Wednesday, May 16, 2012

Neuropathy Inadequately Diagnosed & Treated

Neuropathy A recent national poll found that persons with neuropathy face delayed diagnoses, inadequate pain care, and distressing life changes due to their painful disorders. Peripheral neuropathy affects nearly 7% of Americans and from 2% to 8% of populations worldwide. The many types of neuropathy pose diverse challenges for patients, their families, and healthcare providers, yet relatively few resources are devoted to research and treatment of these disorders.

More than 1,900 patients responded to an online survey recently conducted by The Neuropathy Association [full results here]. A majority of survey participants indicated they experienced an extended period of time from symptom onset to diagnosis of their neurological disease — taking more than one year in 75% of cases, and more than 5 years for 20% of patients.

Friday, May 11, 2012

Is Misuse of Meds by Pain Patients Rampant?

Medication Misuse A nationwide study found that 3 in 5 patients may be noncompliant with prescribed drug regimens, as detected by urine drug testing. The findings further suggest a majority of persons treated for pain may be misusing medications in ways that pose health risks; from missing doses to taking unauthorized drugs. However, there are many factors that might account for these outcomes and should be considered before leaping to conclusions about patient misbehavior.

The recently released study — a Quest Diagnostics Health Trends™ Report titled, “Prescription Drug Misuse in America, Laboratory Insights into the New Drug Epidemic” — describes an analysis of roughly 76,000 urine drug tests (UDT) of patients from 10 years of age and older, in 45 states and the District of Columbia, performed during 2011. Samples came from a wide variety of practices, including pain specialty clinics and hospitals, but excluded drug rehabilitation clinics. [The full report PDF is available here.]

Wednesday, May 9, 2012

Sad News: American Pain Foundation Closes Down

In The News Persons with pain across America, and worldwide, lost a leading ally in the War on Pain. After 15 years, and without warning, the American Pain Foundation closed-down operations. And so, the lights went out on the largest national advocacy organization serving people living with pain, their caregivers and healthcare providers, and allied organizations. Who will fill the void?

A brief notice appearing May 8, 2012, at the American Pain Foundation (APF) website simply stated, “With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately.” It went on to say, “The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts.”

Thursday, May 3, 2012

New Survey: Half of U.S. Adults Have Chronic Pain

Chronic Pain According to a just-released large survey from the Gallup organization, nearly half (47%) of American adults reported having some type of chronic pain in 2011, which would amount to at least 111 million persons. This incredible prevalence of pain appears to confirm earlier estimates by the U.S. Institute of Medicine; although, despite the dissent of some doubters, the numbers actually may be underestimates.

During 2011, an ongoing Gallup-Healthways survey randomly contacted more than 353,000 U.S. adults, aged 18 and older, via telephone. The survey included persons living in all 50 states and the District of Columbia, and calls were made to both landline telephones and cellular phones. Respondents were asked if they had a neck or back condition, a knee or leg condition, or another condition that caused recurring pain in the last 12 months [full report here].

Wednesday, May 2, 2012

Fallacies of Evidence in Pain Research

Making Sense of Pain Research Part 12 – How Critical Thinking Goes Awry

The greatest mistake that consumers of pain research can make is to blindly accept that published results and conclusions, or narrative arguments of some sort, are undoubtedly reasonable and true. We can either become wise or be fooled by commonplace fallacies in the pain literature, which subvert critical thinking to create flawed perceptions of reality. Although uncertainty and doubt are inherent in all scientific endeavors, a most important lesson is depicted in the Latin phrase, Ubi Dubium, Ibi Intellectum — where there is doubt, there also can be understanding.

Tuesday, May 1, 2012

May 2012 – Pain Product Announcements & Warnings

Pain Product Warnings Featured Items: rotigotine transdermal system (Neupro) approved for RLS; adalimumab (Humira) European approval for colitis; fentanyl patch safety alert; proton pump inhibitor (PPI) alert for C. difficile-associated diarrhea; Savella and Neurontin added to FDA Watch list; morphine sulfate injectable recall. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.

Rotigotine Transdermal System (Neupro®) – approved for RLS
U.S. Food and Drug Administration (FDA) officials gave UCB, Inc. an approval in April 2012 to market Neupro for the treatment of core symptoms in moderate-to-severe primary restless legs syndrome (RLS). This continuous delivery skin patch contains the dopamine agonist rotigotine which is believed to work by stimulating dopamine receptors in areas of the brain that regulate movement. This approval also included the indication of advanced stage idiopathic Parkinson's Disease, and the drug was previously approved for the signs and symptoms of early-stage idiopathic Parkinson's Disease. Approvals were based on results of 5 randomized, double-blind placebo-controlled trials, with 2 fixed-dose trials providing efficacy data for the treatment of RLS. The most common adverse effects reported included nausea, application site reactions, somnolence, dizziness, and headache. The patch should not be used by pregnant women or patients who have allergic-type reactions to sulfites. See the Neupro Prescribing Information for full administration and safety instructions.

Saturday, April 28, 2012

Mixed Results in Review of Botox for Headaches

Headache Pain Although botulinum toxin A (Botox®) injections are approved in the United States, Canada, the UK, and other countries for the preventive treatment of severe headache conditions, a recent review and meta-analysis of clinical trials found only small benefits in patients with chronic migraine or chronic daily headaches. At the same time, botulinum toxin A injections were no more beneficial than placebo for preventing episodic migraine or tension-type headaches.

According to background information in the article, botulinum toxin A injections were first proposed as a headache therapy when it was observed that patients with chronic headaches receiving those injections for cosmetic purposes experienced headache improvement. This prompted exploratory studies and clinical trials that suggested benefit; however, the medical literature demonstrating the efficacy of botulinum toxin A for headaches still appears to be conflicted and inadequate.

Friday, April 27, 2012

Treatments for Sciatica Pain Disappointing

Sciatica Sciatica is a term often used to describe any low back and leg pain, but it more specifically applies to lumbosacral radiculopathy due to the impingement of nerve roots as they emerge from the spinal canal. Up to half of all cases of spinal pain may be neuropathic in origin, meaning they are caused by nerve compression, inflammation, and/or injury. A pair of recent studies examined treatments for sciatica and found that very few are helpful and they confer only modest and temporarily relief.

The most commonly affected nerve roots in sciatica are at L4/L5 and L5/S1, so pain typically radiates below the knee, and leg pain may be more pronounced than accompanying low back pain. Intervertebral disk herniation is a typical cause, but others include spondylolisthesis (vertebral displacement) and foraminal stenosis. The lack of reliable treatments for sciatica has been problematic: analgesics may be modestly effective but accompanied by adverse effects, invasive surgery can be effective when disk herniation is present but long-term benefits are unproven, and epidural injections may be effective for only modest periods of time and are not without risks.

Saturday, April 21, 2012

Cancer Patients Still Undertreated for Pain

Cancer Pain Despite guidelines and mandates calling for more aggressive management of pain associated with cancer, millions of persons with the disease still suffer needlessly because practitioners fail to adequately treat their pain, according to a new study. And, this is just the latest report pointing to this as a disgraceful neglect of pain in America and worldwide.

The new study, led by researchers at the University of Texas M.D. Anderson Cancer Center and published online ahead of print in the Journal of Clinical Oncology, is the largest-ever assessment of pain treatment for cancer patients in an outpatient setting. For this investigation, Michael J. Fisch, MD, and his team prospectively enrolled a total of 3,123 ambulatory patients at 38 institutions across the United States [Fisch et al. 2012].

Friday, April 20, 2012

Opium, Opioids & Death: Sophistry vs Science

Editor's Notebook What are we to think of an editorial in this week’s edition of the British Medical Journal with the pithy title, “Opium, Opioids, and an Increased Risk of Death?” The author compares Middle-Eastern opium addicts with patients who have chronic noncancer pain and are prescribed opioid analgesics, claiming that both groups face similarly increased risks of death from their drug use. More than anything, this perspective is a remarkable display of wrong-headed reasoning, or sophistry, found too often in the pain literature these days.

The Demise of “Opium Eaters”

In the brief editorial, Irfan A. Dhalla, MD [Dhalla 2012, ref below] — who is Assistant Professor, Department of Medicine, St. Michael’s Hospital, Toronto, Canada — ostensibly comments on a research report also appearing in this edition of BMJ. This was from Iranian investigators who examined effects of opium use on subsequent risks of death [Khademi et al. 2012, ref below]. The researchers used information collected from more than 50,000 people in northeastern Iran between 2004 and 2008, with many subjects followed until 2011.

Saturday, April 14, 2012

Lethal Cocktails: Alcohol, Sedatives, & Opioids

Drug Cocktail Taking opioid analgesics with other central nervous system (CNS) depressants can increase risks of oversedation, respiratory depression, and death due to overdose. Yet, a new study finds that sedatives are somewhat commonly prescribed along with opioids for chronic noncancer pain, and a proportion of patients add alcohol to the mix. Whether or not patients have a history of a substance use disorder does not seem to make a difference, and practitioners need to be more vigilant when prescribing opioids and sedatives for any patients.

A research team led by Kathleen W. Saunders, from Group Health Research Institute, Seattle, Washington, and colleagues from Kaiser Permanente of Northern California, report on a large survey to assess the prevalence and predictors of concurrent alcohol and sedative use among persons also prescribed long-term opioid therapy for chronic noncancer pain [Saunders et al. 2012]. The study was published in the March 2012 edition of the Journal of Pain.

Thursday, April 12, 2012

Is Acupuncture Just a “Meaningful Placebo”?

Acupuncture Recent examinations of acupuncture for various pain conditions suggest that influences other than needling may play essential roles in any efficacy of this modality. Yet, is that cause to cast it aside as a treatment for pain? Some would argue that acupuncture can still be a meaningful patient-centered option within the context of a multimodal approach to pain management.

Writing in the February 2012 edition of the Journal of Pain and Symptom Management, Edzard Ernst, MD, updates his earlier examination of Cochrane Reviews of acupuncture. Ernst — of Peninsula Medical School, University of Exeter, United Kingdom — has been a stern critic of acupuncture and his work has been discussed in prior Pain-Topics UPDATES [here] and [here].