Does Medical Marijuana Prevents Opioid Overdoses?

PainRelief.com Interview with:

Daniel Kaufman, MS Geisinger Commonwealth School of Medicine
Daniel Kaufman

Daniel Kaufman, MS
Geisinger Commonwealth School of Medicine

Brian J. Piper, PhD, MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18510

Dr. Piper










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

Response: The opioid epidemic has stricken the United States and caused thousands of deaths nationally. Researchers continue to search for a solution to the ongoing escalation in opioid related deaths, with some states turning to medical cannabis as a potential alternative treatment for chronic pain. The objectives of this study were to:

  1. To determine if medical cannabis program implementation had any effect on opioid overdoses at a state-wide level
  2. To contribute to the discussion of researchers searching for a solution to the opioid epidemic facing the United States
  3. Begin the discussion on the standardization of autopsy procedures, including death/overdose determination
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Omega-3 fatty Acid Supplementation May Reduce Muscle Soreness After Exercise-Induced Muscle Damage

MedicalResearch.com Interview with:

Yvoni Kyriakidou, BSc, MSc, RD, ANutr, AFHEA 
Dietitian-Sports Nutritionist
Doctoral Researcher in Exercise Physiology
Translational Physiology Research Group
School of Life Sciences, University of Westminster, England, UK

Yvoni Kyriakidou

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

Response: Exercise-induced muscle damage (EIMD) results in transient muscle inflammation, strength loss, muscle soreness and may cause subsequent exercise avoidance. Omega-3 (primarily found in oily fish) supplementation may minimise EIMD via its anti-inflammatory properties. However, its efficacy remains unclear.

In our study, we gave people omega-3 capsules three times a day for four weeks to build up their levels, or a matching placebo. They then took part in a very intense exercise aimed at causing severe muscle pain and physiologically safe muscle damage. We then measured blood levels of inflammation and muscle damage markers, physical pain and the ability of the participants to do forceful muscle contractions every day for the next three days.

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Opioids Not Only Option for Pain Relief After Cesarean Delivery

PainRelief.com Interview with:
Cristina Wood, MD
Obstetric and Fetal Anesthesiologist
Children’s Hospital Colorado

Dr. Wood

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

Response: ​We all know that opiate abuse is a national crisis, but also is one of the top causes of maternal mortality in the state of Colorado. At the Colorado Fetal Care Center at Children’s Hospital Colorado, we wanted to see what we could do to reduce the need for opiate medications after cesarean delivery. We started by using wound soakers to reduce the opiate requirement and demonstrated an almost 30% reduction in postoperative opiate use. Then, when the Society of Obstetric Anesthesia and Perinatology (SOAP) published guidelines for Early Recovery

After Cesarean (ERAC), we incorporated these into our practice to determine if these interventions would decrease the opiate requirements further. We were so pleased to see that we could further reduce the opiate need for our moms postoperatively. In fact, we reduced it by approximately 80%, with 1/3 of our patients never taking a single narcotic medication after cesarean delivery. 

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Back Pain Relief: Skin Impedance Measurements Can Help Identify Trigger Points

PainRelief.com Interview with:
Giovanni Barassi PhD

Center for Physiotherapy, Rehabilitation and Reeducation
Center of Sports Medicine
“G.d’Annnunzio” University
Chieti, Italy

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

Response: Our research started with the observations made during standard clinical practice concerning the inefficiency of standard physiotherapeutic procedures used for pain relief in chronic nonspecific low back pain, a scourge of modern times, particularly in industrialized countries. Therefore, the need has arisen to search for new approaches in the evaluation and treatment of musculoskeletal problems.

Chronic low back pain is clinically manifest as the pain between rib margins and folds of the inferior gluteus muscle. It usually results from an incorrect lifestyle, typical of modern society having too little physical activity, too much psycho-physical stress, and poor management of body weight. On the background of osteopathic medicine, we developed a concept of the dysfunctional flow of body fluids as a plausible underlier of low back pain, referring by and large to spine bony structures.

It has been shown that alterations in afferent activity coming from visceral, structural, and emotional nociception converge in the same metamers of the spinal cord, resulting in information noise and jam. The final motor output of the reflex arc encompasses somatic, myofascial, and connective tissue responses, with the inevitably added influence of the autonomic nervous system. There also are studies demonstrating the importance of interpreting myofascial dysfunction, not as an isolated local phenomenon but rather as an expression of the central nervous activity. Therefore, a concept has been shaped of somatic and myofascial dysfunction, currently gaining increasing recognition among physicians, osteopaths, and physiotherapists, the professionals dealing with tissue and joint manipulation. The practical crux of the issue is the identification of the “major dysfunction” site, expressing the specific spinal information jam.

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No Decrease in Pain Relief With Less Opioids After Surgery

PainRelief.com Interview with:
Ryan Howard, MD
Academic Development Time Year 1
Resident, General Surgery
University of Michigan

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

Response: Opioids are commonly prescribed to control pain after surgery, but they also carry significant risks such as overdose, long-term dependence, and diversion into the community. While some have advocated for decreasing or eliminating opioids from postoperative pain control regimens, others are concerned that this would lead to uncontrolled pain and dissatisfied patients. To study whether that’s true, we compared two groups of patients undergoing the same surgical procedures. One group received “opioid-sparing” prescriptions after surgery and the other group received “normal-sized” prescriptions.

Conditioned Open-Label Placebos Provide Pain Relief in Some Post-Surgical Patients

PainRelief.com Interview with:
Kristin Schreiber, MD, PhD
Neuroscientist and Clinical Regional Anesthesiologist
Brigham and Women’s Hospital
Assistant Professor of Anesthesia
Harvard Medical School

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

Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.  

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Study Discusses Overlap of Opioid Therapy for Physical and Social Pain Relief

PainRelief.com Interview with:
Mark Sullivan, MD, PhD
Professor, Psychiatry and Behavioral Sciences
Adjunct Professor, Anesthesiology and Pain Medicine, Bioethics and Humanities
Medical Co-Director, UW Telepain

Dr. Sullivan

University of Washington
Seattle, WA 98195

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

Response: This is a review paper than synthesizes neuroscience, pharmacological and epidemiological research on the opioid epidemic. It has been known since at least the 1970s that opioids treat not only pain due to physical damage, but also separation distress.

Functional neuroimaging (fMRI) studies have shown that physical pain (tissue injury) and social pain (social rejection) activate the same limbic brain centers (insula, cingulate cortex). Both chronic pain and depression are associated with dysfunction of the endogenous opioid system in the human brain. Studies of opioid prescribing have shown that patients with chronic pain, who also have anxiety and depressive disorders are more likely to be prescribed long-term opioid therapy at high doses and with concurrent sedatives.

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Challenges in Providing Osteoarthritis Pain Relief

PainRelief.com Interview with:
Rebecca L Robinson
Patient Outcomes and Real-World Evidence
Eli Lilly and Company, Indianapolis, IN

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

Response: Osteoarthritis (OA) pain is unfortunately common and greatly affects patients’ quality of life. Treatment varies from patient to patient and can include nonpharmacologic therapies, over-the-counter (OTC) and prescription pain medications, as well as surgery. The combination of these treatment modalities and especially the use of acetaminophen, NSAIDs or opioids in OA patients has not been examined thoroughly. This study helps to address this gap while also demonstrating variations in treatment received by patients with different levels of pain severity. We analyzed data from the United States OA Adelphi Disease Specific Programme (DSP), which links patient and physician perspectives on the management of OA via cross-sectional surveys.

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Mindfulness-Based Stress Reduction for Chronic Pain in Breast Cancer Patients

PainRelief.com Interview with:
Andra Smith, Ph.D.
Full Professor, School of Psychology
University of Ottawa, Ottawa, ON

Andra Smith, Ph.D. Full Professor, School of Psychology University of Ottawa, Ottawa, ON
Dr. Smith

PainRelief.com:  What is the background for this study?
Response: The process of going through breast cancer treatment is challenging enough on its own and can continue to impact cancer survivors long after treatment ends. One of the common side effects of breast cancer treatment is the development of chronic neuropathic pain (CNP), which for many women is debilitating and difficult to manage. Medications are not always effective and quality of life, cognitive abilities, and overall well-being can be reduced due to this pain. Knowing personally and from previous research how effective mindfulness can be for well-being, it made sense to introduce a mindfulness-based stress reduction program (MBSR) to these women going through chronic neuropathic pain due to breast cancer treatment. Mindfulness has occasionally been dismissed as a ‘fad’ so it was important to investigate the impact of an MBSR program with objective measures that could provide empirical evidence of its effects within this population. Dr. Poulin had the clinical resources and participants for the study while Dr. Smith had the imaging expertise. Together we performed a brain imaging (MRI/fMRI) study with women more than a year following treatment for breast cancer, suffering from chronic neuropathic pain. We scanned them all before and after either an MBSR program or usual care, assessing brain health, resting-state brain activity, and neurophysiological responses to emotional/pain-related words (Emotional Stroop task).    

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Withdrawal Symptoms Common in People Using Cannabis for Pain Relief

PainRelief.com Interview with:
Lara Coughlin, Ph.D.
Assistant Professor | Addiction Center
Department of Psychiatry
University of Michigan

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

Response: In this study we followed people that were seeking certification for medical cannabis use for chronic pain over the course of two years. We assessed the prevalence and progression of cannabis withdrawal.

We found that most people experienced multiple withdrawal symptoms, such as craving cannabis, anxiety, and irritability, when they went without cannabis. People that used cannabis more frequently, used larger amounts, and reported smoking cannabis had more withdrawal symptoms. Over time, people that were younger were more likely to experience increasing withdrawal symptoms and people that vaped cannabis tended not to experience improvement in their withdrawal symptoms.  

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