• Results of New Long Term Study Suggests Further Investigation is Warranted
    A research team led by Mark Ware, MBBS, MRCP, MS, at McGill University Health Centre (MUHC) in Montreal, has published results of a multicenter study of the safety of medical cannabis when used by patients with chronic noncancer pain. The study results, appearing online in The Journal of Pain, conclude that chronic pain patients who used cannabis daily for one year, when carefully monitored, had no increase in serious adverse events compared to pain patients who did not use cannabis. The authors assert that their work will serve as a benchmark study on cannabis side effects when used for pain management. The study compared 215 patients with chronic noncancer pain who were either current or former users of medical cannabis to 216 controls—patients with chronic pain but who did not use cannabis—recruited from 7 clinics across Canada. The cannabis users received a quality-controlled, closely monitored dose of herbal cannabis (2.5 mg per day of product containing 12.5% THC). The researchers found no difference in risk of significant adverse effects between the groups. Based on the study findings, the researchers conclude that quality-controlled herbal cannabis, when used by cannabis-experienced patients as part of a monitored treatment program over one year, appears to have a reasonable safety profile, but that longer term monitoring for functional outcomes is needed. The study abstract, with link to the full journal article, may be read here.
  • Tinnitus: Understanding Malfunctioning Neural Mechanisms
    A research team from Georgetown University Medical Center and Germany’s Technische Universität München reports the identification of a shared brain malady that is a causal factor in tinnitus and in chronic pain that persists long after an initial injury. Identification of the neural mechanism is described as a first step in the development of effective therapies for these conditions. The research is detailed in this month’s edition of Trends in Cognitive Sciences. In both tinnitus and postinjury pain, the brain has been reorganized in response to an injury in its sensory apparatus, according to the authors. The neural mechanisms that normally “gate” or control noise and pain signals can become dysfunctional, leading to a chronic perception of these sensations. The brain regions responsible for these errant sensations are the nucleus accumbens, the reward and learning center, and several areas that serve “executive” or administrative roles—the ventromedial prefrontal cortex and the anterior cingulate cortex. These areas also affect the experience of various comorbidities such as depression and anxiety. But because these systems rely on transmission of dopamine and serotonin between neurons, drugs that modulate dopamine may help restore sensory gating, according to the researchers. Read a press release from Georgetown University Medical Center on the findings here. The journal abstract and full article may be read here.  
  • Critical Care Nurses Can Advocate for Palliative Care Approach
    Palliative care has long been recognized as a valuable option in the treatment armamentarium for many chronic pain conditions, but an article in this month’s issue of Critical Care Nurse points up some of the barriers to palliative care consultations that impede patients and caregivers from discussing the approach with their providers. The article also offers strategies for nurses to engage in the task of integrating palliative care into the treatment regimen, and promulgating the use of palliative care services. Palliative care differs from hospice care in that it is appropriate early in the course of illness, and patients can be simultaneously treated for their condition, including therapies intended to prolong life. Benefits include psychological, spiritual, goal-setting and decision-making support to patients and caregivers that can facilitate earlier adoption of comfort-focused treatment goals, achieve more continuity of care, and reduce the cost of care without an increase in mortality. Read about palliative care and older adults, here. Read about the benefits--to both patients and caregivers--of early palliative care, here. A news story about the benefits of palliative care and strategies for incorporation into treatment plans may be read here. A link to the journal abstract and full-text PDF is also provided.  
  • Clinical Trials of New Biologic Yield Promising Results for Psoriasis
    Results of a multicenter clinical trial led by Mount Sinai researchers and published online October 1 in the New England Journal of Medicine found that a new, experimental biologic reduced the symptoms of psoriasis by 100% in twice as many patients as compared to a more commonly used treatment alternative. The new biologic, brodalumab, is similar to proteins in the human immune system that are built to recognize and block specific target molecules. Brodalumab was designed to block the function of the immune signaling protein interleukin 17 (IL-17) that dock into specifically shaped proteins, IL-17 receptors, to pass on signals that contribute to abnormal, psoriatic inflammation. Plaque psoriasis, the most common form, is a noncontagious chronic disease in which the immune system causes skin cells to grow at an accelerated rate. These skin cells pile up, causing painful, scaly patches that can crack and bleed on the scalp, knees, elbows, and lower back. The lifelong disease affects 2% to 3% of the global population and can have a significant negative impact on health-related quality of life. The just-published Phase III clinical studies recorded the degree of reduction in the Psoriasis Area Severity Index or (PASI), which scores psoriatic plaque redness, scaling and thickness of psoriatic skin lesions and the extent of the body involved. Treatment efficacy is often measured by the reduction of PASI from the baseline. After 12 weeks, 44% of patients randomized to receive the greater dosage of brodalumab (210 mg every other week) in one study had achieved PASI 100 (ie, a 100% reduction), compared with 22% of patients treated with ustekinumab (Stelara), a drug currently approved by the U.S. Food and Drug Administration (FDA) and widely used for the treatment of psoriasis. Read more about the new treatment here.    
Daniel Carr, MD, FABPM
Pain Research, Education, and Policy Program
Department of Public Health and Community Medicine
Tufts Medical Center
Boston, MA


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