PainRelief.com Interview with: Eric C. Schwenk MD Anesthesiology Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania
Dr. Schwent
PainRelief.com: What is the background for this study? What are the main findings?
Response: Patients with refractory chronic migraine (rCM) have typically failed all available medications and many times have nearly constant headache pain and in many cases disability. Aggressive treatment is indicated to provide relief and help break the cycle of pain.
Lidocaine infusions have been used for decades in various acute and chronic pain conditions, including complex regional pain syndrome and pain after surgery. At the Jefferson Headache Center lidocaine has been a mainstay of treatment for such patients for several decades but evidence supporting its benefits is scarce.
The main findings were that patients with rCM experienced acute relief at the end of the infusion and that some relief was sustained at 1 month, although the degree of pain relief faded over time. It was also well tolerated with nausea and vomiting occurring in 16.6% of patients and other side effects occurring less frequently.
PainRelief.com Interview with: Imanuel Lerman MD MSc Associate Professor Affiliate Electrical and Computer Engineering VA San Diego Healthcare System Center for Stress and Mental Health Center for Pain Medicine UC San Diego Health Qualcomm Institute California Institute for Telecommunications and Information Technology (Calit2)
Dr. Lerman
PainRelief.com: What is the background for this study? What are the main findings?
Response:Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. There is extensive clinical literature that offers support for efficacy in chronic pain treatment for both Low frequency and High frequency based spinal cord stimulation. While Low Frequency SCS has been heavily examined since its inception, High Frequency SCS paradigms have recently been clinically approved.
Emerging preclinical work also show sex may alter certain immunological pathways that contribute to chronic pain. But to date few report have identified interactions between sex and SCS. Therefore, we aimed to fill this knowledge gap through a single site (University of California San Diego), large (n=237) retrospective (2004–2020) analyses that compared SCS paradigm Low vs High Frequency SCS, efficacy (pain relief and opiate sparing effects) across sex.
PainRelief.com Interview with: Allison Lee, MD, MS [she/her/hers] Associate Professor of Anesthesiology Division of Obstetric Anesthesia Officer of Diversity, Equity and Inclusion, Department of Anesthesiology Medical Director of the Margaret Wood Center for Simulation and Education Columbia University Medical Center New York, NY 10032
Dr. Lee
PainRelief.com: What is the background for this study?
Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:
Lower labor epidural rates, despite it being the most effective modality for pain relief.
Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
Worse management of pain after cesarean delivery
Given the importance of effective management of postdural puncture headache and in light of growing evidence of complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.
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.
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.
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.
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.
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.
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.
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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