Tag Archives: #pain

Use of Nitrous Oxide for Pain Relief During Labor and Delivery Reevaluated in Light of Greenhouse Gas Emissions Concerns

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PainRelief.com Interview with:
Prof. Bernd Froessler MD, PhD, FANZCA
Department of Anaesthesia
Lyell McEwin Hospital
Clinical Professor
Discipline of Acute Care Medicine
University of Adelaide

Prof. Bernd Froessler

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

Response: Nitrous oxide (N2O) is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID-19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. This 19-day sudden disruption period at our hospital provided a ‘natural experiment’ and opportunity to re-evaluate the role and need for N2O, with the aim to determine the impact of withdrawing N2O on labour analgesia use and maternal and neonatal outcomes.

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Posture and Pill Shape Affect How Quickly Pain Relief Medications Dissolve and Work

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PainRelief.com Interview with:
Rajat Mittal Ph.D.
Professor of Mechanical Engineering 
Professor of Medicine (Secondary Appt.)
Johns Hopkins University

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

Response: I have worked on the biomechanics and fluid dynamics associated with many different organ systems in the past including the cardiovascular system, the larynx and cerebral hemodynamics, and there is very extensive research being done on these organ systems by research groups all over the world. However, as I was looking to initiate research in some new directions, the implications of stomach biomechanics on important conditions such as diabetes, obesity, gastroparesis, malnutrition and GI infections etc. became apparent to me.

Furthermore, it was clear that bioengineering research in this arena lags other more established areas such as cardiovascular flows by at least 25 years and there seemed to be great opportunity to do impactful work. We focused on drug dissolution for our first project because it offered  “low-hanging fruit” in terms of new and impactful insights.

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Fewer Synthetic Cannabinoid Poisonings in States with Legalized Medical Marijuana

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PainRelief.com Interview with:
Tracy Klein, PhD, ARNP, FAANP, FRE, FAAN
Assistant Director, Center for Cannabis Policy, Research and Outreach
Associate Professor, College of Nursing
Washington State University Vancouver
Vancouver, WA

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

Response: This study evaluates data on illicit synthetic cannabinoid poisonings reported to the National Poison Data System (NPDS) which contains data from 55 poison centers in the US (https://aapcc.org/about/our-members). We correlated the 7600 poisonings reported between 2016 and 2019 with the reporting state’s status of cannabis legalization: restrictive, medical and permissive.

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Low Back Pain: Early Physical Therapy Associated with Reduced Imaging, Invasive Procedures and ER Visits

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PainRelief.com Interview with:
Richard L. Skolasky, Jr., Sc.D.
Professor, Orthopaedic Surgery and Physical Medicine & Rehabilitation
Vice Chair of Research, Orthopaedic Surgery
Director, Surgical Outcomes Research Center
Johns Hopkins University
601 North Caroline Street, Room 5244
Baltimore, MD 21287

Dr. Skolasky

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

Response: Low back pain (LBP) affects a sizeable proportion of the US population (from 1.4 to 20%), and accounts for substantial healthcare expenditures (between $12 billion and $91 billion, not accounting for indirect costs associated with loss of productivity and unemployment). Current recommendations for initial treatment of acute low back pain include physical therapy. Earlier initiation of physical therapy has been associated with less healthcare utilization and spending; however, these studies have been limited to single institutions or health systems. Research is needed to evaluate the effects of early physical therapy on healthcare use, particularly within the first 30 days after initial presentation for acute low back pain, when they are most likely to experience pain and seek care.

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Higher Potency Cannabis Associated With Greater Risk of Addiction

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PainRelief.com Interview with:
Kat Petrilli, PhD Student
Addiction and Mental Health Group (AIM)
Department of Psychology
University of Bath

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

cannabis marijuana weed pot

Response: Cannabis is the third most used drug globally, after alcohol and nicotine. Experimental studies show that THC, the main psychoactive component, causes intoxication, cognitive impairments, as well as symptoms of anxiety and psychosis-like experiences and these effects are dose-dependent, which means that higher potency cannabis products (products with high THC concentrations) could increase the risk of harm to cannabis users. 

Previous studies have shown that concentrations of THC in cannabis have increased over the years. In the US and Europe concentrations of THC in cannabis have more than doubled over the past 10 years. In addition, new legal markets have facilitated the appearance of cannabis products with higher potencies than earlier products, such as cannabis concentrates. We also know from previous studies that cannabis use is associated with mental health disorders and 22% of people who use cannabis are estimated to meet the criteria for cannabis use disorder (CUD) or cannabis addiction. 

International increases in cannabis potency and the availability of higher potency cannabis products makes it especially pressing to understand the association of cannabis potency with mental health outcomes. 

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Headache: Clinical Trial Finds Oral Atogepant Reduced Monthly Migraine Days

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Dr. Trugman

PainRelief.com Interview with:

Joel M. Trugman, MD
Associate Vice President
Neuroscience Development
AbbVie

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

Response: Migraine is a disabling chronic disease characterized by recurrent headache attacks and associated symptoms, including nausea, phonophobia, or sensitivity to sound, and photophobia, or sensitivity to light.

The ADVANCE clinical trial is a phase 3, randomized, double-blind, placebo-controlled trial and examined the safety and efficacy of atogepant, an oral, small-molecule calcitonin gene-related peptide receptor antagonist in patients with episodic migraine. The primary efficacy endpoint was the change from baseline in mean monthly migraine days (MMD) across the 12-week treatment period. This analysis that was recently published examined the efficacy of atogepant using 4 levels of mean monthly migraine day (MMD) responder rates. 

This analysis found that all doses of atogepant significantly increased the proportion of participants who achieved a ≥25%, ≥50%, ≥75% and 100% reduction in mean monthly migraine days over 12 weeks of treatment.

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More Nonopioid Medications Prescribed for Pain Relief since CDC Released Chronic Pain Guidelines

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PainRelief.com Interview with:

JASON GOLDSTICK
Dr. Goldstick

Jason E. Goldstick, PhD
Injury Prevention Center
Department of Emergency Medicine
University of Michigan, Ann Arbor

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

Response: In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. A primary goal of this voluntary guideline is that individuals should receive pain management care that provides the greatest overall benefit. Among other things, this may entail beginning opioid treatment only when the clinician determines that the expected benefits outweigh the risks.

Other research has shown reductions in opioid prescribing as reduced since the guideline release; this report examines whether there were changes in nonopioid pain medication prescribing.

Our overall findings were that nonopioid prescribing increased nationally following the guideline release, above and beyond what would’ve been predicted based on the pre-guideline trends, and this finding was generally consistent across patient subpopulations (e.g., those with vs. without prior opioid exposure).

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Study Finds Majority of Hemp Products Mislabeled for CBD and/or THC Content

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PainRelief.com Interview with:
Tory R. Spindle, Ph.D. 
Assistant Professor
Behavioral Pharmacology Research Unit
Department of Psychiatry and Behavioral Sciences 
Johns Hopkins University School of Medicine

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

Due to recent policy changes, hemp products and anything derived from hemp, including non-THC cannabis constituents such as CBD are now federally legal. As a result, CBD products are now available nation-wide, including in states where cannabis remains illegal. Some prior work had shown oral or vaporized cannabinoid products have poor labeling accuracy, but no one had examined the labeling accuracy of topical cannabinoid products, which are a product category growing in popularity. We purchased 105 topical cannabinoid products (e.g., lotions, creams, gels, patches) from national retailers and online. 

We found that the vast majority of the products were inaccurately labeled for CBD and/or THC and that many of the products had health claims on the label that are not recognized by the FDA, the most common of which was pain/inflammation.

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Review of Pain Relief Medications for Back and Neck Pain in Older Adults

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PainRelief.com Interview with:

Michael Perloff, MD PhD Director, Neurology Pain Medicine, Boston Medical Center Assistant Professor, Boston University Medical School
Dr. Perloff

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.

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Study Highlights Challenges of Opioid Use Disorder in Patients with Cancer Pain

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PainRelief.com Interview with:
Katie Fitzgerald Jones MSN, APN
PhD candidate Connell School of Nursing
Boston College
Jonas Mental Health Scholar 2021-2023
American Academy of Nursing Jonas Policy Scholar 
Ruth L. Kirschstein National Service Award (F31NR019929-01)

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

Response: I am a Palliative and Addiction Nurse Practitioner at VA Boston and a Ph.D. candidate at Boston College Connell School of Nursing. In my clinical practice, I regularly care for people with cancer who have a co-occurring substance use disorder. 

How to best care for people with substance use disorders, such as opioid use disorder is especially complex in people with cancer because opioid management is a standard of cancer-pain management and cancer prognoses can influence opioid decisions and vary. It is important when prescribing opioids that you attend to safety while also addressing pain. People with untreated opioid use disorder or concerning opioid behaviors (such as taking more opioids than prescribed or using opioids with unprescribed medications that increase the risk for opioid-related harm such as benzodiazepines) have an increased risk for opioid related-harms. It is also an area that lacks consensus and is absent from cancer-specific pain guidelines.

This study was conducted with leaders in palliative care including senior author, Jessica Merlin to tackle the question of what is consensus among palliative care and addiction clinicians to caring for people with opioid misuse or use disorder and cancer-related pain and how this is influenced by prognosis?

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