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  • A New Approach to Pain Treatment for Patients in Addiction Recovery
    A new approach to pain treatment that combines behavioral therapy with social support has demonstrated the potential for improving outcomes in patients with pain who are also in treatment for medication addiction. Results of a new study conducted by a team from the VA Ann Arbor Healthcare System’s Center for Clinical Management Research and University of Michigan Medical School’s Addiction Center found encouraging results for the program, called ImPAT, the acronym for Improving Pain during Addiction Treatment. Veterans who received care under the program while also being treated for addiction reported decreased pain intensity, improved functional ability, and lower alcohol consumption compared to veterans who received a less focused approach. The 2 groups had similar rates of drug use, however. The findings were published in the journal Addiction. In the study of 129 veterans, half of whom attended the ImPAT sessions and half who did not, the research team observed the comparative differences in pain and function outcomes following just 10 weekly sessions of the program. The authors assert that the ImPAT approach has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide, using team members trained in standard psychological techniques. The approach combines cognitive behavioral therapy with acceptance and commitment therapy, to help patients focus less on their pain, and more on achieving better function in other areas of their lives. Lead author Mark Ilgen, PhD, said, “We want to take the focus off pain and put it onto functioning and finding pleasurable ways to spend time. There’s also a strong link between depression and pain. Pain is responsive to mood, and mood is responsive to social support.” With respect to the treatment of addicted patients, he continued, “We need to study psychological pain management approaches in opioid dependent patients, including those receiving addiction therapies such as buprenorphine.” Tap to read more about addiction or opioids. Read more about the study and the treatment approach here. The article abstract may be read here.  
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  • Back Pain Sufferers on Opioid Therapy at Higher Risk for Illicit Drug Use
    A study conducted by researchers from the University of Minnesota concludes that people suffering from chronic low back pain (cLBP) are more likely than nonsufferers to be users of illicit drugs including marijuana, cocaine, heroin, and methamphetamine. The association may affect prescribers’ decisions about opioid therapy for these patients, according to the authors. Opioids are widely prescribed for patients with cLBP, and previous studies have found that people with a history of illicit drug use are more likely to misuse prescription opioids. The new study is one of the first to focus on rates of illicit drug use among Americans with cLBP. The findings are published in the journal Spine. The research considered 5000 adults aged 20 to 69 from the 2009-2010 National Health and Nutrition Examination Survey. 13% of these met the study definition of cLPB, which was back pain present for at least 3 months. All were asked by confidential survey about their use of marijuana, cocaine, heroin, and methamphetamine. The study found that all 4 substances were more commonly used by the cLPB patient cohort, with more than 2x likelihood for use of heroin or methamphetamine. In addition, patients who used the illicit drugs were more likely to also have a current prescription for opioids. Study author Anna Shmagel, MD, commented "As we face a prescription opioid addiction epidemic, careful assessment of illicit drug use history may aid prescribing decisions." To access the painweek.org library of information about opioids or low back pain, tap on link. A news story about the findings, with link to the journal article may be read here.
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  • Buprenorphine Implant as Effective as Sublingual Route, Plus Avoids Complications
    Researchers at the Icahn School of Medicine, Mt. Sinai have published findings from the first comparative study of buprenorphine implants and sublingual buprenorphine in the management of opioid use disorder. The conclusions indicate that the implants were as effective as the sublingual formulation in achieving the main outcome measure, defined as maintaining abstinence from illicit opioids for at least 4 of the 6 months of the study. The efficacy of commonly administered sublingual buprenorphine can be compromised by failure to adhere to daily dosing schedules. Study author Richard Rosenthal, MD, Medical Director of Addiction Psychiatry at Mt. Sinai, said, “There are some individual and public health risks with daily dosing of sublingual buprenorphine, such as missed doses and accidental pediatric exposure, as well as the risk of theft or intentional diversion…buprenorphine implants are an opportunity to reduce adherence issues and may improve efficacy in stable patients with opioid dependence.” The study enrolled 177 opioid-dependent participants with stable abstinence. Participants were randomly assigned to sublingual buprenorphine with placebo implants or buprenorphine implants with sublingual placebo. Over 6 months, 86% of participants receiving implants and 72% receiving sublingual buprenorphine maintained abstinence from opioids. Dr. Rosenthal commented that follow-up studies are needed to establish the rate of relapse following implant discontinuation, as well as to confirm the findings of efficacy in a broader population. The findings were published online last week in Journal of the American Medical Association (JAMA).  Read more about buprenorphine or implants. A news story about the study conclusions may be read here. The article abstract may be read here.
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  • New Targets and Treatments for Hard-to-Manage Chronic Itch?
    Researchers at Washington University School of Medicine, St. Louis, have discovered the process by which sensory neurons transmit itch signals from the skin to the spinal cord, and then to the brain. The advance may facilitate the development of better, more targeted therapies for chronic itch. Principal investigator Zhou-Feng Chen, PhD, director of the University’s Center for the Study of Itch, commented, “It appears there is cross-talk between pathways called calcium channels in sensory nerve cells that process the itch signal. By interfering with the activity of sensory neurons, we may be able to inhibit multiple types of itching.” The findings were published online earlier this week in the journal Science Signaling. Chronic itching is a serious condition and is often resistant to treatment with antihistamines. The team studied how neurons in the dorsal root ganglion of laboratory mice process 2 types of itch signals, histamine-induced and chloroquine-induced. It had been thought that these traveled through 2 different calcium channels, but experimentation showed that a third calcium channel exists that can transmit either type of itch, and that the original 2 channels work together to process both types as well. The findings suggest that it may be possible to target a single channel “upstream” of neurons in the spinal cord to successfully treat multiple types of itch conditions. Read articles about itching, here. Read more about the research findings here. The journal abstract may be read here.  
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Daniel Carr, MD, FABPM
Director
Pain Research, Education, and Policy Program
Department of Public Health and Community Medicine
Tufts Medical Center
Boston, MA

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