Do Psychological Approaches Offer Pain Relief to Hospitalized Patients?

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PainRelief.com Interview with:
Dr.-Ing. Marcus Komann
IT-Coordinator
Jena University Hospital
Jena, Germany

Ing. Marcus Komann IT-Coordinator Jena University Hospital Jena, Germany

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

Response: A lot of non-pharmacological methods (like relaxation, cold packs, prayer and so on) for post-operative pain relief are used in today’s hospitals. There is also some literature out there on this topic. However, the literature mostly concerns single methods and very specific patient groups. Further, for most methods, the literature is not clear on the pain soothing effects.



We looked at a real-life registry to study the effects of a large number of such methods on a big sample of patients.

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Chronic Back Pain and Headache Often Occur in Same Patient

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PainRelief.com Interview with:

Arani Vivekanantham, MBChB, MPhil
University of Warwick
University Hospitals Coventry and Warwickshire NHS Trust
Coventry, UK
Centre for Epidemiology Versus Arthritis
University of Manchester, Manchester, UK

ni Vivekanantham, MBChB, MPhil University of Warwick University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK Centre for Epidemiology Versus Arthritis University of Manchester, Manchester, UK

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

Response: Around one in five people have persistent low back pain and one in thirty have chronic headaches. People with low back pain are usually managed by musculoskeletal services whilst those with headaches are typically treated by primary care doctors and neurologists. There may be particular challenges in treating people with both disorders because of the risk of medication overuse headache in people taking regular pain killers for back pain.

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Do Men and Women Have Different Pain Relief Response to Opioids?

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PainRelief.com Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY

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

Response: Pain is the leading cause for seeking medical care worldwide, and opioids are the most frequently prescribed drugs for pain relief. Differences and similarities between men and women in both effectiveness and side effects to opioids used for pain relief have been described. In addition, individuals may respond differently to these medications for other reasons for example: the intensity of pain experienced, amount and type of administration of opioids (e.g. fixed doses established by physicians or flexible doses decided by patients), mental condition, age, body weight, and use of alcohol, tobacco and/or cannabis.

However, the role of these factors in influencing sex differences and similarities in the response to opioids used for pain control has not been thoroughly investigated.

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Migraine: Pain Relief from BotoxA May Last At Least 6 Months After Injections Stopped

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PainRelief.com Interview with:
Jason Ching MD
Department of Neurology
George Washington University School of Medicine
Washington, DC

headache migraine

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

Response: The clinical course of chronic migraine patients who respond positively to serial botulinum toxin A (BotoxA) injection therapy and eventually discontinue treatment has not been well-studied. Optimizing the duration of treatment would be beneficial from both a cost and safety perspective.

In our study, we found that over 80% of our chronic migraine patients who achieved our stipulated stopping rule experienced no clinical worsening or associated need to resume prophylactic therapy for at least 6 months following discontinuation of BotoxA.

A greater number of BotoxA treatments required to achieve the stopping rule and the presence of baseline chronic daily headaches for over 6 months duration were factors correlated with clinical deterioration.

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Pain Relief Drug Tramadol Associated with Hypoglycemia

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PainRelief.com Interview with:
Ruben Abagyan, Ph.D.

Dr. Abagyan

Professor, University of California, San Diego
Skaggs School of Pharmacy & Pharmaceutical Sciences
San Diego Supercomputer Center

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

Response: The background for this study was concern about unknown side effects of tramadol that became a popular treatment for chronic pain. With our informatics approach and access to millions of the FDA reports we were in a position to look for those adverse effects and we found that hyperglycemia (low blood sugar) is one of those concerns. There have been a few small-scale studies and case reports of tramadol use associated with hypoglycemia and hospitalizations related to it. The dramatic increase in tramadol prescription rates, especially in light of tighter control over hydocodone/acetaminophen (went from schedule III to II), warranted a larger scale postmarketing study of FDA FAERS reports.

As we compared the hypoglycemia side effect between different opioids we found that only one other drug, methadone (used to treat drug abuse and addiction), has a comparable association with hypoglycemia.  

PainRelief.com: What should readers take away from your report?

Response: Patients using tramadol should should be aware of hypoglycemia symptoms such as shakiness, dizziness, sweating, hunger, irritability, moodiness, anxiety/nervousness, and headache, or, in severe cases, blurred vision, seizures or loss of consiousness.  The same applies to methadone, also known as Dolophine. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: It may be beneficial to perform controlled studies to confirm and understand this association. Our study looked at other drugs with the known pharmacology of tramadol (mu-opioid agonism, serotonin/norepinephrine re-uptake inhibition, and NMDAR antagonism), but did not find an association with hypoglycemia with a specific class.  Would be interesting to learn more about additional/other pharmacology of tramadol and methadone behind the etiology of hypoglycemia. 

PainRelief.com: Is there anything else you would like to add?

Response: We think that studies of this nature are beneficial since rare side effects often go unnoticed in clinical trials due to a limited number of participants. Additionally, hypoglycemia effects may often be attributed to other medications and medical conditions, while tramadol or methadone were unlikely to cause suspicion.

Any disclosures?

Non of the authors have any financial or non-financial conflicts of interest to disclose. 

Citation:

Tigran Makunts, Andrew U, Rabia S. Atayee, Ruben Abagyan. Retrospective analysis reveals significant association of hypoglycemia with tramadol and methadone in contrast to other opioids. Scientific Reports, 2019; 9 (1) DOI: 10.1038/s41598-019-48955-y

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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.

Acupunture Studies for Pain Relief of Chronic Angina

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PainRelief.com Interview with:
Fanrong Liang MD
and Ling Zhao PhD

acupuncture

Acupuncture and Tuina School
Chengdu University of Traditional Chinese Medicine
Chengdu, Sichuan, China

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

Response: Chronic stable angina (CSA) is the cardinal symptom of myocardial ischemia and is associated with an increased risk of major cardiovascular events and sudden cardiac death. CSA affects with an average of 3.4 million people over 40 years of age each year. The most recent survey reported a CSA prevalence of 9.6% in China, making it a considerable burden on healthcare and medical costs, considering China’s large population base. Because of limited medical resources and lack of obvious improvement with percutaneous coronary intervention, Chinese clinicians choose traditional Chinese medicine (TCM) and acupuncture in addition to antianginal treatment for CSA. In China, acupuncture has been used as nonpharmacological treatment for several decades, especially to relieve myocardial ischemia symptoms, improve cardiac function, and prevent recurrence.  

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Chronic Back and Knee Pain Relief: How Do Sham Procedures Compare to Surgery?

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MedicalResearch.com Interview with:

Wayne B Jonas MD

Wayne B Jonas MD

H&S Ventures
Samueli Integrative Health Programs

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

Response: The findings of this study are based on a systematic review of 25 randomized clinical trials evaluating surgical type interventions (open surgeries, arthroscopic, endoscopic, laparoscopic, heart catheterization, radiofrequency, laser, and other interventions) for chronic back and knee pain. In each study, researchers had also performed sham procedures on a control group where they replicated the invasive procedure by omitting the step believed to be therapeutically necessary. The purpose of this it to determine how much of the effects are due to the placebo response.

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Self-Administered Acupressure Studied for Chronic Low Back Pain Relief

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PainRelief.com Interview with:

Susan Murphy, Sc.D., O.T.R.
Associate Professor
Physical Medicine and Rehabilitation Department
Research Health Science Specialist
VA Ann Arbor Health Care System, GRECC

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

Response: Chronic low back pain is very common and affects quality of life by reducing the ability to carry out needed and valued activities. In addition, people with chronic low back pain tend to have other symptoms like fatigue, sleep disturbances, and depression. Medications are typically prescribed but have side effects, and in some cases, may increase the risk of abuse and addiction. Non-pharmacological treatments are an important part of chronic pain management and may reduce pain as well as other symptoms.

In this study, we examined the use of self-administered acupressure as a pain management strategy in people with chronic low back pain. Acupressure is a Traditional Chinese Medicine technique in which physical pressure is applied to specific points on the body. It is similar to acupuncture, but instead of needles, pressure is applied with a finger, thumb, or device. In previous studies, people with cancer-related or osteoarthritis pain who self-applied acupressure had reduced symptoms such as pain and fatigue.

PainRelief.com: What are the main findings?

Response: Our pilot randomized controlled trial involved 67 participants with chronic low back pain. They were randomized into one of three groups – relaxing acupressure, stimulating acupressure, or usual care. Participants in the acupressure groups were trained to apply pressure to specific anatomical points on their body, and asked to complete daily treatment sessions for 6 weeks. We found that people who performed stimulating acupressure had improved pain and fatigue, and people who performed relaxing acupressure had improved pain after 6 weeks compared to those in the usual care group. No differences among the groups were found for sleep quality or disability after 6 weeks. Participants performed an average of 85% of the daily acupressure sessions and there were minimal adverse events. Adverse events, such as skin breakdown, muscle spasm, and headache were attributed to applying too much pressure and adjustments in application technique was done to avoid future issues.

PainRelief.com: What should readers take away from your report?

Response: Self-administered acupressure shows some promising effects on pain and fatigue in people with chronic low back pain. It is a low cost and low risk symptom management strategy that people can adhere to.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Because this was only a pilot study, larger studies are needed to support the effectiveness of this treatment for people with chronic low back pain.

Citation:

Susan Lynn Murphy, Richard Edmund Harris, Nahid Roonizi Keshavarzi, Suzanna Maria Zick, Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial, Pain Medicine, , pnz138, https://doi.org/10.1093/pm/pnz138

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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.

Osteoarthritis: Poor Sleep Linked to More Pain

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PainRelief.com Interview with:
Dr. Daniel Whibley PhD
Department of Physical Medicine and Rehabilitation
University of Michigan, Ann Arbor, Michigan
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
University of Aberdeen, Scotland, UK

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

Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.

We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening,  these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.

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Study Tests Pain Relief by Coating Joint Implants with Pain Medication

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PainRelief.com Interview with:

Ebru Oral, PhD
Associate Professor, Orthopaedic Surgery
Associate Director, Harris Orthopaedic Laboratory
Massachusetts General Hospital, Boston, MA,
Harvard Medical School, Cambridge, MA

Ebru Oral, PhD Associate Professor, Orthopaedic Surgery Associate Director, Harris Orthopaedic Laboratory Massachusetts General Hospital, Boston, MA, Harvard Medical School, Cambridge, MA
Dr. Oral

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

Response: This study focuses on the possibility of delivering analgesics from the polymeric implant surfaces used in total joint arthroplasty. Currently, there are multi-modal regimens for controlling pain during and after surgery, including peri-articular injections and systemic medications.

The study shows that it is possible to accomplish the delivery of the commonly used drug bupivacaine from the implants at relevant concentrations. The long-term goal is to provide this material as a tool in controlling pain locally so that the use of systemic opioid medications can be decreased.

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