PainRelief.com Interview with: Dan LyMD MPP Staff Physician, VA Boston Healthcare System Ph.D. Candidate in Health Policy (Economics) Harvard University
PainRelief.com: What is the
background for this study?
Response: New low back pain is a common complaint in primary care clinics. Prior research examining care patterns up to 2010 and sampling individual visits has found increasing use of opioids and advanced imaging and decreasing use of NSAIDs during this time period.
However, because care is delivered longitudinally, this study examined the care delivered to patients for new low back pain over the course of the year, which allowed me to look at the timing and sequence of care.
Ty S. Schepis, PhD
Department of Psychology
Texas State University
San Marcos, TX
Dr. Schepis
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Prescription opioid misuse motives have been studied in adolescents, young adults, and across the population. One study across the population suggested that older adults differed from younger adults, but this was not fully clear.
We wanted to examine motives across age groups and to investigate the correlates of opioid motive groups in older adults (50 and older). We found that motives changed with aging, with increasing endorsement of pain relief motives, particularly pain relief without other motives.
In contrast, more recreational opioid misuse motives (e.g., to experiment, to get high) peaked in adolescents or young adults. Finally, non-pain relief motives in older adults (50 and older) were associated with higher rates of any past year substance use disorder and past year suicidal ideation.
Ari J. IsaacsonMD Director of Clinical Research Clinical Associate Professor, Vascular Interventional Radiology University of North Carolina
PainRelief.com: What is the
background for this study?
Response: The current treatments for pain due to osteoarthritis of the knee that does not respond to medication or physical therapy include knee injections and knee replacement. However, some people are too young or unable to undergo knee replacement. Knee injections are often ineffective and need to repeated every few months. There is a need for a treatment option that can reliably relieve knee pain for a year or longer in patients who are not ready or able to undergo knee replacement.
PainRelief.com Interview with: Debbie Feldman,, Ph.D. Professeure titulaire/Full Professor Faculté de médecine/Faculty of Medicine École de réadaptation/School of Rehabilitation Université de Montréal
Dr. Feldman
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: The goal was to explore clinical management of new cases of musculoskeletal conditions associated with chronic pain, at the population level. Few studies to date have addressed treatment at the population level and none explored initial management specifically. Furthermore, not much is known regarding patient and provider characteristics that are potentially associated with different treatment options (except for some information regarding prescription of opioids). Main findings are in the answer below.
PainRelief.com Interview with: Ty S. Schepis, Ph.D. Associate Professor Department of Psychology Texas State University
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: We were interested in
examining the underlying reasons for prescription opioid misuse both across the
population and in older adults specifically. Given that pain conditions and
physical health limitations increase with aging, we wondered if different age
groups would display different patterns of motives. Indeed, they did. Adults 50
and older were particularly likely to misuse opioid medication only for pain
relief reasons (over 80%); in contrast, roughly 65% of young adults (18-25
years) endorsed only non-pain relief motives for misuse.
For older adults, opioid
misuse involving any non-pain relief motives was associated with a greater rate
of also having another substance use disorder and past-year suicidal thoughts.
PainRelief.com Interview with: Benjamin W. Friedman, MD, MS Department of Emergency Medicine Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, 10467
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Low back pain is a highly prevalent problem that causes more than 2 million visits to American emergency departments annually. Nonsteroidal anti-inflammatory drugs are first line medical management of this ailment, but are only modestly effective. We conducted an RCT to determine if adding acetaminophen to nonsteroidal anti-inflammatory drugs could improve outcomes two days and seven days after an ED visit for low back pain. Unfortunately, acetaminophen did not improve this outcomes.
Sir Richard Doll Professor Senior Academic Advisor to the Dean Charles E. Schmidt College of Medicine Florida Atlantic University
PainRelief.com: What is the
background for this study?
Response: Migraine
headaches are among the most common and potentially debilitating disorders
encountered by primary healthcare providers. In the treatment of acute migraine
as well as prevention of recurrent attacks there are prescription drugs of
proven benefit. For those without health insurance or high co-pays, however,
they may be neither available nor affordable and, for all patients, they may be
either poorly tolerated or contraindicated.
PainRelief.com Interview with: Eric J. Roseen, DC, MSc Assistant Professsor, Department of Family Medicine Boston University School of Medicine and Boston Medical Center
Dr. Roseen
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.
Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
PainRelief.com: What is the
background for this study?
Response:With the development of technologies, there is a growing body of research on social robots aiming to meet the care needs of people with dementia. The use of a robotic seal PARO has been shown to improve mood and acute pain for people with dementia. However, little attention has been paid to the effect of PARO on people with dementia and chronic pain.
PainRelief.com Interview with: Carrie Cuttler, Ph.D. Assistant Professor Washington State University Department of Psychology Pullman, WA, 99164-4820
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Use of cannabis for
headache and migraine is relatively common yet there have been few studies
examining the effectiveness of medical cannabis for these purposes.
PainRelief.com: What should readers take away from your report?
Response: We analyzed data from nearly 20,000 cannabis use sessions tracked using the medical cannabis app Strainprint. The results show that headache and migraine severity ratings were reduced by nearly 50% from before to immediately after cannabis use. The results further revealed that men report larger reductions in headache severity following cannabis use than do women and that use of cannabis concentrates was associated with larger reductions in headache severity ratings than use of more traditional cannabis flower.
We also demonstrate that dose of cannabis used to manage these conditions increases across time and that efficacy of cannabis in reducing headache decreases across time. This indicates that there is some evidence of tolerance to the acute effects of cannabis on ameliorating headache across time. More encouragingly we found that baseline ratings of headache and migraine remained stable across time/cannabis use sessions which indicates that cannabis is not associated with the medication overuse headaches (i.e., increases in baseline headache and migraine severity across time as a function of the use of medications to treat these conditions) that more conventional treatments tend to produce.
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