Pain Relief from NSAIDS and COVID-19 Outcomes

PainRelief.com Interview with:
Anton Pottegård DMSc PhD

Professor (MScPharm, PhD, DMSc)
Clinical Pharmacology and Pharmacy, Department of Public Health
University of Southern Denmark
Head of Research, Hospital Pharmacy Funen
Odense University Hospital

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

Response: Early in the COVID-19 pandemic, concerns were raised that use of the common painkiller ibuprofen – a so-called NSAID – to treat symptoms of COVID-19 might lead to more severe disease. This started with tweets from the French health minister and culminated with a warning issued by the WHO. This warning was later retracted, but naturally patients and physicians were concerned regarding the safety of ibuprofen. We therefore established a nationwide Danish collaboration between researchers and regulators and established a prospective cohort of all Danish patients that contracted COVID-19, including data on what prescription medicines they used. We used these data to evaluate whether users of ibuprofen or other NSAIDs on average had a more severe course of COVID-19 than those not using these drugs.

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Newly Discovered Molecule Causes Pain Relief and Cartilage Healing in Osteoarthritis

PainRelief.com Interview with:
Prof Francesco Dell’Accio and
Dr Suzanne E Eldridge
Department of Experimental Medicine and Rheumatology
William Harvey Research Institute
Barts and The London, Queen Mary’s School of Medicine and Dentistry,
London

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

Response: Our main research focus is osteoarthritis. Osteoarthritis is the most common form of arthritis, affecting 10-30% of the population over the age of 60, causing joint pain and disability for many. In osteoarthritis, the cartilage that covers the bones in the joints is destroyed. Therefore, the bones grind over each other, causing pain and disability. Joint replacement surgery is often carried out.  

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Study Finds Tumeric Had Moderate Pain Relief Effect on Knee Osteoarthritis

PainRelief.com Interview with:
Dr Benny Antony MD,PhD Senior Research Fellow

National Health and Medical Research Council of Australia Fellow 
Menzies Institute for Medical Research
Unit Coordinator, Lecturer & Examiner, College of Health & Medicine
University of Tasmania
Associate Editor, International Journal of Rheumatic Diseases https://onlinelibrary.wiley.com/journal/1756185x 

UTAS- Menzies Institute for Medical Research Benny Antony –  18/07/2017 Hobart Tasmania  photography  - Peter Mathew
Dr. Antony

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

Response: Osteoarthritis is the most common joint disorder in adults around the world, with more than 300 million people suffering from the disease. Considering the increasing prevalence of the disease and lack of effective treatment strategies, there is an urgent need for effective and safe treatment. Curcuma longa, commonly known as Turmeric, is a popular anti-inflammatory medication. Previous studies in osteoarthritis have shown that various formulations of turmeric extracts are effective and safe for the treatment of osteoarthritis.

We decided to select an inflammatory-phenotype of knee osteoarthritis patients who might benefit from a safe, natural anti-inflammatory therapy and randomised them to placebo and treatment groups.

Over, 12 weeks we found that the Turmeric extract group had a greater reduction in knee pain compared to the placebo group. We also looked at the effect of the treatment on knee structural abnormalities, but we did not find any significant difference between the treatment and placebo groups.

Study Compares Dry Needling Techniques for Relief from Heel Pain

PainRelief.com Interview with:
Dr. Pablo Herrero Gallego. PT, PhD.
Head of iPhysio Research Group.
Editor-in-Chief Journal of Invasive Techniques in Physical Therapy
Zaragoza, Spain

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

Response: The background of this study is that there has been an increasing use of minimally invasive techniques in physiotherapy in the last years, that apparently leading to very good results in the clinical practice, but there are no studies comparing the effectiveness of different treatment modalities. In the case of this study, about plantar heel pain (PHP), many physiotherapists use dry needling (DN) or percutaneous needle electrolysis (PNE) to treat myofascial trigger points when conservative treatment fails. However, although some clinicians claim that PNE has a superior effect to DN because it adds a galvanic current to the mechanical stimuli with the needle, there is no evidence to support this. Because of it, we decided to conduct this first study comparing these two treatment options for PHP.

Contact Athletes Cope With Pain Better

PainRelief.com Interview with:
Claire Thornton, PhD
Northumbria University
Newcastle upon Tyne, UK

Dr. Thornton

PainRelief.com:  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)  

Total Hip Replacement Can Be Safely Performed with Minimal Opioids for Pain Relief

MedicalResearch.com Interview with:
Andrew Wickline MD FAAOS
New Hartford, NY 13413

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

Response: Joint replacement has long been synonymous with pain relief–but not until 6-12 weeks after surgery.  Many patients put off joint replacement due to fear and anxiety–particularly about the possible pain after surgery often seen in the first several months.  Opioids have long been the mainstay of controlling pain after surgery but are associated with significant side effects and risk for addiction and injury. 

Our study shows that with our comprehensive protocol, 97% of patients can have successful surgical recovery with little to no opioids being necessary to stay comfortable.  Additionally, it shows that 94% of patients can go home within 24 hours and 95% will likely need no post-operative therapy to recover.

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What is the Biological Basis of Acupuncture for Systemic Inflammation Modulation?

PainRelief.com Interview with:
QIUFU MA, PhD
Professor, Neurobiology, Cancer Biology
Harvard Medical School
Dana-Farber Cancer Institute

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

Response: This study aimed to understand the biological basis behind acupuncture practice. Modern randomized clinical trials have demonstrated the efficacy of acupuncture practice in treating certain human diseases, such as gastrointestinal disorders and chronic pain, but the underlying biological basis still poorly understood.

Our hypothesis is that acupuncture can drive the somatosensory autonomic pathways to modulate body physiology. A key innovation of this study is the development of new genetic tools to manipulate different autonomic nervous pathways, and we then used the severe systemic inflammation (cytokine storms) induced by bacterial endotoxins as the experimental model.

We found that electroacupuncture stimulation (ES) can drive distinct autonomic pathways in acupoint- and stimulation-intensity-dependent manners. Low intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on adrenal chromaffin cells. High intensity ES at the abdomen activates splenic noradrenergic neurons via the spinal-sympathetic axis, and this activation produces either anti- or pro-inflammatory effects, dependent on adrenergic receptor profiles under different diseases states

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Business Model Can Help With Pain Relief Decisions After Surgery

Dr. Schug

PainRelief.com 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

PainRelief.com:  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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ACP Recommends Non-Pharmacologic Treatments for Pain Relief From Acute Non–Low Back, Musculoskeletal Injuries

PainRelief.com Interview with:
Timothy Wilt, MD, MPH
Chair ACP Clinical Guidelines Committee
Professor of Medicine
Minneapolis VA Center for Care Delivery and Outcomes Research.

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

Response: Acute non-low back musculoskeletal pain is common, disabling and costly. Most are treated in outpatient settings. Numerous pharmacologic and nonpharmacologic treatment options exist but there is uncertainty of their benefits, harms and costs. Additionally, opioid prescriptions are common for acute musculoskeletal injuries but have harms and can lead to chronic opioid use including dependence and overdose. ACP and AAFP developed these evidence based guidelines to assist clinicians in providing the highest quality care to their patients by considering information on benefits, harms and costs alongside patient values and preferences. Our main recommendations are as follows:

1)      ACP and AAFP recommend that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain; improve physical function; and improve the patient’s treatment satisfaction.

2)      ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, and to improve physical function, or with oral acetaminophen to reduce pain.

3)      ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain.

4)      ACP and AAFP suggest against clinicians treating patients with acute pain from non–low back, musculoskeletal injuries with opioids, including tramadol.

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