Michael Perloff, MD PhD Director, Neurology Pain Medicine, Boston Medical Center Assistant Professor, Boston University Medical School
PainRelief.com: What is the background for this study?
Response: Spine-related pain (low back pain/neck pain) is very common in older adults. Physicians can be reluctant to use pain medications older patients due to reduced liver and kidney function, comorbid medical problems and background polypharmacy. We performed an extensive review of the medical literature with a focus on double-blind, placebo controlled, clinical trials.
PainRelief.com Interview with: Douglas P. Beall, MD, FSIR Chief of Radiology Services Clinical Radiology of Oklahoma
Dr. Bealll
PainRelief.com: What is the background for this study?
Response: Degenerative disc disease (DDD) is the leading cause of chronic low back pain and one of the world’s most common medical conditions contributing to high medical and disability costs. Healthy spinal discs act aids spine movement and distributes force which allows for spine flexibility and even distribution of the load that is placed on the spine. Each has a firm outer layer and a soft, jelly-like core. With normal aging, discs tend to become dry, thin, cracked or torn, which can cause pain and abnormal motion.
Substances called hydrogels, with biochemical similarities to the intervertebral disc designed to augment both the core and outer layer, have been used for years to help repair degenerated discs. First-generation hydrogels are placed as a soft solid, through a surgical incision, but were not simple to place and had a tendency to migrate from where they were originally placed.
For a first-in-human trial, our team conducted a prospective, single-arm feasibility study to evaluate an experimental, injectable hydrogel for safety and performance in relieving chronic low back pain caused by DDD. We used a second-generation hydrogel (Hydrafil™) developed by ReGelTec, Inc.. Unlike earlier hydrogels, it can be temporarily modified into a liquid and injected rather than placed through a small incision. In 2020, this product received FDA’s breakthrough device designation, allowing expedited review based on promising early evidence.
We recruited 20 patients, aged 22 to 69, who each described their pain as four or higher on a zero to 10 scale. None had found more than mild relief from non-surgical management, which includes rest, analgesics, physical therapy, and back braces. Patients were sedated for the procedure, and the gel was heated to become a thick liquid. Guided by fluoroscopic imaging, an interventional radiologist used a 17-gauge needle to inject the gel directly into the affected disc(s). The gel filled in cracks and tears and adhered to the disc’s core and outer layer.
PainRelief.com Interview with: Donatella Bagagiolo Osteopath D.O. BSc. (Hons) Ost. Director of Research Department, Scuola Superiore di Osteopatia Italiana Torino Italy
PainRelief.com: What is the background for this study?
Response:Osteopathic medicine, depending on different legal and regulatory structures around the world, is a medical profession (e.g. USA), an allied health profession (e.g. UK) or a part of complementary and alternative medicine (e.g. Italy or France). Osteopathic medicine plays an important role primarily in musculoskeletal healthcare. In recent years, systematic reviews have been published to evaluate the clinical efficacy and safety of osteopathic medicine for conditions such as low back pain, neck pain and migraine. However, due to differences in methodologies and the quality of systematic reviews, no clear conclusions were achieved. The aim of our overview was to summarize the available clinical evidence on the efficacy and safety of osteopathic medicine for different conditions.
PainRelief.com Interview with: Mark W Werneke, PT, MS, Dip. MDT Net Health Systems, Inc. Pittsburgh PA
Mark W Werneke
PainRelief.com: What is the background for this study?
Response: Coronavirus pandemic (COVID-19) has had a profound effect on changing health care delivery systems and resulted in a rapid growth of telerehabilitation care models. In addition, patients experiencing chronic low back pain increased during the pandemic which was confounded by mandatory lockdowns and lack of physical activity. There is scant literature demonstrating telerehabilitation’s effectiveness and efficiency for patients with low back pain seeking rehabilitation services during COVID-19 pandemic compared to traditional in-person office visit care.
The primary aim of our study was to examine the association between telerehabilitation treatments administered during every day clinical practice and functional status, number of visits, and patient satisfaction with treatment result outcomes compared to in-person care observed during the height of the pandemic. Using Focus on Therapeutic Outcomes (FOTO) database, our sample consisted of 91,117 episodes of care from 1,398 clinics located in 46/50 US states. Propensity score matching analytics was used to match episodes of care with or without telerehabilitation and standardized differences (S-D) were used to assess whether successful matching between telerehabilitation and no-telerehabilitation subgroups allowed for valid outcome comparisons.
PainRelief.com Interview with: Dr. Mohamad Bydon MD Professor of Neurosurgery Mayo Clinic Rochester, Minnesota
:Dr. Bydon MD
PainRelief.com: What is the background for this study?
Response: Patients presenting with back or leg pain due to degenerative lumbar spine disease often undergo spinal fusion to mitigate the symptoms and halt the progression of the disease.
PainRelief.com: What are the main findings?
Minimally invasive surgery (MIS) in the lumbar spine encompasses a variety of techniques, such as percutaneous screw placement and operation via tubular retractors, and aims to limit the distortion of patients’ anatomy as much as possible. Eventually, compared to open fusion, MIS fusion is associated with decreased muscle destruction, incision size, and time-to-mobilization.
PainRelief.com Interview with: Louise Fleng Sandal PhD Adjunkt, Institut for Idræt og Biomekanik SDU University of Southern Denmark
Dr. Sandal
PainRelief.com: What is the background for this study?
Response:Low back pain is a globally prevalent condition with a high economic cost. Many people seek help with primary care from their general practitioner, physiotherapist or chiropractor. Evidence-based guidelines on first line treatment include learning to self-manage, staying active, exercising and learning about the condition. However, many find this difficult without advice and support, but primary care physicians often lack the time and resources to support self-management.
Digital solutions, such as smartphone technology, utilizing artificial intelligence can be used to tailor self-management support to the individual and be available at the individuals convenience.
PainRelief.com Interview with: Christopher M Proctor, PhD Group Leader, Bionic Systems Group BBSRC David Phillips Fellow Electrical Engineering Division University of Cambridge United Kingdom
Dr. Proctor
PainRelief.com: What is the background for this study? What types of pain might be amenable to treatment with this device?
Response: Spinal cord stimulation has been shown to be effective for patients with severe neuropathic pain. However, the most effective devices that are clinically available today require a rather invasive surgical procedure. Our innovation aims to reduce the surgical burden while providing the best possible treatment.
PainRelief.com: Would you describe the technology?
Spinal Implant – Unrolling
Response: Our minimally invasive spinal cord stimulator is an ultra thin implant that can be inserted into the epidural space within the spinal column through a needle. Once in place, the device can be expanded in a controlled way to cover a large area along the spinal cord. Covering a large area allows for more precise targeting of the nerves that cause you to feel pain.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: We believe that this technology could vastly expand the use of spinal cord stimulation for patients with chronic pain conditions. We are currently fundraising to conduct further pre-clinical testing with an aim to be ready for clinical testing within 3 years.
Any disclosures? The main authors of this study are co-inventors on a related patent application.
BY BEN J. WOODINGTON, VINCENZO F. CURTO, YI-LIN YU, HÉCTOR MARTÍNEZ-DOMÍNGUEZ, LAWRENCE COLES, GEORGE G. MALLIARAS, CHRISTOPHER M. PROCTOR, DAMIANO G. BARONE
SCIENCE ADVANCES 25 JUN 2021 : EABG7833
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.
PainRelief.com Interview with: Benjamin W. Friedman, MD, MS, FAAEM, FACEP, FAHS Professor of Emergency Medicine Vice-chair for Clinical Investigation Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx, NY 10467
PainRelief.com: What is the background for this study? What are the main findings?
Response:A very large number of patients present to US EDs annually with back pain. No medications have proven more effective than NSAIDs for low back pain. Similarly, combining other medications such as skeletal muscle relaxants or opioids with NSAIDs does not improve outcomes more than NSAIDs alone.
Prior to our study, little was known about which NSAIDs were most efficacious for acute low back pain.
The main finding of our study is that ketorolac was more efficacious than ibuprofen for some two and five day outcomes that are important for patients.
PainRelief.com Interview with: Christina Abdel Shaheed PhD Researcher and Academic University of Sydney
Dr. Abdel Shaheed
PainRelief.com: What is the background for this study? What are the main findings?
Response:Paracetamol (acetaminophen) is one of the most widely used drugs for pain relief globally. Our study (https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50992) examined the evidence on the efficacy of paracetamol versus placebo for 44 different pain conditions. There is strong evidence paracetamol provides greater pain relief than placebo for four conditions: craniotomy, knee or hip osteoarthritis, tension headache and perineal pain following childbirth, however sometimes the effects were very small.
Paracetamol was no more effective than placebo for acute low back pain. There is uncertainty regarding the benefits of paracetamol for the remaining 39 pain conditions. To note, most studies evaluated single doses of the pain reliever, which does not reflect typical use of the medicine.
PainRelief.com: What should readers take away from your report?
Response: If people are considering paracetamol for their pain, the recommendation is to:
Stick within the safe limits for using paracetamol (maximum 4 g daily for adults, which will vary depending on the formulation used).
Bear in mind there are different types of paracetamol products (long-acting, which should be taken less frequently, versus short-acting); and cold and flu preparations (including decongestant) and popular over-the-counter products for pain relief (including ibuprofen) can also contain paracetamol.
Do not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
Consider combining the medicine with other non-drug strategies to optimise pain relief, particularly for conditions like osteoarthritis e.g. exercise and healthy eating.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response:High quality clinical trials evaluating typical use of paracetamol are needed to resolve the uncertainty around its effectiveness for the majority of pain conditions.
Disclosures: Some of the authors on this study were also involved in the PACE trial which evaluated the efficacy of paracetamol vs placebo for acute low back pain.
Citation:
Abdel Shaheed, C., Ferreira, G.E., Dmitritchenko, A., McLachlan, A.J., Day, R.O., Saragiotto, B., Lin, C., Langendyk, V., Stanaway, F., Latimer, J., Kamper, S., McLachlan, H., Ahedi, H. and Maher, C.G. (2021), The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Med J Aust, 214: 324-331. https://doi.org/10.5694/mja2.50992
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.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, 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. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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