Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

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

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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Physicians Differently Prescribe Pain Relief Medications to White and Minority Patients

PainRelief.com Interview with:
Dan P. Ly M.D., M.P.P., Ph.D.
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine
University of California, Los Angeles

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

Response: We know that minority patients were less likely to receive opioids than white patients, but this could have been due to minority patients seeing lower opioid-prescribing physicians. As far as I could tell, nobody had been able to examine whether the same physician prescribed opioids differently to their minority patients.

I find that this is the case: the same physician was less likely to prescribe opioids to their minority patients with new low back pain, and instead was more likely to prescribe NSAIDs to their minority patients. And unfortunately, this differential prescribing may have had the consequence of leading to more chronic opioid use in white patients.  

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Back Pain: SelfBACK app To Help Patients Find Pain Relief From Self-Managed Program

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.

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Chronic Pain Sufferers Face Different Pain Triggers During Pandemic

MedicalResearch.com Interview with:
Rubén Nieto
eHealth Lab Research Group,
Faculty of Health Sciences
Universitat Oberta de Catalunya
Barcelona, Spain

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

Response: The COVID-19 pandemic is one of the most serious global challenges to have faced healthcare and society in the last century, taking a drastic toll on the world’s population. It has caused deaths, worsened people’s quality of life and upended the economy, among other consequences. Despite this, there is little research on how people are coping with the pandemic. In our opinion, it is of particular interest to study people with chronic pain, since COVID-19 and the circumstances surrounding it can have a greater impact on them.

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Pain Suppresses the Activity Of the Brain Reward System

Stéphane Potvin, PhD
Centre de recherche
Institut Universitaire en Santé Mentale de Montréal
Full professor; Department of psychiatry and addiction
University of Montreal

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

Dr. Potvin: Let’s begin by using a concrete example. First, imagine that you are taking a walk and it is really cold outside; so cold, in fact, that you can no longer enjoy the experience. Upon returning home, you realize that you no longer feel the pain, and you now have a smile on your face. During this sequence of events, what happened in your brain? To figure it out, we performed a functional neuroimaging study during which a painful cold gel was applied on the right foot of a group of healthy volunteers. What we discovered is that during pain stimulation, there was a clear de-activation of the medial orbito-frontal cortex, which is one of the main “pleasure” centers in the brain. Intriguingly, we observed that after the cold pain stimulation was discontinued, participants experienced significant levels of pleasant emotions that lasted for approximately 4 minutes.

Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

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

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

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How Do Primary Care Physicians Handle Opioids For Patients Seeking Chronic Pain Relief?

PainRelief.com Interview with:
Laura Militello
Unveil, LLC
Applied Decision Science, LLC

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

Response: Little is known about how primary care clinicians’ (PCC) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. When it comes to pain management, primary care clinicians (PCCs) find themselves in a somewhat unexpected role. Few conditions intersect with a range of specialties (i.e. mental health, orthopedics, endocrinology, etc.), disability, and aberrant behavior in the way that chronic pain does. PCCs find themselves in a position where they are asked to assess and diagnose sometimes vague and diffuse pain, and determine appropriate treatment often before the underlying cause of the pain is well-understood.

A recent cultural shift in the U.S. has created a situation in which a formerly default treatment, prescription opioid therapy, is no longer considered safe or appropriate for many patients with chronic pain. The addictive qualities and overall safety profile of opioid medications have come into sharp focus in recent years, leading to a push to reduce opioid use while also trying to achieve pain relief with little guidance for PCCs about how to manage this change in treatment plans. Others have documented the uneasiness many experience in managing patients with chronic pain. One participant in our study described the sense that opioid prescribing sometimes extends into unexpected and disconcerting territory in this way: “I never signed up to be an enforcer.” The complexity and moral uncertainty (6) associated with managing patients with chronic pain is an important backdrop for the findings from this study.

Are Invasive Procedures Effective for Chronic Pain Relief? A Systematic Review

PainRelief.com Interview with:
Wayne B. Jonas, MD
Executive Director
Samueli Integrative Health Programs, H&S Ventures,
Alexandria, VA

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

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo-controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

Study Finds Chronic Pain Patients Used More Opioids For Pain Relief When COVID-19 Cancelled Elective Procedures

PainRelief.com Interview with:

Dr. Shantha Ganesan MD
 Pain Medicine Specialist
Kings County Hospital Center

David Kim, MD, PGY-2
SUNY Downstate Department of Anesthesiology 

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

Response: The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled.

Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by increasing access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Given the cancellation of elective interventional pain management procedures and relaxed regulations on controlled substances during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time.

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What is the Biological Basis of Acupuncture for Systemic Inflammation Modulation?

PainRelief.com Interview with:
QIUFU MA, PhD
Professor, Neurobiology, Cancer Biology
Harvard Medical School
Dana-Farber Cancer Institute

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

Response: This study aimed to understand the biological basis behind acupuncture practice. Modern randomized clinical trials have demonstrated the efficacy of acupuncture practice in treating certain human diseases, such as gastrointestinal disorders and chronic pain, but the underlying biological basis still poorly understood.

Our hypothesis is that acupuncture can drive the somatosensory autonomic pathways to modulate body physiology. A key innovation of this study is the development of new genetic tools to manipulate different autonomic nervous pathways, and we then used the severe systemic inflammation (cytokine storms) induced by bacterial endotoxins as the experimental model.

We found that electroacupuncture stimulation (ES) can drive distinct autonomic pathways in acupoint- and stimulation-intensity-dependent manners. Low intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on adrenal chromaffin cells. High intensity ES at the abdomen activates splenic noradrenergic neurons via the spinal-sympathetic axis, and this activation produces either anti- or pro-inflammatory effects, dependent on adrenergic receptor profiles under different diseases states

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