Although botulinum toxin A (Botox®) injections are approved in the United States, Canada, the UK, and other countries for the preventive treatment of severe headache conditions, a recent review and meta-analysis of clinical trials found only small benefits in patients with chronic migraine or chronic daily headaches. At the same time, botulinum toxin A injections were no more beneficial than placebo for preventing episodic migraine or tension-type headaches.
According to background information in the article, botulinum toxin A injections were first proposed as a headache therapy when it was observed that patients with chronic headaches receiving those injections for cosmetic purposes experienced headache improvement. This prompted exploratory studies and clinical trials that suggested benefit; however, the medical literature demonstrating the efficacy of botulinum toxin A for headaches still appears to be conflicted and inadequate.
Sciatica is a term often used to describe any low back and leg pain, but it more specifically applies to lumbosacral radiculopathy due to the impingement of nerve roots as they emerge from the spinal canal. Up to half of all cases of spinal pain may be neuropathic in origin, meaning they are caused by nerve compression, inflammation, and/or injury. A pair of recent studies examined treatments for sciatica and found that very few are helpful and they confer only modest and temporarily relief.
Despite guidelines and mandates calling for more aggressive management of pain associated with cancer, millions of persons with the disease still suffer needlessly because practitioners fail to adequately treat their pain, according to a new study. And, this is just the latest report pointing to this as a disgraceful neglect of pain in America and worldwide.
What are we to think of an editorial in this week’s edition of the British Medical Journal with the pithy title, “Opium, Opioids, and an Increased Risk of Death?” The author compares Middle-Eastern opium addicts with patients who have chronic noncancer pain and are prescribed opioid analgesics, claiming that both groups face similarly increased risks of death from their drug use. More than anything, this perspective is a remarkable display of wrong-headed reasoning, or sophistry, found too often in the pain literature these days.
Taking opioid analgesics with other central nervous system (CNS) depressants can increase risks of oversedation, respiratory depression, and death due to overdose. Yet, a new study finds that sedatives are somewhat commonly prescribed along with opioids for chronic noncancer pain, and a proportion of patients add alcohol to the mix. Whether or not patients have a history of a substance use disorder does not seem to make a difference, and practitioners need to be more vigilant when prescribing opioids and sedatives for any patients.
Recent examinations of acupuncture for various pain conditions suggest that influences other than needling may play essential roles in any efficacy of this modality. Yet, is that cause to cast it aside as a treatment for pain? Some would argue that acupuncture can still be a meaningful patient-centered option within the context of a multimodal approach to pain management.
Accidental opioid overdose deaths can occur when rotating (switching) patients from one opioid analgesic to another. Now, a pair of new papers from well-respected experts in pain management challenge the use of equianalgesic tables to determine opioid dosing and, instead, provide more practical guidance on opioid safety during rotation. This is “must-read” advice for all prescribers.
Antidepressants are believed to help manage select pain syndromes, with fewer adverse effects than nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. One of these antidepressants, duloxetine, was approved for treating chronic musculoskeletal pain, including osteoarthritis (OA). Is this agent effective alone or in combination with NSAIDs for the relief of knee pain due to OA? An evidence-based assessment raises some doubts.
What Number Am I? Or, You? by correspondent Thomas Sachy, MD, MSc
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