• Efficacy of Oral Steroids for Pain in Question
    A new study appearing in the May 19 edition of JAMA examines the benefit to patients with sciatica from a short course of oral steroids. The study found no significant difference compared to placebo in measures of pain improvement and only modest improvement in overall function. Oral steroids are used by many primary care physicians and have been included in some clinical guidelines; however, no adequate clinical trials of oral steroids for radiculopathy have been conducted to date, according to background information in the article. In patients with sciatica that does not resolve quickly, common treatment includes invasive procedures such as epidural steroid injections (ESI) and surgery. Oral administration of steroid medication can be delivered quickly by primary care providers, carries less risk, and would be much less expensive than an ESI. However, in this study of 269 adults with radicular pain of 3 months or less who were randomly assigned to a tapered course of prednisone or placebo, no difference was recorded in lower extremity pain scores between the 2 groups. View related content here. Read more about the study findings here.    
  • Increased Risk Not Reported in Patients Using Both Marijuana & Opioids
    As reported in yesterday’s Daily Dose, medical cannabis is increasingly engaged as an alternative to opioids for chronic pain. Additionally, many patients use marijuana in conjunction with opioids. This use has raised concerns that the combination could increase the risk of patients for abuse of other substances. However, a new study in the May issue of the Journal of Studies on Alcohol and Drugs reports that people who use medical cannabis for chronic pain and who also take prescription pain medications are not at increased risk for serious alcohol and other drug involvement. According to the authors, the intersection of medical cannabis and prescription pain medication has not been widely studied to date. This research examined 273 subjects at a medical cannabis clinic in Michigan, 60% of whom reported using prescription pain medication in conjunction with marijuana within the prior month. No significant differences were found in the rate of co-occurring substance use between those who used prescription pain medication and those who did not. The authors caution that this was an observational study and affirm the recommendations of other subject experts that providers become more knowledgeable about medical cannabis as access to and demand for marijuana for medical and recreational purposes escalates. Read a press release about the study findings here. View related content here.
  • Marijuana as Pain Therapy—Providers Need to Answer Patient Questions
    A leading medical marijuana researcher advises clinicians to learn more about the plant and its constituents in order to provide informed counseling to patients with pain who are increasingly interested in it as a therapeutic alternative. Speaking last week at the American Pain Society Annual Scientific Meeting, Mark Ware, MD, from McGill University Health Center, noted the need for more rigorous clinical study of marijuana to evaluate its safety and efficacy for pain conditions. Ware highlighted several challenges impeding the conduct of such research. One of these challenges is the continuing legal inconsistency attending medical marijuana. Additionally, it is unclear who will pay for the necessary phase 3 clinical trials needed to better understand the substance’s efficacy for various pain conditions. Another obstacle to valid research is lack of standardized product, as cannabis originating from different regions can contain different compounds. Nonetheless, with the legalization of medical marijuana in more than 20 states so far, Ware advises clinicians to become better informed to answer patient inquiries by reviewing the scientific literature, understanding local legal issues and potential liability, and weighing the risks and benefits against other analgesic alternatives. View related content here. Read more commentary on the topic of medical marijuana here.  
  • Mind/Body Techniques Counteract Effects of Chronic Pain on Brain Anatomy
    In an address given last week at the annual meeting of the American Pain Society, M. Catherine Bushnell, PhD, an official at the National Institutes of Health, presented new evidence that yoga can be an important tool for preventing or reversing the effects of chronic pain on the brain. Imaging studies in both rats and humans have shown that reductions in gray matter volume and white matter integrity are associated with chronic pain. Dr. Bushnell stated that studies conducted at the NIH demonstrate that mind-body techniques including yoga and meditation can counter these anatomical effects in the brain. The studies show yoga practitioners have more gray matter than controls in multiple brain regions, including those involved in pain modulation. Bushnell said gray matter changes in the insula or internal structures of the cerebral cortex are most significant for pain tolerance. The findings offer further affirmation that mind-body practice appears to exert a protective effect on brain gray matter that counteracts the neuroanatomical effects of chronic pain. Read more on the findings here. View related content 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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