A thought-provoking essay by a long-term pain practitioner presents a controversial indictment of current pain management perspectives and approaches. Of special concern are procedural techniques, or interventions, that may be driven more by economics than better patient care and, in the ongoing turf wars between interventionists and medical practitioners, patients with pain are in danger of becoming collateral damage.
Writing online ahead of print publication in the journal Pain Practice, Gerald M. Aronoff, MD, DABPM, suggests pain management today seems all about the money. He wants practitioners to assess whether they are contributing to the problems of excessive and escalating healthcare costs and declining care for patients with pain [Aronoff 2011].
A recently reported clinical trial examined electroacupuncture — needles inserted at acupoints with electric current applied — for chronic, peripheral neuropathic pain. This therapy afforded no significant pain relief or other benefits; however, the study also serves as an example of poor-quality evidence garnering more attention in a pain journal than it probably deserves.
After more than a decade of increasing opioid prescribing for chronic pain, the pendulum may be swinging the other way. A recent editorial in a major journal appears to reflect common misunderstandings and negative perspectives on the effectiveness and potential harms of opioids. So, it seems essential at this time to dispel the myths and shift the dialog back toward patient needs and benefits of opioids.
A clinical trial of chondroitin sulfate for osteoarthritis of the hand reported modest improvements in pain and functionality, compared with placebo. However, realizing full benefits of active therapy required 6 months and there were no clinically important gains in morning stiffness or grip strength. While certain questions remain unanswered, it seems doubtful that chondroitin is a viable alternative therapy for most patients with arthritic hand pain.
A Cochrane Review of data from about 45,000 patients involved in approximately 350 individual clinical trials provides evidence of what to expect from commonly used pain relievers taken at specific doses for acute postoperative pain. The review also identifies analgesics for which there is only poor or no reliable evidence. Topping the list for pain relief were etoricoxib and oxycodone-plus-acetaminophen, while codeine scored the worst.
A new study demonstrates that high-dose vitamin D helps to relieve debilitating joint and muscle pain in women with breast cancer who are taking estrogen-lowering drugs to shrink the tumors. This is yet another demonstration of vitamin D’s possible role in maintaining bone health while also aiding musculoskeletal aches and pains.
Recently reported research proposes that simple aspirin should be favored over triptan-class drugs as first-line therapy for both migraine and tension-type headaches, regardless of pretreatment pain intensity. While this may make sense for certain patients, there are some concerns with this particular research that merit closer inspection.
A well-designed but small study of PENS (percutaneous electrical nerve stimulation) for superficial, chronic nerve-related pain found that the modality was effective in providing short-term relief. However, while this approach may be promising for certain manifestations of neuropathic pain, the many limitations of this trial and needs for further research should be taken into account.
Imagine having such tight regulations on prescribing a class of medications, such as anti-hypertensives, that practitioners stop using them altogether for patients with high blood pressure. In effect, something similar may be happening with opioid analgesics in Washington state where aggressive new pain-management laws, meant to curb opioid overdose deaths, have some prescribers shunning these medications and leaving patients without adequate pain relief. Could this portend what might lie ahead elsewhere?
Featured Items: tapentadol extended-release tablets (Nucynta) approved for chronic pain; subcutaneous abatacept (Orencia) approved for rheumatoid arthritis; citalopram hydrobromide (Celexa) safety warning. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.
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