Martin CHEATLE PhD
A specialist in pain and substance abuse discusses findings from the research on vulnerable populations in the pain community. Patients with pain and concurrent substance use disorders are particularly at risk for depression and suicidal ideation. To what degree does this underlie the problem of unintended opioid overdose?
Jennifer BOLEN JD
The enforcement arms of both commercial and government payor plans are focused on reimbursement claims for clinical laboratory services. Ongoing changes to billing and coding for services further complicate the picture for practitioners. Here’s what you need to know to stay in control of reimbursement claims, while continuing to provide responsible pain management for your […]
Paul J. CHRiSTO MD, MBA
Abigail T. BROOKS PharmD
Effective use of naloxone for opioid overdose requires, first, the ability to recognize the symptoms and signs of opioid induced respiratory depression. All healthcare providers, responders, and patients need education in identifying overdose emergencies. Stakeholders also need to keep abreast of the evolving jurisprudence surrounding naloxone availability and distribution.
- Celecoxib Found to Slow Tumor Progression in Animal Study
Celecoxib, one of the most widely prescribed pain and anti-inflammatory medications, may be additionally effective in retarding the rate of growth of a specific type of cancer, neurofibromatosis type II (NF2). NF2 is a relatively rare inherited form of cancer in humans, caused by mutations in the anti-tumor gene NF2, which leads to benign tumors of the auditory nerve. The findings, from new research in animal models, suggest that the drug could be similarly effective on other types of tumors. The study was conducted by a team from The Scripps Research Institute (TSRI), Jupiter FL, and appears online ahead of print in the journal Cancer Research. Marketed as Celebrex® by Pfizer Co., celecoxib targets the enzyme cyclooxygenase-2 (COX-2), which is linked to pain and inflammation. The enzyme is also critical in the creation of prostaglandins, compounds that act like hormones and play a role in promoting tumor growth. COX-2 expression is typically low in normal tissue, but high in several types of cancers. The Scripps research was investigating a cancer signaling pathway, which was found to work through activation of genes that promote tumor cells using enzymes that include COX-2. The team proceeded to evaluate the COX-2 inhibitory effect of celecoxib and resultant impact on tumor growth. Animals who received a daily dose of the drug exhibited significantly slower tumor growth than did controls. TSRI research associate William Guerrant, PhD, commented “Our study shows that COX2 inhibitors do have an effect on the tumor cells. They also have an impact on inflammatory responses that play a role in tumor growth. It’s possible that in other cancers these effects might actually be stronger because of the drug’s impact on inflammation.” Read a news story about the discovery, with link to the journal article, here.
- Vascular Surgery Specialist Cautions Against Misdiagnosis of Potentially Serious Condition
Clinicians from the Wexner Medical Center at Ohio State University caution against misdiagnosis of shoulder and arm pain commonly experienced by athletes and those who work as hair stylists, mechanics, and similar occupations. The pain complaint could be the result of thoracic outlet syndrome (TOS), a more serious condition caused by compression of the vein, artery or nerves running between the collarbone and the first rib. TOS can, in severe cases, also result in large and dangerous blood clots. Because it is missed, some patients may have TOS and resultant pain for years without realizing it. Patrick Vaccaro, MD, Chief of the Division of Vascular Diseases and Surgery at Wexner Medical Center commented “There are a wide range of symptoms and many causes to consider with upper extremity pain, so TOS can be missed or take a while to diagnose.” Thoracic outlet syndrome is commonly caused by repetitive overhead motions and can be seen in anyone from tennis players or swimmers to musicians, trade workers and those who sit at a desk with their arms too high. Only about a third of people who develop the disorder can recover with physical therapy. Most will ultimately need surgery to open the thoracic outlet by removing a section of the first rib. “I’ve had several patients tell me it’s been life-changing. You remove part or most of the rib, and it’s the first time they remember not being in pain,” said Dr. Vaccaro. Read more about the recommendations, with access to further information from the Wexner Medical Center, here.
- New Sensing Technology may Permit Precise Assessment of Knee Damage and Rehabilitation
Research engineers at the Georgia Institute of Technology are refining a wearable device that can enable precise detection of noises emanating from the knee joint. In the future, this capability may assist orthopaedic specialists in assessing joint damage and tracking the progress of rehabilitation therapies. Omer Inan, PhD, assistant professor of electrical and computer engineering undertook the development work under a grant from the Defense Advanced Research Projects Agency (DARPA) who had issued a call for research proposals on wearable technologies for assisting rehabilitation of injured service personnel. Inan, a former NCAA champion discus thrower, had the further motivation of his own chronic knee pain from repeated joint stress during competition. His team of 17 researchers have published their work online in the journal IEEE Transactions in Biomedical Engineering. The sounds of cracking and grinding, or crepitus, occur in healthy intact joints as well as those that have been compromised by injury or disease, but the resulting acoustic patterns are markedly different. An injured knee will produce erratic noise patterns, whereas a healthy knee produces a more constant sound. Using the new acoustic sensing technology, it may be possible to graph and decode the sounds of the knee in different motions and conditions, creating an intelligible physiological signal for clinicians to evaluate, similar to that of an electrocardiogram. Read more about this engineering advance and future potential here.
- Small Study Suggests Elevated Risk for Major Birth Defects
Conclusions from a recent study suggest that pregabalin, approved by the FDA for the treatment of fibromyalgia and neuropathic pain, as well as other conditions, may be associated with an elevated risk for major birth defects. These include heart defects, structural issues with other organs, and central nervous system damage. The study found that women who took pregabalin during the first trimester of pregnancy were 3 times as likely to deliver babies with defects of these categories. Birth defects due to chromosomal abnormality were excluded from the reported results. The research was published online last week in the journal Neurology®. The study examined records of 164 women from 7 countries who took pregabalin during a pregnancy and 656 pregnant women who did not take any anti-seizure medication. Some of the study subjects who took pregabalin were also taking other anti-seizure drugs as well. Study author Ursula Winterfeld, PhD, with the Swiss Teratogen Information Service and Lausanne University Hospital in Lausanne, Switzerland commented “We can’t draw any definitive conclusions from this study, since many of the women were taking other drugs that could have played a role in the birth defects.” She also pointed out the small sample size represented and the need for further confirmation. Nonetheless, Winterfeld noted, the possibility of association suggests that caution is warranted in prescribing pregabalin for women of childbearing age. Read a news story about the research conclusions here. The journal abstract may be read here.
Department of Public Health and Community Medicine
Tufts Medical Center