Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

PainRelief.com Interview with:
Allison Lee, MD, MS  
[she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

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

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.

Acetaminophen Label Changes Impact On Hospital Admissions for Overdoses

PainRelief.com Interview with:
Tony Antoniou PhD
Department of Family and Community Medicine
Li Ka Shing Knowledge Institute
St. Michael’s Research Institute

Dr. Antoniou

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

Response: Acetaminophen is used by millions of people worldwide and included as an ingredient in hundreds of over the counter products for pain and the common cold. Accidentally taking more than the safe dose of the drug is therefore possible. This is important because taking too much acetaminopohen can lead to potentially serious and fatal liver injury.

In Canada, changes to acetaminophen product labels warning individuals of the risk of taking too much of the drug and letting consumers know that the product can take acetaminophen were made to try and prevent accidental overdoses. We studied whether these label changes had any impact on the number of people being hospitalized with accidental acetaminophen overdose over a 16-year period.

Osteopathic Medicine Reviewed for Non-Specific Low Back Pain

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.

Risk of Low Back Pain in Women May Vary with Age of Menarche

PainRelief.com Interview with:
Ingrid Heuch MD, PhD
Department of Research, Innovation and Education,
Division of Clinical Neuroscience
Oslo University Hospital, Norway

Dr. Heuch

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

Response: Low back pain represents a major health problem in today’s society. In this study more than 27 000 women aged 20-69 years were included in the Trøndelag Health Study, HUNT, in Norway. As in most population-based studies, women were more likely to be affected with chronic low back pain than men. Our study showed a U-shaped relationship between age at menarche (age at a woman’s first menstruation) and risk of low back pain, also after many years. Both women with an early or late age at menarche experienced higher risk of low back pain. Compared to women with menarche at age 14 years, menarche at age 11 years increased the risk by 32% and menarche at age 17 years by 43%. No association was found between age at menopause and risk of low back pain.

Telerehabilitation Found Effective for Low Back Pain Relief

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.

As Opioid Prescriptions Fall, Alternate Prescriptions for Pain Relief Increase

PainRelief.com Interview with:
Lauren R. Gorfinkel MPH
New York State Psychiatric Institute
New York, NY
Department of Medicine, University of British Columbia
Vancouver, Canada

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

Response: The opioid crisis has led to clear declines in opioid prescribing across North America, however, chronic pain remains an extremely common health problem with limited treatment options. This study was therefore interested in using nationally-representative data to find out whether alternative pain medications are growing more popular as opioid prescriptions decline.

Risk of AMA Hospital Discharge High Among Patient with Opioid-Related Conditions

PainRelief.com Interview with:
Peggy Compton, RN, PhD, FAAN
Professor and van Ameringen Endowed Chair
Program Director, Hillman Scholars in Nursing Innovation
Department of Family and Community Health
University of Pennsylvania School of Nursing
Philadelphia, PA 19104

Dr. Compton

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

Response: Patients with substance use disorders are highly likely to leave the hospital against medical advice (AMA) or self-discharge, putting them at risk for poorer health outcomes including progressing illness, readmissions, and even death. Inadequate pain management is identified as a potential motivator of self-discharge in this patient population.  The objective of these secondary analyses was to describe the association between acute and chronic pain and AMA discharges among persons with opioid-related conditions.

PainRelief.com:  What are the main findings?

Response: The main findings were that 16% of the 7,972 admissions involving opioid-related conditions culminated in an AMA discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to have an AMA discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge. 

PainRelief.com: What should readers take away from your report?

Response: These findings underscore the importance of aggressive and effective pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.  

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Future research should be aimed at evaluating approaches for effective pain management in patients with opioid related disorders.  These patients may present with high levels of opioid analgesic tolerance and opioid-induced hyperalgesia, suggesting that non-opioid analgesic approaches may be warranted to effectively manage their pain.  Regardless of the specific pain management approach employed, patients with opioid-related disorders should believe that their complaints of pain are taken seriously and managed aggressively to maximize duration of hospital stay.

Citation:

Compton, P., Aronowitz, S.V., Klusaritz, H. et al. Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study. Harm Reduct J 18131 (2021). https://doi.org/10.1186/s12954-021-00581-6

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Less-is-More Approach to Pain Relief After Surgery

PainRelief.com Interview with:
Dr Deanne Jenkin PhD
UNSW Australia,
now Research Fellow at The Daffodil Centre
Sydney, Australia

Dr Jenkin

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

Response: At the time, long-term opioid use for chronic non-cancer pain was increasing and there were signs that their benefit was overestimated whilst the harms were underestimated. Our randomized trial found that after going home from fracture surgery, strong opioids were not better for pain relief compared to a milder, potentially safer opioid alternative.

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Physical Therapy After Knee Replacement Linked to Less Long Term Opioids for Pain Relief

PainRelief.com Interview with:
Deepak Kumar, PT, PhD
Assistant Professor, Physical Therapy
Assistant Professor, BU School of Medicine
Director, Movement & Applied Imaging Lab

Dr. Kumar

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

Response: We investigated the association of physical therapy interventions with long-term opioid use in people who undergo total knee replacement surgery.   For people with advanced osteoarthritis, total knee replacement is the only option. The number of total knee replacement surgeries has been increasing and is expected to rise exponentially over the next few years with an aging population and rising rates of obesity. However, up to a third of patients continue to experience knee pain after this surgery. Also, a significant proportion of people become long-term opioid users after total knee replacement. Reliance on opioids may reflect a failure of pain management in these patients. Given that physical therapy interventions are known to be effective at managing pain due to knee osteoarthritis, we wanted to study whether physical therapy before or after surgery may reduce the likelihood of long-term opioid use.

We used real-world data from insurance claims for this study. In our cohort of about 67,000 patients who underwent knee replacement between 2001-2016, we observed that, receiving physical therapy within 90 days before surgery or outpatient physical therapy within 90 days after surgery were both related to lower likelihood of long-term opioid use later. We also observed that initiating outpatient physical therapy within 30 days and 6 or more sessions of physical therapy were associated with reduced likelihood of long-term opioid use compared to later initiation or fewer PT sessions, respectively. However, we did not see an association between type of physical therapy. i.e., active (e.g., exercsise) vs. passive (e.g., TENS) and long-term opioid use.

Importantly, most of our findings were consistent for people who had or had not used opioids previously. We also were able to account of a larger number of potential factors that could confound these associations because of the large sample size. However, there are limitations to our work. Since we only had access to insurance claims data but not to health records, we are unable to make any inferences about association of physical therapy with pain or quality of life, etc.

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Acupuncture for Pain Relief from Chronic Prostatitis and Chronic Pelvic Pain Syndrome

PainRelief.com Interview with:

Zhishun Liu, MD, PhD
Guang’anmen Hospital
China Academy of Chinese Medical Sciences
Beijing, China

acupuncture

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

Response: Pharmacologic therapy has so far failed to reveal universal benefits in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); the evidence for acupuncture is limited, although it is also recommended in current guidelines.

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