A Holiday Wish List for Holistic Pain Care

For the 78 million adults with chronic pain in the United States alone, freedom from pain is probably at the top of their “wish lists” for the holidays. The range of therapeutic options for achieving this is actually much broader than many patients and healthcare providers may realize. However, most important may be a holistic perspective that puts the patient at the center of the pain management universe and recognizes that pain relief is but one step on a long road to recovery for better physical, mental, emotional, and spiritual health.

For the past several years in these News/Research UPDATES we have reported on the many and varied approaches to pain management that have appeared in the medical press and scientific literature. Until now, however, we have not assembled a complete listing of those. Most of our list entries below may be familiar to readers, while others may spark new ideas for consideration.

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Low Health Literacy Burdens Arthritis Patients

Health literacy has been defined as the capacity to obtain, process, and understand basic health information and services needed to make appropriate healthcare decisions. As recent research in patients with arthritis discovered, a great many them do not understand even basic terms relating to their care, which poses a challenge for healthcare providers.

A recently published study in JCR: Journal of Clinical Rheumatology found that many patients seen at a rheumatology clinic — including some with a long history of rheumatoid arthritis (RA) — do not recognize common and important terms related to their health and medical treatment. Researchers led by Christopher J. Swearingen, PhD, of the University of Arkansas for Medical Sciences, Little Rock, enrolled 194 patients seen at a university Rheumatology clinic. Each subject was tested using two word lists: one having terms relating to general health and medicine and the other including words specifically related to rheumatology and arthritis. Health literacy scores were compared with patients' health and other characteristics.

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Do Opioids Incur Higher AE Risks in the Elderly?

Assessing Research from Evidence-Based Pain Management (EBPM) Perspectives.

A pair of recently published investigations found that elderly patients with chronic pain taking opioid analgesics had higher risks of serious adverse events (AEs) compared with those taking NSAIDs or coxibs, and the opioids varied among themselves in AE potential. This would appear to caution against opioid use in these patients and contradict current guidelines; however, a closer look at the research evidence casts some doubt on its validity and clinical relevance.

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Mistreated Acute Pain Still A Dire Problem

As we come to the close of the “Decade of Pain Control and Research” in the United States, it is both surprising and disappointing that acute pain is apparently still widely mismanaged or undertreated, according to a recent review in the journal Pain Medicine. One solution may rest with a greater understanding and application of multimodal pain management therapies.

Raymond Sinatra, MD, PhD, from the Yale School of Medicine, New Haven, Connecticut, comments that millions of patients each year suffer acute pain due to trauma, illness, or surgery. Pain accounts for 40% of the 100 million visits to emergency departments, and most patients report moderate to severe pain following the 73 million surgical procedures performed annually in the U.S. Yet, studies indicate that nearly 50% to more than 70% of those patients have unrelieved acute pain and, in one investigation, 40% of patients did not receive analgesics for their severe pain. The elderly, aged 70 years or older, seem to be particularly undertreated when it comes to providing effective analgesia for acute pain conditions.

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The Most Widely Abused & Dangerous Drug for Pain

With concerns about prescription analgesic misuse and abuse taking precedence, policy makers, regulatory agencies, healthcare professionals, and the public have ignored the most harmful and prevalently misused drug. Commonly, and erroneously, used by patients to self-treat pain, this drug surpasses heroin, crack cocaine, crystal meth, and 16 other abused substances when it comes to harming the individual and others, according to a recent report in The Lancet medical journal.

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Stretching to Tame the Pain of Plantar Fasciitis

Plantar fasciitis can be an annoying, possibly debilitating, cause of foot pain. According to a new study, patients with acute plantar fasciitis who regularly perform simple stretching exercises can experience superior pain relief and greater satisfaction than are afforded by treatment with shockwave therapy.

Plantar fasciitis is a common cause of pain on the bottom of the heel and roughly two million patients are treated for the disorder each year. Whether plantar fascia-specific stretching or shock-wave therapy is most effective as an initial treatment for this condition has been unclear. Writing in the Journal of Bone and Joint Surgery (JBJS), an international team of investigators report on the relative effectiveness of these two forms of treatment in patients with acute plantar fasciitis [Rompe et al. 2010]. All participants had heel pain that had persisted for a maximum of 6 weeks and had not been previously treated.

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Acupuncture Alters Pain Sensations in the Brain

Acupuncture for pain relief has been studied extensively, but only recently using brain imaging. A new investigation has found that acupuncture reduces activation in several brain areas involved in the perception and processing of pain, as well as sparking a placebo-like analgesic response.

Using functional magnetic resonance imaging (fMRI), researchers in Germany captured pictures of the brain while patients experienced a pain stimulus, both during acupuncture and without acupuncture, to determine acupuncture's effects on how the brain processes pain [Theysohn et al. 2010]. Study results were presented November 30, 2010 at the annual meeting of the Radiological Society of North America (RSNA).

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New IOM Report Snubs Vitamin D Research

A new report from the U.S. Institute of Medicine (IOM) dramatically revises recommendations for adequate intake and blood levels of vitamin D in healthy persons, while raising serious questions about the veracity of research promoting benefits of the vitamin for various disorders. However, we reaffirm our position on vitamin D for ameliorating pain.

As followers of Pain Treatment Topics and this UPDATES weblog know, we have advocated for vitamin D as being of potential benefit for a range of chronic pain disorders, primarily musculoskeletal in origin [research reviews here and blogpost series here]. A preponderance of research evidence has demonstrated that persons with pain typically have deficient blood levels of vitamin D, and limited trials have generally (though not always) shown improvements in pain with vitamin D supplementation. Now, a new report might appear to contradict much of the prior evidence and challenge current recommendations.

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Dec2010 – Pain Product Announcements & Warnings

Featured Items: denosumab (Xgeva) approval; duloxetine hcl (Cymbalta) approval for musculoskeletal pain; acetaminophen IV (Ofirmev) approval; propoxyphene-containing analgesics (Darvon, Darvocet) withdrawn. — Brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.

Denosumab (Xgeva™) — FDA Approved For Cancer-Related Bone Pain
Amgen received a November 2010 U.S. Food and Drug Administration approval for Xgeva to reduce bone pain and other skeletal-related events in patients with bone metastases from solid tumors. The drug was given a 6-month priority review because it offered an advance in the treatment of metastatic bone pain and skeletal-related events (SREs). Xgeva is a human IgG2 monoclonal antibody that binds and inhibits RANKL, a protein that is essential for cells responsible for bone resorption. The drug, a reformulation of the osteoporosis drug Prolia, is administered every 4 weeks as a 120 mg subcutaneous injection.

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