The ongoing Pain-Topics series, “Making Sense of Pain Research,” has encouraged professionals and patients to develop a “healthy skepticism” toward everything they read in journals, hear at conferences, or see in the news. As it turns out, skepticism regarding modern science, including the field of pain medicine, is somewhat of an international movement. Its mantra might be “Stop the B.S.” (with the irreverent logo at right); yet, there is an apparent danger of skepticism becoming close-minded cynicism falling into the trap of contempt prior to investigation that might preclude truly objective analyses of research.
Friday, July 29, 2011
Wednesday, July 27, 2011
According to an increasingly vocal assembly of international health and human rights organizations, disparities in access to pain care worldwide are staggering. Instead of healthcare settings being places where human rights are preserved, they often are institutions where rights are abused and pain is mistreated or untreated to the point of being torture. While such problems might be smugly perceived as the plight of developing countries, even in the most modern societies, including the U.S., the epidemic of pain is a plague that can and should be humanely addressed and eradicated.
Friday, July 22, 2011
A newly-reported imaging study found that oral morphine administration in patients with chronic low back pain altered gray matter thicknesses in several brain structures. While the authors imply that these neuroplastic changes might be detrimental, it seems equally likely that long-term opioid administration restores the pain-altered brain to a more normal, healthy state.
As opioid analgesics are increasingly prescribed for chronic noncancer pain, it is important to understand potential effects of these agents in changing neurobiological structure and function of the brain. Researchers at Stanford University, California, conducted a longitudinal, MRI (magnetic resonance imaging) study examining 10 individuals with chronic, moderate-to-severe, nonradicular low back pain who were administered long-acting oral morphine (MS-Contin) daily for 1 month [Younger et al. 2011].
Part 8 — Precision, Accuracy, & Significance of Mean Values
Research outcomes are commonly reported as average, or mean, values; however, averages can be misleading, so it is important that they are examined from perspectives of their precision and accuracy. And, better understandings of statistical measures such as the Standard Deviation (SD), Standard Error of the Mean (SEM), and Standardized Mean Difference (SMD) are essential for assessing the validity and clinical significance of pain research data.
Friday, July 15, 2011
Even with all of the advances in medical science, patients in America only have a 1 in 4 chance of receiving adequate pain relief following surgery. It is even worse in many other parts of the world, according to recent commentary in The Lancet medical journal, and this unresolved acute postoperative pain often leads to problematic chronic pain conditions, affecting up to half of patients undergoing common operations.
A prior Pain-Topics UPDATE [here] discussed another article in The Lancet series on pain, which focused on the epidemic of unresolved chronic noncancer pain worldwide. In this second paper, Christopher L Wu and Srinivasa Raja from John Hopkins University School of Medicine, Baltimore, review the progress made in treatments for postoperative pain over the past decade [Wu and Raja 2011] They stress that, despite considerable advancements in pain management, a high percentage of patients continue to experience moderate-to-severe pain after surgery. And, inadequate post-surgical pain management is not just limited to adults; a study from the U.S. reported as many as 86% of children experiencing significant pain on the first day home after undergoing routine procedures like tonsillectomy.
A newly reported clinical trial found that patients experiencing mild migraine attacks achieved significant pain relief with a homeopathic preparation of ginger and the herb feverfew. However, this was a small study with numerous limitations and potential sources of bias.
Writing in the journal Headache, from the American Headache Society, researchers report a multi-center trial involving subjects meeting International Headache Society criteria for migraine with or without aura and experiencing 2-6 migraines per month; 77% were female, 87% Caucasians, mean age 41 years [Cady et al. 2011]. They were randomized 3:1 to receive either a sublingual feverfew/ginger product or a matching placebo, and were instructed to treat with study medication at the earliest recognition of migraine.
Thursday, July 14, 2011
Words do make a difference and the language used to describe pain conditions, treatments, and affected persons can either perpetuate or dispel harmful misconceptions and negative stereotypes. An important reminder of this and helpful suggestions come from the American Pain Foundation.
Previous research has shown that merely hearing certain pain-related words can fire-up the brain's pain centers in persons with pain [see prior UPDATE here]. Equally important is the communication of healthcare providers in their discussions with patients, in conversations with colleagues, in written articles, or during conference presentations. A 2-page handout, “Tips for Using Language to Communicate Effectively, Empower People and Create Change about Pain and its Management” [PDF here], offers excellent advice. Here are some highlights [with our added commentary]:
Saturday, July 9, 2011
While much has been said and written about problems associated with opioid analgesics, relatively little has been effectively done as yet to stem the tide of misuse, abuse, overdoses, and deaths. Rather than waiting for federal or state agencies to come to their rescue, one rural coalition took control themselves in developing a successful opioid overdose prevention program. This truly demonstrates the power of the community for solving its own public health problems.
Friday, July 8, 2011
According to new research published in the British Medical Journal, commonly used medications to treat pain and inflammation are linked to an increased risk of irregular heart rhythm, known as atrial fibrillation or flutter. The implicated agents involve non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors. While absolute risk increases are modest, there could be strong concerns regarding use of these agents by select patients.
These drugs have already been linked to an increased risk of heart attacks and strokes [see prior Pain-Topics UPDATES here and here], but no study has examined whether they also increase the risk of atrial fibrillation — a condition associated with increased long-term risk of stroke, heart failure, and death.
When it comes to treating chronic lower back pain, a new U.S. government funded study suggests that massage therapy may be better than medication or exercise for easing discomfort and improving function — at least in the short term. However, the type of massage that is best, duration of therapy, and who might benefit most need further consideration.
At an integrated healthcare delivery system in the Seattle Washington area, 401 persons with nonspecific chronic lower back pain were enrolled in a parallel-group, randomized, controlled trial to test 2 types of massage therapy compared with usual care [Cherkin et al. 2011]. Participants were blinded to massage type — either structural massage (n = 132) or relaxation massage (n = 136) — while the rest were randomly assigned to usual care (n = 133). Those in the massage groups were given approximately 60-minute massage treatments once-weekly for 10 weeks by one of 27 therapists. Usual medical care included opioid analgesics, anti-inflammatory drugs (NSAIDs), and/or muscle relaxants/sedatives. Average age was 47 years and most participants were female, white, employed, married, and had back pain for at least 1 year.
Friday, July 1, 2011
A virtual avalanche of articles has appeared in the medical literature recently discussing opioid analgesics for chronic pain. Almost without exception, the news and views are disparaging; in some cases reflecting a poor quality of evidence and, in others, conveying biases of the authors. Ongoing concerns about opioid misuse, abuse, and fatalities may be obscuring a problem of equal or greater importance — intentional self-harm, suicide, by drug overdose among persons with chronic pain. It may be time for a rational reassessment of this problem before it is too late.
Chronic pain affects more than a third of all citizens, it is widely undertreated or mistreated, patients are stigmatized, physicians are inadequately educated, and it costs more than half a trillion dollars each year in medical expenses and lost productivity alone. Those are just a few of the startling findings of a newly released report from the U.S. Institute of Medicine (IOM), which also proposes a multifaceted blueprint for action. The big question is, will something really be done about this public health crisis… and soon?
The 2010 Patient Protection and Affordable Care Act required the U.S. Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem. The lengthy report, released on June 30, 2011 — Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research — calls for a cultural transformation of attitudes toward pain and its prevention and management. The entire consensus report is available [here].
Featured Items: tamper-resistant oxycodone (Oxecta) approved; painful fissure ointment (Rectiv) approved; proton pump inhibitors (PPIs) class safety alert; oxycodone/acetaminophen tablets (Endocet) recalled; two combination products (butalbital-APAP-caffeine tablets and hydrocodone bitartrate-APAP) recalled; Tylenol caplets safety recall. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.
Tamper-Resistant Oxycodone (Oxecta™) — FDA Approved
Pfizer and Acura Pharmaceuticals announced a June 2011 U.S. Food and Drug Administration (FDA) approval for their immediate-release pain medication Oxecta. This novel formulation uses a drug delivery system from Aversion Technology designed to reduce the incidence of abuse and tampering. The new technology discourages abuse by causing the active ingredient to gel or to irritate nasal passages, thereby hindering injection or inhalation. Oxecta is a controlled substance intended for patients with moderate to severe pain that cannot be managed by other analgesic products.