Category: Pain Management

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Epidural Steroid Injections for Chronic Back Pain

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The American Academy of Neurology (AAN) has developed a new systematic review to summarise for neurologists and other clinicians the evidence for epidural steroid injections and whether they reduce pain and disability for people with certain kinds of chronic back pain. The systematic review is published online in Neurology®.

It updates a 2007 assessment by the AAN. With an epidural steroid injection, a steroid or corticosteroid medication is injected into the epidural space with the aim of helping reduce certain kinds of back pain.

“Chronic back pain is common and can negatively impact a person’s quality of life, making it difficult to move, sleep and participate in daily activities,” said author Carmel Armon, MD, of Loma Linda University School of Medicine in California and a Fellow of the American Academy of Neurology. “In our review, studies show epidural steroid injections may have limited efficacy. They may modestly reduce pain in some situations for up to three months and reduce disability for some people for up to six months or more.”

For the review, researchers analysed all available studies over a 16-year period. A total of 90 studies were examined. The review focused on the use of epidural steroid injections to reduce pain for people with radiculopathy and spinal stenosis. Radiculopathy is a condition caused by a pinched nerve in your spine. Spinal stenosis is a condition where spinal cord or nerves have become compressed because the space around the spinal cord has become too small. For people with radiculopathy, the review says studies show epidural steroid injections may be effective at modestly reducing pain and disability for up to three months after the procedure.

When compared to people not receiving the treatment, 24% more people receiving the treatment reported reduced pain, and 16% more reported reduced disability for up to 3 months. The treatment may also reduce disability for up to six months or more, with 11% more of those treated reporting reduced disability. Most of the reviewed studies looked at people with radiculopathy in their lower backs, so it is unclear how effective the treatment is for those with radiculopathy in their necks. For people with spinal stenosis, studies show epidural steroid injections might modestly reduce disability for up to six months or more after the procedure.

When compared to people not receiving the treatment, 26% more people receiving the treatment reported reduced disability up to three months, and 12% more for up to six months or more. The treatment was not found to reduce pain for up to three months. All studies looked at people with stenosis in their lower backs, so researchers do not know how effective the treatment is for people with stenosis in their necks.

“Our review affirms the limited effectiveness of epidural steroid injections in the short term for some forms of chronic back pain,” said author Pushpa Narayanaswami, MD, of Beth Israel Deaconess Medical Center in Boston and a Fellow of the American Academy of Neurology. “We found no studies looking at whether repeated treatments are effective or examining the effect of treatment on daily living and returning to work. Future studies should address these gaps.”

Source: American Academy of Neurology

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Empathy for Other Peoples’ Pain Peaks in Young Adulthood

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Empathy responses to others in pain peak in young adulthood according to a new study led by Kent’s School of Psychology. Psychologists have discovered that young adults are especially sensitive to social pain, such as situations of embarrassment, grief and sadness, and empathise more strongly with others experiencing social pain than adolescents or older adults do.

Empathy is a critical component of social interaction that enables individuals to understand and share the emotions of others.

The research, published in the journal Social Cognitive and Affective Neuroscience, explored how empathy responses differ between adolescents (10-19 years old), young adults (20-40 years old) and older adults (60+ years old), by recording brain activity while participants viewed photographs of people in physically or socially painful situations. Findings showed that brain responses to painful situations increased from adolescence to young and older adulthood. This demonstrates that empathy responses develop throughout the lifespan as social experience and exposure to different social and pain-related situations increases.

While the research showed that people’s brain empathy responses get stronger as they age, the increased brain activity in older adults comes alongside reduced ratings of pain for others. Professor Heather Ferguson, lead researcher on the paper and Professor of Psychology at Kent, suggests that this is because older adults are less good at expressing empathy for others compared to young adults.

Professor Ferguson said: ‘This study provides valuable insights into the complex nature of empathic responses to others in pain. Empathy responses to others in pain peak in young adulthood, as seen in their behavioural ratings of pain intensity felt by others. However, the brain becomes increasingly reactive to seeing others in pain as we age, which suggests that older adults experienced empathy at the time of viewing the photographs of pain – but were less accurate later at rating the intensity of this pain.’

Source: University of Kent

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The Cycle of Pain and Substance in Cancer Survivors

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Experiencing pain may increase the odds that cancer survivors will use cigarettes and cannabis, according to a recent study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society. The study also found that cigarette smoking and pain are linked to more treatment-related side effects and worse health among cancer survivors.

Pain and use of cigarettes, e-cigarettes, alcohol, and cannabis commonly occur together in the general population. To characterise pain in relation to such non-opioid substance use specifically among cancer survivors (who often experience pain), investigators analysed data from two national samples of individuals with a past diagnosis of cancer in the United States: 1252 adults from Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study and 4130 adults from the 2020 National Health Interview Survey.

PATH data indicated that higher past-week pain intensity was associated with a greater likelihood that cancer survivors would use cigarettes, e-cigarettes, and cannabis, and a lower likelihood that they would drink alcohol. National Health Interview Survey data indicated that chronic pain was associated with a greater likelihood of cigarette smoking and a lower likelihood of alcohol use. In both studies, cigarette smoking and pain were linked to fatigue, sleep difficulties, poorer mental/physical health, and lower quality of life.

“These findings show that because pain and substance use are interconnected among cancer survivors, it’s important to focus on treating both together in cancer care. Pain can drive substance use, and substance use can worsen pain, creating a cycle that’s hard to break,” said lead author Jessica M. Powers, PhD, of Northwestern University’s Feinberg School of Medicine. “While cancer survivors might smoke cigarettes or use substances to get immediate relief from their pain and cope with other symptoms, this can be incredibly harmful for their health by reducing the effectiveness of cancer treatments and increasing risk for cancer recurrence.”

Source: Wiley

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Radiology’s Role in Managing Pain in Cancer Patients

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SCP – Dr Winter performing a CT-guided interventional procedure

World Cancer Day, observed every 4 February, aims to raise awareness about cancer, encourage prevention and look at ways of improving a cancer patient’s quality of life. Interventional radiology plays a significant role in pain management for cancer patients.

Traditionally, radiology was used for diagnosing the cause of the pain but interventional radiology has changed this paradigm. Since American radiologist Charles Dotter, first used a guidewire and catheter to perform an interventional procedure in 1964, radiologists have become actively involved in intervention, including interventions for pain management. Today, many minimally invasive procedures are routinely performed in busy radiology departments.

Dr Arthur Winter, a radiologist at SCP Radiology says, ‘Interventional radiology has developed rapidly. Pain management procedures are becoming a daily part of busy radiology departments and play a crucial role in managing pain for cancer patients.

‘Cancer-related pain can be a significant burden, affecting patients’ quality of life and hindering their ability to carry out daily activities,’ says Dr Winter. ‘Radiology offers various techniques and treatments that help alleviate this pain effectively. These therapeutic interventions in pain management include image-guided interventional radiology procedures and radiation therapy.’

Understanding pain

Pain is a signal from the nervous system to let you know that something is wrong in your body. It is transmitted in a complex interaction between specialised nerves, the spinal cord and the brain. It can take many forms, be localised to one part of the body or appear to be widespread.

The nature of cancer pain

Cancer pain can arise from multiple sources, including the tumour itself, which may invade or compress surrounding tissues, organs or nerves. Metastases, the spread of cancer to other parts of the body, can also cause significant pain. Additionally, pain can result from the treatment of cancer, such as chemotherapy and radiation therapy.

Multidisciplinary approach to pain management

Effective pain management for cancer patients requires a comprehensive, multidisciplinary approach. Oncologists, radiologists, pain specialists and other healthcare providers collaborate to develop individualised care plans. Radiology is essential in both the diagnostic and therapeutic phases of this process, providing crucial insights and treatment options.

These personalised care plans, tailored to each patient’s needs, ensure:

  • Accurate diagnosis and identification of pain source or sources
  • Targeted and effective treatment interventions
  • Ongoing monitoring and adjustment of pain management strategies

Imaging techniques

Diagnostic radiology initially uses various imaging techniques to identify the source and extent of pain in cancer patients. These techniques include: X-rays, CT scans, MRI, PET scans and ultrasound.

By identifying the precise location and cause of pain, radiology can help:

  • Determine the most appropriate interventions, such as surgery, radiation therapy or minimally invasive interventional procedures
  • Monitor the effectiveness of pain management strategies and make necessary adjustments
  • Avoid unnecessary treatments that may not address the underlying cause of pain

Interventional radiology

Interventional radiology uses minimally invasive techniques to diagnose and treat various conditions and, for cancer patients experiencing pain, it offers several effective treatments:

  • Radiofrequency ablation (RFA): This uses heat, generated by radiofrequency energy to destroy cancerous tissues – often to treat painful bone metastases or tumours that are difficult to reach surgically
  • Cryoablation: Involves freezing cancerous tissues to destroy them. It is particularly useful for treating painful bone or soft tissue tumours, providing rapid pain relief
  • Nerve blocks: Involve the injection of anaesthetic agents or steroids near specific nerves to block pain signals. They can provide significant pain relief for patients with nerve-related pain

Palliative radiation therapy

In this instance, radiologists are involved with planning imaging only. The actual radiotherapy is performed by the radiation therapist, who works under the supervision of a radiation oncologist. Palliative radiation therapy is specifically designed to relieve symptoms and improve the quality of life for cancer patients. It focuses on pain control and symptom management rather than curing the disease.

Radiation oncologists deliver targeted doses of radiation to cancerous tissues, this palliative radiation therapy can help:

  • Reduce tumour size, alleviating pressure on surrounding tissues and nerves
  • Control bleeding or ulceration caused by tumours
  • Provide rapid pain relief, often within days to weeks of treatment

Improving quality of life

Dr Winter highlights that chronic pain can significantly diminish quality of life and contribute to depression, particularly in patients with underlying cancer. ‘These patients, in particular, should be considered for interventional procedures. For instance, there are highly effective treatments available to manage pain associated with pancreatic and pelvic cancers’.

‘Specialists, such as oncologists and neurologists, acknowledge the significant role of interventional radiology in pain management and collaborate closely with us to support their patients. As a rapidly advancing branch of radiology, it provides minimally invasive solutions and it is incredibly rewarding to witness patients regain their quality of life through effective symptom relief.’

Categories : Paediatrics Pain ManagementTags :

Preterm Babies Receive Insufficient Pain Management

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A large proportion of babies born very early need intensive care, which can be painful. But the healthcare system fails to provide pain relief to the full extent. This is shown by the largest survey to date of pain in neonatal care, now published in the journal Pain.

Every day for 4.5 years, neonatal care staff have recorded the occurrence of pain, the causes of pain, and how pain is assessed and treated in premature babies in Sweden. The study covers 3686 babies born between 22 and 31 weeks of gestation from 2020 to 2024. The total observation time was just over 185 000 days of care. Data were collected in the Swedish Neonatal Quality register.

In the evaluation of the register data, the researchers found that babies born extremely early, in weeks 22 to 23, had the highest proportion of painful medical conditions and almost daily painful intensive care procedures throughout the first month after birth. However, this is not surprising.

“There is a strong correlation between acute morbidity and being born very early. The earlier a baby is born, the more intensive care it needs. Intensive care involves procedures that can be painful, such as ventilator treatment, tube feeding, insertion of catheters into blood vessels and surgical procedures. It also requires various tests and investigations that may involve pain,” says Mikael Norman, professor of paediatrics at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and lead researcher of the study.

90 percent of the most extremely preterm infants had to undergo painful procedures. Despite this, healthcare professionals reported that only 45 percent of babies experienced pain – which may be because pain was largely prevented or treated. However, a check of the  drugs administered suggests other explanations may exist.

“Somewhat surprisingly, the smallest babies who were most exposed to pain had the lowest proportion of treatment with morphine. This may be a case of undertreatment,” says Mikael Norman.

Could not determine duration of pain

One limitation is that the study could not determine the duration or severity of pain for each day reported.

“The caregivers only answered yes or no to the question of whether the infant had experienced any pain in the last 24 hours. This could range from short-term, so-called procedural pain from for example a needle prick during a test to more continuous pain due to various medical conditions.

“Much is done to alleviate pain in babies. No child in neonatal care is left with severe pain untreated,” he continues.

However, it is a problem and a challenge that healthcare professionals are not always able to determine whether children are in pain.

“This involves developing better rating scales or physiological techniques to measure pain. Better pain treatments are also needed, perhaps with combinations of drugs with less risk of side effects,” says Dr Norman.

It is very important to improve pain management for premature babies, as we now know that their development is negatively affected by the strong signals in the brain that pain causes.

“The vision for all neonatal care is to be pain-free. The results of this survey will be of great importance for improving neonatal care and for future research in the field,” concludes Mikael Norman.

Source: Karolinska Institutet

Categories : Dentistry Pain ManagementTags :

Non-opioid Pain Relievers Beat Opioids After Dental Surgery

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A combination of acetaminophen and ibuprofen controls pain after wisdom tooth removal better than opioids, according to a Rutgers Health study that could change how dentists treat post-surgical pain.

The trial in more than 1800 patients found that those given a combination of ibuprofen and acetaminophen experienced less pain, better sleep and higher satisfaction compared with those receiving the opioid hydrocodone with acetaminophen.

“We think this is a landmark study,” said Cecile Feldman, dean of Rutgers School of Dental Medicine and lead author of the study, which was published in the The Journal of American Dental Association. “The results actually came in even stronger than we thought they would.”

Dentists, who rank among the US’ leading prescribers of opioids, wrote more than 8.9 million opioid prescriptions in 2022. For many young adults, dental procedures such as wisdom tooth extraction are their first exposure to opioid medications.

“There are studies out there to show that when young people get introduced to opioids, there’s an increased likelihood that they’re going to eventually use them again, and then it can lead to addiction,” said study co-investigator Janine Fredericks-Younger.

To compare opioid and non-opioid pain relief, the researchers conducted a randomised trial on patients undergoing surgical removal of impacted wisdom teeth, a common procedure that typically causes moderate to severe pain.

Half the patients received hydrocodone with acetaminophen. The other half got a combination of acetaminophen and ibuprofen. Patients rated their pain levels and other outcomes, such as sleep quality, over the week following surgery.

Results showed the non-opioid combination provided superior pain relief during the peak-pain period in the two days after surgery. Patients taking the non-opioid medications also reported better sleep quality on the first night and less interference with daily activities throughout recovery.

Patients who received the over-the-counter combo were only half as likely as the opioid patients to require additional “rescue” pain medication. They also reported higher overall satisfaction with their pain treatment.

“We feel pretty confident in saying that opioids should not be prescribed routinely and that if dentists prescribe the non-opioid combination, their patients are going to be a lot better off,” Feldman said.

The study’s size and design make it particularly notable. With more than 1,800 participants across five clinical sites, it’s one of the largest studies of its kind. It also aimed to reflect real-world medication use rather than the tightly controlled conditions of many smaller pain studies.

“We were looking at the effectiveness – so how does it work in real life, taking into account what people really care about,” said Feldman, referring to the study’s focus on sleep quality and the ability to return to work.

The findings align with recent recommendations from the American Dental Association to avoid opioids as first-line pain treatment. Feldman said she hopes they will change prescribing practices.

“For a while, we’ve been talking about not needing to prescribe opioids,” Feldman said. “This study’s results are such that there is no reason to be prescribing opioids unless you’ve got those special situations, like medical conditions preventing the use of ibuprofen or acetaminophen.”

Members of the research team said they hope to expand their work to other dental procedures and pain scenarios. Other researchers at the school are testing cannabinoids for managing dental pain.

“These studies not only guide us on how to improve current dental care,” said Feldman, “but also on how we can better train future dentists here at Rutgers, where we constantly refine our curriculum the light of science.”

Source: Rutgers University

Categories : Pain ManagementTags :

fMRI Brain Scan Predicts the Effectiveness of Spinal Cord Surgery

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A 10-minute brain scan can predict the effectiveness of a risky spinal surgery to alleviate intractable pain. The Kobe University result gives doctors a much-needed biomarker to discuss with patients considering spinal cord stimulation.

For patients with chronic pain that cannot be cured in any other way, a surgical procedure called “spinal cord stimulation” is seen as a method of last resort. The treatment works by implanting leads into the spine of patients and electrically stimulating the spinal cord. Because the spinal cord transmits sensations to the brain from all over the body, the position of the leads is adjusted so that the patients feel the stimulation at the site of the pain. The Kobe University anaesthesiologist Ueno Kyohei says: “A big issue is that the procedure is effective for some but not for other patients, and which is the case is usually evaluated in a short trial of a few days to two weeks prior to permanent implantation. Although this trial is short, it is still an invasive and risky procedure. Therefore, clinicians have long been interested in the possibility of predicting a patient’s responsiveness to the procedure through non-invasive means.”

Functional magnetic resonance imaging, or fMRI, has become a standard tool to visualize how the brain processes information. More precisely, it can show which parts of the brain are active in response to a stimulus, and which regions are thus functionally connected with each other. “In an earlier study, we reported that for the analgesic ketamine, pain relief correlates negatively with how strongly connected two regions of the default mode network are before the drug’s administration,” explains Ueno. The default mode network, which plays an important role in self-related thought, has previously been implicated in chronic pain. Another relevant factor is how the default mode network connects with the salience network, which is involved in regulating attention and the response to stimuli. Ueno says, “Therefore, we wanted to examine whether the correlation of the activities within and between these networks could be used to predict responsiveness to spinal cord stimulation.”

He and his team published their results in the British Journal of Anaesthesia. They found that the better patients responded to spinal cord stimulation therapy, the weaker a specific region of the default mode network was connected to one in the salience network. Ueno comments, “Not only does this offer an attractive biomarker for a prognosis for treatment effectiveness, it also strengthens the idea that an aberrant connection between these networks is responsible for the development of intractable chronic pain in the first place.”

Undergoing an fMRI scan is not the only option. Combining pain questionnaires with various clinical indices has been reported as another similarly reliable predictor for a patient’s responsiveness to spinal cord stimulation. However, the researchers write that “Although the cost of an MRI scan is controversial, the burden on both patients and providers will be reduced if the responsiveness to spinal cord stimulation can be predicted by one 10-minute resting state fMRI scan.”

In total, 29 patients with diverse forms of intractable chronic pain participated in this Kobe University study. On the one hand, this diversity is likely the reason why the overall responsiveness to the treatment was lower compared to similar studies in the past and also made it more difficult to accurately assess the relationship between brain function and the responsiveness. On the other hand, the researchers also say that, “From a clinical perspective, the ability to predict outcomes for patients with various conditions may provide significant utility.” Ueno adds: “We believe that more accurate evaluation will become possible with more cases and more research in the future. We are also currently conducting research on which brain regions are strongly affected by various patterns of spinal cord stimulation. At this point, we are just at the beginning of this research, but our main goal is to use functional brain imaging as a biomarker for spinal cord stimulation therapy to identify the optimal treatment for each patient in the future.”

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A Groundbreaking New Approach to Treating Chronic Abdominal Pain

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Researchers at the University of Vienna develop gut-stable oxytocin analogues for targeted pain treatment of chronic abdominal pain

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A research team at the University of Vienna, led by medicinal chemist Markus Muttenthaler, has developed a new class of oral peptide therapeutic leads for treating chronic abdominal pain. This groundbreaking innovation offers a safe, non-opioid-based solution for conditions such as irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD), which affect millions of people worldwide. The research results were published in Angewandte Chemie.

An innovative approach to pain management

Current medications used to treat chronic abdominal pain often rely on opioids. However, opioids can cause severe side effects such as addiction, nausea, and constipation. Additionally, they affect the central nervous system, often leading to fatigue and drowsiness, which impairs the quality of life of those affected. The addiction risk is particularly problematic and has contributed to the ongoing global opioid crisis. Therefore, there is an urgent need for alternatives that minimise these risks.

This new therapeutic approach targets oxytocin receptors in the gut, which, in addition to its role in social bonding, also affects pain perception. When the peptide hormone oxytocin binds to these receptors, it triggers a signal that reduces pain signals in the gut. The advantage of this approach is that the effect is gut-specific, thus having a lower risk of side effects due to its non-systemic, gut-restricted action.

Oxytocin itself cannot be taken orally because it is rapidly broken down in the gastrointestinal tract. However, Prof Muttenthaler’s team has successfully created oxytocin compounds that are fully gut-stable yet can still potently and selectively activate the oxytocin receptor. This means these newly developed oxytocin-like peptides can be taken orally, allowing for convenient treatment for patients. This approach is especially innovative since most peptide drugs (such as insulin, GLP1 analogues) need to be injected as they are also quickly degraded in the gut.

“Our research highlights the therapeutic potential of gut-specific peptides and offers a new, safe alternative to existing pain medications, particularly for those suffering from chronic gut disorders and abdominal pain,” explains Muttenthaler.

Next steps and future outlook

With support from the European Research Council, the scientists are now working to translate their research findings into practice. The goal is to bring these new peptides to market as an effective and safe treatment for chronic abdominal pain. Moreover, the general approach of oral, stable, and gut-specific peptide therapeutics could revolutionise the treatment of gastrointestinal diseases, as the therapeutic potential of peptides in this area has not yet been fully explored.

The team has already secured a patent for the developed drug leads and is now actively seeking investors and industrial partners to advance the drug leads towards the clinic.

Source: University of Vienna

Categories : Pain ManagementTags :

First-visit Communication with Doctor Affects Outcomes of Pain Patients

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Chronic pain, defined as daily or significant pain that lasts more than three month, can be complicated to diagnose and treat. Studies have shown that, since chronic pain conditions are clouded with uncertainties, patients often struggle with anxiety and depression – something challenging to for they and their doctors to discuss and manage.

A recent study of 200 chronic neck or back pain sufferers found that effective physician-patient communication during the initial consultation helps patients manage their uncertainties, including their fears, anxieties and confidence in their ability to cope with their condition.

Study leader Charee Thompson, communication professor at University of Illinois Urbana-Champaign, said: “We found that providers and patients who perceive themselves and each other as competent medical communicators during consultations can alleviate patients’ negative feelings of uncertainty such as distress and increase their positive feelings about uncertainties such as their sense of hope and beliefs in their pain-management self-efficacy. Providers and patients successfully manage patients’ uncertainty through two fundamental medical communication processes – informational and socioemotional, each of which can have important clinical implications.”

According to the study, informational competence reflects patients’ abilities to accurately describe their symptoms and verify their understanding of doctors’ explanations and instructions, as well as clinicians asking appropriate questions, providing clear explanations and confirming patients’ understanding. The extent to which doctors and patients establish a trusting relationship through open, honest communication and patients’ feelings of being emotionally supported by the physician reflects socioemotional communication competence.

Thompson and her co-authors — Manuel D. Pulido, a communication professor at California State University, Long Beach; and neurosurgery chair Dr. Paul M. Arnold and medical student Suma Ganjidi, both of the Carle Illinois College of Medicine — published their findings in the Journal of Health Communication.

The current study was based on uncertainty management theory, the hypothesis that people faced with uncertainty about a health condition appraise it and decide whether obtaining information is a benefit or a threat. For example, patients may seek information about the origins of a new symptom to mitigate their anxiety-related uncertainty — or, conversely, they might avoid information-seeking so they can maintain hopeful uncertainty about their prognosis, the team wrote.

The study was conducted at an institute in the Midwest composed of several clinics and programs that treat diseases and injuries of the brain, spinal cord and nervous system. Ranging in age from 18–75, those in the study sample had pain that included but was not limited to their neck, back, buttocks and lower extremities. About 59% of the patients were female. 

Before the consultation, the patients completed surveys rating how they experienced and managed their pain and their certainty or uncertainty about it. They and the providers also completed post-consultation surveys rating themselves and each other on their communication skills. 

The patients rated how well the provider ensured that they understood their explanations and asked questions related to their medical problem. 

To determine if patients’ levels of uncertainty changed, on the pre- and post-consultation surveys the patients ranked how certain or uncertain they felt about six aspects of their pain – including its cause, diagnosis, prognosis, the available treatment options and the risks and benefits of those. The patients also rated themselves on catastrophising – their tendency to worry that they would always be in pain and never find relief.

Patients’ feelings of distress were reduced when they and their physician mutually agreed that the other person was effective at seeking and providing medical information, and when the patients felt emotionally supported by their doctors, the team found.

“Patients’ ratings of their providers’ communication competency significantly predicted reductions in their pain-related uncertainty and in their appraisals of fear and anxiety, as well as increases in their positive uncertainty and pain self-efficacy,” Thompson said. “Providers’ reports of patients’ communication competency were likewise associated with decreases in patients’ pain-related uncertainty and marginally significant improvements in their positive appraisals of uncertainty.”

In a related study, the U. of I.-led team found that, for a subset of spinal pain patients, satisfaction, trust in and agreement with their doctor were strongly associated with the doctors exceeding patients’ expectations for shared decision-making and the quality of the provider’s history-taking and people skills. U. of I. graduate student Junhyung Han was a co-author of that paper, which was published in the journal Patient Education and Counseling. 

The team wrote that providers and patients need to discuss their mutual expectations for testing, medication and treatment, such as which options are worth pursuing and their potential to meet patients’ expectations for pain relief. 

Thompson said that while these studies’ findings highlight the effects that providers’ overall communication skills have on chronic pain patients’ emotions, expectations and attitudes about their condition, the patients’ communication skills matter, too. 

“I wanted to challenge the notion that pain patients are frustrated or ‘difficult’ because they have unrealistic standards,” Thompson said. “No matter how high their expectations are, what seems to matter most to conversation outcomes is the extent to which patients’ expectations are met or exceeded.

“Consultations mark what may be a long, challenging diagnostic and treatment journey for these patients, and they could benefit from learning about therapies and strategies to help them manage their pain and uncertainties,” Thompson said. “Giving them the tools and language to communicate their symptoms and concerns to providers could make their interactions more productive. Learning about the uncertain nature of pain may validate their fears and anxieties, while awareness and education about the various treatment options and therapies such as cognitive behavioural therapy could enhance their coping and dispel feelings of helplessness and fear.”

Source: University of Illinois at Urbana-Champaign

Categories : Gender Pain ManagementTags :

Men and Women Use Different Biological Systems to Reduce Pain

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In a new study evaluating meditation for chronic lower back pain, researchers at University of California San Diego School of Medicine have discovered that men and women utilise different biological systems to relieve pain. While men relieve pain by releasing endogenous opioids, the body’s natural painkillers, women rely instead on other, non-opioid based pathways. The study was published in PNAS Nexus.

Synthetic opioid drugs, such as morphine and fentanyl, are the most powerful class of painkilling drugs available. Women are known to respond poorly to opioid therapies, which use synthetic opioid molecules to bind to the same receptors as naturally-occurring endogenous opioids. This aspect of opioid drugs helps explain why they are so powerful as painkillers, but also why they carry a significant risk of dependence and addiction.

“Dependence develops because people start taking more opioids when their original dosage stops working,” said Fadel Zeidan, PhD, professor of anaesthesiology and Endowed Professor in Empathy and Compassion Research at UC San Diego Sanford Institute for Empathy and Compassion. “Although speculative, our findings suggest that maybe one reason that females are more likely to become addicted to opioids is that they’re biologically less responsive to them and need to take more to experience any pain relief.”

The study combined data from two clinical trials involving a total of 98 participants, including both healthy individuals and those diagnosed with chronic lower back pain. Participants underwent a meditation training program, then practiced meditation while receiving either placebo or a high-dose of naloxone, a drug that stops both synthetic and endogenous opioids from working. At the same time, they experienced a very painful but harmless heat stimulus to the back of the leg. The researchers measured and compared how much pain relief was experienced from meditation when the opioid system was blocked versus when it was intact.

The study found:

  • Blocking the opioid system with naloxone inhibited meditation-based pain relief in men, suggesting that men rely on endogenous opioids to reduce pain.
  • Naloxone increased meditation-based pain relief in women, suggesting that women rely on non-opioid mechanisms to reduce pain.
  • In both men and women, people with chronic pain experienced more pain relief from meditation than healthy participants.

“These results underscore the need for more sex-specific pain therapies, because many of the treatments we use don’t work nearly as well for women as they do for men,” said Zeidan.

The researchers conclude that by tailoring pain treatment to an individual’s sex, it may be possible to improve patient outcomes and reduce the reliance on and misuse of opioids.

“There are clear disparities in how pain is managed between men and women, but we haven’t seen a clear biological difference in the use of their endogenous systems before now,” said Zeidan. “This study provides the first clear evidence that sex-based differences in pain processing are real and need to be taken more seriously when developing and prescribing treatment for pain.”

Source: University of California – San Diego