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

Posted on by

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. 

Continue reading →

Mass General Studies Molecule Linking Sleep Deprivation with Increased Pain Sensitivity

Posted on by

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.

Continue reading →

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

Posted on by

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.

Continue reading →

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

Posted on by

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.  

Continue reading →

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

Posted on by

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.

Continue reading →

Buprenorphine Initiation and Retention Through Telehealth for Opioid Use Disorder

Posted on by

PainRelief.com Interview with:
Lindsey Hammerslag, Ph.D.
Assistant Research Professor
Division of Biomedical Informatics
University of Kentucky
Lexington, KY 40536

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

Response: This study was designed to examine whether COVID-related changes to buprenorphine prescribing policies, which allowed the use of telehealth during treatment initiation, were associated with benefits for people with opioid use disorder. There’s a push to return to normalcy, with some COVID-related policies being rolled back during the unwinding, and we felt that it was important to make sure that we could provide the evidence policy makers need to make good decisions for patients.

Continue reading →

Study Finds Modest Decrease in Opioid Prescriptions after Insurer Opioid Prescribing Limit

Posted on by

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?

Response: Almost every state has implemented a policy to restrict the duration of opioid prescriptions for acute pain, as have many major insurers. Prior studies have evaluated the effects of these limits on opioid prescribing, but there are no large-scale studies that have evaluated the effects of limits on patient-reported outcomes, such as pain control.

In this study, we evaluated the effect of a major Michigan insurer’s
5-day opioid prescribing limit in February 2018 on both opioid prescribing and patient-reported outcomes after surgery.

To do so, we leveraged our access to a statewide surgical registry in Michigan that has been collecting data on opioid prescribing and patient-reported outcomes from adult patients undergoing common general surgical procedures since 2017.

Pages: 1 2

Cannabis-Related Hospitalizations Following Legalization in Canada

Posted on by

PainRelief.com Interview with:
Daniel Myran, MD, MPH, CCFP, FRCPC
Canada Research Chair, Social Accountability, University of Ottawa
Investigator, Bruyère Research Institute 
Assistant Professor, Department of Family Medicine
Lecturer, School of Epidemiology and Public Health
Adjunct Scientist, ICES
University of Ottawa

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

Response: Canada legalized recreational, or non-medical, cannabis in October 2018. Legalization in Canada took a phased approach initially, only the sale of flower-based cannabis products and oils was permitted and there were very few legal cannabis stores and legal sales. Starting in early 2020, Canada allowed the sale of expanded products (e.g. cannabis edibles, vape pens, concentrates), and the number of retail stores began expanding. In this study, we took advantage of this evolution of the legal cannabis market to understand how different phases of legalization were associated with hospitalizations due to cannabis.  

Pages: 1 2

Columbia Model Predicts Return-to-Use Risk After Treatment for Opioid Use Disorder

Posted on by

PainRelief.com Interview with:
SEAN X. LUO, M.D., PH.D.
Assistant Professor of Clinical Psychiatry
Data Science Research Group
Division on Substance Use Disorders
Department of Psychiatry
Columbia University

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

Response: Opioid use disorder presents a major public health crisis, with increasing overdose death through the last 5 years. Treatment delivery continues to be difficult, with a large number of patients not stably maintained on Medication for Opioid Use Disorder (MOUD) after the initial treatment engagement.

In this study we applied novel statistical methods to a newly harmonized dataset incorporating 3 large clinical trials from the National Drug Treatment Clinical Trials Network (CTN) to develop individual level risk prediction models for opioid use disorder. We showed that urine toxicology data in the first 3 weeks after initiation of treatment can predict return-to-use at the end of 3 months with surprising accuracy.

Continue reading →

Miami Thoracic Surgeons Achieve Pain Control With Minimal or No Opioids

Posted on by

PainRelief.com Interview with:
Dao Minh Nguyen, MD, MSc FRCSC FACS
Thoracic Cancers Group Go-Lead
Sylvester Comprehensive Cancer Center
University of Miami Miller School of Medicine

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

Response: Patients undergoing thoracic surgery operations experience significant acute incisional pain as well as chronic pain many months after.

The mainstay of treatment is based on frequent use of potent and addictive-prone opioids such as hydromorphone, oxycodone at high dosages and long duration.
There is a high incidence of persistent opioid users and chronic opioids users in surgical patient population. This certainly contributes to the opioid epidemic in the USA and worldwide.

We implemented a peri-operative care protocol for patients undergoing thoracic surgery operations called Enhanced Recovery after Thoracic Surgery (ERATS). The overarching goal of ERATS is to streamline care for thoracic surgery patients particularly in the postoperative period to mitigate pain with opioid-free strategy, to minimize postoperative complications, rapid return to baseline states and safe, early discharge home. This protocol follows guidelines of the ERAS principles and is developed for thoracic patients to address their unique needs.

Once pain is adequately addressed with opioid-free strategy with elimination of opioid-associated side effects, rapid recovery after surgery can be achieved.

Continue reading →