Routine Lumbar X-Rays of Limited Value in Assessing Low Back Pain

PainRelief.com Interview with:
Lingxiao Chen
 | MBBS, MMed, PhD Candidate
The University of Sydney
Institute of Bone and Joint Research | The Kolling Institute
Sydney Medical School | Faculty of Medicine and Health
Statistical Editor of BMJ Open Sport & Exercise Medicine

back pain

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

Response: Current guidelines for treatment of low back pain (LBP) do not recommend routinely using diagnostic imaging, except when patients either present with severe, progressive neurologic deficits or with signs or symptoms indicative of a serious or specific underlying condition (eg, fracture or cancer). Nonetheless, diagnostic imaging is still widely used in clinical practice for low back pain. Previous studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain–related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine.

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Redheads May Experience Pain Differently

PainRelief.com Interview with:
David E. Fisher MD, PhD
Edward Wigglesworth Professor & Chairman
Dept of Dermatology
Director, Melanoma Program MGH Cancer Center
Director, Cutaneous Biology Research Center
Massachusetts General Hospital
Harvard Medical School

Dr. Fisher

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

Response: This study followed up on prior published work from other investigators which demonstrated altered pain thresholds in humans and mice who had the redhair light-skin phenotypes.  The key focus of our current study was to firstly validate the overall findings, and then to  the mechanistic basis for the differences.  Of note, our laboratory does not primarily focus on the science of pain or nociceptive, but rather on skin and melanoma. For this reason we had accumulated a number of valuable genetic models of pigmentation (such as redhaired mice harboring alterations in the identical gene implicated in human red hair).  These mouse models served as the key resources for carrying out the current study.

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Migraine: Galcanezumab (Emgality®) for Pain Relief in Patients with Previous Preventive Medication Failures

PainRelief.com Interview with:
Dulanji K. Kuruppu, MD

Medical Advisor, Migraine & Headache Disorders
US Medical Affairs
Eli Lilly and Company
LTC-South, Indianapolis IN 46221 U.S.A.

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

Response: Galcanezumab is a monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) and is approved for the preventive treatment of migraine and for the treatment of episodic cluster headache in adults. The CONQUER study assessed the efficacy and safety of galcanezumab in 462 adults with episodic or chronic migraine who previously did not benefit from 2 to 4 standard-of-care migraine preventive medication categories. This study consisted of a 3-month double-blind, placebo-controlled period (months 1-3) followed by an open-label period (months 4-6). The primary endpoint, which was the mean change from baseline in the number of monthly migraine headache days for galcanezumab vs placebo over months 1-3, was met. In this post-hoc analysis, we assessed onset of effect of galcanezumab in the CONQUER population.

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Radiofrequency Ablation Provides Faster Pain Relief for Patients with Bone Metastases

PainRelief.com Interview with:
Jason R. Levy, MD, FSIR
Vascular and Interventional Radiologist
Northside Hospital in Atlanta, Georgia

Dr. Levy

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

Response: For patients whose cancer has spread to their bones, their pain is often treated using radiation, which can take weeks to provide relief. In our study we examined the effectiveness of Radiofrequency Ablation (RFA) for the palliative treatment of patients with painful osseous metastases.

Radiofrequency Ablation is a minimally invasive treatment that uses radiofrequency waves to create heat that kills tumor cells and destroys nerve fibers to reduce transmission of pain signals to the brain. The procedure was followed up with cement injections to help stabilize the bone and prevent fractures that often occur following other treatments.

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Aimovig® plus OnabotulinumtoxinA (onabot) For Migraine Pain Relief

PainRelief.com Interview with:
Fred Cohen, MD
Department of Medicine, 
Montefiore Medical Center and the Albert Einstein College of Medicine
Bronx, New York

Dr. Fred Cohen

PainRelief.com:  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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Lower Ketamine Dose Can Provide Pain Relief for Acute Pain in ER

PainRelief.com Interview with:
Shannon Lovett, MD, FACEP
Associate Professor
Associate Medical Director, ED Clinical Operations
Department of Emergency Medicine
Stritch School of Medicine

Dr. Lovett

PainRelief.com:  What is the background for this study?  What types of pain were treated?

Response: The opioid crisis has led emergency medicine providers to utilize other medications to treat pain, including ketamine. Prior to our study, there was a range of recommended ketamine doses in the treatment of pain, and the most frequently studied dose demonstrating analgesic efficacy was 0.3 mg/kg. We challenged that dose by comparing a lower dose, 0.15 mg/kg, to 0.3 mg/kg of IV ketamine for acute moderate to severe pain in the emergency department. We treated acute (onset < 7 days) abdominal, back, flank, musculoskeletal, and headache pain. 

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Topical NSAIDS for Knee Osteoarthritis Pain Relief

PainRelief.com Interview with:
Dylan Wolff
M.D. Candidate

Dylan Wolff
M.D. Candidate
Dr. Mary Mulcahey

Mary K. Mulcahey, MD, FAAOS, FAOA
Director, Women’s Sports Medicine Program
Associate Professor
Assistant Program Director
Department of Orthopaedic Surgery
Tulane University School of Medicine
New Orleans, LA


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

Response: Osteoarthritis Research Society (OARSI) guidelines include topical non-steroidal anti-inflammatory drugs (NSAIDs) as a level 1A recommendation for non-operative management of knee osteoarthritis, but previous reviews have demonstrated that clinical adoption of this treatment option lags. We conducted a systematic review and meta-analysis of 18 studies evaluating diclofenac, ketoprofen, and ibuprofen in topical preparations. We found that they are safe and effective for reducing pain and improving physical function in patients with knee osteoarthritis. Diclofenac had the strongest quality and number of studies and showed a moderate effect size for symptomatic improvement. With regards to safety, adverse events were low in the topical treatment groups, and topical preparations containing dimethyl sulfoxide (DMSO) showed a higher odds ratio for adverse events than preparations without DMSO. 

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Chronic Pain Sufferers Face Different Pain Triggers During Pandemic

MedicalResearch.com Interview with:
Rubén Nieto
eHealth Lab Research Group,
Faculty of Health Sciences
Universitat Oberta de Catalunya
Barcelona, Spain

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

Response: The COVID-19 pandemic is one of the most serious global challenges to have faced healthcare and society in the last century, taking a drastic toll on the world’s population. It has caused deaths, worsened people’s quality of life and upended the economy, among other consequences. Despite this, there is little research on how people are coping with the pandemic. In our opinion, it is of particular interest to study people with chronic pain, since COVID-19 and the circumstances surrounding it can have a greater impact on them.

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Fibromyalgia: Evaluation of Pain Relief Therapies

PainRelief.com Interview with:
VINÍCIUS CUNHA OLIVEIRA, PhD 
Departamento de Fisioterapia – UFVJM 
Brasil

Dr. Oliveira

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

Response: Fibromyalgia is a chronic health condition of unknown etiology characterized by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety. It causes disability, lowers quality of life and is responsible for with high direct and indirect costs. Many therapeutic options are available and delivered to these patients and it is important to patients and clinicians to understand the average effects sizes of these interventions in order to make their choices.

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NSAID Ibuprofen Arginate Provides More Rapid Pain Relief Than Standard Ibuprofen

PainRelief.com Interview with:
Dr. Perez Cajaraville MD EDPM
Clinical Director Pain Unit
HM Hospitales
Madrid. Spain

Dr. Cajaraville

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

Response: The addition of L-arginine to the molecule of ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), in the salt form of ibuprofen arginate has the rationale to enhance the absorption rate of the active S-(+) enantiomer of ibuprofen to achieve a rapid onset analgesic action. Despite availability of ibuprofen arginate in the market for many years, a comprehensive review of the evidence of the analgesic efficacy, tolerability and safety in different pain models has not been previously reported.

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