Michael S. SAENGER MD
Sean MACKEY MD, PhD, CPE
Barbara L. KORNBLAU JD, OTR/L, CPE
Kevin L. ZACHAROFF MD, FACIP, FACPE, FAAP
Dr. Zacharoff sketches the background history of Prescription Drug Monitoring Programs, and offers an assessment of how well they are performing and how they can be improved. Watch the segment for recommendations on what you need to know to successfully engage these tools in your prescribing practice.
- IBS Symptom Improvements Shown With Altered Microbiome Composition
Findings from a recent study appearing this month in Alimentary Pharmacology & Therapeutics suggest dietary modifications that may improve symptoms and pain for children with irritable bowel syndrome (IBS). The research took the form of a randomized, double-blind crossover trial of children aged 7 to 17 years with Rome III-defined IBS. The purpose was to evaluate the efficacy of low fermentable oligosaccharides, disaccharides, monosaccharides, and polylols (FODMAP) diet in pediatric IBS, and to determine if gut microbial composition or metabolic capacity are associated with response to the diet. The study found that patients who received the low FODMAP diet vs a typical American diet experienced fewer abdominal pain events. Additionally, of the patients who exhibited improvement, baseline gut microbial compositions were enriched with taxa known to have greater saccharolytic metabolic capacity. The study authors state that future research may shed light on whether evaluation of the gut microbiome can assist in devising of personalized dietary intervention therapy to treat pediatric IBS. A news story about the findings, with link to the journal abstract, may be read here.
- AAPM Announces Participation in Opioid Abuse Task Force and Return to PAINWeek for 3rd Consecutive Year
In a news release earlier this week, Daniel Carr, MD, MA, President-elect of the American Academy of Pain Medicine (AAPM) commented on the organization’s announcement that it is joining a consortium of 27 physician groups in an initiative to combat the public health crisis of opioid abuse. Dr. Carr has been a faculty member and Keynote Speaker at the PAINWeek® National Conference on Pain in past years. The American Medical Association (AMA) Task Force to Reduce Opioid Abuse was convened to work on a long-term comprehensive approach to the problem of opioid abuse, misuse, and diversion in the US. In his statement, Dr. Carr stated, “AAPM was delighted to participate in AMA’s broad-based effort to augment existing resources through patient and provider education, and looks forward to supporting these ongoing efforts." In a related announcement, the AAPM said it will return to the PAINWeek conference for the 3rd consecutive year to contribute its expertise in pain management to the agenda. On Wednesday, September 9, the AAPM will present a 4-hour version of Essential Tools for Treating the Patient in Pain™—which is designed for clinicians and all healthcare practitioners interested in obtaining an overview of the fundamentals of pain medicine in addition to identifying best practices and practical approaches to the treatment of common pain disorders. For more information about AAPM and other courses at PAINWeek, click here. Read more about the AMA initiative here.
- Pain-Processing Pathway Insights and Better Treatment Options
A new study appearing this month in the Proceedings of the National Academy of Sciences (PNAS) finds that commonly prescribed antidepressants alter a key signaling protein in the brain that processes both pain and mood. Conducted by researchers at the Icahn School of Medicine at Mount Sinai, the findings are termed significant for the insights offered into the brain’s reward system that may facilitate the development of better treatment options for both pain and depression. The study focused on mice suffering from chronic neuropathic pain, a condition often related to diabetes, infection, or trauma—and which persists even after the original source of the pain is gone. This pain often leads to depression, but brain mechanisms underlying this connection were previously unknown, as were the mechanisms by which common antidepressant drug classes—tricyclic (TCA) antidepressants or selective serotonin norepinephrine inhibitors (SNRIs)—counter both pain and depression related symptoms. The study suggests that antidepressants that target monoamines, signaling chemicals in the brain that regulate chronic pain and depression, act in the nucleus accumbens, a part of the brain’s reward system, and likely through pathways that pass on messages to nerve cells through a controlling protein, RGS9-2. Antidepressant medications are increasingly prescribed for neuropathic pain, as they lack the addictive potential of opioids, and are more effective for these pain conditions. Read more about the study findings here. The journal abstract may be read here.
- Human Nociceptor Model May Prove Superior to Existing Animal Models
In a presentation at the plenary session of the 2015 American Academy of Neurology annual meeting, researchers from Massachusetts General Hospital, Boston, reported success in obtaining pain-sensing neurons from human patients with pain conditions for use in modeling the condition and deriving better therapeutic approaches. Human-derived neurons could soon replace traditional animal models and be used to investigate disease mechanisms with unprecedented insight, according to the research team. Study author Brian Wainger, MD, PhD, stated that the derived nociceptor neurons “are able to mimic the diversity of bona fide nociceptors, and they can model disease-relevant pathophysiologic processes like TRPV1 sensitization in inflammatory pain.” Animal models have heretofore provided a valuable understanding of sensory physiology, but are limited in the extent to which they can capture the complexity and heterogeneity of human pain conditions. The team reported that the derived neurons successfully recapitulated the function of quintessential nociceptor receptors and channels, and that they replicated disease-relevant pathophysiologic processes. Having achieved their preliminary goals, the researchers said the stage is now set for drug screens based on in vitro disease-relevant phenotypes using human neurons and also for the development of novel treatments in the future. “We’ve seen that the derived neurons can be used to investigate disease mechanisms,” Dr. Wainger said. “We hope that these phenotypes in a dish can now be used to screen for novel treatments in a targeted, patient-specific manner.” Read a news story about the research and presentation of findings here.
Department of Public Health and Community Medicine
Tufts Medical Center