Tag Archives: pain

Green Light Exposure May Provide Pain Relief and Reduce Need for Opioids

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PainRelief.com Interview with:

Padma Gulur MD
Professor of Anesthesiology and Population Health
Executive Vice Chair, Duke Anesthesiology 
Director, Pain Management Strategy and Opioid Surveillance
Duke University Health System

Padma Gulur MD Professor of Anesthesiology and Population Health Executive Vice Chair, Duke Anesthesiology Director, Pain Management Strategy and Opioid Surveillance Duke University Health System

PainRelief.com:  What is the background for this study?  How is the light administered? Might your findings help explain why green is widely considered a ‘calming’ color?

Response: Pain management continues to be challenging given the limited options for pain relief and the significant continued reliance on opioid medications as a primary mode of pain relief which has lead to the prescription opioid epidemic facing the country. Opioid exposure during clinical care is a key risk factor for subsequent misuse, and the probability of prolonged use scales with both dose and duration of opioid exposure. Minimizing opioid exposures reduces misuse risk. To do so while still effectively treating pain relies on opioid sparing multimodal pain relief strategies. In practice, this manifests as polypharmacy or the use of multiple medication classes. However most medications come with a significant side effect burden. Non-pharmacological options remain limited in efficacy or are difficult to integrate into clinical care. Recent pre-clinical findings have demonstrated robust pain relief in response to exposure to green light. These effects occurred both through the addition of green illuminating light in the environment and through green-biased filtration of visualized ambient light. 

We are conducting a pilot trial of exposure to green light for pain relief in paients that have recently undergone surgery to understand its effect on acute pain and to study its effect on chronic pain we are conducting the study in fibromyalgia patients. Our goal is to evaluate the feasibility and efficacy of eyeglasses-based colored light therapy. Recruitment for the acute arm of the study is complete. The chronic arm of the study is currently recruiting.

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Selenium Level Can Affect Liver Toxicity When Acetaminophen is Used for Pain Relief

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PainRelief.com Interview with:

Dr Charareh Pourzand PhD/DSc, FHEA, FRSB
Reader in Biopharmaceutics
Medicines Design Theme Leader
Head of UVA Photobiology, Iron & Oxidative stress group
Department of Pharmacy & Pharmacology
Centre for Therapeutic Innovation
University of Bath, Bath, United Kingdom



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

Response: It is recognized that acetaminophen (also known as paracetamol), a medication that is globally used for fever and pain, can cause acute liver damage when taken at higher level than the recommended dose.

This study demonstrated that acetaminophen can decrease the mouse liver’s antioxidant capacity by decreasing both the level of thioredoxin reductase (a selenoprotein and antioxidant enzyme) activity and glutathione (GSH, an antioxidant molecule) content in a dose- and time-dependent manner. These decreases also correlated with the extent of the liver damage exerted by acetaminophen. In addition, both mild-deprivations in selenium or excess selenium supplementation diets increased the extent of liver injury compared with mice with normal dietary selenium levels.  

In acetaminophen-treated mice, animals reared on selenium-deficient and excess selenium-supplemented diets also exhibited an increase in the oxidation state of the thioredoxin reductase-mediated system in subcellular compartments of the hepatocytes, notably in mitochondria which is the energy factory of the organism.

These observations revealed how the alteration of the function of the main antioxidant thioredoxin and GSH systems by acetaminophen is linked to hepatotoxicity.  Moreover it became apparent that the maintenance of the redox environment by thiols is a crucial determinant for the extent of acetaminophen-induced liver toxicity. Finally our study revealed the importance of dietary selenium level and the selenoproteins activity in protecting mice against the liver failure that can occur in acetaminophen overdose.

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Can Placebos Be Effective Even If We Know It’s Not a ‘Real’ Drug?

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pain relief placebos

Darwin A. Guevarra, Ph.D.
Postdoctoral Fellow
Michigan State University

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

Response: Placebos are these inactive treatments that often work because people believe they are taking a real treatment. For the most part, they have real beneficial effects. However, there’s a utility-ethical issue when it comes to placebos. On one hand, they reliably work in managing daily nonclinical nuisance like emotional distress and even a host of clinical ailments like pain and depression. But, it seems like you have to lie to people that they’re taking a real treatment in order to get placebos to work. As it turns out though, there’s over a dozen studies showing that placebos can still work even when people are fully aware they are taking them. These studies educate participants about the placebo effects, how they work, and how they can probably still work even when people know they are taking one. This really opens up the possibility of ethically harnessing the beneficial effects of placebos. But there’s one glaring issue. These studies that found positive effects of non-deceptive placebos only show it with self-report and no studies show beneficial effects on biological measures. This casts some doubt on whether these self-reported beneficial effects are real.

Our study wanted to test if we can observe non-deceptive placebo effects on objective biological markers. In this case, we used a neural measure called the late positive potential that can track emotional distress. We find that non-deceptive placebos do reduce self-reported, but more importantly, neural measures of emotional distress.

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Deprescribing Opioids Used For Chronic Non-Cancer Pain Relief

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PainRelief.com Interview with:
Dr Stephanie Mathieson PhD
NHMRC Health Professional Research Early Career Fellow
The University of SydneyFaculty of Medicine and Health, Sydney School of Public Health
Australia

Dr Stephanie Mathieson is a Research Fellow at the Institute for Musculoskeletal Health, The University of Sydney. Her National Health and Medical Research Council (NHMRC) Health Professional Research Early Career Fellow is focused around reducing the opioid epidemic in Australia.

Dr. MATHIESON

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

Response: This study aimed to review the current evidence of the efficacy of interventions designed to reduce/cease the prescription of, or the use of, opioid analgesics in patients with chronic non-cancer pain.

As clinical practice guidelines now discourage the initial prescription of opioid analgesics for chronic non-cancer pain, clinicians need to know which opioid dose reduction methods are most effective and safe for deprescribing opioid analgesics in their patients.

PainRelief.com:?  What are the main findings?

Response: Our systematic review extended the previous body of literature by incorporating five new randomised trials; however, clinical and statistical heterogeneity prevented meta-analysis. There were ten patient-focused interventions (i.e. aimed at reducing a patient’s opioid dose), and two clinician focused interventions (i.e. aimed at changing the clinician’s behaviour). Overall, our review was unable to recommend any one opioid analgesic deprescribing strategy in patients with chronic pain due to the small number of trials and heterogeneity.

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Neck Pain Relief Utilizing Progressive Resistance Exercise

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PainRelief.com Interview with:
ROSS ILES  PhD, Dip WDP, BPhysio(Hons)
Insurance Work and Health Group
Senior Research Fellow Department of Physiotherapy
Adjunct Senior Lecturer,Health Services Division
School of Public Health and Preventive Medicine
Monash University Melbourne, VIC Australia

ROSS ILES PhD, Dip WDP, BPhysio(Hons) Insurance Work and Health Group Senior Research Fellow Department of Physiotherapy Adjunct Senior Lecturer Health Services Division School of Public Health and Preventive Medicine Monash University Melbourne, VIC Australia
Dr. ILES

PainRelief.com:  What is the background for this study

Response: Chronic neck pain is estimated to have a worldwide mean lifetime prevalence of 48.5%, and the pain and disability associated with this condition accounts for 2.5% of the total years lost to disability in Australia. Chronic neck pain is known to be associated with neck muscle weakness in all planes of movement of up to 66% when compared to participants presenting with no history of neck pain. Therefore, neck strengthening exercises are commonly utilised in the treatment of chronic neck pain, with many different programs being described within the literature. Studies investigating the effect of strengthening exercises on chronic neck pain have found a short to intermediate term improvement in pain by a moderate to large amount. However, many strengthening programs do not target the multi-directional weakness which has been shown to be prevalent in this population group.

Through a case series of patients with chronic neck pain we aimed to determine whether a neck-specific progressive resistance program targeting all planes of cervical movement led to a change in pain and disability, and to investigate the relationship between neck strength, pain, and disability.

Data analysis was performed on patients after completing nine sessions of a neck-specific progressive resistance exercise intervention utilising the Melbourne Protocol and the Multi-Cervical Unit (MCU) technology under supervision of the treating physiotherapist. Participants completed isotonic exercises against the MCU provided resistance in the planes of cervical flexion, extension, and lateral flexion, all at neutral cervical rotation and 25 degrees left and right. Neck pain and disability were assessed with the Numerical Rating Scale (NRS) and Neck Disability Index (NDI) respectively, with neck strength measured and recorded through the MCU.

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Study Finds Patients Feel Empowered By Interventions for Pain Relief

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PainRelief.com Interview with:

Johan Hambraeus, MD
Board certified in anesthesiology, family medicine & Pain management
Department of Epidemiology and Global Health
Umeå University, Sweden

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

Response: When working with interventional pain management a striking feature is that all procedures are painful. It is often discussed about sedation before procedures, but whether to provide sedation seems to be more based on the local tradition than on facts. And it is not seldom that patients describe that they have phobic fear of needles, but despite this they cope with the interventional pain management and all the painful procedures.

Therefore we wanted to understand how it is felt and how the patients describe their experiences.

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Study Evaluates Effects of Inhaled Cannabis for Pain Relief in Adults With Sickle Cell Disease

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PainRelief.com Interview with:

Donald I. Abrams, MD
Division of Hematology-Oncology
Department of Medicine,
Zuckerberg San Francisco General Hospital
University of California, San Francisco

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

Response: A number of years ago, Kalpna Gupta, PhD, an investigator then at the University of Minnesota, came and told me about her mice with Hemoglobin SS who experienced pain that responded to laboratory cannabinoids. She was going to apply for a grant from the National Heart, Lung and Blood Institute to continue her studies and sought us out because of our prior clinical trials with cannabis and pain. Dr. Gupta wanted to include a pilot proof of principle human study in her application and asked if we could design one. As cannabidiol (CBD) was just becoming known at that time, we suggested to do a study in patients with sickle cell disease and pain looking at a delta-9-tetrahydrocannabinol (THC)-dominant strain of inhaled cannabis, a CBD-dominant strain, a balanced 1:1 strain and placebo. She said that we would only have funds to do a two-arm study, one of which needed to be placebo. As we had already shown that there was a trend for vaporized cannabis that was predominantly THC to add to the analgesic effect of sustained-release opioids in patients with chronic pain, we chose to investigate a 4.4% THC:4.9% CBD product obtained from the National Institute on Drug Abuse.

We designed a crossover trial so that each participant would spend two 5-day inpatient stays separated by at least a month in our Clinical Research Center at Zuckerberg San Francisco General Hospital. During one stay they would add vaporized cannabis to their stable ongoing analgesic regimen and during the other stay they would inhale placebo cannabis three times a day. We use the Volcano vaporizer device that heats the plant material and not an oil as has become popular in the recent “vaping” craze. Our target was to enroll 35 patients with sickle cell disease and chronic ongoing pain on an opioid-containing regimen. Our primary endpoint was change in pain as measured by way of a visual analog scale and the Brief Pain Inventory as well as safety.

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Which Back Pain Patients Get Pain Relief from Yoga?

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PainRelief.com Interview with:
Eric J. Roseen, DC, MSc
Department of Family Medicine
Boston University School of Medicine
Department of Rehabilitation Science
Massachusetts General Hospital Institute of Health Professions
Boston, MA 02215

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

Response: The Back to Health Study is a noninferiority randomized controlled trial of yoga, physical therapy, and back pain education for chronic low back pain. Participants were recruited from a SafetyNet hospital (Boston Medical Center) and seven affiliated federally-qualified community health centers. Participants reflected the population served by this health system, they were predominately low-income and non-white.

The yoga intervention consisted of 12 group-based, weekly, 75-minute, hatha yoga classes incorporating poses, relaxation and meditation exercises, yoga breathing and yoga philosophy. Thirty minutes of daily home practice was encouraged and supported with at-home yoga supplies. The physical therapy intervention consisted of 15 one-on-one 60-minute appointments over 12 weeks. During each appointment, the physical therapist utilized the Treatment-Based Classification Method and supervised aerobic exercise, while providing written instructions and supplies to continue exercises at home. The self-care intervention consisted of reading from a copy of The Back Pain Handbook, a comprehensive resource describing evidence-based self-management strategies for chronic lower back pain including stretching, strengthening, and the role of psychological and social factors. Participants received check-in calls regarding the reading every three weeks.

The main findings from the trial published in Annals of Internal Medicine found that yoga was non-inferior to physical therapy in terms of pain and function outcomes.

In this study published in Pain Medicine, we wanted to dig deeper and understand the characteristics of patients who tended to do better no matter what treatment they received (i.e., predictors) and characteristics that modified the likelihood that they would improve with a particular treatment (i.e., treatment effect modifiers). This type of information is useful to patients and clinicians who are trying to decide which type of treatment may be best for a unique individual experiencing back pain.

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Pain Relief Patch Significantly Reduced Moderate to Severe Chronic Pain

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PainRelief.com Interview with:
Peter Hurwitz
President
Clarity Science, LLC

Clarity Science Logo. (PRNewsFoto/Clarity Science)

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

Response: Over the past several years, there has been a big push from healthcare professionals and patients to identify alternative pain management treatments and multimodal approaches that have been shown to have minimal side effects for those who experience mild to moderate and chronic pain conditions. These strategies may include non-pharmacological and pharmacological therapies. Topical therapies have been shown to address various pain conditions with minimal side effects as compared to oral over-the-counter (OTC) agents, prescription NSAIDs, and prescription opioids. T

his IRB-approved study evaluated whether a topical analgesic pain-relieving patch containing methyl salicylate (10%), Menthol (6%) and Camphor (3.1%) could reduce pain severity and improve function in patients over the course of 14 days.

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Furry Social Robots May Provide Some Pain Relief

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­PainRelief.com Interview with:

­ Shelly Levy-Tzedek, PhD
Head of the Cognition, Aging and Rehabilitation Lab
Faculty of Health Sciences, Dept. of Physical Therapy 
& The Zlotowski Center for Neuroscience
& ABC Robotics Initiative
The Ben Gurion University of the Negev

Prof. Levy-Tzedek

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

Response: It is known that close, effective human touch can help alleviate pain. We set out to test whether touch interaction with a social robot can also reduce the sensation of pain. We found that it does: young, healthy people who touched the robot during the application of painful stimuli reported feeling less pain than when it was in the room with them (with no direct contact), or when it was not present at all. They also reported increased levels of happiness. 

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