Nitrous Oxide “Cracking” Can Reduce Greenhouse Gas From Pain Killer Used During Childbirth

PainRelief.com Interview with:
Dr Clifford L Shelton
Consultant Anaesthetist, Wythenshawe Hospital
Senior Clinical Lecturer, Lancaster Medical School (Director of Simulation and Skills)
Executive Editor, Anaesthesia Reports
Deputy Chair of PCPIE, National Institute of Academic Anaesthesia Health Services Research Centre

Dr. Annie Pinder
North West School of Anaesthesia,
Health Education England North West, Manchester, UK

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

Response: Inhaled nitrous oxide is the most commonly-used pain relief for labour in the UK – used by an estimated 77% of women in labour. However, it has a high ‘carbon footprint’ and depletes the ozone layer so healthcare organisations must take steps to reduce its release. Previous works have also noted high levels of nitrous oxide in the work environment of midwives working on labour ward, which can have health implications.

In Scandinavia, nitrous oxide ‘cracking’ technology has been used for several years to address these concerns and this has recently become available in the UK – however, there is little available effectiveness of the technology in the clinical workplace. We previously conducted a bench experiment to assess the ability of cracking technology to reduce ambient nitrous oxide concentrations under ideal circumstances and found a substantial improvement when the technology was in place. However, controlled experimental situations are not representative of real-life.

In this study we therefore aimed to assess whether ambient nitrous oxide levels would be reduced when the technology was implemented on the low-risk birth centre of a typical UK maternity hospital.

Use of Medical Cannabis Can Expose Patients to Harmful Contaminants

PainRelief.com Interview with:
Maxwell C. K. Leung, Ph.D.
Assistant Professor
Systems Biology and Toxicology
New College of Interdisciplinary Arts and Sciences
Arizona State University, West Campus

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

Response: Over 200 million Americans currently have legal access to medical cannabis, recreational cannabis, or both. Yet, cannabis remains an illicit Schedule 1 substance at the federal level. This limits the efforts of several federal agencies to regulate harmful contaminants – including pesticides, heavy metals, solvents, microbes, and fungal toxins – in cannabis.

Over Half of Older Adults Use OTC Pain Relievers for Joint Pain Relief

PainRelief.com Interview with:
Beth Wallace, M.D. M.Sc
Associate Investigator, Center for Clinical Management Research
Staff Physician, Rheumatology
VA Ann Arbor Healthcare System
Assistant Professor, Division of Rheumatology
University of Michigan

Dr. Wallace

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

Response: Arthritis and joint pain are common among older adults. We used data from the University of Michigan National Poll on Healthy Aging to understand how a national sample of older adults experiences and manages joint pain.

PainRelief.com: What are the main findings?

Response: Seventy percent of adults aged 50-80 report that they have joint pain. Three in five have a diagnosis of arthritis, including 30% who have a diagnosis of osteoarthritis (also called “wear and tear” or “bone on bone” arthritis).

Of those with joint pain, half said that it limited their usual activities, but about three in four said that they saw arthritis and joint pain as a normal part of aging that they could manage on their own.

More than half of all adults use over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve) for joint pain. One in ten used a prescription oral steroid, like prednisone. This is important because these medications can cause or worsen health conditions common in older people, such as high blood pressure and heart disease. More than a quarter of adults who used oral steroids for joint pain did not remember discussing the risks of these medications with their health care provider.

Ninety percent of those with joint pain used non-medication treatments, like exercise, massage, and splints and braces, to manage their symptoms. Most people who used these treatments found them to be very helpful.

University of Pittsburgh Study Finds Durable Pain Relief in Obese Patients Following Bariatric Surgery

PainRelief.com Interview with:
Wendy C. King, PhD
Epidemiology Data Center
School of Public Health
University of Pittsburgh
Pittsburgh, PA

Dr. King

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

Response: Previous studies had provided evidence that bariatric surgical procedures are associated with improvements in pain, physical function and work productivity. However, most prior studies only followed participants 1-2 years, at which point participants were at the peak of their weight loss. 

Among a large cohort of US adults, we wanted to evaluate how much initial improvements in pain, physical function and work productivity declined during long-term follow-up, when some degree of weight regain is not uncommon. We limited our study to adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), the two most common bariatric surgical procedures done today.

Cannabis During Pregnancy May Have Long Term Mental Health Consequences for Children

David-Baranger
Dr. Baranger

PainRelief.com Interview with:

David A. A. Baranger, PhD
Department of Psychological and Brain Sciences

Dr. Brogdan

Ryan Bogdan, PhD
Associate Professor of Psychological & Brain Sciences
Department of Psychiatry
Washington University in St Louis
St Louis, Missouri



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

David Baranger: Prenatal cannabis use is increasing in the United States. Prior work from our group found that prenatal cannabis exposure, particularly when it occurred after mothers learned they were pregnant, was associated with worse mental health outcomes in children aged 9-10.

In this study we followed up with this same group of children, who are now as old as 12, to ask whether anything has changed. Have they improved, or gotten worse? To our surprise, we found that children with prenatal cannabis exposure still had worse mental health outcomes – things had not gotten better, nor had they gotten worse.  

Repurposing Old Drugs May Lead to Chronic Pain Relief Medications

PainRelief.com Interview with:
Shane Cronin PhD
Staff scientist in the Penninger lab at IMBA
Former postdoc in the Woolf lab at Harvard Medical School and
F.M. Kirby Neurobiology Center, Boston Children’s Hospital

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

Response: We and others have shown that the BH4 (tetrahydrobiopterin) metabolic pathway is upregulated in injured nerves and contributes to pain hypersensitivity in various rodent models of chronic pain. BH4 is a metabolite and an important cofactor for the aromatic amino acid hydroxylases for the production of dopamine and serotonin for example. it has also been previously shown to exert cofactor independent roles such as ROS scavenging and Fe3+ reduction in maintaining mitochondrial health.

Moreover, gene association studies in humans have also demonstrated a correlation between low levels of the bottleneck enzyme for BH4 biosynthesis, GCH1, and reduced severity of chronic pain (nicely reviewed here: PMID: 28667479). We believe that targeting this increase of BH4 after nerve injury is a viable strategy to reduce the ensuing pain. So, we set up a screening platform using transgenic mouse DRG neurons in which GFP is controlled by the Gch1 promoter – when Gch1 is turned on (as is in the case of nerve injury), GFP gets turned on as a proxy for BH4 activation and ‘in vitro cellular pain’. 

States with Mandated Prescription Monitoring Programs Had Marked Increase in Heroin-Related Deaths

PainRelief.com Interview with:
Dr. Tongil “TI” Kim,
Assistant professor of marketing
Naveen Jindal School of Management
The University of Texas at Dallas (abbreviated UT Dallas)

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

Response: We examine the early deployment of mandated prescription drug monitoring program (PDMP) use (2006-2015) in the U.S., when 19 states mandated PDMP use. We find 6.37 more heroin-related deaths per million population per year—a 50.1% increase—following PDMP mandates compared to states that did not.

Twin Study Find Cannabis Legalization Linked to Increased Marijuana Use in Adults

PainRelief.com Interview with:
Stephanie Zellers
Psychology
University of Minnesota

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

Response: Many cross-sectional studies have found increases in adult cannabis consumption after the passage of recreational cannabis legalization. These studies, in large population samples across the USA, provide information about possible effects of recreational legalization in representative samples, but cannot draw causally informative conclusions. There are many confounders, like genes, pre-existing differences, and secular trends, that could be alternative explanations for any effects identified.

We utilized a longitudinal twin study to rule out many additional unmeasured confounds shared within families, like genes and aspects of the rearing environment. Importantly, we have data on identical twins before and after recreational legalization, and we have pairs where one twin lives in a recreationally legal state while their co-twin does not. By comparing these twins, we can estimate the causal impact of recreational legalization, after controlling for unmeasured confounds shared by individuals in a family.

Medical Marijuana Users Also More Likely to Also Use Tobacco

PainRelief.com Interview with:
Marc L. Steinberg, Ph.D.,
Professor, Department of Psychiatry, Rutgers RWJMS
Director, Doctoral Psychology Internship Program, Rutgers UBHC – Piscataway
Research Lab Website: Tobacco Research & Intervention Lab

Dr. Steinberg

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

Response: As the use of cannabis for therapeutic purposes (often called ‘medical marijuana’) has grown, my colleague, Dr. Mary Bridgeman, and I became interested in exploring more about the population who use marijuana for therapeutic purposes. My research has historically focused on tobacco use and so that was one issue in particular that we focused on in this study.

We know that individuals who use cannabis, in general, are more likely to smoke, but we did not know if that was also true for those who used cannabis for therapeutic purposes.  

Uninsured Pay Higher Out-of-Pocket Costs for Opioid Antidote Naloxone

PainRelief.com Interview with:
Evan D. Peet, PhD Professor
Pardee RAND Graduate School

Dr. Peet

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

Response: This study is part of a broader CDC funded project looking at access to naloxone and naloxone’s impacts on opioid-related overdose deaths. There have been increasing efforts to expand access to naloxone, with a variety of different laws being passed by states across the nation. But one part of access that has been understudied is the cost borne by patients.

High out-of-pocket costs may act as a barrier to this life-saving drug, so in this study we look at trends in out-of-pocket costs of naloxone and how they vary by payor and drug brand.