Nabrun DASGUPTA MPH, PhD
Gregory T. CARTER MD, MS
Drs. Carter and Schatman consider the consequences that would accrue from the removal of opioids from the therapeutic options for chronic pain. The segment also discusses the characteristics of a “better” opioid, and the research understanding needed to get there. Click here to view part 2 of this discussion.
Michael E. SCHATMAN PhD, CPE
Drs. Carter and Schatman consider the consequences that would accrue from the removal of opioids from the therapeutic options for chronic pain. The segment also discusses the characteristics of a “better” opioid, and the research understanding needed to get there. Click here to view Part 1 of this discussion.
Michael M. BOTTROS MD
- Two Surveys Find Discussion is Often Insufficient and Misdirected
An article posted last week in The National Pain Report discusses the findings of two new surveys that express the dissatisfaction of patients with chronic pain over the quality of their patient-provider conversations. In one survey, conducted on behalf of Teva Pharmaceuticals respondents characterized these discussions as “uncomfortable”, primarily arising from the stigma attending prescription medication abuse. A significant proportion of both prescribers and patients worry that frank discussion of abuse would damage their relationships with patients (provider concern) or suggest that they have an addiction problem (patient concern). A second survey that is still underway finds that even when patient-provider conversation is occurring, it is too often focused on issues of adherence, conformance and conditions for continued prescribing, and not on approaches to managing pain conditions (as opposed to cure) and improving overall patient quality of life. The study is being managed by Terri Lewis, PhD, a patient advocate who is exploring some of the topics raised in the draft of the National Pain Strategy suggested by the Institute of Medicine’s 2011 report on relieving pain in America. Read the National Pain Report posting here, with opportunity to participate in Dr. Lewis’ survey.
- Study Finds Both are Equally Effective Additions to the Treatment Armamentarium
A randomized trial of two surgical techniques found that both are “highly effective” in reducing temporal-type migraine severity and frequency. The results are reported in this month’s issue of Plastic and Reconstructive Surgery. Both techniques focus on the nerve associated with temporal migraine, the zygomaticotemporal branch of the trigeminal nerve (ZTBTN), and involve either decompression or partial removal (neurectomy) of the nerve. Bahman Guyuron, MD, Emeritus professor of plastic surgery at Case School of Medicine, Cleveland, developed the procedures after observing that some patients with migraine experienced improvement in their symptoms after undergoing cosmetic forehead lift surgery. Neurectomy of the ZTBTN has been performed as part of several plastic and neurosurgery procedures for decades, with no apparent complications. The trial involved 20 patients with temporal-type migraine, all of whom reported severe and frequent attacks that were not relieved by standard medications. Surgery was performed on both sides of the head, with decompression on one side and neurectomy on the other. A comparison of outcomes performed a year after surgery found that in almost 90% of cases, the test subjects experienced a minimum of one half reduction in migraine frequency and severity. Further, the results were almost identical between sides, and no complications were reported from either procedure. Read more about the trial results, with link to the journal article, here.
- Male and Female Pain Processing Differs (in Study Mice)
In conclusions that may have profound implications for the understanding and approach to chronic pain, researchers from McGill University, The Hospital for Sick Children, and Duke University report that pain is processed differently in male vs female mice. The findings are reported online in advance of publication in the journal Nature Neuroscience. Co-senior author Jeffrey Mogil, PhD, E.P. Taylor Professor of Pain Studies at McGill University and Director of the Alan Edwards Centre for Research on Pain, commented “Research has demonstrated that men and women have different sensitivity to pain and that more women suffer from chronic pain than men, but the assumption has always been that the wiring of how pain is processed is the same in both sexes.” Existing theory has held that pain transmission through the nervous system engages immune system cells called microglia. The current study of mice found, however, that this is only the case in males, where it was demonstrated that interfering with microglia function was effective in blocking pain. The same intervention was ineffective in female mice, because a different type of immune cell, T cells, appears to be involved in pain transmission. The authors contend that the findings will materially impact work on the development of future generations of pain medications for humans, because of the similarity in nervous system structure in mice and humans. To watch a video about Women and Chronic Pain, with Dr. Hal Blatman, click here. PAINWeek 2015, the national conference in Las Vegas September 8-12, will present “Fibromyalgia” and “Simplifying the Gender Specific Complexities of Female Chronic Pelvic Pain” and other topics about women and pain. For more information or to register, go to painweek.org. To read more about research into women and pain, click here. Read more about the findings mentioned above, here. A link to the Nature Neuroscience abstract may be found here.
- Fibromyalgia and Hyperbaric Oxygen Therapy: Encouraging Results in Small Study
Results of a small study published in the June edition of the journal PLOS ONE found that women with fibromyalgia experienced relief from pain and other symptoms after undergoing hyperbaric oxygen therapy. Brain scans of the patients showed that 2 months of hyperbaric oxygen therapy, most often associated with treating “the bends” in scuba divers, may have also repaired abnormal brain activity in pain-related areas of the brain, the researchers said. Lead study author Shai Efrati, MD, director of the Sagol Center for Hyperbaric Medicine and Research in Tel Aviv, Israel, stated “70% of the patients could not be categorized as suffering from fibromyalgia at the end of the treatment.” According to the American College of Rheumatology (ACR), fibromyalgia affects 9 times more women than men. Symptoms include chronic widespread pain, intense pain in response to pressure on certain body parts, fatigue, and poor sleep. The condition is poorly understood and has not been traced to a single cause. Physical or emotional factors may trigger symptoms, the ACR says. Fibromyalgia is typically treated with a combination of therapies, including drugs, lifestyle changes, and cognitive behavioral therapy. In this study, 48 women who had been diagnosed with fibromyalgia at least 2 years earlier were placed in 2 groups. Half underwent 40 hyperbaric oxygen therapy treatments over 2 months. The treatments were given 5 times a week in sessions of 90 minutes each. During the treatment, patients breathed 100% oxygen pressurized to twice the normal air pressure. The therapy is thought to increase oxygen flow to body tissues, improving healing. Fibromyalgia is not currently one of the FDA-approved conditions for hyperbaric oxygen therapy, which continues to be tested for this and other “off-label” conditions. To learn more about brain abnormalities in fibromyalgia, click here. To read about fibromyalgia and hypersensitivity, click here. Read a news story about the findings above, here.
Department of Public Health and Community Medicine
Tufts Medical Center