders and chronic pain are very prevalent among adults. For example, about one third of U.S. adults report some level of sleep disturbance. Both common life experience and medial research strongly suggest that sleep deprivation leads to heightened pain experience/perception. However, the mechanisms of this link are not entirely clear. Hence we decide to study this important question.

NADA, N-arachidonoyl dopamine was first discovered to be an agonist for the Cannabinoid Receptor 1 and it was found in the brain of animals. It belongs to the endocannabinoid family. Additionally, NADA also belongs to the endovanilloid family. Administration of NADA to rodents produces a wide variety of behavioral changes, including behaviors mimicking the physiological paradigms association with cannabinoids. However, its physiological function is not well characterized.

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Chronic Pain Relief: CMAJ Study Evaluates Predictors of Fatal and Non-Fatal Overdoses

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PainRelief.com Interview with:
Li Wang, PhD
Associate professor
Department of Anesthesia
Michael G. DeGroote Institute of Pain Research and Care
McMaster University
Ontario, Canada

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

Response: Chronic pain affects one in five people globally and is commonly treated with opioids. Unfortunately, opioid use may lead to serious harms including fatal and nonfatal overdose. Identifying predictors of opioid overdose may improve the shared decision-making for clinicians and patients when considering a trial of opioids for chronic pain. Although there have been previous reviews looking at predictors of opioid overdose following prescription for chronic pain, they have important limitations.

Our systematic review included 28 studies and 23,963,716 patients prescribed opioids for chronic pain that reported the associations of 103 predictors with opioid overdose. The baseline risk of non-fatal overdose was 1 in 500, and the risk of fatal overdose was 1 in 1000.

We identified 10 predictors, supported by moderate-to-high certainty evidence, that increased the risk of opioid overdose by 2-fold or more, including prescription of high-dose opioids (≥90mg morphine equivalent/day), fentanyl prescription, multiple opioid prescribers, use of multiple pharmacies, history of overdose, current substance use disorder, depression, bipolar disorder, other mental illness, or pancreatitis. The absolute risks of development of opioid overdose in patients with the predictor range from 4-12 per 1000 for non-fatal overdose and 2-6 per 1000 for fatal overdose, respectively.

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Post C-Section Pain Relief: Noninvasive Bioelectronic Device Reduced Need for Opioids

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PainRelief.com Interview with:
Jennifer Grasch, MD
Fellow, Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
The Ohio State University Wexner Medical Center

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

Response: Cesarean delivery is the most commonly performed major surgery in the US. Almost all patients who have a cesarean delivery take opioid pain medications for postoperative pain, but we know that opioids have many short- and long-term side effects.

We conducted a triple-blind sham-controlled randomized clinical trial testing the efficacy of adding transcutaneous treatment with a high-frequency (20,000 Hz) electrical stimulation device to a multimodal analgesic protocol after cesarean delivery. 

Participants who were randomly assigned to the functional device used 47% less opioid medication postoperatively in the hospital and were prescribed fewer opioids at discharge than those who received treatment with a sham device.  

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PainRelief Through Optogenetics: Scientists Make Flexible Gel to Deliver Light to Peripheral Nerves

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PainRelief.com Interview with:
Xinyue Liu, Ph.D.
Assistant Professor
Department of Chemical Engineering and Materials Science
Michigan State University
Siyuan Rao, Ph.D.
Assistant Professor
Biomedical Engineering Department
Binghamton University, SUNY

Dr. Liu

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

Response: The background lies in the field of optogenetics and its application to the study and modulation of pain perception. Optogenetics is a powerful tool that allows precise control of neural cell populations using light. It has been widely used in neuroscience to investigate how different cells in the brain and nervous system function and how their activity can be modulated. Specifically, in the context of pain research, optogenetics offers the potential to explore the neural mechanisms underlying pain perception and to develop new therapeutic interventions for pain management.

However, one of the challenges in applying optogenetics to the study of pain and nociceptive circuits is the delivery of light to peripheral nerves that experience mechanical strain during locomotion. Traditional light-delivery devices made from rigid materials, such as glass fibers, are not well-suited for this purpose. They can impede the natural behaviors of animals and may cause tissue damage when used in dynamic conditions.

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