Tag Archives: pain relief

Cincinnati Children’s Hospital Study Addresses How Early Life Surgery Can Influence Later Responses to Pain

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PainRelief.com Interview with:
Michael P. Jankowski, PhD
Theodore W. Striker, MD Chair in Anesthesia Research
Professor and Director of Research
Department of Anesthesia, Division of Pain Management
Cincinnati Children’s Hospital Medical Center

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

Response: It is estimated that chronic pain can affect up to 20% of children undergoing surgery.  We know that alterations in sensory input during critical periods of development can have lasting effects on normal sensory processing later in life.  The developing peripheral nervous system undergoes substantial changes in function during the neonatal period as it receives information from the external environment.  Injuries, including surgery, that occur during this early developmental window can change the way a patient responds to re-injury in adolescence and young adulthood, a phenomenon called neonatal nociceptive priming. 

         At the same neonatal time, the immune system is also developing and responding to changes in the body.  Surgery is known to cause an immune response that is normally activated to facilitate wound healing and regulate acute pain so that the tissues can undergo proper repair after damage.  However, it was not clear how early life surgery could affect the developing immune system to influence pain responses later in life. 

         Since we knew that one particular type of immune cell, the macrophage (which regulates inflammation and tissue repair in addition to acute pain), can play a role in long term responses to surgery, we investigated how this cell type may play a role in the transition from acute post-surgical pain in neonates to prolonged responses to reinjury later in adolescence. 

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Psychological Interventions For Non-Specific Chronic Low Back Pain

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PainRelief.com Interview with:

Ms Emma Ho | BAppSc(Phty)(Hons), PhD Candidate
The University of Sydney                                          
Faculty of Medicine and Health | Charles Perkins Centre Musculoskeletal Research Hub | Sydney NeuroMusculoskeletal Research Collaborative
Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences

Emma Ho

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

Response: Adults with chronic low back pain (lasting for more than 12 weeks) not only experience physical disability but can also suffer psychological distress in the form of anxiety, depression, and fear avoidance (avoiding movement for fear of pain).

Clinical guidelines therefore consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain. However, not much is known about the different types of psychological therapies available as well as their comparative effectiveness and safety, leaving doctors and patients often unclear about the best choice of treatment. Accordingly, the aim of our systematic review with network meta-analysis was to determine the comparative effectiveness and safety of psychological interventions for chronic non-specific low back pain.

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Pharmacists May Play An Important Role in Pain Management

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PainRelief.com Interview with:
Nathorn (Nui) Chaiyakunapruk PharmD, PhD
Professor, Department of Pharmacotherapy
University of Utah College of Pharmacy
Salt Lake City, UT 84112

Dr. Chaiyakunapruk

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

Response: Pain and pain-related diseases are the major causes of disability and disease burden worldwide. Over the last two decades, as the role of the pharmacist has expanded, pharmacist engagement in disease state management including pain management has been shown to improve clinical outcomes. Several systematic reviews have been conducted to date that assessed the impact of pharmacist interventions on pain management. However, the evidence on the effect of any type of pharmacist intervention, whether led by a pharmacist or in a supportive role, on pain intensity over time in individuals with pain of any etiology is currently inadequate. This study aims to fill that gap.

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Study Identify Mechanism That Converts Normal to Chronic Pain

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PainRelief.com Interview with:
Dr. Daniela Mauceri PH.D.
Neurobiology
Heidelberg University
Heidelberg Germany

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

Response: Physiological, normal, pain prevents damage to the tissues and, in case of injury, resolves with healing. Pathological, chronic pain however, will persist after injury is mended and can manifest even in absence of causes. The transition from physiological to chronic pain is sustained by alterations of gene expression in the cell belonging to the pain circuitry such as neurons of the dorsal horn spinal cord. Epigenetic changes are important mechanisms regulating gene transcription in mammalian cells and had been previously implicated in pain chronification. A detailed understanding of which epigenetic mechanism would be critical in the establishment of chronic pain was still missing and the identity of the regulated genes still elusive.

PainRelief.com:  What are the main findings?

Response: In our study we described how one particular epigenetic molecule named Histone Deacetylase 4 (HDAC4) is inactivated in the neurons of the dorsal horn spinal cord in persistent inflammatory pain. We also showed that inactivation of HDAC4 leads to increased expression of Organic Anion Transporter 1 (OAT1) and found that OAT1 is responsible for the mechanical hypersensitivity typical of chronic pain. 

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

Response: Our study suggests that finding ways to maintain HDAC4 in an active state might prevent pain chronification by blunting the upregulation of OAT1. Alternatively, blocking OAT1 activity with a pharmacological approach might also be beneficial.

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

Response: Chronic pain is a severe pathological condition affecting a considerable part of the worldwide population. Treatments are still unsatisfactory. Our study, although performed using a mouse model of chronic inflammatory pain puts forward two potential new candidates (HDAC4, OAT1) for not only future investigations but also, importantly, for the development of future therapeutic approaches.

The research work was funded by the CRC1158 on Chronic Pain by the German Research Foundation.

Citation:

Litke, C., Hagenston, A.M., Kenkel, AK. et al. Organic anion transporter 1 is an HDAC4-regulated mediator of nociceptive hypersensitivity in mice. Nat Commun 13, 875 (2022). https://doi.org/10.1038/s41467-022-28357-x

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MORE Study Integrates Mindfulness for Opioid Misuse and Chronic Pain in Primary Care

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PainRelief.com Interview with:
Eric L. Garland, PhD LCSW
Distinguished Endowed Chair in Research
Distinguished Professor and Associate Dean for Research
University of Utah College of Social Work
University of Utah, Salt Lake City
www.drericgarland.com

Dr. Garland

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

Response: This was a 5-year NIH-funded clinical trial conducted in the primary care setting. Mindfulness-Oriented Recovery Enhancement reduced opioid misuse by 45%, more than doubling the effect of standard supportive psychotherapy, and far exceeding the effect size of any known therapy for opioid misuse among people with chronic pain. At the same time, MORE decreased chronic pain symptoms to a greater extent than the current gold-standard psychological treatment for chronic pain, CBT. MORE also decreased emotional distress and depression.

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

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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.

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Telerehabilitation Found Effective for Low Back Pain Relief

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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.

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As Opioid Prescriptions Fall, Alternate Prescriptions for Pain Relief Increase

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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.

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NEJM: Study Recommends Hip Implants Be Fixed with Bone Cement

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PainRelief.com Interview with:
Matthew Costa
Professor of Orthopaedic Trauma Surgery
University of Oxford 
Honorary Consultant Trauma Surgeon
John Radcliffe Hospital, Oxford

Dr. Costa

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

Response: The number of patients sustaining a fracture of the hip is increasing rapidly as patients all around the world live into older age. It estimated there will be over 6 million hip fractures by 2050. Approximately half of hip fractures occur at the neck of the thigh bone (femur) and the majority of patients over 60 years with such a fracture are treated with a partial hip replacement in which the head of the femur is replaced with a metal implant (hemiarthroplasty).

There is controversy about how best to fix the hemiarthroplasty implant to the bone of the femur. If the implant is not securely bonded to the patient’s bone it can loosen causing pain and restricting movement and activities of daily living. This study was about the best way to fix the implant to the patient’s bone.

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Many Young Adults and Adolescents Vape Both Tobacco and Cannabis

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PainRelief.com Interview with:
Ruoyan Sun PhD
Assistant Professor
School of Public Health
The University of Alabama at Birmingham

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

Response: Many people consider vaping as just nicotine vaping, but these vaping devices can be used to vape cannabis as well. We are curious about how many e-cigarette users are vaping cannabis. Using the Population Assessment of Tobacco and Health (PATH) study from 2018 to 2019, we investigated the proportion of current (past 30-day) e-cigarette users (ages 12-24) who vaped cannabis and their frequency of cannabis vaping.  

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