PainRelief.com Interview with: Benjamin W. Friedman, MD, MS, FAAEM, FACEP, FAHS Professor of Emergency Medicine Vice-chair for Clinical Investigation Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx, NY 10467
PainRelief.com: What is the background for this study? What are the main findings?
Response:A very large number of patients present to US EDs annually with back pain. No medications have proven more effective than NSAIDs for low back pain. Similarly, combining other medications such as skeletal muscle relaxants or opioids with NSAIDs does not improve outcomes more than NSAIDs alone.
Prior to our study, little was known about which NSAIDs were most efficacious for acute low back pain.
The main finding of our study is that ketorolac was more efficacious than ibuprofen for some two and five day outcomes that are important for patients.
PainRelief.com Interview with: Roger Cady, MD VP Neurology Lundbeck Pharmaceutical La Jolla Research Center San Diego, CA 92121
PainRelief.com: What is the background for this study?
Response: The RELIEF study evaluated how preventive migraine candidates may benefit from a VYEPTI infusion during an active migraine attack when administered within 1 to 6 hours of a moderate to severe migraine attack. VYEPTI is the first and only intravenous (IV) infusion approved for the preventive treatment of migraine in adults.
PainRelief.com Interview with: Hanna Grol-Prokopczyk PhD Associate Professor Department of Sociology University at Buffalo, SUNY
PainRelief.com: What is the background for this study?
Response: Although chronic pain is recognized as an extremely common and costly health problem, little research has explored temporal trends in pain prevalence. Indeed, as recently as 5-6 years ago, there was no published research using general population data examining whether pain prevalence in the U.S. was going up, going down, or staying constant. (This can be contrasted to conditions such as diabetes and cancer, for which information about long-term trends is readily available. Of note, chronic pain affects more Americans than diabetes, cancer, and heart disease combined.) In recent years, a few studies have documented rising pain prevalence in the U.S., but most have used data on middle-aged or older adults.
PainRelief.com Interview with: Bruce J. Sangeorzan, M.D., Professor Director, RR&D Center for Excellence in Limb Loss Prevention and Prosthetic Engineering Veterans Affairs University of Washington
PainRelief.com: What is the background for this study?
Response: We began a series of studies in the early 2000’s when ankle replacement was limited to a few centers like our own. We knew that ankle arthrodesis– or fusion—was an effective treatment for ankle arthritis. But ankle fusion is not appropriate for some people and it also results in loss of ankle motion. There were a growing number of ankle replacements being done but little was known about their effectiveness or how long they last.
We wanted to study whether replacement and fusion were comparable for pain relief and activity and wanted to know if maintaining motion of the ankle (by using a replacement) would have an advantage without additional risk. Three studies were done involving more than 800 patients from 6 centers.
This most recent study compared two groups of patients who had similar amount of pain and activity before treatment. All of the patients had already tried non -surgical solutions such as activity modification, bracing and injections with out improvement. One group had fusion of the ankle and the other had replacement of the ankle. Patients were questioned and examined four years or more after surgery and compared to their condition before treatment.
PainRelief.com Interview with: Christina Abdel Shaheed PhD Researcher and Academic University of Sydney
Dr. Abdel Shaheed
PainRelief.com: What is the background for this study? What are the main findings?
Response:Paracetamol (acetaminophen) is one of the most widely used drugs for pain relief globally. Our study (https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50992) examined the evidence on the efficacy of paracetamol versus placebo for 44 different pain conditions. There is strong evidence paracetamol provides greater pain relief than placebo for four conditions: craniotomy, knee or hip osteoarthritis, tension headache and perineal pain following childbirth, however sometimes the effects were very small.
Paracetamol was no more effective than placebo for acute low back pain. There is uncertainty regarding the benefits of paracetamol for the remaining 39 pain conditions. To note, most studies evaluated single doses of the pain reliever, which does not reflect typical use of the medicine.
PainRelief.com: What should readers take away from your report?
Response: If people are considering paracetamol for their pain, the recommendation is to:
Stick within the safe limits for using paracetamol (maximum 4 g daily for adults, which will vary depending on the formulation used).
Bear in mind there are different types of paracetamol products (long-acting, which should be taken less frequently, versus short-acting); and cold and flu preparations (including decongestant) and popular over-the-counter products for pain relief (including ibuprofen) can also contain paracetamol.
Do not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
Consider combining the medicine with other non-drug strategies to optimise pain relief, particularly for conditions like osteoarthritis e.g. exercise and healthy eating.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response:High quality clinical trials evaluating typical use of paracetamol are needed to resolve the uncertainty around its effectiveness for the majority of pain conditions.
Disclosures: Some of the authors on this study were also involved in the PACE trial which evaluated the efficacy of paracetamol vs placebo for acute low back pain.
Citation:
Abdel Shaheed, C., Ferreira, G.E., Dmitritchenko, A., McLachlan, A.J., Day, R.O., Saragiotto, B., Lin, C., Langendyk, V., Stanaway, F., Latimer, J., Kamper, S., McLachlan, H., Ahedi, H. and Maher, C.G. (2021), The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Med J Aust, 214: 324-331. https://doi.org/10.5694/mja2.50992
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Dr Renato Vellucci Contract Professor University of Florence Pain and Palliative care Clinic University Hospital of Careggi Florence, Italy
Dr. Vellucci
PainRelief.com: What is the background for this study? What are the main findings?
Response: Chronic low back pain (CLBP) is the most prevalent chronic pain (CP) condition and the leading global cause of years lived with disability. According to the axiom pain as a biopsychosocial issue, mood and sleep disturbances represent key issues. However, the impact of different analgesic therapies on quality of life (QoL) and functional recovery has been poorly assessed to date. Focusing on combination of chronic pain and sleep, they both perform a mutual reinforcement.
Pain disorganizes the sleep architecture, and disturbed and unrefreshed sleep increases spontaneous pain and lowers pain thresholds. Sleep disorders may augment stress levels, thus making it difficult for patients to perform simple tasks impairing their cognitive ability. Poor sleep may predict the growth and intensification of pain over time, with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. Epidemiology of chronic pain unequivocally demonstrates the role of sleep quality in the development of chronic pain.
Notwithstanding this strong two-way relationship between chronic pain and sleep, little knowledge is available about the neurochemical determinants of this interplay and therapeutical strategies to break this vicious circle. Fifty percent of people with chronic low back pain have sleeping disturbances, with an 18-fold increase in insomnia versus healthy people. A recent study investigated the relationship between sleep disturbances and back pain and found that it is two sided with sleep disturbance being associated with risk of back pain whilst back pain can also lead to sleep disturbances. Thus, it can be hypothesized that, by reducing pain and physical dysfunction, sleep quality could be improved, thus enriching the QoL of people with CLBP.
Similarly, improvements in sleep after cognitive behavioral therapy in patients with chronic pain due to osteoarthritis were associated with reduced pain. Earlier evidence suggested that tapentadol prolonged-release treatment ameliorate in parallel QoL and sleep quality in a greater proportion of patients compared to that of patients following oxycodone/naloxone prolonged- release treatment (50% versus 37.7%). Other tapentadol studies conducted in a real-life context documented, along with effective pain control, similar improvements in mental and physical health and suggested beneficial effects in terms of less night awakenings and greater percentages of patients reporting restful sleep.
PainRelief.com Interview with: David Andreu, PhD Professor of Chemistry Department of Experimental & Health Sciences Pompeu Fabra University Barcelona Biomedical Research Park Barcelona, Spain
Prof. David Andreu (right) Maria Gallo, (first author) Prof. Rafael Maldonado
PainRelief.com: What is the background for this study? What are the main findings?
Response: Background is the (earlier) finding of a cross-talk between CB1 and 5HT2A receptors (two GPCRs forming a heterodimer) that can be acted upon (disrupted) by peptides that allow to dissociate analgesic (CB1-mediated) from (unwanted) cognitive effects ( CB1/5HT2A heterodimer-mediated, memory impairment etc); this is reference 18 of our paper.
PainRelief.com Interview with: Erika A. Petersen, MD, FAANS, FACS Professor of Neurosurgery Residency Program Director UAMS Department of Neurosurgery
PainRelief.com: What is the background for this study?
Response: Painful diabetic neuropathy is a common occurrence for patients with diabetes and can have a tremendous negative impact on their quality of life. Currently, the best available treatments include several types of medications and topical solutions, but there are many patients who do not achieve adequate pain relief or cannot tolerate side effects from these treatments. We need new options for patients who have tried the recommended first- and second-line treatments but still suffer with severe pain.
PainRelief.com Interview with: John Traynor, PhD Edward F Domino Research Professor Professor and Associate Chair for Research Department of Pharmacology, Medical School Professor of Medicinal Chemistry, College of Pharmacy University of Michigan, Ann Arbor MI
Dr. Traynor
PainRelief.com: What is the background for this study? What are the main findings?
Response: Response: Morphine and related drugs acting at the mu-opioid receptor are the most effective treatment for moderate to severe pain, yet their use is limited by serious on-target side effects including respiratory depression, and physical and psychological dependence that has led to the opioid crisis. Current opioid drugs are required because our own endogenous pain relieving chemicals, the enkephalins and endorphins opioid peptides, cannot efficiently relieve pain.
We have discovered a class of drugs (positive allosteric modulators, PAMs) that bind to the mu-opioid receptor to enhance the activity of endogenous opioids. These “enkephalin amplifiers” afford pain relief in mouse models without the need for morphine-like compounds and do so with a much reduced side-effect profile.
Kao-Ping Chua, MD, PhD Susan B. Meister Child Health Evaluation and Research Center Department of Pediatrics, University of Michigan Medical School Ann Arbor MI 48109.
Dr. Kao-Ping Chua
PainRelief.com: What is the background for this study?
Response: Prior studies suggest that opioid prescriptions for surgical procedures are associated with increased overdose risk in patients. Additionally, studies suggest that opioid prescriptions are associated with increased overdose risk in patients’ family members, who often have access to patients’ opioids. However, studies have not specifically assessed whether opioid prescriptions for dental procedures are associated with increased overdose risk in patients and their family members.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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