Convincing new evidence demonstrates how patients’ beliefs and expectations of benefit or adverse effects can directly influence response to opioid analgesic therapy. This has important implications for the role of healthcare providers in helping to shape and optimize patient response to any pain relieving treatment.
Researchers from Britain and Germany examined how divergent expectancies may alter the efficacy of potent opioid analgesia. Efficacy of a fixed concentration of the intravenous (IV) μ-opioid agonist remifentanil in ameliorating a heat pain stimulus was assessed in each of 22 healthy volunteers under 3 experimental conditions. Besides subject self-reports of pain decrease/increase, functional magnetic resonance imaging (fMRI) was used to record brain activity to corroborate subjective responses and to reveal underlying neural mechanisms. The procedure was as follows…
With all the emphasis lately on the alleged epidemic of overdoses and deaths associated with prescription opioids an overlooked dark secret is that pain relievers — both Rx and over-the-counter — are increasingly used in suicide attempts, particularly by women. Better strategies than prescriber education and restricting access to these medications are needed for effectively dealing with this other “epidemic.”
Writing in the June 2011 edition of the journal Pain, an international team of researchers report using a laser to produce brief pin pricks of “pure pain” (pain without touch) on the hands of a small group of 8 volunteers [Gallace et al. 2011]. Pain stimuli were then repeated after subjects crossed their arms at the wrists. Subjects rated their pain during each condition and their brain responses to the pain were measured via electroencephalography (EEG).
Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract causing abdominal pain, diarrhea, GI bleeding, and weight loss. Current therapies for the condition reduce the inflammation but some are expensive and may incur rare but serious side effects, including infections and lymphoma.
Part 6 – Understanding RR, RRR, ARR, & NNT
The healing art of homeopathy dates back several centuries, yet it remains controversial. A recently reported clinical trial demonstrated that homeopathic remedies were of no help for treating painful rheumatoid arthritis (RA), but benefits of the homeopathic consultation itself were substantial. Yet, there are serious deficiencies in this research that leave open the question of whether homeopathic remedies might be of value in treating RA.
When heart attack survivors or those with heart disease take nonsteroidal anti-inflammatory drugs, or NSAIDs, it puts them at higher risk for recurring heart attack or death, according to a new study in Circulation, a journal of the American Heart Association. Results of the new research suggest that even short-term use of these pain relievers is unsafe for these patients with pain.
It is well known that non-adherence to prescribed opioid regimens can decrease both the safety and effectiveness of this analgesic therapy. A new study examined factors associated with such noncompliance and found that somatization strongly influenced over- and underuse of medication. This may suggest strategies for more effective opioid prescribing, but there were some important limitations of this research.
According to a new survey from the American Osteopathic Association (AOA), more than 85% of Florida residents say they, or someone they care for, have experienced pain in the past month. This comes at a unique time in Florida when the state legislature is revamping health policies and introducing safeguards to prevent prescription analgesic abuses, which may inadvertently thwart access to those pain medications.
It is often assumed that patients with disability related to low-back pain (LBP) will have reduced physical activity, and treatment emphasizes maintaining or gradually increasing activity. Now, researchers have found that there is no significant correlation between physical activity level and disability in acute/subacute LBP. In chronic LBP, as might be expected, persons with higher levels of disability are less likely to be physically active, and whether increased activity would be helpful for them is largely unknown.
According to a pair of studies in an upcoming edition of the American Journal of Preventive Medicine, a surprising majority of Americans do not know what is in their over-the-counter (OTC) analgesics. Most people do not bother to read warnings on product labels, which is particularly troublesome with acetaminophen. However, even more alarming is that 70% of acetaminophen poisoning cases are intentional attempts to inflict self harm.
Part 5 – Helping to Determine Clinical Significance
Now that the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioid analgesics has been announced [see 
Researchers at the Rockefeller University in New York, have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the effectiveness of selective serotonin reuptake inhibitors, or SSRIs. Could this discovery, published online in the Proceedings of the National Academy of Sciences, explain cases of depressed patients with pain who do not respond as expected to antidepressant therapy when they also are taking over-the-counter analgesics?
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