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
- 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.
- New Research Demonstrates Effectiveness of Combination Therapy
Results of a randomized, controlled clinical trial conducted by researchers at Fred Hitchinson Cancer Research Center conclude that weight loss in combination with vitamin D supplementation is more effective in reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases, including some cancers. The results are published online ahead of the July print issue of Cancer Prevention Research. Lead author Catherine Duggan, PhD, noted that previous studies had shown that weight loss can contribute to reduced levels of inflammation, and that some evidence suggests that addressing vitamin D insufficiency via supplements can have a similar effect. This study is the first to test whether adding vitamin D augments the considerable effect of weight loss on inflammatory biomarkers, Duggan said. The study population was comprised of 218 healthy, overweight older women who had lower-than-recommended levels of vitamin D (less than 32 ng/mL). The women then took part in a 12-month diet and exercise program (including 45 minutes of moderate-to-vigorous exercise five days a week). Half of the study participants were randomly selected to receive 2,000 IU of vitamin D daily for the duration of the year-long trial, and the other half received an identical-appearing placebo, or dummy vitamin. Biomarkers of inflammation were measured at the beginning and end of the study. The researchers then compared changes in these levels between the two groups. “We were quite surprised to see that vitamin D had an effect on an inflammation biomarker only among women who lost at least 5 percent of their baseline weight,” Duggan said. “That suggests vitamin D can augment the effect of weight loss on inflammation.” Read more about the study findings here.
Department of Public Health and Community Medicine
Tufts Medical Center