Part 11 – Weighing Evidence in Law and Medicine
Just as “Where’s the beef?!” was the exhortation in a once-popular hamburger commercial in the U.S., healthcare providers and patients should be demanding “Where’s the proof?!” when it comes to research in the pain management field. This article in our ongoing Series, “Making Sense of Pain Research,” examines parallels of proof in law and medicine regarding several critical questions: What qualifies as evidence? What are the requirements of evidence as proof? How much proof is necessary for reaching valid and just clinical decisions?
Drug overdose deaths have risen dramatically in the United States, with fatalities involving prescription opioids and illicit heroin prominently implicated. However, since the mid-1990s a small number of community-based programs have offered naloxone — a medication approved since 1971 that reverses the often fatal effects of opioid overdose — to illicit-drug abusers and their families and friends. According to new data from the from the U.S. Centers for Disease Control and Prevention (CDC) the number of at-home overdose rescues using naloxone has been remarkable; yet, patients prescribed opioids for pain rarely have access to this potentially lifesaving medication.
Excess body weight may incur many health problems and research has linked obesity with various chronic pain conditions, including fibromyalgia syndrome (FMS). A new report furthers the notion that obesity in persons with FMS may be associated with greater disability and poorer quality of life. However, the implied causal relationship between obesity and FMS is uncertain and there is a possibility that this whole line of investigation may be wrong-headed and unhelpful.
Limited clinical research has demonstrated that massage may provide safe and effective pain relief for persons with osteoarthritis (OA), a slowly progressive disease of the joints that afflicts roughly 27 million Americans. But, questions remain about the optimal frequency and length of massage sessions to produce best results. A recently reported study found that a 60-minute massage once per week may be most beneficial; however, some aspects of this trial were disappointing and cast doubt over the outcomes.
Along with the increasing prescribing of opioid analgesics for chronic pain have come growing concerns about patients misusing or developing addiction to those medications. Some believe that the phenomenon of craving in patients with chronic pain treated long-term with opioids may not only predict medication misuse but may also signal addiction. Several investigations have explored opioid craving and its effects in such patients, but the research has been of low quality and critical questions remain unanswered.
By guest author, Dmitry M. Arbuck, MD
Small-scale studies have demonstrated a positive relationship between body weight, particularly obesity, and self-reported pain of various types. Now, a study of more than 1-million Americans confirms the presence of higher rates of pain among the heaviest of individuals. The exact reasons for this, which comes first, pain or obesity, and whether losing weight is beneficial are still unclear.
Clueless in Seattle by correspondent Thomas Sachy, MD, MSc
Featured Items: fentanyl sublingual spray (Subsys) approved for breakthrough cancer pain; FDA safety alert regarding Endo/Novartis opioid product packaging problem; natalizumab (Tysabri) FDA safety alert; FDA approval of TIRF REMS program. — All brand names are trademarks of their respective manufacturers. Compiled by: Winnie Dawson, MA, RN, BSN. 
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