U.S. Chronic Pain Data Updated — Alarming News!

New data from the largest single survey to date propose that an astounding 78 million American adults suffer from chronic pain lasting 3 months or longer. This is higher than previous estimates and suggests this is an unrestrained epidemic that could become a major political issue concerning the quality of healthcare in the United States.

Last June, 2010, we reported [here] on a comprehensive examination of worldwide surveys that discovered chronic pain prevalences ranging from 12% to 80% in the selected populations, with an estimated 76.5 million adults afflicted in the United States. Now, a very large research survey in the U.S. corroborates those findings and reports an alarming increase in prevalence of chronic pain. Using a unique cross-sectional, Internet-based approach researchers were able to gather data from a representative sample of 27,035 adults (ages ≥18 years) to estimate the point prevalence of chronic pain, and to describe sociodemographic factors and other characteristics of the problem [Johannes et al. 2010].

Read more »

Propoxyphene Products Withdrawn in USA. Why?

After more than 5 decades of use in many millions of patients the opioid analgesic propoxyphene is being withdrawn from the United States market at the FDA’s request due to concerns about potential cardiac arrhythmias. Was this prudently cautious or a delayed overreaction? And, it raises a further question: Could a ban on methadone lie ahead?

Earlier today (November 19, 2010), Xanodyne Pharmaceuticals agreed to withdraw the DEA-Schedule IV opioid analgesic propoxyphene — eg, Darvon® and Darvocet® brands — from the U.S. market at the request of the United States Food and Drug Administration (FDA). New data showed that the drug could cause serious cardiotoxicity, even when used at therapeutic doses, so the FDA concluded that the safety risks of propoxyphene outweigh its benefits for pain relief. The agency requested that generic manufacturers of propoxyphene-containing products remove their products as well.

Read more »

Study Suggests Vitamin D May Not Benefit Knee OA

In prior research reports [here] and blogposts [here] we have advocated for vitamin D supplementation as helping to relieve the pain of musculoskeletal and certain other conditions. However, in fair balance, new research raises important doubts about benefits of vitamin D specifically for lessening symptoms or slowing progression of knee osteoarthritis (OA).

According to research presented November 8, 2010, at the American College of Rheumatology Annual Scientific Meeting in Atlanta, Georgia, investigators in Boston enrolled 146 persons with symptoms of knee OA in a study to examine disease-modifying effects of vitamin D supplementation [McAlindon et al. 2010]. Participants were 57% female, 79% Caucasian, mean age 62 years and, on average, they were borderline obese (mean body mass index = 30.7 [BMI definitions here]). Although more than half (56%) were taking vitamin D supplements in unspecified amounts, their average vitamin D level was insufficient (mean=22.3 ng/mL).

Read more »

Benefits of Tai Chi for Arthritis Pain Examined

Tai chi — a traditional Chinese martial art and exercise regimen characterized by slow, gentle, graceful movements — has been demonstrated as beneficial in patients with fibromyalgia and other chronic pain conditions. A newly-reported, well-designed study found tai chi significantly helps to relieve arthritis pain and improves well-being; although, ways of maximizing clinical benefits need further consideration.

In these UPDATES blogposts, we have previously described research demonstrating benefits of tai chi for fibromyalgia pain [here] and for chronic pain in general [here]. Now, in a large, community-based, randomized controlled trial, researchers from the University of North Carolina at Chapel Hill School of Medicine evaluated the effectiveness of the Arthritis Foundation’s 6-week, twice-weekly tai chi course for reducing symptoms, increasing function, and improving psychosocial status in persons with arthritis [Callahan et al. 2010]. Their study was presented November 8, 2010, at the annual scientific meeting of the American College of Rheumatology in Atlanta, Georgia.

Read more »

Tricyclic Antidepressants for Headaches Reviewed

Migraine headaches afflict between 8.4% and 18% of the worldwide population, and tension-type headaches are even more pervasive, occurring in up to 30% of adults. A recently reported analysis of available data found that tricyclic antidepressants, specifically amitriptyline, offer advantages over placebo or selective serotonin reuptake inhibitors; however, patient tolerability of the drugs may be a concern and a number of research questions remain unanswered.

Researchers from the United States, writing in the British Medical Journal, report a data meta-analysis to evaluate the efficacy and relative adverse effects of tricyclic antidepressants (eg, amitriptyline, clomipramine, desipramine, and others) in the treatment of migraine and tension-type headaches [Jackson et al. 2010]. An extensive literature search for randomized trials of adults administered tricyclics as monotherapy for at least 4 weeks produced 37 studies meeting the inclusion criteria; most of the studies (81%) investigated amitriptyline as the tricyclic agent.

Read more »

Naloxone ‘Reboots’ Opioid Pain-Relief System

In a prior research report we described potential benefits of using low-doses of the opioid antagonist naloxone to “reboot” the body’s natural opioid-receptor system in patients who are not achieving adequate pain relief with opioid medications [Leavitt 2009]. While anecdotes are not conclusive scientific evidence, a new case report describes a protocol and provides further support for this novel application of naloxone.

Colleagues from the Liaoning University of Traditional Chinese Medicine, Liaoning Province, China, recently informed us of an important case study of naloxone for reversing resistance to high-dose morphine in a 56-year-old male patient with terminal bladder cancer [Dongfeng et al. 2010]. Despite surgery, chemotherapy, and radiotherapy the carcinoma metastasized and the disease was progressing. The patient experienced severe, refractory abdominal and low back pain that could not be controlled with high-dose oral morphine and transdermal fentanyl analgesia equivalent to 1,200 mg morphine per day in total, plus the patient received adjuvant therapy (eg, acetaminophen, carbamazepine) as well as morphine (30 mg oral or 10 mg IV three times daily) for breakthrough pain flares. Adverse effects of opioid analgesia — delirium, nausea, vomiting, and constipation — were significant and intolerable.

Read more »

Hold the Patient; Help the Pain?

For newborn infants, being held and swaddled appears to be a simple and effective way to reduce acute pain during routine but painful procedures, according to new research. This raises a simple and important question: Would being held and comforted also be helpful for minimizing pain during procedures in children and adults?

Read more »

Help Promote Safe Opioid Use in Elderly Patients

Pain is a pervasive complaint among elderly patients and it can be challenging for healthcare providers to treat both safely and effectively. Opioids are often a recommended option for acute or chronic pain in this population and the vast majority of elderly patients will be compliant with the prescribed therapeutic regimen; but they (and their family caregivers) must be educated on safe opioid use. There are implications here for all healthcare providers who may prescribe opioids, whether in community medicine, dentistry, emergency care, hospice or palliative care, and other settings.

Prior surveys have found that undertreated pain or inadequate pain relief for both acute and chronic conditions are common in older patients. A newly-reported large-scale study in the Annals of Internal Medicine notes this situation worsens as persons approach later years of life [Smith et al. 2010]. In the report, unrelieved pain of at least moderate severity was experienced by a quarter of persons (26%) during the last two years of life and this increased to affect nearly half of them (46%) during the last month of life, regardless of the cause of death (eg, cancer, heart disease, frailty, or other). Earlier reports suggested that 70% of patients with cancer have significant pain, yet fewer than half of them receive adequate pain relief [discussed in blogpost here].

Read more »

Using Hypnosis to Help Patients Manage Pain

By guest author, Michael Ellner, MSH, CHt

A quick thanks for the invitation to write this guest blog. I welcome the opportunity to give readers of Pain-Topics.org some insights and practical hands-on advice, much of it taken from the 6 hours of CME training on Mind-Body Medicine that Dan Cleary and I recently taught at PAINWeek 2010. This was the 4th year that Dan and I taught the Hypnosis Track at this event on behalf of the International Medical and Dental Hypnotherapy Association (IMDHA), and we want to thank the hundreds of frontline clinicians who attended our courses.

My focus here is two-fold. First, I want to introduce you to the benefits and advantages of using certified hypnosis professionals in the management, amelioration, and even elimination of pain. Second, I want to review the basic tools and concepts of effective communication and rapport building that can improve your patient-interaction skills.

Read more »

Chronic Neck Pain Can Be Real “Pain in the Neck”

Past research has reported that a third to half of all adults may suffer acute or chronic neck pain in any given year. Now, a new survey paints a rather dismal picture when it comes to chronic neck pain, with patients seeking care from multiple practitioners, over a long period of time, and often receiving numerous inadequate therapies.

Researchers at Duke University and the University of North Carolina — reporting in the upcoming November issue of Arthritis Care & Research — surveyed 5,357 North Carolina households, questioning respondents aged 21 or older about “chronic impairing neck pain” [Goode et al. 2010]. This was described as (1) neck pain and activity limitation nearly every day for the past 3 months, or (2) greater than 24 episodes of neck pain in the previous year with each episode limiting activity for a day or more. Cases of neck pain with concurrent low back pain were excluded.

Read more »

Shockwave Therapy Beneficial for Tendon Pain

A small study of athletes suggests that shockwave therapy, which delivers pulses of sound waves to injured body tissue via a hand-held probe placed on the skin, may heal chronically injured hamstring tendons. However, further research on shockwave therapies is needed and it should be recommended cautiously.

Writing in the American Journal of Sports Medicine, Italian researchers report on testing the effectiveness of shockwave therapy in chronic cases of so-called proximal hamstring tendinopathy (PHT) in 40 professional athletes [Cacchio et al. 2010]. (Hamstring muscles, with their associated tendons are on the back side of the thigh, superficially observed from the bottom of the buttocks to the back of the knee.) All of the athletes had experienced recurrent, debilitating pain and tenderness from PHT for at least 6 months.

Read more »

NIDA Misses Mark on Naloxone for Opioid Overdose

In a prior posting [here] and recently published article [PDF here] we stressed the life-saving potential of at-home naloxone as an overdose antidote for all patients prescribed long-term opioid medications. Along with that we lamented the lack of government or manufacturer interest in supporting such an approach. Now, along comes a U.S. government organization expressing interest; however, they seem headed in the wrong direction.

Briefly, we have written about the demonstrated effectiveness of naloxone for reversing opioid effects and alleviating fatal respiratory depression during overdose. In an emergency, it can be easily and quickly administered via the nose (intranasally) — using a prefilled syringe of naloxone with an atomizer tip — by any family caregiver or bystander who has received about 10-minutes of training (or, in certain cases, by the patient). Another possibility, would be development of an Autoinjector (similar to the well-known EpiPen) for intramuscular injection. Either approach would be inherently safe and should cost perhaps $25, or less. To date, however, neither manufacturers nor government agencies have shown any interest.

Read more »

Nov2010 – Pain Product Announcements & Warnings

Featured Items: botulinum toxin type A (Botox) approval, generic oxycodone hydrochloride 5 mg capsule approval, methotrexate recall, fentanyl transdermal system recall.
— Brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.

Botulinum Toxin Type A (Botox®) —Approved by FDA For Chronic Migraine
Allergan received an October 2010 U.S. Food and Drug Administration approval for Botox as chronic migraine prevention therapy. The product is intended for patients who experience migraine headaches 14 or more days per month. Treatment involves multiple Botox injections in the muscles of the head and neck approximately every 12 weeks to reduce future headache symptoms. Approval was based on 2 controlled trials of more than 1,300 patients, with results showing that treated patients had slightly fewer headache days than patients who received the sham treatment. The 2 most frequent adverse reactions reported by participants in the treatment group were neck pain and headache. It may be important to note that Botox treatment can be costly in comparison with other preventive therapies and may not be approved for insurance coverage. For full product information, see the prescribing information and medication guide for Botox.

Read more »