Tag Archives: pain relief

Why is Exercise Prescribed for Low Back Pain Relief?

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PainRelief.com Interview with:
Matthew Jones PhD, AEP
Lecturer
Department of Exercise Physiology, Faculty of Medicine
UNSW SYDNEY

Dr. Jones


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

Response: Bck pain is the leading cause of disability worldwide and is associated with significant individual and societal costs. Low back pain can significantly impact an individual’s ability to carry out day to day tasks. Clinical guidelines consistently recommend that people with low back pain take exercise, and there does not appear to be a type of exercise (e.g., walking, Pilates, lifting weights) that is better than another for reducing pain and improving function. Despite hundreds of studies of exercise in people with low back pain, researchers do not have a good idea of how it works. This is important, because if we know how something works, we can design more effective interventions to reduce the burden of low back pain. The aim of this review was to summarise why researchers think exercise helps people with chronic low back pain (i.e., pain persisting for longer than 3 months).

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Understanding Back Pain During Neuroendovascular Procedures

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PainRelief.com Interview with:

Adnan Qureshi, MD
Zeenat Qureshi Stroke Institute
Department of Neurology
University of Missouri
Columbia, MO

Dr. Qureshi

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

Response: Optimizing of patient experience is a very important goal for any procedure. Neuro Endovascular procedures are unique because most of them are performed awake to perform repeated neurological examinations during the procedure. The angiographic tables have to be made of unique stiff material to ensure X rays can pass through and any movement during procedure can distort images. We believe understanding the factors that can be improved upon given the unique settings remains an important goal of the specialty. 

Our research broadens our understanding of complications of the procedures. Previous studies have look at the risk of stroke or bleeding but not complications like back pain which are far more common.

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Motion Control Shoes May Reduce Painful Injuries in Some Pronation-Prone Runners

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PainRelief.com Interview with:
Laurent Malisoux, PhD
Group Leader, Public Health Research
Department of Population Health
Luxembourg Institute of Health

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

Response: Pronation refers to the way the foot rolls inward during the gait cycle. Foot pronation during running is normal, but over-pronation (increased amount or poor timing) has previously been related to the risk of running-related injury. Indeed, alterations in the movements at the foot-ankle complex results in abnormal repetitive load, and may subsequently lead to an injury at the foot-ankle complex or more proximally in the kinetic chain. A previous trial demonstrated that motion control shoes reduced the risk of injury in recreational runners.1

Importantly, in the previous trial, the effect of motion control shoe was investigated on all injury types concurrently. However, risk factors as well as mechanisms underlying the development of injury might differ across injury types. Thus, motion control shoes may only be effective in preventing some injury types, and the effect might be partially masked if it is assessed on different injury types concurrently.

The present study is a secondary analysis of the abovementioned trial. Based on previous literature, we assumed that some injury types, namely Achilles tendinopathy, plantar fasciopathy, exercise-related lower leg pain and anterior knee pain, were related to over-pronation and were defined as pronation-related running injuries, while other running-related injuries are not. We hypothesised that motion control shoes aiming at reducing excessive pronation would reduce the risk of pronation-related running injuries in recreational runners compared to shoes with no motion control technology.

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Recorded Music plus Text During Anesthesia Reduced Need for Pain Medication

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PainRelief.com Interview with:
Prof. Dr. Ernil Hansen
Department of Anesthesiology
University Hospital Regensburg
Regensburg, Germany

Prof. Dr. Hansen

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

Response: It is becoming more and more clear that besides drugs and surgery it is communication that makes therapy effective. A meta-analysis we had conducted recently, suggested some beneficial effects of taped words played during surgery in older studies.

Our current study on 385 patients showed evidence that a text based on hypnotherapeutic principles an reduce postoperative pain and use of opioids. Pain within the first 24h after surgery decreased by 25%, opioid requirement by 34%. Six patients needed to be treated to save one patient from opioid exposure at all. High demand for analgesics was reduced by 41%. 

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5-Year Follow-Up of Open-Label Placebo Trial for Chronic Low Back Pain Relief

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PainRelief.com Interview with:
Claudia Carvalho, PhD
Instituto Universitário de Ciências Psicológicas
Social e da Vida
Lisbon, Portugal

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

Response:  Some clinical trials on chronic pain have shown placebo responses that rival those of commonly prescribed first-line therapies for low back pain (LBP).  However, prescribing placebos would pose ethical problems in clinical practice.  One solution to this problem is the use of open label placebos (OLP), which are presented to patients openly as pills without active ingredients, along with a rationale indicating that because of classical conditioning of relief with active medications, the pills themselves might reduce pain. OLP has been shown effective compared to treatment-as-usual for a number of clinical conditions, including chronic LBP.  Having conducted the first clinical trial on OLP on back pain, my colleagues and I wondered whether the effects were long-lasting. To answer that question, we conducted a five-year follow-up on the patients who had received OLP for their back pain.

In our original study, patients who took OLP pills for three weeks experienced greater reduction in back pain intensity and in back pain related disability than patients that simply continued their usual treatment. Additionally, after this phase of the trial, we offered OLP to participants  in the treatment as usual group) and they also reported a significant reductions in pain and disability, together with a spontaneous decrease in the use of pain medication by participants.

In our current follow-up, we found that patients who had taken OLP for three weeks had maintained their reductions in pain and disability 5 years later. In addition, pain medication usage was reduced by 49%. This follow-up study is currently in press (https://journals.lww.com/pain/Fulltext/9000/Open_label_placebo_for_chronic_low_back_pain__a.98186.aspx)

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Guided Radiofrequency Ablation Can Provide Pain Relief for Patients with Moderate to Severe Osteoarthritis of the Shoulder and Hip

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PainRelief.com Interview with:
Felix M. Gonzalez, M.D.
Radiology Department at Emory University School of Medicine
Atlanta, Georgia

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

Response: Arthritis afflicts 30 million Americans yearly with the most common form being degenerative arthritis. The main joints affected are the knee, hip and shoulder joints.  

Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention. The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion. People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks: Prolonged use is linked to increased risks of heart disease and kidney damage. Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time and there are long-term safety issues, including a risk of cartilage damage.  

Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections — two standard treatments — were no longer helping.  

Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.  

In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%. 

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Pain Suppresses the Activity Of the Brain Reward System

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Stéphane Potvin, PhD
Centre de recherche
Institut Universitaire en Santé Mentale de Montréal
Full professor; Department of psychiatry and addiction
University of Montreal

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

Dr. Potvin: Let’s begin by using a concrete example. First, imagine that you are taking a walk and it is really cold outside; so cold, in fact, that you can no longer enjoy the experience. Upon returning home, you realize that you no longer feel the pain, and you now have a smile on your face. During this sequence of events, what happened in your brain? To figure it out, we performed a functional neuroimaging study during which a painful cold gel was applied on the right foot of a group of healthy volunteers. What we discovered is that during pain stimulation, there was a clear de-activation of the medial orbito-frontal cortex, which is one of the main “pleasure” centers in the brain. Intriguingly, we observed that after the cold pain stimulation was discontinued, participants experienced significant levels of pleasant emotions that lasted for approximately 4 minutes.

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Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

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PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

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

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

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Stronger Pain Relief When Patient and Provider Demonstrate Facial Mirroring

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PainRelief.com Interview with:
Dan-Mikael Ellingsen PhD
Department of Psychology, University of Oslo
Norwegian Centre for Mental Disorders Research (NORMENT),
Division of Mental Health and Addiction
Oslo University Hospital, Oslo, Norway.

Dr. Ellingsen

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

Response: We know that the patient-clinician relationship can have an important impact on clinical outcomes, but we know relatively little about how this works. A better understanding of the behavioral, physiological, and brain mechanisms behind the patient-clinician interaction may help demystifying the therapeutic relationship and how it influences treatment outcomes.

In order to investigate the behavioral and brain mechanisms involved when patients and clinicians interact, we simultaneously recorded brain activity (using functional MRI) in clinicians and patients with chronic pain, while they underwent a pain treatment session. We also recorded and analyzed non-verbal communication – facial expressions – during the interaction. We found that when the patient and clinician had first established a level of rapport – or therapeutic alliance – through a clinical intake and consultation, they showed stronger concordance in brain activity in brain areas involved in empathy and “theory of mind” (the process of trying to understand other people’s mental states) when they engaged during treatment. We also found that in interactions where the patient and clinician showed more mirroring in facial expressions, the patient also reported higher therapeutic alliance and stronger pain relief from the treatment.

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High Dose Pain Reliever Paracetamol -Acetaminophen Linked to Increase in Overdoses

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PainRelief.com Interview with:
Andrea Burden, Ph.D.
Assistant Professor of Pharmacoepidemiology
Institute of Pharmaceutical Sciences
Zurich Switzerland

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

Response: Paracetamol (also known as acetaminophen) is one of the most commonly used medications in the world. While the drug is generally safe, daily intake exceeding 4,000 milligrams (4 grams) can lead to irreversible liver injury and even death. Traditionally in Europe, paracetamol is available in two dose formulations, the 500 and 1,000 milligram tablets. The lower dose formulation is often available over-the-counter (without a prescription), while the high-dose formulation requires a medical prescription. In the last decade, there has been accumulating evidence that both the availability of high-doses of paracetamol, and the quantity of paracetamol available to patients, are associated with the risk of overdose. Therefore, in this study, we aimed to identify if there was an increase in the number of calls to the National Poison Information Centre in Switzerland for paracetamol-related overdoses after the high-dose 1,000 milligram (1 gram) paracetamol tablets became available in October of 2003. We also examined if there were differences in the circumstances of the overdose and severity between the 500 milligram or 1,000 milligram tablets.

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