Michael R. CLARK MD, MPH, MBA
A prominent psychiatrist and pain educator discusses the challenge of managing patients with chronic pain who also suffer with borderline personality disorder and depression, including the special difficulties associated with demanding, noncompliant, and high-utilizer patients. Dr. Clark is Vice Chair of Clinical Affairs, Johns Hopkins University School of Medicine, the Director of the Adolf Meyer […]
John J. BURKE
Charles E. ARGOFF MD, CPE
Charles E. ARGOFF MD, CPE
- Research Suggests Modifications to Therapy may be Indicated
New research published this week in the journal Scientific Reports suggests that methadone treatment may need to change to address a side-effect: alteration in testosterone levels among male patients receiving the therapy. Low testosterone in men has been associated with poor quality of life as well as erectile dysfunction, fatigue, and mood disturbances. Methadone, which is used for opioid addiction treatment, was found to significantly suppress testosterone levels in men who were opioid users, compared to men not using opioids. In women using methadone for addiction treatment, testosterone levels were not significantly impacted, even considering the menstrual cycle. Study recommendations include providing treatment for testosterone deficiency, as well as engaging the lowest possible doses of opioids including methadone to minimize suppression. Read a news story about the research findings here.
- More Common Surgical Options are More Expensive, No More Effective
A new study in the September issue of Neurosurgery reports that percutaneous stereotaxic rhizotomy (PSR) provides good pain relief at much lower cost than other types of surgical treatments for trigeminal neuralgia, yet is the least utilized treatment modality. The authors emphasize that the preliminary findings need further verification, but are nonetheless consistent with the only two previous studies evaluating the cost-effectiveness of surgical options for trigeminal neuralgia. Trigeminal neuralgia is a relatively common chronic pain condition, especially among older adults. It is associated with a typical pattern of painful facial tics, thought to be caused by blood vessels placing pressure on the trigeminal nerve in the face. When this pain can't be adequately controlled by medications, various surgical procedures may be recommended. The study compared costs and outcomes of 3 different surgical options among 94 patients and concluded that PSR was by far the most cost-effective. Read a news story about the study here.
- New Findings May Lead to Better Prediction and Management
Results of a study published in the journal Inflammatory Bowel Diseases suggest that there is “compelling evidence” of alterations of DNA in several regions of the genome in children with Crohn’s disease (CD) that may be related to key environmental exposure. In addition to providing new insights into how genes and the environment interact, the findings may suggest new approaches for clinical management of CD. The study called out "highly significant" changes in two specific gene locations, including genes responsible for immune and cellular functions that could contribute to the development of CD. Two probes for these locations proved to accurately predict which children would have CD, providing a potentially useful "biomarker" for use as a diagnostic test. A news story about the study findings, with link to the study abstract, may be read here.
- NSAIDs can cause changes to cell membranes; findings could have wide repercussions for drug developers
Researchers have discovered that three commonly used nonsteroidal anti-inflammatory drugs, or NSAIDs, alter the activity of enzymes within cell membranes. Pain / Anesthetics News From Medical News Today
Department of Public Health and Community Medicine
Tufts Medical Center