PainRelief.com Interview with: Kristin Schreiber, MD, PhD Neuroscientist and Clinical Regional Anesthesiologist Brigham and Women’s Hospital Assistant Professor of Anesthesia Harvard Medical School
PainRelief.com: What is the background for this study?
Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.
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%.
Dr. Ashraf Habib, MB BCh Chief of the Division of Women’s Anesthesia Professor of Anesthesiology Duke University, Durham, NC
PainRelief.com: What is the background for this study?
Response: Cesarean sections (C-sections) occur every day in the United States, with more than 1.2 million procedures in the US each year according to the CDC. Since postsurgical pain after C-sections can range from moderate to severe discomfort, it is important that this pain is managed effectively and safely. The amount of pain experienced and the way pain is treated can have an impact on a new mother’s postsurgical recovery. While opioids were once considered the standard treatment to manage pain after surgery, postsurgical opioid consumption can have a negative impact on a new mother’s recovery experience, causing unwanted side effects such as drowsiness, itching, nausea, vomiting, constipation and the risk of persistent use or dependence. In fact, research shows nearly nine in 10 mothers and mothers-to-be have concerns about taking opioids during and after childbirth, yet 51% of all C-section patients are still prescribed an opioid to manage postsurgical pain.
We recently published results from a Phase 4 study in Anesthesia and Analgesia that revealed the long-acting local anesthetic EXPAREL (bupivacaine liposome injectable suspension), when administered with bupivacaine as part of transversus abdominis plane (TAP) field block, provided a significant reduction in opioid consumption and a greater percentage of opioid-spared patients, with optimized pain control through 72 hours. This was a multicenter, randomized, double-blind study across 13 clinical sites in the United States, in patients undergoing elective C-section and receiving spinal anesthesia and a multimodal analgesic regimen. Patients were randomized to receive EXPAREL 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone administered via TAP field block after delivery.
PainRelief.com Interview with: Sandip Biswal MD Associate Professor of Radiology Co-Section Chief, Musculoskeletal Imaging Director, Musculoskeletal Imaging Fellowship Member, Molecular Imaging Program at Stanford (MIPS) and Bio-X Department of Radiology Stanford University School of Medicine
PainRelief.com: What is the background for this study? Response: Our ability to manage patients with chronic pain remains woefully inadequate. Chronic pain patients are faced with limited resources and inadequate care, and as a result, they make up the #1 disease group in the world—numbering more than heart disease, diabetes and cancer combined. Those suffering from low back pain, headache, fibromyalgia, arthritis and many other pain syndromes make up this ever-growing population. A big part of our inability to care for chronic pain patients is due to the fact that our current imaging methods for correctly identifying pain generators remain substantially inaccurate. Our ability to accurately identify the cause of a person’s pain, discomfort, inflammation or other related musculoskeletal symptom(s) using current clinical imaging approaches, such as magnetic resonance imaging (MRI), computed tomography (CT), digital radiography (x-ray) and ultrasound, is quite limited, lacks sensitivity/specificity and can even misguide treatment. As a musculoskeletal radiologist, I witness these shortcomings on a daily basis. I, for example, see firsthand how the lack of reliable diagnostic tools leads to significant misdiagnosis, mismanagement, incorrect use of opioids, unhelpful surgeries and, ultimately, therapeutic failures. We need a much better way to diagnose pain generators.
Accordingly, our group has been developing new clinical imaging methods that pinpoint the site of pain generation using imaging probes—more specifically, positron-emission tomography (PET) tracers that specifically target “pain receptors” or “pain molecules.” These pain receptors or pain molecules are present in abundance at the site of pain generation. After injecting one of these imaging probes into a patient through the vein, we give the probe a few minutes to circulate around the body and stick to areas that have a high density of pain receptors. We can then take a picture of the patient with a special camera that will show “hot spots” on the image that signify the location of high number of pain receptors, thereby highlighting “painful” pro-inflammatory and/or pro-nociceptive tissues. With this approach, doctors and patients have information with which they can make more objective decisions about the diagnosis and treatment of one’s pain.
Johan Hambraeus, MD Board certified in anesthesiology, family medicine & Pain management Department of Epidemiology and Global Health Umeå University, Sweden
PainRelief.com: What is the background for this study?
Response: When working with interventional pain management a striking feature is that all procedures are painful. It is often discussed about sedation before procedures, but whether to provide sedation seems to be more based on the local tradition than on facts. And it is not seldom that patients describe that they have phobic fear of needles, but despite this they cope with the interventional pain management and all the painful procedures.
Therefore we wanted to understand how it is felt and how the patients describe their experiences.
PainRelief.com Interview with: Leon Timmerman, PhD St Antonius Hospital, Department of Anesthesiology Intensive Care and Pain Medicine The Netherlands
Dr. Timmerman
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Chronic pain is commonly treated
with pain medication. However, the results of pharmacological treatment are
often poor. One of the reasons might be that half of the patients do not use
their medication as prescribed. Underuse as well as overuse are common and have
been described to result in reduced treatment effect, health care risks and
unnecessary treatment changes. The are many risks factors described for
non-adherent behavior.
The way people think about their pain medication have been shown to be related to
the way they use their medication. With this study, we confirmed this relation
with a prospective study. Baseline beliefs about pain medication, measured by
‘Pain Medication Attitudes Questionnaire’, were found to be related to
underuse of pain medication, the occurrence of side effects and patient
satisfaction after three months.
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