Tag Archives: #chronicpain

Chronic Pain Conditions Among Women in the Military Health System

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PainRelief.com Interview with:
Andrew J. Schoenfeld, MD
Professor, Harvard Medical School
Orthopaedic Surgery
Brigham and Women’s Hospital 

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

Response: The impetus for this research stems from my time as the Director of the Medical Evaluation Board at Fort Bliss Texas during my time on active duty with the Army between 2009-13 and my time in Ann Arbor VA between 2013-15.  We wanted to understand the impact that repeated exposure to the high intensity deployment to combat theaters during 2006-2013  had on women active duty servicemembers and women civilian dependents of active duty servicemembers who were deploying

PainRelief.com: What are the main findings?

Response: Significant increases in the diagnosis of Chronic Pain conditions among women active duty service members as well as women civilian dependents who were affiliated with the military between 2006-13.

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Chronic Pain Improved in TBI Patients Receiving Collaborative Care

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PainRelief.com Interview with:
Jeanne M. Hoffman, PhD, ABP
Professor, Department of Rehabilitation Medicine
University of Washington School of Medicine  

dr_jeanne_m_hoffman

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

Response: We were interested in finding a way to improve the treatment of pain for individuals with traumatic brain injury who often struggle with chronic pain, but may not always be able to benefit from the therapies that are available. 

PainRelief.com: What are the main findings?

Response: We found that using an approach called “collaborative care”, which is an integrated, team-driven approach to delivering patient-centered evidenced based care that, in our study, included 12 sessions of cognitive behavioral treatment of pain, led to improvements in pain interference at the end of treatment, which lasted an additional 4 months after treatment ended. 

We also found improvements in pain intensity after treatment as well as reductions in the collaborative care group in symptoms of anxiety and depression and increases in satisfaction with care.

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Cincinnati Children’s Hospital Study Addresses How Early Life Surgery Can Influence Later Responses to Pain

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PainRelief.com Interview with:
Michael P. Jankowski, PhD
Theodore W. Striker, MD Chair in Anesthesia Research
Professor and Director of Research
Department of Anesthesia, Division of Pain Management
Cincinnati Children’s Hospital Medical Center

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

Response: It is estimated that chronic pain can affect up to 20% of children undergoing surgery.  We know that alterations in sensory input during critical periods of development can have lasting effects on normal sensory processing later in life.  The developing peripheral nervous system undergoes substantial changes in function during the neonatal period as it receives information from the external environment.  Injuries, including surgery, that occur during this early developmental window can change the way a patient responds to re-injury in adolescence and young adulthood, a phenomenon called neonatal nociceptive priming. 

         At the same neonatal time, the immune system is also developing and responding to changes in the body.  Surgery is known to cause an immune response that is normally activated to facilitate wound healing and regulate acute pain so that the tissues can undergo proper repair after damage.  However, it was not clear how early life surgery could affect the developing immune system to influence pain responses later in life. 

         Since we knew that one particular type of immune cell, the macrophage (which regulates inflammation and tissue repair in addition to acute pain), can play a role in long term responses to surgery, we investigated how this cell type may play a role in the transition from acute post-surgical pain in neonates to prolonged responses to reinjury later in adolescence. 

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Tapentadol Provided Pain Relief and Improved Sleep in Patients with Chronic Musculoskeletal Pain

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PainRelief.com Interview with:
Dr Renato Vellucci
Contract Professor University of Florence
Pain and Palliative care Clinic
University Hospital of Careggi
Florence, Italy

Dr. Vellucci

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

Response: Chronic low back pain (CLBP) is the most prevalent chronic pain (CP) condition and the leading global cause of years lived with disability. According to the axiom pain as a biopsychosocial issue, mood and sleep disturbances represent key issues. However, the impact of different analgesic therapies on quality of life (QoL) and functional recovery has been poorly assessed to date. Focusing on combination of chronic pain and sleep, they both perform a mutual reinforcement.

Pain disorganizes the sleep architecture, and disturbed and unrefreshed sleep increases spontaneous pain and lowers pain thresholds. Sleep disorders may augment stress levels, thus making it difficult for patients to perform simple tasks impairing their cognitive ability. Poor sleep may predict the growth and intensification of pain over time, with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. Epidemiology of chronic pain unequivocally demonstrates the role of sleep quality in the development of chronic pain.

Notwithstanding this strong two-way relationship between chronic pain and sleep, little knowledge is available about the neurochemical determinants of this interplay and therapeutical strategies to break this vicious circle. Fifty percent of people with chronic low back pain have sleeping disturbances, with an 18-fold increase in insomnia versus healthy people. A recent study investigated the relationship between sleep disturbances and back pain and found that it is two sided with sleep disturbance being associated with risk of back pain whilst back pain can also lead to sleep disturbances. Thus, it can be hypothesized that, by reducing pain and physical dysfunction, sleep quality could be improved, thus enriching the QoL of people with CLBP.

Similarly, improvements in sleep after cognitive behavioral therapy in patients with chronic pain due to osteoarthritis were associated with reduced pain. Earlier evidence suggested that tapentadol prolonged-release treatment ameliorate in parallel QoL and sleep quality in a greater proportion of patients compared to that of patients following oxycodone/naloxone prolonged- release treatment (50% versus 37.7%). Other tapentadol studies conducted in a real-life context documented, along with effective pain control, similar improvements in mental and physical health and suggested beneficial effects in terms of less night awakenings and greater percentages of patients reporting restful sleep.

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