Acupuncture for Chronic Musculoskeletal Pain Relief: A Review of Randomized Trial Interview with:
Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
 Director, Center For Complementary And Integrative Medicine                                             
Division of Rheumatology
Tufts Medical Center, Boston, MA

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

Response: Chronic Musculoskeletal Pain is a complex disorder without effective treatment Acupuncture, originating in China more than 3,000 years ago, is one of the most popular sensory stimulation therapies. However, despite the fact that acupuncture is widely used for pain relief in a number of conditions including severe knee osteoarthritis, acute postoperative pain, musculoskeletal disorders, evidence of the effect of Chronic Musculoskeletal Pain relief is scarce.

Our study was to determine the efficacy of acupuncture for pain relief in this field.

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Neck Pain: Deep Tissue Massage Can Offer Short Term Pain Relief Interview with:

Oscar Javier Pico-Espinosa | MD, MSc, PhD (c) Epidemiology
Karolinska Institutet  What is the background for this study?

Response: Persistent neck pain is a common condition and one of the main causes of sick leave worldwide. Patients often utilize non-pharmacological therapies such as massage or exercises. However, the evidence supporting the effectiveness of such treatments is either lacking or conflicting. With that in mind, we designed the Stockholm Neck (STONE) trial, where we compared deep tissue massage, strengthening and stretching exercises and a combination of those two (up to six sessions over six weeks), versus advice (up to three sessions of advice to stay active).

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Pain Medication Beliefs Can Enhance (or Impair) Pain Relief Interview with:
Leon Timmerman, PhD
St Antonius Hospital, Department of Anesthesiology
Intensive Care and Pain Medicine
The Netherlands

Leon Timmerman, PhD St Antonius Hospital, Department of Anesthesiology Intensive Care and Pain Medicine The Netherlands
Dr. Timmerman  What is the background for this study?  What are the main findings?

Response: Chronic pain is commonly treated with pain medication. However, the results of pharmacological treatment are often poor. One of the reasons might be that half of the patients do not use their medication as prescribed. Underuse as well as overuse are common and have been described to result in reduced treatment effect, health care risks and unnecessary treatment changes. The are many risks factors described for non-adherent behavior.

The way people think about their pain medication have been shown to be related to the way they use their medication. With this study, we confirmed this relation with a prospective study. Baseline beliefs about pain medication, measured by ‘Pain Medication Attitudes Questionnaire’,  were found to be related to underuse of pain medication, the occurrence of side effects and patient satisfaction after three months.  

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Off-Label Gabapentinoid Prescriptions for Cancer Pain Relief Double Interview with:
Alex Fauer, RN, OCN®
Ph.D. Candidate
University of Michigan School of Nursing Interview with: Alex Fauer, RN, OCN® Ph.D. Candidate University of Michigan School of Nursing  What are the main findings?

Response: Our primary finding of the paper is that the age-, sex-, and US region-adjusted percentage of adults who used a gabapentinoid increased from 2.34% to 5.60% from 2005 to 2015. The total number of gabapentinoid prescriptions  filled  among  US  adults diagnosed with  cancer was  approximately  1.19  million in 2005, but increased to 3.52 million in 2015.

We also found that adults aged 18-44 were the highest users of gabapentinoids.

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Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief Interview with:

Samannaaz Khoja, PT, PhD
Research Assistant Professor
Department of Physical Therapy
University of Pittsburgh School of Health and Rehabilitation Sciences

Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
Dr. Khoja What is the background for this study? 

ResponseThe purpose of this study was to describe and compare rates of physicians’ recommendation for physical therapy (PT), lifestyle-counseling, and pain medication for knee osteoarthritis (KOA) between 2007 and 2015. The study also aimed to identify patient, physician and practice-level factors associated with each treatment recommendation.   We used survey data from the National Ambulatory Medical Care Survey, data from this survey is publicly available and is housed within the CDC. We identified 2297 knee OA related visits, which approximated to 67 (±4) million weighted physician visits between 2007 and 2015 (around 8 million visits/year).

Do Psychological Approaches Offer Pain Relief to Hospitalized Patients? Interview with:
Dr.-Ing. Marcus Komann
Jena University Hospital
Jena, Germany

Ing. Marcus Komann
 Jena University Hospital
 Jena, Germany  What is the background for this study?

Response: A lot of non-pharmacological methods (like relaxation, cold packs, prayer and so on) for post-operative pain relief are used in today’s hospitals. There is also some literature out there on this topic. However, the literature mostly concerns single methods and very specific patient groups. Further, for most methods, the literature is not clear on the pain soothing effects.

We looked at a real-life registry to study the effects of a large number of such methods on a big sample of patients.

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Do Men and Women Have Different Pain Relief Response to Opioids? Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY  What is the background for this study?

Response: Pain is the leading cause for seeking medical care worldwide, and opioids are the most frequently prescribed drugs for pain relief. Differences and similarities between men and women in both effectiveness and side effects to opioids used for pain relief have been described. In addition, individuals may respond differently to these medications for other reasons for example: the intensity of pain experienced, amount and type of administration of opioids (e.g. fixed doses established by physicians or flexible doses decided by patients), mental condition, age, body weight, and use of alcohol, tobacco and/or cannabis.

However, the role of these factors in influencing sex differences and similarities in the response to opioids used for pain control has not been thoroughly investigated.

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Pain Relief Drug Tramadol Associated with Hypoglycemia Interview with:
Ruben Abagyan, Ph.D.

Dr. Abagyan

Professor, University of California, San Diego
Skaggs School of Pharmacy & Pharmaceutical Sciences
San Diego Supercomputer Center  What is the background for this study?  What are the main findings?

Response: The background for this study was concern about unknown side effects of tramadol that became a popular treatment for chronic pain. With our informatics approach and access to millions of the FDA reports we were in a position to look for those adverse effects and we found that hyperglycemia (low blood sugar) is one of those concerns. There have been a few small-scale studies and case reports of tramadol use associated with hypoglycemia and hospitalizations related to it. The dramatic increase in tramadol prescription rates, especially in light of tighter control over hydocodone/acetaminophen (went from schedule III to II), warranted a larger scale postmarketing study of FDA FAERS reports.

As we compared the hypoglycemia side effect between different opioids we found that only one other drug, methadone (used to treat drug abuse and addiction), has a comparable association with hypoglycemia. What should readers take away from your report?

Response: Patients using tramadol should should be aware of hypoglycemia symptoms such as shakiness, dizziness, sweating, hunger, irritability, moodiness, anxiety/nervousness, and headache, or, in severe cases, blurred vision, seizures or loss of consiousness.  The same applies to methadone, also known as Dolophine. What recommendations do you have for future research as a result of this work?

Response: It may be beneficial to perform controlled studies to confirm and understand this association. Our study looked at other drugs with the known pharmacology of tramadol (mu-opioid agonism, serotonin/norepinephrine re-uptake inhibition, and NMDAR antagonism), but did not find an association with hypoglycemia with a specific class.  Would be interesting to learn more about additional/other pharmacology of tramadol and methadone behind the etiology of hypoglycemia. Is there anything else you would like to add?

Response: We think that studies of this nature are beneficial since rare side effects often go unnoticed in clinical trials due to a limited number of participants. Additionally, hypoglycemia effects may often be attributed to other medications and medical conditions, while tramadol or methadone were unlikely to cause suspicion.

Any disclosures?

Non of the authors have any financial or non-financial conflicts of interest to disclose. 


Tigran Makunts, Andrew U, Rabia S. Atayee, Ruben Abagyan. Retrospective analysis reveals significant association of hypoglycemia with tramadol and methadone in contrast to other opioids. Scientific Reports, 2019; 9 (1) DOI: 10.1038/s41598-019-48955-y

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Chronic Back and Knee Pain Relief: How Do Sham Procedures Compare to Surgery? Interview with:

Wayne B Jonas MD

Wayne B Jonas MD

H&S Ventures
Samueli Integrative Health Programs  What is the background for this study?

Response: The findings of this study are based on a systematic review of 25 randomized clinical trials evaluating surgical type interventions (open surgeries, arthroscopic, endoscopic, laparoscopic, heart catheterization, radiofrequency, laser, and other interventions) for chronic back and knee pain. In each study, researchers had also performed sham procedures on a control group where they replicated the invasive procedure by omitting the step believed to be therapeutically necessary. The purpose of this it to determine how much of the effects are due to the placebo response.

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Osteoarthritis: Poor Sleep Linked to More Pain Interview with:
Dr. Daniel Whibley PhD
Department of Physical Medicine and Rehabilitation
University of Michigan, Ann Arbor, Michigan
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
University of Aberdeen, Scotland, UK  What is the background for this study?  What are the main findings?

Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.

We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening,  these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.

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