Tag Archives: pain

Which Older Adults Use Cannabis for Chronic Pain Relief?

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PainRelief.com Interview with:
Julie Bobitt, PhD
Director, Interdisciplinary Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL. 61820

Dr. Julie Bobitt
Dr. Julie Bobitt

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

Response: Our previous research found that older adults, who we interviewed, used cannabis primarily for pain related reasons and that they were reporting using cannabis to reduce or altogether stop their use of opioids.  We wanted to further study this and we wanted to see if there were any differences between self-reported pain in non-cannabis users vs. cannabis users and then if there were differences between groups who used cannabis alone versus those who used opioids alone, versus cannabis in combination with opioids. 

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Studies Find Plant-Based Spray Can Provide Pain Relief from Inflammatory Skin Conditions

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PainRelief.com Interview with:
Markéta SAINT AROMAN, MD
Medical Director in Pierre Fabre Group.

Markéta SAINT AROMAN, MD

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

Response: Patients with inflammatory skin diseases frequently experience cutaneous pain as a symptom of their disease and may also experience burning and stinging sensations.

Signs and symptoms of inflammation are also experienced by patients who have undergone therapeutic and aesthetic skin resurfacing procedures (such as laser treatment, chemical peels and photodynamic therapy).

Diseases such as eczema (atopic dermatitis (AD), hand eczema) and psoriasis and dermatological procedures are all associated with disruption to the skin barrier which can expose cutaneous nerve endings, which are responsible for transmitting sensory information including itch and pain and increase sensitivity to environmental irritants. Heat sensations and oedema associated with inflammation also activate pain receptors. The impulse to scratch, which is a feature of AD and psoriasis and also occurs during the healing process following dermatological procedures, is a cause of cutaneous pain. At a molecular level, inflammation is characterized by the release of prostaglandins, cytokines, chemokines, proteases, neuropeptides, and growth factors, which are known to act directly on peripheral pain-sensing neurons.

The efficacy of the spray used in the study may be explained by the inclusion of two plant extracts demonstrated to have anti-inflammatory, immunomodulatory and antalgic activities.
The oat plantlet extract contains immumomodulatory saponins and anti-inflammatory flavonoids which inhibit the production of inflammatory mediators and stimulate keratinocyte proliferation and skin barrier repair. 

The extract of Uncaria tomentosa contains active compounds targeting peripheral pain sensation pathways.

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Back Pain: Web-Based Self-help Intervention to Prevent Depression

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PainRelief.com Interview with:

Lasse B. Sander, PhD
Institute of Psychology
Department of Rehabilitation Psychology and Psychotherapy
Albert-Ludwigs-University of Freiburg
Freiburg, Germany

Lasse B. Sander, PhD Institute of Psychology Department of Rehabilitation Psychology and Psychotherapy Albert-Ludwigs-University of Freiburg Freiburg, Germany
Dr. Sander

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

Response: People with chronic pain have a significantly increased risk of developing depression. When depression and pain collide, this is a considerable burden for those affected. In addition, pain management is made more difficult due to comorbidity.

We have known for some years now that the onset of depression can be delayed or even completely prevented by means of early psychological therapies. However, until now there has been no scalable application option available for routine healthcare.

In our study we were able to show that this can be achieved by a digital self-help intervention.

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Trial of Desipramine, Cognitive Behavioral Therapy, and Placebo for Low Back Pain Relief

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PainRelief.com Interview with:
Thomas Rutledge, PhD, ABPP
Staff Psychologist, VA San Diego Healthcare System
Professor of Psychiatry
UC San Diego

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

Response: The goal of this study was to combine our team’s pharmacy, psychiatry, and psychology expertise with chronic pain to conduct a rigorous, head-to-head efficacy trial. The clinical trial literature for chronic back pain is enormous. On the surface, this literature suggests that many medication and pain psychology treatments are effective by standards of statistical significance. These findings are difficult to interpret, however, because there are few trials comparing statistically effective chronic back pain treatments with active control treatments and nearly no trials randomizing patients with chronic back pain to medication versus pain psychology treatments. We hoped that our trial could offer data to help fill these gaps. Mindful of the increasing concerns about long-term opioid use for chronic pain, we also believed the study could have value by focusing on non-opioid agents (Desipramine) and cognitive behavioral therapy.

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Review of Compounded Topical Creams for Pain Relief

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PainRelief.com Interview with:


Debra A. Schwinn, M.D. (Committee Chair) – President-Elect of Palm Beach Atlantic University; former professor of anesthesiology, pharmacology, and biochemistry at the University of Iowa

Edmund J. Elder, Ph.D., R.Ph. – Director of the Zeeh Pharmaceutical Experiment Station, School of Pharmacy at the University of Wisconsin–Madison

·John T. Farrar, M.D., Ph.D. -Associate Professor of epidemiology and neurology, University of Pennsylvania School of Medicine 

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

Response: Compounding is the process of altering or combining ingredients to create medications that are tailored for an individual. Typically, compounded topical pain creams – which are applied to the skin in the form of gels, lotions, or ointments – are used by patients who cannot tolerate oral pain medications.

However, compounded topical preparations are not subject to the same level of extensive testing and stringent regulatory oversight as FDA-approved products. There are a number of safety concerns associated with their use, ranging from minor skin irritations to drug toxicity.

In response, FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to make recommendations for how the available scientific data on safety and effectiveness should inform future prescribing decisions.

PainRelief.com: What are the main findings?

Response: The report found there is limited scientific evidence to support the safety and effectiveness of compounded topical pain creams in adults. The committee assessed 20 Active Pharmaceutical Ingredients (APIs) that are commonly used in compounded topical pain creams. Out of the 20 APIs reviewed, 3 individual APIs and 1 two-drug combination demonstrate potential clinical effectiveness in compounded topical pain creams.

When possible, providers should prescribe FDA-approved products. Pharmacists and providers who prescribe compounded topical pain creams should also educate their patients about how much to use, which conditions to use it for, and the potential risks.

Among the report’s other findings about safety and effectiveness:

·         The rate and extent of the drug’s absorption into the skin and beyond is often unknown

·         There is no clear clinical rationale for specific combinations of APIs and dosages used

·         Labeling requirements for compounded preparations are often inadequate

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Acupuncture for Migraine Pain Relief

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PainRelief.com Interview with:

Prof. Wei Wang
Department of Neurology,
Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology,
Wuhan, Hubei, P.R. China

acupuncture

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

Response: The burden of migraine is substantial, resulting in considerable economic and social losses. The latest Global Burden of Disease Study showed that 1.25 billion people had migraine in 2017. A significant number of patients are still not responding well to drug therapy, or cannot tolerate the adverse effects of drugs, or have contraindications, which can lead to low medication compliance, headache chronification and acute medication overuse. Prophylactic drugs should be recommended for migraineurs who have at least four headache days per month, but only 13% of patients reported current use of preventive drugs. Besides, ineffectiveness of and/or contraindications to migraine medication affect 10-15% of people with migraine. Hence, a need exists to investigate non-drug interventions.

Previous studies suggest that acupuncture works particularly well on a range of pain disorders. However, clinical evidence for the benefit of manual acupuncture for migraine prophylaxis remains scarce. Appropriate placebo control settings and successful blinding are two critical elements in addressing this challenge. Sham acupuncture involving penetrating needles should be avoided in clinical trials. Previous acupuncture research has often used penetrating sham acupuncture, involving needling non-acupuncture points, needling irrelevant acupuncture points, or superficial needling. However, whether the needle is inserted into an acupuncture point or a non-acupuncture point, it could produce a physiological effect. Comparisons between true acupuncture and sham acupuncture might also be biased by unsuccessful blinding. To ensure an inert placebo control and successful blinding, we recruited acupuncture-naive patients, using non-penetrating sham acupuncture at heterosegmental non-acupuncture points as the control, and designed the same procedures to perform the same rituals as much as possible in the manual and sham acupuncture groups.

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Surgery vs Conservative Care Pain Relief from for Persistent Sciatica

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PainRelief.com Interview with:

Dr. Chris Bailey
Western Bone and Joint Institute

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

Response: Acute and subacute sciatica from a lumbar disc herniation is recognized to have a very good natural history with approximately 90% making significant improvement within 4 months of onset.  Hence, studies have shown that surgery for disc herniation has a short-term benefit over non-operative care. 

In many cases, the patients not receiving surgery will improve to the level of those receiving surgery by 6 months (Peul et al, 2007).  Chronic sciatica we felt was a different situation.  

What are the main findings?

Response: Our study confirmed that surgery has a greater advantage for these patients out to 1 year following surgery.  An unpublished stat from our work found that there is a 70% greater chance of significant improvement in sciatica with surgery compared to non-operative care (including physiotherapy, education, medications, and epidural injections).  We recommend that a referral is made to a surgeon for these patients as the likelihood of improvement without surgery is much less than for acute sciatic.

PainRelief.com: What should readers take away from your report?

Response:  Previous studies have also had a difficult time controlling for cross-over and maintaining distinct treatment cohorts.  Our study was designed in such a way to utilized the inherent wait times for consultation in our Canadian health care system so to prevent crossover from the non-op group to the surgical group.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Our plan is to perform future cost effectiveness analysis and publish on long term outcomes as well.

Citation:

Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
Chris S. Bailey, M.D., Parham Rasoulinejad, M.D., David Taylor, M.D., Keith Sequeira, M.D., Thomas Miller, M.D., Jim Watson, M.D., Richard Rosedale, P.T., Stewart I. Bailey, M.D., Kevin R. Gurr, M.D., Fawaz Siddiqi, M.D., Andrew Glennie, M.D., and Jennifer C. Urquhart, Ph.D
Nengl j med 382;12 nejm.org March 19, 2020

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Knee Osteoarthritis: Physical Therapy vs Steroid Injection for Pain Relief

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MedicalResearch.com Interview with:
Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT
Professor with Baylor University Graduate School 

Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT Professor with Baylor University Graduate School

Study authors in addition to Gail Deyle are Chris Allen, Stephen Allison, Norman Gill, Benjamin
Hando, Evan Petersen, Douglas Dusenberry, and Daniel Rhon

Summary:

Physical therapy is superior to glucocorticoid (steroid) injections for stiff and aching knees says Dr Gail Deyle, a physical therapist specializing in orthopaedics and manual physical therapy. A study recently published in the New England Journal of Medicine directly compared physical therapy with glucocorticoid injections to determine which was better primarily at one year but also in the short term.

The research was a collaborative effort of providers from physical therapy, orthopaedics, and
rheumatology at two Army Medical Centers. Dr Deyle, who is a professor with Baylor University Graduate School, and the senior author of the study, states, our results leave no doubt that physical therapy should be strongly considered for patients with knee osteoarthritis. They will clearly benefit from a physical therapist’s hands-on treatment and decision making for exercise and activity selection.

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Targeting Specific Inflammatory Cells May Offer Enhanced Pain Relief

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PainRelief.com Interview with:
Prof. Dr. Halina Machelska
Department of Experimental Anesthesiology
Charité-Universitätsmedizin Berlin
Berlin, Germany

Prof. Dr. Halina Machelska Department of Experimental Anesthesiology Charité-Universitätsmedizin Berlin Berlin, Germany

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

Response: Pathological pain such as pain resulting from nerve injury is often accompanied by inflammation. This is manifested by accumulation of immune cells, including macrophages, in the damaged tissue. Current research mostly emphasizes the role of these cells in the enhancement of pain. One of the suggested strategies in the basic research is to deplete immune cells from the affected tissue. However, several previous preclinical studies, including our own, have shown that this approach did not sufficiently decrease pain. We think that one of the reasons is that not all immune cells invading damaged tissue are detrimental and in fact, some are needed there to counteract pain.

Macrophages are very heterogeneous and they comprise at least two subpopulations, pro-inflammatory M1 and anti-inflammatory M2 macrophages. Our idea in this study was to promote the analgesic properties of macrophages. We took advantage of the cytokine interleukin-4 (IL-4) to switch macrophages from the M1 to the M2 state.

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Chiropractic Care Linked to Lower Use of Opioids for Spinal Pain Relief

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PainRelief.com Interview with:
Jim Whedon DC, MS
Director of Health Services Research
SCU Health System
Southern California University of Health Sciences
Whittier, CA 

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

Response: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids.

Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Overall, in the states of CT, MA and NH, at any particular time in the study period of 2012-2017, between 1.55 and 2.03 times more nonrecipients of chiropractic care.filled an opioid prescription, as compared with recipients.

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