Aimovig® plus OnabotulinumtoxinA (onabot) For Migraine Pain Relief Interview with:
Fred Cohen, MD
Department of Medicine, 
Montefiore Medical Center and the Albert Einstein College of Medicine
Bronx, New York

Dr. Fred Cohen  What is the background for this study?

Response: OnabotulinumtoxinA (onabot) and calcitonin gene-related peptide monoclonal antibodies (CGRP-targeted mAbs) are two medications used to treat chronic migraine. While both have been shown to significantly reduce monthly headache days, they are some patients that require further treatment after receiving one of these therapies. Prior to this study, there was limited data on the efficacy and safety of concomitant treatment with onabot and a CGRP-targeted mAb. 

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Inadequate Pain Control After Spine Surgery is Common Interview with:
Michael M. H. Yang MD, MSc

Departments of Clinical Neurosciences, Section of Neurosurgery, 
Community Health Sciences
Icahn School of Medicine at Mount Sinai
New York, New York  What is the background for this study?

Response: Spine surgery has been ranked as one of the most painful surgical procedures. Patients who experience poor pain control have delayed recovery, take more opioids, and stay in the hospital longer. The objective of our study was to determine patient and surgical factors that increased the chance for poorly controlled pain after spine surgery. These risk factors were incorporated into a score that can be used to determine the likelihood of a poor patient pain experience. What are the main findings?

Response: Overall, 57% of patients experienced poorly controlled pain after their spinal operation in our study. We found 7 risk factors for poor pain control: younger age, female sex, daily use of opioid medication, higher neck or back pain intensity, higher depression score, surgery involving 3 or more levels, and fusion surgery. These risk factors were used to create the Calgary Postoperative Pain After Spine Surgery (CAPPS) Score. Patients identified as low-, high-, and extreme-risk by the CAPPS score had 32%, 63%, and 85% chance of experiencing poorly controlled pain, respectively.

Contact Athletes Cope With Pain Better Interview with:
Claire Thornton, PhD
Northumbria University
Newcastle upon Tyne, UK

Dr. Thornton  What is the background for this study?  What are the main findings?

Response: There is evidence that high contact athletes (i.e. rugby players, martial artists) tolerate more pain and report pain as lees intense than other athletes. Being able to cope with pain is essential in risky, painful, collision-based sports, yet there is little research into the mechanisms behind intra-athlete differences in pain responses. Use of adaptive coping styles and/or being challenged may impact upon how an athlete performs while in pain.

We wanted to examine performance during pain among different athlete groups to try to understand how pain influences performance while manipulating challenge and threat states.

We split athletes into 3 groups: Experienced contact athletes [>3 years’ experience in the sport], novice contact athletes and non-contact athletes)  

Business Model Can Help With Pain Relief Decisions After Surgery

Dr. Schug Interview with:
Professor Stephan A Schug MD FANZCA FFPMANZCA EDPZ 
Emeritus Professor and Honorary Senior Research Fellow
Anaesthesiology and Pain Medicine
Medical School  University of Western Australia  What is the background for this study?

Response: This paper is the result of applying a widely used tool in operations research, Multi-Criteria Decision Analysis (MCDA), to a medical problem, namely the use of parenteral analgesics in postoperative pain management. MCDA is a modelling approach which is aimed at achieving evidence-based decisions in settings of multiple conflicting criteria. It is commonly applied to decisions in politics and business; one of our co-authors is Lawrence D Phillips from the London School of Economics and Political Sciences, where he uses this methodology in these settings. However, there is increasing use of this methodology in medicine now, in particular in assessment of medicines with obviously conflicting criteria such as efficacy, adverse effects, safety and even price. The methodology has been applied to a number of medicine (eg psychoactive drugs) and considered by the European Medicines Agency (EMA).

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Green Light Exposure May Provide Pain Relief and Reduce Need for Opioids Interview with:

Padma Gulur MD
Professor of Anesthesiology and Population Health
Executive Vice Chair, Duke Anesthesiology 
Director, Pain Management Strategy and Opioid Surveillance
Duke University Health System

Padma Gulur MD
Professor of Anesthesiology and Population Health
Executive Vice Chair, Duke Anesthesiology 
Director, Pain Management Strategy and Opioid Surveillance
Duke University Health System  What is the background for this studyHow is the light administered? Might your findings help explain why green is widely considered a ‘calming’ color?

Response: Pain management continues to be challenging given the limited options for pain relief and the significant continued reliance on opioid medications as a primary mode of pain relief which has lead to the prescription opioid epidemic facing the country. Opioid exposure during clinical care is a key risk factor for subsequent misuse, and the probability of prolonged use scales with both dose and duration of opioid exposure. Minimizing opioid exposures reduces misuse risk. To do so while still effectively treating pain relies on opioid sparing multimodal pain relief strategies. In practice, this manifests as polypharmacy or the use of multiple medication classes. However most medications come with a significant side effect burden. Non-pharmacological options remain limited in efficacy or are difficult to integrate into clinical care. Recent pre-clinical findings have demonstrated robust pain relief in response to exposure to green light. These effects occurred both through the addition of green illuminating light in the environment and through green-biased filtration of visualized ambient light. 

We are conducting a pilot trial of exposure to green light for pain relief in paients that have recently undergone surgery to understand its effect on acute pain and to study its effect on chronic pain we are conducting the study in fibromyalgia patients. Our goal is to evaluate the feasibility and efficacy of eyeglasses-based colored light therapy. Recruitment for the acute arm of the study is complete. The chronic arm of the study is currently recruiting.

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Joint Replacement: Have Opioid Prescription Patterns for Pain Relief Changed? Interview with:
Rahul Shah
Medical Student
The University of Texas Medical Branch  What is the background for this study?

Response: The United States has a unique overreliance on opioids for managing both acute and chronic pain, compared to many other developed nations. Opioid misuse and addiction frequently start with large doses of opioids prescribed after surgical interventions. This overprescribing contributes to the high rates of opioid use disorder and overdose deaths in the United States. There have been myriad interventions to curb opioid overprescribing, ranging from the DEA’s hydrocodone rescheduling law to opioid prescribing guidelines issued by the CDC, states and orthopedics specialty organizations. 

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