Feature Channels: Pain

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One of the biggest concerns of patients considering knee replacement is the amount of pain they will have after surgery. Although it is a very successful operation overall to relieve arthritis pain and restore function, persistent postoperative pain can be a problem for some individuals. Researchers determined which patients were at highest risk for increased postoperative pain based on demographic and surgical variables.

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Stem cell transplant was viable and effective in halting or reversing degenerative disc disease of the spine, a meta-analysis of animal studies showed, in a development expected to open up research in humans. Recent developments in stem cell research have made it possible to assess its effect on intervertebral disc (IVD) height, Mayo Clinic researchers reported in a scientific poster today at the 30th Annual Meeting of the American Academy of Pain Medicine.

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As more people in the United States become severely obese, bariatric surgery has grown in popularity as a corrective measure; however, serious neurologic complications can result immediately after surgery or even years later (Juhasz-Pocsine et al, Neurology 2007;68(21):1843-50).

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Not only are neuropathic pain symptoms quite common in knee osteoarthritis (OA), but scientists can predict who will respond to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) by assessing the nervous system’s own capacity to regulate pain, new research suggests. Patients whose tests had indicated superior conditioned pain modulation (CPM) had less pain and fewer neuropathic symptoms at study’s end, in results reported in a scientific poster today at the 30th Annual Meeting of the American Academy of Pain Medicine.

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Two hormones credited with reducing pain and need for opioid analgesics when released naturally during pregnancy and childbirth worked similarly when administered simultaneously to patients with intractable pain, research shows.

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A multidisciplinary treatment plan that combined splint use, physical therapy and discontinuation of bisphosphonates brought excellent results for a 58-year-old woman diagnosed with bisphosphonate-related osteonecrosis of the jaw (BRONJ). The treatment team and study authors highlighted the effectiveness of advanced imaging technology and multidisciplinary collaboration for patient outcomes that included a 90% decrease in pain, improved function and normalized imaging results. They presented study results today in a scientific poster at the 30th Annual Meeting of the American Academy of pain Medicine.

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Of nearly 1 million veterans who receive opioids to treat painful conditions, more than half continue to consume opioids chronically or beyond 90 days, new research says. Results presented at the 30th Annual Meeting of the American Academy of Pain Medicine reported on a number of factors associated with opioid discontinuation with the goal of understanding how abuse problems take hold in returning veterans.

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Not only are neuropathic pain symptoms quite common in knee osteoarthritis (OA), but scientists can predict who will respond to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) by assessing the nervous system’s own capacity to regulate pain, new research suggests. Patients whose tests had indicated superior conditioned pain modulation (CPM) had less pain and fewer neuropathic symptoms at study’s end, in results reported in a scientific poster today at the 30th Annual Meeting of the American Academy of Pain Medicine.

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Patients who benefited from intradiscal biacuplasty (IDB) to treat discogenic low-back pain maintained initial gains in pain relief and physical function when rechecked at 1 year, a new study showed. Furthermore, patients who were in the sham treatment group and were later offered IDB achieved the same positive results as patients in the original treatment arm, researchers reported in a scientific poster today at the 30th Annual Meeting of the American Academy of Pain Medicine.

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Success rates soared to 75% for patients who waited less than 2 years for a spinal cord stimulator (SCS) implant, compared with 15% for patients whose implants happened 20 years after the onset of pain, according to a retrospective analysis. The length of time patients waited for a referral also varied by specialty, as shown in a scientific poster presented today at the 30th Annual Meeting of the American Academy of Pain Medicine.

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Two commonly delivered epidural injection modalities deliver minimal differences in pain relief and function at 1 and 6 months, new research shows. Results presented today at the 30th Annual Meeting of the American Academy of Pain Medicine indicate both injection types were effective for treating unilateral lumbosacral radicular pain (ULSRP).

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Determining MRI RF heating safety is a complex process that requires complete understanding of the potential interactions between the MRI system, lead behavior, and individual patient characteristics.1 A comprehensive analysis was performed to evaluate a new MR-compatible SCS lead. Materials and Methods: Anesthetized porcine (Sus scroffa; n = 5) were implanted with leads and temperature probes in the spinal canal (Figure 1) and scanned in a 1.5T MRI system at multiple landmarks. MRI RF heating predictions from animal model simulations were compared to in vivo electrode temperature measurement to confirm model accuracy. Multiple human models were combined with several MRI coils to simulate the electromagnetic effects due to variations in human morphology. Simulations were performed for hundreds of clinical lead paths in each human model and combined with lead characterization analyses to predict the temperature rise at the electrodes in the spinal cord for each patient situation.

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Postsurgical pain scores were highly correlated with reports of overall patient satisfaction during hospital stays, in a new finding that was true for some types of surgery more than others. The researchers, who presented results in a scientific poster today at the 30th Annual Meeting of the American Academy of Pain Medicine, stressed the importance of improving patient care in the peri-operative setting in alignment with new federal requirements tying performance to pay.

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Prescriptions for benzodiazepines are rising in primary care, and their frequent combined use with opioid analgesics may be contributing to medication-related deaths, a finding that goes largely unreported, according to Stanford researchers.

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Researchers found initial confirmation that a novel scaffold protein previously unassociated with the mu opioid receptor (MOR) regulates MOR-induced signaling activation. The MOR is the target of opioid drugs like morphine and is an important mechanism for pain regulation in the body. The research approach was designed to open new avenues to the treatment of chronic pain, a serious public health problem with major economic and societal costs.

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A new approach to breast reconstruction surgery aimed at helping patients’ bodies get back to normal more quickly cut their postoperative opioid painkiller use in half and meant a day less in the hospital on average, a Mayo Clinic study found. The method includes new pain control techniques, preventive anti-nausea treatment and getting women eating and walking soon after free flap breast reconstruction surgery. It has proved so effective, it is now being used across plastic surgery at Mayo Clinic.

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Scientists reported today on at least five new experimental substances — based on a tiny protein found in cone snail venom — that could someday lead to the development of safe and effective oral medications for the treatment of chronic nerve pain. They say the substances could potentially be stronger than morphine, with fewer side effects and lower risk of abuse. They presented the research at the 247th National Meeting & Exposition of the American Chemical Society.

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In the fight against a nationwide prescription opioid abuse epidemic, Penn Medicine researchers are using storytelling to help doctors recall important, potentially lifesaving national guidelines on how to prescribe these medications.

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The lessening of pain sensitivity achieved with spinal manipulation therapy (SMT) occurs as a result of the treatment and not as much from a placebo effect caused by the expectation of receiving SMT, according to a study published in The Journal of Pain.

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In the fall of 2012, barbara was enjoying the fruits of a successful career in the arts, an active social life, and good health, which included spinning classes, yoga, and swimming. Then a routine bladder infection set off a series of painful and discomforting symptoms. She felt a searing pain in her pelvic area and it hurt during intercourse.

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A new study provides evidence for what many people who experience headache have long suspected—having more stress in your life leads to more headaches. The study released today will be presented at the American Academy of Neurology’s 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.

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When it comes to chronic pain, psychological interventions often provide more relief than prescription drugs or surgery without the risk of side effects, but are used much less frequently than traditional medical treatments, according to a comprehensive review published by the American Psychological Association.

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New research suggests that sedating patients before a nerve block needed to diagnose or treat chronic pain increases costs, risks and unnecessary surgeries, and sedation does nothing to increase patient satisfaction or long-term pain control.

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Not only is heroin addictive and deadly, its use is increasing among Americans. That disturbing trend parallels the spike of opioid based prescription painkiller abuse in recent years, say Mayo Clinic experts.

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More than 14 percent of pregnant women were prescribed opioids (narcotics) for pain at some time during their pregnancy, according to a study posted to the online version of Anesthesiology. Given the surprising rate these medications were prescribed to pregnant women, more research is needed to assess the risk of opioids to unborn babies, the study suggests.

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With nearly one-third of Americans suffering from chronic pain, prescription opioid painkillers have become the leading form of treatment for this debilitating condition. Unfortunately, misuse of prescription opioids can lead to serious side effects—including death by overdose. A new treatment developed by University of Utah researcher Eric Garland has shown to not only lower pain but also decrease prescription opioid misuse among chronic pain patients.

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Since the 1970s, the frequency and use of pain relief during childbirth – and most especially the use of epidural analgesia during labor – has increased dramatically. Reports on epidural rates range from 47 percent to as high as 76 percent of vaginal births, while between 39 percent and 56 percent of women use narcotic analgesics – including drugs like Fentanyl – via IV for managing labor and delivery pain. Only about 14 percent of women, the literature reveals, use no pharmacologic method to relieve childbirth pain.

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A new evidence review from The Cochrane Library found that administering a drug called clonidine before surgery may be a good alternative for controlling post-surgical pain and help reduce a child’s anxiety after surgery.

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Setting the stage for possible advances in pain treatment, researchers at The Johns Hopkins University and the University of Maryland report they have pinpointed two molecules involved in perpetuating chronic pain in mice. The molecules, they say, also appear to have a role in the phenomenon that causes uninjured areas of the body to be more sensitive to pain when an area nearby has been hurt.

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Prevalence and incidence rates of vulvodynia were substantial among all ethnic groups.

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Not prescribing opioids first or as a long-term therapy for chronic, non-cancer pain and avoiding MRIs, CTs and X-rays for low-back pain are among the tests and treatments identified by ASA that are commonly ordered but not always necessary. As part of the ABIM Foundation’s Choosing Wisely campaign, ASA today released its second list of five targeted, evidence-based recommendations that can support conversations between patients and physician anesthesiologists about what care is really necessary.

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Everybody feels pain differently, and brain structure may hold the clue to these differences. In a study published in the current online issue of the journal Pain, scientists at Wake Forest Baptist Medical Center have shown that the brain’s structure is related to how intensely people perceive pain.

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Scientists from the Florida campus of The Scripps Research Institute have described a pair of drug candidates that advance the search for new treatments for pain, addiction and other disorders.

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Scientists have discovered how the element sodium influences the signaling of a major class of brain cell receptors, known as opioid receptors. The discovery suggests new therapeutic approaches to a host of brain-related medical conditions.

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Scientists at the UNC School of Medicine and The Scripps Research Institute have discovered how salt acts as a key regulator for drugs used to treat a variety of brain diseases including chronic pain, Parkinson’s disease, and depression.

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Meredith Messerli’s dream of attending college seemed out of reach a year ago. Debilitating migraine headaches forced her to miss two years of high school and retreat to the shutter-darkened confines of her Flower Mound home as her family searched frantically for a therapy that would work.

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For patients with herniated discs in the lower (lumbar) spine, surgery leads to greater long-term improvement in pain, functioning, and disability compared to nonsurgical treatment, concludes an eight year follow-up study in Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

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Tempromandibular pain disorders (TMDs) are characterized by a dysfunction of the TMD joint and cause orofacial pain, masticatory dysfunction or both. A new study published in The Journal of Pain showed that standard treatment approaches yield modest to large improvement in pain, but the addition of cognitive behavioral therapy may be helpful.

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There is strong evidence showing that individuals who experienced chronic pain during childhood have chronic pain as adults, but few studies have evaluated the characteristics of pain that persists from childhood through adult years. Researchers from the University of Michigan found that one in six adult pain patients had pain as children or adolescents, and their pain was widespread and neuropathic with psychological comorbidities and decreased function.

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The methods used to anesthetize prostate cancer patients and control pain when their prostate glands are surgically removed for adenocarcinoma may affect their long-term cancer outcomes, a study led by Mayo Clinic has found.

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Women being treated with breast cancer drugs known as aromatase inhibitors can markedly ease the joint pain associated with the drugs by engaging in moderate daily exercise, Dana-Farber Cancer Institute and Yale University investigators report in a study to be presented during the San Antonio Breast Cancer Symposium.

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A new study by a movement disorder neurologist at The Ohio State University Wexner Medical Center found that depression improved among patients with Parkinson’s disease who participated in a long-term group exercise program.

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Vitamin D decreases pain in women with type 2 diabetes and depression, according to a study conducted at Loyola University Chicago. These findings were presented at an Oct. 24, 2013 research conference at Loyola’s Health Sciences Campus.

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Hip pain is no longer reserved for older adults. More and more young, active people are developing this problem, which often requires surgery to repair. Hip preservation specialists at The Ohio State University Wexner Medical Center see patients from their teens through their sixties who have femoral acetabular impingement, or FAI. "FAI has become much more common in the last 10 years, and in younger people these injuries tend to be sports-related,” said Dr. Thomas Ellis, vice chair of the department of Orthopaedics at Ohio State’s Wexner Medical Center.

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JFK exuded strength and vitality, but less apparent was the daily battle he waged with chronic back pain. He often used crutches while walking to minimize pain and back pain may have been a contributing factor in his November 1963 assassination.

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The American Headache Society (AHS) today released a list of specific tests or procedures that are commonly performed but not always necessary in the treatment or migraine and headache. The list was developed as part of Choosing Wisely®, an initiative of the ABIM Foundation. It identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary. The list is being released simultaneous with its publication in the November/December, 2013 issue of the journal Headache.

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A study in the December issue of Anesthesiology suggests a role for brain imaging in the assessment and potential treatment of chronic pain. University of Michigan researchers are the first to use brain imaging procedures to track the clinical action of pregabalin, a drug known by the brand name Lyrica® that is prescribed to patients suffering from fibromyalgia and neuropathic pain.

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Lisa Hoglund, PT, PhD, assistant professor of the Department of Physical Therapy at University of the Sciences in Philadelphia, said many factors that contribute to seasonal aches and pains can be avoided by practicing good posture and stretching.

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A comprehensive analysis of more than 1 million hospital admissions finds that over 50 percent of all nonsurgical patients were prescribed opioids during their hospitalizations -- often at very high doses.

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People with chronic pain and emotional distress are more likely to be given ongoing prescriptions for opioid drugs, which may not help, finds a new review in General Hospital Psychiatry.