Acupuncture and Massage May Be Part of Pain Management Plan in Patients with Advanced Cancer

PainRelief.com Interview with:
Jun J. Mao, MD, MSCE
Chief, Integrative Medicine Service
Laurance S. Rockefeller Chair in Integrative Medicine
Memorial Sloan Kettering Cancer Center

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

Response: Most of the pain intervention trials focused on cancer survivors who completed treatment or patients in hospice care, little is know how these treatments work in patients living with advanced cancer. With the improvement in cancer treatment, many people are now living with advanced cancer but suffer from pain from their cancer or treatment.

Since acupuncture and massage have been found effective to manage pain in other populations, we designed this study to compare the effectiveness of these two interventions for musculoskeletal pain among patients living with advanced cancer. We hoped these results will aid patients and their doctors to make informed decision in pain treatment.

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Rutgers Study Finds Modest Decrease in Non-Prescription Opioid Use with Cannabis Legalization, But Concentrated in People Addicted to Cannabis

PainRelief.com Interview with:
Hillary Samples, PhD, MHS
Assistant Professor of Health Systems and Policy
Rutgers School of Public Health
Core Faculty
Center for Pharmacoepidemiology and Treatment Science

Rutgers Institute for Health, Health Care Policy and Aging Research
New Brunswick, NJ 08901

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

Response: Early studies suggesting that cannabis legalization is associated with lower rates of opioid-related harms received considerable media attention. At the time, overdose deaths were driven by prescription opioids, and medical cannabis was often framed as a policy approach to address the opioid epidemic. However, as research in this area grew, the relationship between medical cannabis legalization and opioid-related harms became less clear. Many studies of cannabis legalization were unable to examine opioid use by individual people, and individual-level studies outside the legal context showed links between cannabis use and higher risk of opioid-related harms. Thus, our goal was to build evidence of the relationship between medical cannabis legalization and individual-level opioid use.

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Chronic Pain Extends Beyond Mere Physical Symptoms

PainRelief.com Interview with:
Dahee Wi, PhD, RN
Department of Biobehavioral Nursing Science
University of Illinois Chicago
College of Nursing, Chicago, Illinois

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

Response: Chronic pain, defined as persistent or recurrent pain lasting longer than three months, is a significant health problem, particularly among U.S. active duty service members (ADSM). ADSMs are at an elevated risk for chronic pain due to the nature of military service and related job training. Chronic pain is a leading cause of disability and medical discharge in the military, significantly impacting readiness and mission capabilities.

Chronic pain is often accompanied by multiple comorbid conditions, making it essential to view it not just as a single symptom but in relation to co-occurring symptoms of other conditions. The study conducted network analysis, an analytic technique that provides graphical representations of the relationships between selected measures. This approach can offer new insights into the complex interplay of physical, emotional, and social factors in chronic pain

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WashU Study Surveys Cannabis Use for Sleep

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Associate Professor
The Health & Cognition (THC) Lab
Department of Psychology
Washington State University

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

Response: We know that one of the top 5 reasons cannabis users report using cannabis is for sleep disturbances, but we don’t know very much about the types of products they prefer to use for sleep or their perceptions of its effects and side effects relative to more conventional sleep aids (e.g., benzodiazepines, antihistamines, melatonin).

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CAMH Study Finds Potential Risks to Baby from Cannabis Exposure During Pregnancy

PainRelief.com Interview with:
Maryam Sorkhou
PhD student at the Institute of Medical Sciences
University of Toronto

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

Response: While studies on animals strongly suggest that exposure to cannabis during pregnancy can affect brain development, the impact of using cannabis during pregnancy in humans is not yet clear. Some studies suggest potential negative effects, while others find no impairments.

In light of increasing trends towards legalization and potentially decreased perceptions about the risks of cannabis, our meta-analysis of 57 studies aimed to fill this gap by exploring the associations between prenatal cannabis use and birth and childhood outcomes.

Study Finds Any Physical Activity, Even Sleeping, Is Better than Sitting for Cardiovascular Health

PainRelief.com Interview with:
MARK HAMER, PhD
PROFESSOR OF SPORT AND EXERCISE MEDICINE
DIVISION OF SURGERY & INTERVENTIONAL SCIENCE
UNIVERSITY COLLEGE LONDON

PainRelief.com: Can you provide more insight into how much more beneficial moderate to vigorous activities are compared to light activities or standing, in terms of measurable health outcomes?

Response: Our study suggests that the best activity that you can do for your heart is moderate-vigorous activity, followed by a trio of common daily activities: lighter activity, standing and sleeping, with sedentary behaviour being the most harmful. There was a very large and strong association between spending more time in moderate to vigorous activities and better heart health outcomes (outcomes included: BMI, waist circumference, HDL cholesterol, HDL: total cholesterol ratio, triglycerides and blood glucose levels).

For example, replacing 30 min of sedentary behaviour with moderate to vigorous activity was associated with 0.63kg/m2 lower BMI (or –2.4cm lower waist circumference). If an individual were to replace the sedentary time with 30 minutes of light activity instead, we would expect to see a ~0.5 kg/m2 lower BMI. And if an individual replaced their sedentary time with 30 min of either standing or sleep, we would expect to see a ~0.4kg/m2 decrease.  These difference in benefits was much larger when considering cholesterol and triglyceride outcomes.

It was notable that heart health benefits are likely to be observed after replacing just a few minutes of sedentary/sitting time with moderate to vigorous activity. However, to achieve comparable benefits with standing or light activity, it could require 1-3 hours of replacement depending on the outcome (slightly less for measures of obesity such as BMI, much more for cardiometabolic blood biomarkers like cholesterol or triglycerides).

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Study Finds False or Misleading Claims Not Uncommon Among Ketamine Prescribers

PainRelief.com Interview with:
Michael J. DiStefano, PhD

Department of Clinical Pharmacy
Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus, Aurora

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

Response: Ketamine has been an FDA-approved anesthetic since 1970. However, it is increasingly used off-label to treat a variety of mental health and pain conditions. Some providers also offer oral formulations of ketamine, which do not have FDA approval for any indication. Esketamine, an enantiomer of ketamine, is a nasal spray that recently received FDA approval and is narrowly indicated for people with treatment-resistant depression. Esketamine has an extensive FDA REMS (Risk Evaluation and Mitigation Strategies) protocol in place to promote safe use. There is no analogous safety protocol in place for the off-label or unapproved use of ketamine.

Given increasing interest in using ketamine to treat a variety of conditions, we were interested to see how the drug is being promoted to potential patients. The FDA typically regulates consumer advertising for prescription drugs, but only for manufacturers, packers, and distributors of these drugs, designations which don’t seem to include these clinics. The FDA requires that consumer drugs ads are accurate and provide balanced information on both benefits and risks.

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Osteoarthritis: Emory Study Compares Cell-based vs Corticosteroid Injections

PainRelief.com Interview with:
Dr. Ken Mautner, MD
Associate Professor, Department of Physical Medicine and Rehabilitation and
Department of Orthopedic Surgery
Emory University
Atlanta, GA

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

Response: With so much talk about “stem cell” therapy in orthopedics today and with the burden of pain from millions who suffer from knee osteoarthritis,  we wanted to conduct a well designed study that would allow us to see if there is a superior source of cellular treatments for knee osteoarthritis.  We were fortunate to receive a large grant from the Marcus Foundation to conduct this study.  

While there are some studies out there on the topic, very few have the scientific rigor that our study had including patients being blinded to whether they were getting a steroid injection or a cellular treatment.  

Our study included four different treatment options: an injection of bone marrow concentrate, stroll vascular fraction, umbilical cord tissue, and corticosteroids.  

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Dental Pain: Progress Toward Reducing Opioids for Pain Relief Slowed During Pandemic

PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua

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

Response: Using national data, we show that U.S. dental opioid prescribing decreased 45% between 2016-2022, but this decrease slowed during the COVID-19 pandemic.

If pre-pandemic trends had continued, we estimated that 6.1 million fewer opioid prescriptions from dentists would have been dispensed between June 2020 and December 2022.

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Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain

PainRelief.com Interview with:
Satya Surbhi, PhD
Assistant Professor, Division of General Internal Medicine, Department of Medicine
and Center for Health System Improvement, College of Medicine
Director of Measurement and Reporting, Tennessee Population Health Consortium
University of Tennessee Health Science Center

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

Response: Pain is highly prevalent among individuals with chronic kidney disease (CKD), in whom commonly utilized analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are often contraindicated. Opioids can be an alternative means of analgesia in patients with CKD, but they are associated with numerous unwanted adverse effects and current efforts are aimed at curbing opioid use in general, which leaves patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD compared to opioids are unknown.    

The objectives of this study were to

1) compare the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain and

2) to examine the heterogeneity of treatment effects on outcomes by factors including age, sex, race, smoking status, BMI, cancer, eGFR and UACR levels, benzodiazepine use, and opioid/non-opioid prescription year. 

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