Here is a lesson in evidence-based pain management. Researchers reported that intrathecal midazolam, a benzodiazepine, was a beneficial supplement to standard analgesic therapy for recalcitrant lower-back pain. However, because of the study design and limited data this is not valid evidence of treatment effects, which raises questions about why this study was published.
Writing in the journal Pain Medicine, Jan Prochazka, MD, and colleagues from the Czech Republic describe a prospective, observational, open-label investigation of single-dose intrathecal administration of midazolam (off-label) in patients with chronic low-back pain or failed back surgery syndrome [Prochazka et al. 2011]. The primary outcome measure was pain relief determined by a patient questionnaire during subsequent visits to the pain therapy clinic. A positive analgesic-effect result was considered at least 50% pain reduction along with improved quality of life and functionality.
While there are many treatments for chronic low back pain, none are effective in all cases and the search is ongoing for helpful therapies. There is limited evidence that yoga instruction can be helpful for some patients, but it could be that only the stretching component of yoga is most effective. Another possibility is that a self-help book for back-pain relief could be just as beneficial for patients who follow its exercise recommendations. Which approach is best?
Past studies and commentary have claimed that higher opioid analgesic doses increase mortality rates; yet, the research methods used to establish this should be challenged by critical readers. A recent data-mining investigation from Canada is a good example of how evidence can be statistically manipulated to arrive at outcomes with questionable validity, perpetuating myths of opioid harms that may not truly exist.
Chronic pain may be associated with too much or too little physical activity. New research finds that the right amount, duration, and intensity of leisure-time exercise can make a significant difference in who has long-lasting pain, but there also are differences between men and women and younger versus older age groups.
Recent results from the 15th annual consumer survey conducted by the American Massage Therapy Association (AMTA) show that consumers have a growing awareness of the health benefits of massage. In fact, 90% of individuals perceive massage as effective in reducing pain and an increasing number of people consult physicians and other healthcare professionals about massage therapy.
A newly-reported clinical trial from Sweden found that exercise is as effective as drug therapy, or as relaxation techniques, in preventing migraines. However, reductions in monthly frequency of migraines with all 3 treatments appear rather modest and may be disappointing to some patients. Yet, there were limitations of this research and the true value of these treatment approaches might not have been fully explored.
Medication therapy is a mainstay for helping to relieve pain of all types, facilitate functionality, and improve quality of life. It is sometimes difficult for patients and practitioners alike to imagine ending a clinical encounter without a medication prescription. However, an important new article outlines 24 principles of prescribing that advocate for a paradigm shift from “more and newer” to “fewer and more time-tested” drugs when it comes to managing pain and other health conditions. There are vital lessons here for healthcare providers and their patients.
In a large study of elder adults, those taking opioid analgesics were found to have a higher risk of developing pneumonia than among similar persons not taking opioids. At the same time, the researchers found that benzodiazepines, often given for insomnia and anxiety, did not affect pneumonia risk in this population. However, one must question the validity of this study and whether it is merely another “myth-representation” of alleged problems with opioids.
Patients taking oral steroids are twice as likely as the general population to have severe vitamin D deficiency, according to a study of more than 22,000 children and adults. This suggests that healthcare providers should closely monitor vitamin D levels in patients being treated with steroid medications for pain-related or other conditions. While vitamin D supplementation may be necessary, new evidence also reveals how much daily vitamin D is too much and could be toxic.
Recent news and research articles have been decrying escalating trends in overdoses and deaths from opioid analgesics and heroin. Yet, rarely is mention made of the fact that there is an effective and safe antidote for such tragedies — naloxone. Isn’t it time to stop the complaining, and conducting pilot studies, and to start using naloxone on a broad scale to address the problems?
Research consistently finds that patients’ beliefs and expectations of benefit from pain treatments can influence their responses, and that a considerable component of pain relief might relate to placebo effects. An often overlooked phenomenon is how the beliefs and expectations of healthcare providers and family members — engendering a placebo by proxy effect — also might affect a patient’s response to pain management therapies.
Featured Items: infliximab (Remicade) approved for pediatric ulcerative colitis; tumor necrosis factor-alpha (TNFa) blocker safety warning; ondansetron (Zofran) safety warning. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.
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