Tag Archives: #painrelief

Study Evaluates Long-Acting Bupivacaine for Pain Relief During Knee Replacement

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PainRelief.com Interview with:
Prof. Hemant G. Pandit, DPhil
Leeds Institute of Rheumatic and Musculoskeletal Medicine
Chapel Allerton Hospital, University of Leeds
Leeds, United Kingdom

Prof. Pandit

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

Response:  Knee replacement is highly successful for treating severe arthritis. There are 100,000 people who undergo knee replacement surgery every year in the UK, with numbers set to rise significantly in future. It remains however a painful procedure with nearly half of patients reporting severe pain post-operatively. Currently pain control is provided by injecting a local anaesthetic of bupivacaine hydrochloride around the knee during surgery providing good pain relief for 12 to 24 hours. However, patients typically experienced the worst pain the next morning when they are encouraged to bend their knee and get out of bed. 

Liposomal bupivacaine is a local anaesthetic preparation which can provide sustained release of pain relief medication over a longer period of time (up to 72 hours). The drug is costly and is used in routine clinical practice in the USA with previous studies showing varying results with the use of LB. We therefore (researchers at the Universities of Oxford and Leeds) developed the SPAARK (Study of Peri-Articular Anaesthetic for Replacement of the Knee) Trial, to test whether liposomal bupivacaine would be more effective at managing the pain compared to current treatments in patients undergoing a knee replacement. 

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Acetaminophen Label Changes Impact On Hospital Admissions for Overdoses

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PainRelief.com Interview with:
Tony Antoniou PhD
Department of Family and Community Medicine
Li Ka Shing Knowledge Institute
St. Michael’s Research Institute

Dr. Antoniou

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

Response: Acetaminophen is used by millions of people worldwide and included as an ingredient in hundreds of over the counter products for pain and the common cold. Accidentally taking more than the safe dose of the drug is therefore possible. This is important because taking too much acetaminopohen can lead to potentially serious and fatal liver injury.

In Canada, changes to acetaminophen product labels warning individuals of the risk of taking too much of the drug and letting consumers know that the product can take acetaminophen were made to try and prevent accidental overdoses. We studied whether these label changes had any impact on the number of people being hospitalized with accidental acetaminophen overdose over a 16-year period.

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Osteopathic Medicine Reviewed for Non-Specific Low Back Pain

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PainRelief.com Interview with:
Donatella Bagagiolo Osteopath D.O. BSc. (Hons) Ost.
Director of Research Department, Scuola Superiore di Osteopatia Italiana
Torino Italy

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

Response: Osteopathic medicine, depending on different legal and regulatory structures around the world, is a medical profession (e.g. USA), an allied health profession (e.g. UK) or a part of complementary and alternative medicine (e.g. Italy or France). Osteopathic medicine plays an important role primarily in musculoskeletal healthcare. In recent years, systematic reviews have been published to evaluate the clinical efficacy and safety of osteopathic medicine for conditions such as low back pain, neck pain and migraine. However, due to differences in methodologies and the quality of systematic reviews, no clear conclusions were achieved. The aim of our overview was to summarize the available clinical evidence on the efficacy and safety of osteopathic medicine for different conditions.

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Risk of Low Back Pain in Women May Vary with Age of Menarche

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PainRelief.com Interview with:
Ingrid Heuch MD, PhD
Department of Research, Innovation and Education,
Division of Clinical Neuroscience
Oslo University Hospital, Norway

Dr. Heuch

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

Response: Low back pain represents a major health problem in today’s society. In this study more than 27 000 women aged 20-69 years were included in the Trøndelag Health Study, HUNT, in Norway. As in most population-based studies, women were more likely to be affected with chronic low back pain than men. Our study showed a U-shaped relationship between age at menarche (age at a woman’s first menstruation) and risk of low back pain, also after many years. Both women with an early or late age at menarche experienced higher risk of low back pain. Compared to women with menarche at age 14 years, menarche at age 11 years increased the risk by 32% and menarche at age 17 years by 43%. No association was found between age at menopause and risk of low back pain.

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Telerehabilitation Found Effective for Low Back Pain Relief

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PainRelief.com Interview with:
Mark W Werneke, PT, MS, Dip. MDT
Net Health Systems, Inc.
Pittsburgh PA

Mark W Werneke

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

Response: Coronavirus pandemic (COVID-19) has had a profound effect on changing health care delivery systems and resulted in a rapid growth of telerehabilitation care models. In addition, patients experiencing chronic low back pain increased during the pandemic which was confounded by mandatory lockdowns and lack of physical activity. There is scant literature demonstrating telerehabilitation’s effectiveness and efficiency for patients with low back pain seeking rehabilitation services during COVID-19 pandemic compared to traditional in-person office visit care.

The primary aim of our study was to examine the association between telerehabilitation treatments administered during every day clinical practice and functional status, number of visits, and patient satisfaction with treatment result outcomes compared to in-person care observed during the height of the pandemic. Using Focus on Therapeutic Outcomes (FOTO) database, our sample consisted of 91,117 episodes of care from 1,398 clinics located in 46/50 US states. Propensity score matching analytics was used to match episodes of care with or without telerehabilitation and standardized differences (S-D) were used to assess whether successful matching between telerehabilitation and no-telerehabilitation subgroups allowed for valid outcome comparisons.

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Less-is-More Approach to Pain Relief After Surgery

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PainRelief.com Interview with:
Dr Deanne Jenkin PhD
UNSW Australia,
now Research Fellow at The Daffodil Centre
Sydney, Australia

Dr Jenkin

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

Response: At the time, long-term opioid use for chronic non-cancer pain was increasing and there were signs that their benefit was overestimated whilst the harms were underestimated. Our randomized trial found that after going home from fracture surgery, strong opioids were not better for pain relief compared to a milder, potentially safer opioid alternative.

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Physical Therapy After Knee Replacement Linked to Less Long Term Opioids for Pain Relief

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PainRelief.com Interview with:
Deepak Kumar, PT, PhD
Assistant Professor, Physical Therapy
Assistant Professor, BU School of Medicine
Director, Movement & Applied Imaging Lab

Dr. Kumar

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

Response: We investigated the association of physical therapy interventions with long-term opioid use in people who undergo total knee replacement surgery.   For people with advanced osteoarthritis, total knee replacement is the only option. The number of total knee replacement surgeries has been increasing and is expected to rise exponentially over the next few years with an aging population and rising rates of obesity. However, up to a third of patients continue to experience knee pain after this surgery. Also, a significant proportion of people become long-term opioid users after total knee replacement. Reliance on opioids may reflect a failure of pain management in these patients. Given that physical therapy interventions are known to be effective at managing pain due to knee osteoarthritis, we wanted to study whether physical therapy before or after surgery may reduce the likelihood of long-term opioid use.

We used real-world data from insurance claims for this study. In our cohort of about 67,000 patients who underwent knee replacement between 2001-2016, we observed that, receiving physical therapy within 90 days before surgery or outpatient physical therapy within 90 days after surgery were both related to lower likelihood of long-term opioid use later. We also observed that initiating outpatient physical therapy within 30 days and 6 or more sessions of physical therapy were associated with reduced likelihood of long-term opioid use compared to later initiation or fewer PT sessions, respectively. However, we did not see an association between type of physical therapy. i.e., active (e.g., exercsise) vs. passive (e.g., TENS) and long-term opioid use.

Importantly, most of our findings were consistent for people who had or had not used opioids previously. We also were able to account of a larger number of potential factors that could confound these associations because of the large sample size. However, there are limitations to our work. Since we only had access to insurance claims data but not to health records, we are unable to make any inferences about association of physical therapy with pain or quality of life, etc.

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Pain Relief Study of Low Carb Ketogenic Diet

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PainRelief.com Interview with:
Rowena Field
B.App.Sc (phty) M.Physio. APAM
Physiotherapist/Director
PhD research candidate Sydney University
STEPP (solutions tools and education for persistent pain)

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

Response: Chronic pain is a difficult problem to treat because it is multifactorial, driven by the brain continuing to arrive at the conclusion that protection is required. Turning up the sensitivity in the nervous system results in ongoing pain as a protector even though there is no new tissue damage. Other protection mechanisms such as increased inflammation, and increased sympathetic ‘fight or flight’ also occur.

Chronic pain becomes part of a whole system protective response, so looking at other treatment options that alter the system (such as diet) are useful additions to pain management. A ketogenic diet restricts carbohydrate to below 50g/day producing ketones for energy from fat. It has been used to treat epilepsy over the last two centuries and successfully reduces nervous system excitability. Many of the drugs used for chronic pain (such as Lyrica) are also anti-epileptic medications, suggesting common pathways. As well as these impacts on the nervous system, pre-clinical research has also shown ketones to be signalling molecules that reduce inflammation.

Combined with the clinical reports that pain reduction occurred when people were on ketogenic diets, it seemed reasonable to test the diet specifically in a chronic pain population.

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Acupuncture for Pain Relief from Chronic Prostatitis and Chronic Pelvic Pain Syndrome

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PainRelief.com Interview with:

Zhishun Liu, MD, PhD
Guang’anmen Hospital
China Academy of Chinese Medical Sciences
Beijing, China

acupuncture

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

Response: Pharmacologic therapy has so far failed to reveal universal benefits in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); the evidence for acupuncture is limited, although it is also recommended in current guidelines.

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Including a Body Map Can Help Clinicians Manage Chronic Pain

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PainRelief.com Interview with:
Ben Alter, MD, PhD
Assistant Professor
Director, Translational Pain Research
Division of Pain Medicine
Department of Anesthesiology and Perioperative Medicine
University of Pittsburgh Medical Center

Dr. Ben Alter

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

Response: In the clinical environment, I am often asking patients where their pain is.  There is a large amount of research establishing that widespread or “all-over” pain is difficult to manage and impacts nearly every aspect of a patient’s life. In fact, a tally of body areas is involved with the diagnosis of fibromyalgia, although this is not the only diagnostic criteria. What wasn’t clear to us was whether patterns of pain across the body also impacted important facets of the pain experience.  

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