Cynthia F. KNORR-MULDER MSN, BCNP, NP-C
Gary W. JAY MD, DAPPM, FAAPM
Kevin L. ZACHAROFF MD, FACIP, FACPE, FAAP
Has The Decade of Pain had a positive impact on the caliber of pain education in the US? A prominent pain educator and practitioner offers an assessment of pain education today, including lessons learned from the past that may guide future improvements. Watch the video for thoughtful insights from this distinguished PAINWeek contributor.
Michael S. SAENGER MD
- Animal Research Identifies a Nonopioid Alternative for Pain Control
Findings from animal studies suggest that a combination of isovaline and anesthetic agents may preclude the need for opioid medications—and their attendant adverse effects—for procedural sedation and anesthesia. The results are reported in Anesthesia & Analgesia. Isovaline is a unique type of analgesic that acts on one specific type of neuroceptor: the GABAB receptors. Because it doesn't cross the "blood-brain barrier," isovaline acts only on peripheral neuroreceptors outside the central nervous system. A research team from the University of British Columbia, Vancouver, constructed a series of mouse studies to evaluate isovaline as an opioid alternative for general anesthesia. The mice were administered propofol in combination with either isovaline or the opioid fentanyl. The team found that propofol alone produced hypnosis, but didn't block pain responses, while the addition of isovaline "resulted in loss of consciousness and immobility to noxious stimuli." The same result was achieved with the combination of propofol and fentanyl, but with the attendant risk of respiratory depression. The study concluded that because of its lack of effect on the central nervous system, isovaline might be considered as a valid alternative for general anesthesia and procedural sedation. Read more about GABAB here. Read more about the findings here. Editorial commentary on the findings may be read here. The study abstract may be read here.
- Molecular Process Critical to Maintaining GI Health
New insight into the role of the immune system in maintaining homeostasis of bacteria in the intestinal tract may be useful in the development of targeted therapies for various inflammatory bowel diseases, as well as colorectal cancer. The study, appearing online last week in Cell Reports identified a molecule, called Absent in Melanoma 2 (AIM2) that detects the DNA of harmful microorganisms and regulated inflammation in the gut. AIM2 is found in all immune and epithelial cells, and defects in AIM2 may adversely affect DNA sensing, thereby contributing to intestinal inflammatory disorders including IBD, ulcerative colitis, Crohn’s disease, and colorectal cancer. The research found that when AIM2 detects the DNA of harmful microorganisms (pathogens) in immune and epithelial cells, the protein activates a molecular machine called the inflammasome. This in turn activates the enzyme caspase-1, which then produces 2 proteins (IL-1β and IL-18) that play important roles in the GI tract, including activation of immune cells, induction of antimicrobial peptides, and regulation of epithelial cell proliferation. But defects in AIM2-mediated inflammasome activation lead to growth of IBD-causing bacteria like E. coli, as well as dysregulated inflammation and compromised healing of intestinal injury. Senior author Hasan Zaki, PhD, Assistant Professor of Pathology at UT Southwestern Medical Center, commented on the findings, “By extension, manipulation of the AIM2 signaling pathway may be a promising treatment option for these conditions.” Read more about inflammatory bowel disease, here. Read about the connection between stress reduction and IBD, here. Read more about the research findings here. The article abstract may be read here.
- Real Patient Experience Insights Into Opioid Therapy for Chronic Pain
Researchers led by the Cedars-Sinai Center for Outcomes Research and Education have compiled results from their analysis of more than 2 billion tweets and online posts to study the harmful side effects of opioid medication taken for chronic pain. The team asserts their belief that theirs is the first investigation of its kind to examine social media data related to gastrointestinal side effects from narcotics. In their online communications, patients detailed numerous GI issues from opioid therapy, including nausea, vomiting, and severe constipation that was even more severe than their underlying pain complaint. According to the researchers, this data reveals GI side effects often not captured by traditional clinical research. The study was published online in the Journal of Opioid Management. In the study, researchers engaged a social media data service called Treato to collect and index patient and caregiver content from more than 3000 health-related websites. Treato reviewed 1.8 billion posts in its repository. The investigators then narrowed their search to 3303 relevant tweets and posts that mentioned GI side effects from narcotics medication. The online data additionally showed that many people on opioid therapy for chronic pain are not warned by their doctors of the potential side effects. Some patients turn to over-the-counter remedies or other solutions of questionable value without first consulting physicians. Brennan Spiegel, MD, MSHS, director of Cedars-Sinai Health Services Research and director of the Center for Outcomes Research and Education commented: “By informing doctors and prescribers about these results, we can hopefully improve the communication and shared decision-making between doctor and patient around pain medications.” Read more about how social media provides tools for patient engagement and education, here. Read about migraine sufferers and tweets, here. Read about the Cedars-Sinai study above, here. The article abstract may be read here.
- Developing a Strong Foot Core Can Forestall Pain and Injury
Patrick McKeon, PhD, ATC, CSCS, a professor at the School of Health Sciences and Human Performance, Ithaca College, comments in a news release that the benefits of going barefoot in avoiding pain from a variety of foot conditions are being ignored. Barefoot activities can greatly improve balance and posture and prevent common injuries like shin splints, plantar fasciitis, stress fractures, bursitis, and tendonitis in the Achilles tendon, according to McKeon. The practice can help to develop a strong ‘foot core,’ by toning the small, often overlooked muscles in the feet that play a role similar to the core muscles in the abdomen in movement and stability. McKeon describes a foot core feedback loop involving the larger “extrinsic” muscles of the foot and leg, the smaller “intrinsic” muscles of the foot, and the neural connections that send information from those muscle sets to the brain. Shoe wearing is culpable in the breakdown of this loop, by dampening the information connection of body and environment and of small muscles to large muscles. The disconnect can then lead to overuse injuries and pain that accompany various foot maladies. McKeon also details an exercise, called short-foot that can additionally help to develop the foot core. Read about minimally invasive treatment for plantar fasciitis, here For more info re foot pain diagnosis and treatment, here. A news story about the recommendations, with link to a video on the short-foot exercise, may be read here.
Department of Public Health and Community Medicine
Tufts Medical Center