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Preclinical studies have demonstrated the analgesic potential of cannabidiol (CBD). Those suggesting an effect on pain-processing receptors have brought CBD back into focus. This study assessed the effect of CBD on acute pain, hyperalgesia, and allodynia compared with placebo. Twenty healthy volunteers were included in this randomized, placebo-controlled, double-blinded, crossover study assessing pain intensities (using numeric rating scale), secondary hyperalgesia (von Frey filament), and allodynia (dry cotton swab) in a well-established acute pain model with intradermal electrical stimulation. The authors compared the effect of 800-mg orally administered CBD on pain compared with placebo. They further examined the effect on hyperalgesia and allodynia. Cannabidiol whole blood levels were also measured. Pain ratings (mean ± SD) did not differ significantly after CBD application compared with placebo (5.2 ± 0.7 vs 5.3 ± 0.7, P-value 0.928), neither did the areas of hyperalgesia and allodynia differ significantly after CBD application compared with placebo (hyperalgesia 23.9 ± 19.2 cm2 vs 27.4 ± 17.0 cm2, P-value 0.597; allodynia 16.6 ± 13.1 cm2 vs 17.3 ± 14.1 cm2, P-value 0.884). The CBD whole blood level (median, first to third quartile) was 2.0 µg/L (1.5-5.1) 60 minutes and 5.0 µg/L (4.0-10.4) 130 minutes after CBD application. Although the oral application of 800-mg CBD failed to show a significant effect, it is important to focus future research on different dosing, routes of administration, and CBD as a part of multimodal treatment strategies before negating its effects on acute pain.
Recent sham-controlled studies suggest placebo effects contribute to acute pain relief following mindfulness interventions. However, the specific effects of mindfulness processes and their interaction with placebo effects remain unclear. This study aimed to characterize the role of mindfulness and placebo processes underlying mindfulness-based pain attenuation. Both treatment (focused-attention mindfulness vs sham) and instruction ("told mindfulness" vs "told sham") were manipulated in a balanced placebo design. Changes in acute heat pain were evaluated in 153 healthy adults randomized to receive 6 x 20 minutes of one of the four treatment by instruction interventions or no treatment. Participants receiving any intervention demonstrated improved pain outcomes (unpleasantness, intensity and tolerance) relative to no treatment. The instruction manipulation increased expectation for pain relief in those told mindfulness relative to told sham, but there were no main effects or interactions of treatment or instruction on pain outcomes. However, irrespective of actual intervention received, the belief of receiving mindfulness predicted increased pain threshold and tolerance, with expectancy fully mediating the effect on pain tolerance. These findings suggest a lack of specific effects of mindfulness and instruction on acute pain. Nonetheless, participants' expectancies and beliefs about the treatment they received did predict pain relief. Together with the overall improvement following any intervention, these findings suggest that expectancy and belief may play a stronger role in attenuating acute pain in novices following brief mindfulness interventions than the actual mindfulness-specific processes or instructions delivered.
Purpose: Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain.
Patients and methods: GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis.
Results: Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD -2.14, 95% CI -2.65 to -1.63; p<0.00001) and after 30 days after the end of treatment with ketamine (MD -1.68, 95% CI -2.25 to -1.12; p<0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p<0.00001).
Conclusion: There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review.
Opioids are integral to multimodal analgesic regimens in children with moderate to severe acute pain. Throughout normal childhood there are marked changes in physiology, and social and psychological development that influence the perception and expression of pain, the pharmacology of opioids, and how they are used. A multidimensional pain assessment is key to guiding appropriate opioid prescribing. Most of the commonly used opioids in adults are used in children, with the increasing exception of codeine (as a result of regulatory change), and are generally well tolerated. Patient groups at increased risk of ventilatory impairment include neonates and those with obstructive sleep apnoea, severe neurodevelopmental conditions, trisomy 21, and severe epilepsy. Slow-release opioids are not recommended for general use, but may be used in select populations, for example, following scoliosis surgery, major trauma or burns. Prescribing and administration errors are a major issue in paediatrics generally; the potential consequences of opioid prescribing or administration errors are serious, particularly following hospital discharge. Opioids prescribed at discharge are frequently in excess of a child's analgesic requirements; three to five days supply appears sufficient for the majority of common paediatric operations. Discharge opioid prescriptions have been linked to long-term opioid use in adolescents with risk factors. Misuse of prescription opioids by adolescents is also concerning, with prevalence estimates ranging from 1.1% to 20%. Caregivers have a tendency to underdose opioids in their children; caregiver education may improve appropriate administration. Caregivers must also be provided with instructions on safe storage and disposal of unused opioids.
Background: Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement.
Methods: One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR + NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved.
Results: In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR + NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR + NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P < 0.001). The per-protocol analysis found a statistically higher success rate for the LOR + NS group compared to the LOR-alone group (98% vs. 82%; P = 0.017) when only patients in whom stimulation was achieved were included.
Conclusions: Addition of NS technique did not statistically improve the success rate for epidural placement when analyzed in an intention-to-treat format and was associated with a longer procedural time. In a per-protocol analysis a statistically higher success rate for patients in whom stimulation was obtained highlights the potential benefit of adding NS to LOR.
Trial registration: ClinicalTrials.gov identifier NCT03087604 on 3/22/2017; Institutional Review Board Wake Forest School of Medicine IRB00039522, Food and Drug Administration Investigational Device Exemption: G160273.
Opioids remain the major drug class for the treatment of acute, chronic and cancer pain, but have major harmful effects such as dependence and opioid-induced ventilatory impairment. Although no new typical opioids have come onto the market in the past almost 50 years, a plethora of new innovative formulations has been developed to meet the clinical need. This review is intended to shed light on new understanding of the molecular pharmacology of opioids, which has arisen largely due to the genomic revolution, and what new drugs may become available in the coming years. Atypical opioids have and are being developed which not only target the mu opioid receptor but other targets in the pain pathway. Biased mu agonists have been developed but remain 'unbiased' clinically. The contribution of drugs targeting non-mu opioid receptors either alone or as heterodimers shows potential promise but remains understudied. That gene splice variants of the mu opioid receptor produce multiple receptor isoforms in different brain regions, and may change with pain chronicity and phenotype, presents new challenges but also opportunities for precision pain medicine. Finally, that opioids also have pro-inflammatory effects not aligned with mu opioid receptor binding affinity implicates a fresh understanding of their role in chronic pain, whether cancer or non-cancer. Hopefully, a new understanding of opioid analgesic drug action may lead to new drug development and better precision medicine in acute and chronic pain relief with less patient harm.
Misuse of prescription opioids forced an inevitable response from authorities to intervene with consequences felt by all.In the Australian community one person will die for approximately every 3600 adults prescribed opioids, while in the hospital setting a postoperative patient managed primarily with opioids, as opposed to epidural analgesia, has an additional risk of death as high as between one in 56 to 477.Opioids maintain a valid role in acute pain management when use is reasoned and with full awareness of the harms and how they are to be avoided, such as in those at risk of ongoing use, the opioid naïve, and when opioid-induced ventilatory impairment may occur.Clinicians managing acute pain can focus on assessing pain versus nociception, strategically apply antinociceptive medications and neural blockade when indicated, assess pain with an emphasis on the degree of bothersomeness and functional impairment and, finally, optimise the use of framing and placebo-enhancing communication to minimise reliance on medications.
The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyses have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, the utilization of big data in acute pain and regional anesthesia research has considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.
Objectives: In the last 30 years, opioid maintenance treatment prescription (OMT) has changed patients' and also changed physicians' practices. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. The objective of this qualitative study was to explore medical care challenges and solutions identified by GPs in the management of acute pain among patients receiving OMT.
Design and setting: Qualitative study with semistructured interviews were used as a data collection technique with a sampling strategy using a snowball sampling method to obtain a purposive sample of practicing GPs. Analysis was undertaken using a thematic analysis method.
Participants: Twelve GPs, working in France (Brittany) who prescribe OMT were interviewed.
Results: The thematic analysis resulted in two main themes relating to specificities and difficulties identified: (1) Medical care and training challenges identified by GPs treating patients on OMT with acute pain, with four subthemes : management of these situations not concerning primary care, lack of training prompts GPs to rely on peer and specialist support, lack of guidelines and conflicting recommendations between clinicians in different settings (2) linked to the patient-GP relationship, with six subthemes: Implementing an individualised centred approach, acute pain management during OMT relies on a relationship based on trust, GPs found difficulties in evaluating and treating pain, difficulties in care adherence, fear of patients destabilisation, fear of misuse and diversion.
Conclusion: The complexity of acute pain and OMT entails significant challenges for clinicians and patients. In primary care, it is hard to achieve a balance between pain relief and opioid use disorder treatment, in a global patient-centred approach. Fear of misuse or diversion was not a important factor, except for patients not known to the practitioners, but GPs were concerned with the risks of patient destabilisation in situations of acute pain.
Methods: Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018.
Main outcome measures: Pain and anxiety outcomes were measured as a numeric rating score (scale 0-10).
Results: Compared with standard care, women with virtual reality intervention experienced less average pain (score 6.0 versus 3.7, mean difference 2.3, 95% CI 0.61-3.99, P = 0.009) and anxiety (score 5.45 versus 3.3, mean difference 2.15, 95% CI 0.38-3.92, P = 0.02).
Conclusion: Virtual reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a mixed-methods randomised control trial. Its wide potential role in ambulatory gynaecological procedures needs further evaluation.
Tweetable abstract: Virtual reality can be used as a part of a multimodal strategy to reduce acute pain and anxiety in patients undergoing outpatient hysteroscopy.
Background: Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage.
Methods: We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other.
Results: This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6.
Conclusions: Clinically, these results suggest that individual pain-state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient- and surgery-specific factors may help indicate which patients are at increased risk of PPP.
Significance: Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
Like morphine, methadone is a pure agonist at the µ opioid receptor. However, in distinction to morphine which has an elimination half-life of 2-3 h, methadone has an elimination half-life of 24-36 h. In addition to its effects at the µ opioid receptor, methadone is an antagonist at the N-methyl-D-aspartate (NMDA) receptor and also inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine, in the central nervous system. Given its long half-life and high oral bioavailability, methadone has had a primary role in the outpatient treatment of patients with a history of opioid abuse or addiction. However, its unique pharmacology and cellular effects make it a valuable agent in the treatment of both acute and chronic pain of various etiologies. The following manuscript reviews the pharmacologic properties of methadone and discusses its clinical applications in the practice of pediatric anesthesiology and pediatric critical care medicine.
This review features key medical articles from global anaesthesia journals with commentary from Dr John Barnard The Review covers topics such as epidural anaesthesia, inhalational anaesthetics, intravenous opioid analgesics, muscle relaxants, neuromuscular blocking drugs and intravenous reversal agents.
- Dexamethasone as an analgesic adjuvant after total knee arthroplasty
- Delirium with regional vs. general anaesthesia for hip fracture surgery in the elderly
- Balanced multi-electrolyte solution vs. saline for critically ill adults
- Opioid-free general anaesthesia for improving postoperative outcomes
- Anterior suprascapular nerve block vs. interscalene brachial plexus block for arthroscopic shoulder surgery
- QOL after nonoperative vs. operative management of proximal femoral fractures in frail patients
- Effects of booster sessions on self-management interventions in chronic musculoskeletal pain
- Primary-care CBT for long-term opioid users with chronic pain
- Persistent pain after hysterectomy, caesarean section, prostatectomy or donor nephrectomy
- Mediators of relationships between pain intensity and 3-month QOL in adolescents with chronic pain
- Relationships between pain and psychological distress during the pandemic
Issue 26 (2021)
- Hypoxaemia following total hip/knee arthroplasty
- COVID-19 risk to healthcare workers performing tracheal intubation
- Surgical cancellation rates due to perioperative hypertension
- Predicting opioid-induced respiratory depression in inpatients
- Analgesic efficacy and safety of CEI vs. IEB for labour
- Transition from acute to persistent pain in women presenting to an ED
- Patients’ experiences with telecare for chronic pain
- Digital health psychological intervention for paediatric chronic pain
- CFT for nonspecific persistent LBP
- Parental multisite chronic pain and risk of offspring developing additional chronic pain sites
Issue 25 (2020)
In this edition we feature:
- Medicinal cannabis use in a time of policy change in NZ
- Breast cancer surgery under propofol vs. sevoflurane general anaesthesia
- Nonintubated anaesthesia + PNVB vs. intubated anaesthesia in paediatric video-assisted thoracic surgery
- Spinal vs. general anaesthesia for hip fracture repair
- Perioperative gabapentinoid use for managing postoperative acute pain
- Caring for patients with pain during the COVID-19 pandemic
Issue 24 (2020)
In this edition we feature:
- Persistent postoperative opioid use
- CUD: perioperative outcomes after major elective surgery
- Sphenopalatine ganglion block for PDPH
- Effect of tranexamic acid by baseline mortality risk in acute bleeding
Issue 23 (2020)
In this edition we feature:
- Complications from perioperative transoesophageal echocardiography
- Prediction of hospitalisation length and complications by frailty assessments
- Low- vs. high-dose intraoperative opioids
Issue 22 (2019)
In this edition we feature:
-Breast cancer recurrence after regional vs. general anaesthesia
- Preoperative chloride levels and mortality/morbidity after noncardiac surgery
- Intraoperative nonopioid adjuvant analgesic agent use
CPD Credit: CPD participants may claim this under Knowledge and skills ‘Journal readings’ activity at 1 credit per hour.
This open access journal is the official Journal of the Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM), covering clinical and basic research, education, patient care, health economics, and policy to inform all practitioners in pain management, such as anesthesiologists, interventional pain physicians, neurosurgeons, neurologists, and any specialists who are interested in pain medicine.
The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing you the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and physical and rehabilitation therapists.
PAIN® is the official publication of the International Association for the Study of Pain® (IASP®). PAIN® publishes original research on the nature, mechanisms, and treatment of pain and provides a multidisciplinary forum for the dissemination of research in the basic and clinical sciences.
Pain Medicine is dedicated to pain clinicians, educators, and researchers with an interest in pain from various medical specialties and related health disciplines. The journal reflects the rapid growth in pain science and practice, as well as the field's need for policy, ethical, and forensic commentary on pain and its management. It promotes the visibility and development of pain medicine as a worldwide interdisciplinary medical specialty within a collaborative, multidisciplinary pain field.
Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management.
- Dose reductions among chronic opioid therapy recipients
- Enhanced mindfulness-based stress reduction in episodic migraine
- Effect of relevant education on long-term opioid use before spinal surgery
- Education of opioid use risk prior to elective lower-extremity surgery
- ‘Embodied’ VR intervention for low back pain
- Mindfulness-oriented recovery enhancement in patients misusing opioids for chronic pain
- Wearable TENS for knee OA pain
- ESPB for pain control after spinal surgery
- Closed-loop SCS for chronic back and leg pain: clinical and QOL outcome durability
- SCS-related adverse events reported to TGA
Issue 64 (2021)
- Evidence-based psychological interventions for chronic pain
- Opioid stewardship practices in hospitals
- Implantable restorative neurostimulator for refractory chronic LBP
- Pain reprocessing therapy for chronic back pain
- Healthcare provider utilisation of prescription monitoring programmes
- Transcranial DCS for knee OA pain with dysfunctional descending pain inhibitory system
- Intra-articular botulinum neurotoxin vs. physical therapy in knee OA
- Effect of migraine on propranolol for painful temporomandibular disorder
- Catastrophisation effects of MRI report, and benefits of clinical reporting
- Liraglutide, after weight loss, for pain and weight control in knee OA
Issue 63 (2021)
- Opioid use disorder and initiation of physical therapy for LBP
- Comorbid chronic pain and depression: shared risk factors
- Association between chronic pain and long-term cognitive decline in the elderly
- Cannabinoids, cannabis and cannabis-based medicine for pain management
- Adverse effects of heavy cannabis use
- C. sativa terpenes selectively enhances cannabinoid activity
- Opioid consumption and pain after orthopaedic/urological surgery
- High-frequency SCS for painful diabetic neuropathy
- Guidance for steroid injections with COVID-19 vaccination
- Opioids: extramedical use and harm in chronic noncancer pain
Issue 62 (2021)
- Multifaceted intervention to improve LBP care in ED
- Primary-care access for individuals on prescribed opioids
- Effect of local vibratory stimulation on proprioceptive control
- Midlife family financial strain, sense of control and pain in later years
- Day-case THA
- Disposal kits and fact sheets do not improve un-needed opioid disposal
- Systemic opioid prescribing patterns and care costs on initiation of SCS
- UK recommendations on opioid stewardship
- Cannabidiol for acute LBP in ED
- Internet-delivered ACT as microlearning for chronic pain
Issue 61 (2021)
In this edition we feature:
- Chronic back pain subgroups according to walking performance, pain and disability
- Effect of aerobic exercise on response to opioids for chronic LBP
- Relationships between sensory profiles and self-reported pain in neuropathy
- Insights into the role of TRPA1 channels in cold pain
- Antidepressants for back pain and osteoarthritis
- Progression of withdrawal symptoms in medical cannabis recipients for chronic pain
- Neural systems underlying placebo analgesia
- Neuromodulation with burst and tonic SCS decreases opioid consumption
- Telemedicine for chronic pain during and after COVID-19
- Evaluation of state policy interventions targeting the US opioid epidemic
Issue 60 (2020)
In this edition we feature:
- Community pharmacy naloxone supply: effect of rescheduling as over-the-counter
- Effects of opioid stewardship interventions
- Deprescribing long-term opioids in chronic pain
- Buprenorphine/naloxone vs. methadone for failed back surgery syndrome/opioid addiction
- Transcranial DCS for chronic neuropathic pain in multiple sclerosis
- Effect of OUD on initiating physical therapy for LBP
- Graded motor imagery for reducing phantom limb pain in amputees
- Psychosocial and functional outcomes and opioid usage following burst SCS
- Self-administered skills-based VR intervention for chronic pain
- Botulinum neurotoxin for neuropathic pain
Analgesic dependence severity and medication overuse headache
Opioid/benzodiazepine prescriptions for patients with overdose history
Conventional vs. burst SCS in chronic neuropathic pain model: effect of amplitude
Psychophysical-based prediction of duloxetine efficacy for migraine prevention
Transdiagnostic emotion-focused exposure for chronic pain with anxiety/depression
Brief CBT for chronic pain
Botulinum toxin for chronic pelvic pain in endometriosis
REN for acute migraine treatment
Pulsed radiofrequency outcomes according to electrodiagnosis in intractable lumbosacral radicular pain
Perioperative duloxetine for acute postoperative analgesia
Issue 58 (2019)
In this edition we feature:
- Single-fraction stereotactic vs. conventional multifraction RT for pain relief of bone metastases
- Ketamine infusions for chronic pain
- Opioid safety initiative for TKR
- Brief psychological expectancy intervention for postoperative pain
- Benchmarking children’s persistent pain services in Australasia
- Reasons for percutaneous SCS explantation
- Role of afferent input in postamputation pain
- Ketoprofen or methylprednisolone in acute sciatica
- Chronic insufficient sleep alters pain habituation and sensitisation processes
- Pronociceptive effect of sleep deprivation mediated by nucleus accumbens
Issue 57 (2019)
The first research paper selected for this issue found that combining three nonopioid analgesics with morphine for postoperative
analgesia provided better analgesia with significant morphine-sparing over 48 hours postsurgery when compared with morphine
alone. An oromucosal spray containing THC (Δ9-tetrahydrocannabinol) and cannabidiol was found to be effective and well
tolerated when used as add-on treatment for refractory chronic pain, with the effect particularly promising in neuropathic
pain. A prospective 2-year trial has addressed the question of opioid efficacy for chronic noncancer pain, finding limited
effectiveness as long-term management. A post hoc analysis of the TOPCARE (Transforming Opioid Prescribing in Primary
Care) study has identified reasons for opioid discontinuation and associated outcomes.
Issue 56 (2019)
This issue begins with a study demonstrating that anxiety, depression and their interaction all affected changes in pain disability at 1 year of follow-up in attendees of a multidisciplinary chronic LBP (low back pain) clinic. Other research included this issue found that intravenous lignocaine provided a similar degree of pain relief with fewer side effects compared with intravenous morphine when given to patients presenting at an ED with undifferentiated severe pain. Another paper reports on fremanezumab, a humanised monoclonal antibody that targets CGRP (calcitonin gene-related peptide), for treating migraine, nicely complementing a review on the role of CGRP in the pathophysiology of migraine. This issue concludes with research reporting that both sleep and fatigue impact on the success of multidisciplinary programmes for chronic pain.
Issue 55 (2019)
This issue begins with a retrospective analysis reporting decreased opioid use and increased successful extubation in the operating room when a multimodal analgesia protocol that enhances recovery after cardiac surgery was used. Other included research reports that mechanistic pain profiling was able to predict pain alleviation associated with NSAID plus paracetamol (acetaminophen) use for chronic knee OA (osteoarthritis). An internet-delivered exposure therapy programme for fibromyalgia was found to be cost effective with large societal cost savings. This issue concludes with an open-label study reporting on the real-world use of long-term onabotulinumtoxin A for managing chronic migraine.
Conference Review - APS 39th Annual Scientific Meeting (2019)
This review focuses on the 2019 APS (Australian Pain Society)
39th Annual Scientific Meeting, held at the Gold Coast Convention and Exhibition Centre in Queensland, in the IASP Global Year Against Pain in the Most Vulnerable. The meeting provided a programme that included mechanistic and clinical research spanning psychological, surgical, pharmaceutical, social and epidemiological domains. It provided attendees with the opportunity to learn from these sessions and also to meet and network with colleagues interested in pain management research.
From the wealth of presentations, ten have been selected for inclusion in this Conference Review, which we hope you will find interesting and informative.
Issue 54 (2019)
To begin the first issue for 2019, data from three RCTs of the humanised monoclonal antibody galcanezumab for treating episodic or chronic migraine have been analysed and reported, focussing on the impact of continued treatment among participants who did not achieve an optimal early response. This is followed by the presentation of ≤2-year data from an
Australian RCT of the internet-delivered pain management programme the Pain Course, which offers varying levels of clinician support. Betulinic acid, extracted from Hyptis emoryi (a desert lavender plant), has been studied and found to offer broadspectrum biological and medicinal properties that could have potential as a natural nonopioid treatment for chronic pain. This issue concludes with an analysis of US prescription drug monitoring programme data alerting physicians to escalating opioid
dosage patterns as an important indicator of increased mortality risk, particularly in patients with OUD (opioid use disorder).
SPEAKER SERIES The changing experience of cancer: Challenges, opportunities and the role of palliative medicine in cancer (2019)
In a recent seminar hosted in Sydney, Professor Ahmedzai from the UK discussed the paradigm shift from treating patients dying of cancer to people living with their disease. This summary of that presentation has been produced to enable those who could not attend to benefit from the valuable learning opportunities provided. These included: i) the changing landscape of cancer as a chronic disease for many patients, and the implications for palliative care delivery; ii) insights into the mechanisms of pain at all stages of the disease, including treatment-induced pain and focusing on practical approaches to tailoring care, including patient selection, initiation of targeted therapies and multimodal analgesia; iii) the role of opioids and considerations for special patient populations, including a practical approach to patient assessment, titration, rotation and screening of hepatic impairment; and iv) challenges and opportunities for the future positioning of palliative medicine in relation to oncology and interventional pain medicine.
Issue 53 (2018)
Research papers selected for this issue include the impact that legalising cannabis for medical use has had on opioid prescriptions/use in the US, an evaluation of composite responder outcomes of pain intensity and physical function in clinical trials of neuropathic pain, the use of a mobile app in the management of chronic musculoskeletal pain, guidelines regarding the use of onabotulinumtoxin A for chronic migraine, and the contributions of chronic pain among suicide decedents and of
opioids in depression among patients with chronic pain.
SPEAKER SERIES Treatment of chronic cancer pain: current evidence (2018)
This is a summary of a presentation by A/Prof Michael Franco, from Monash Health, Victoria, who spoke on the current evidence for treating chronic cancer pain as part of Breakfast Session 6 at the MOGA (Medical Oncology Group of Australia) 2018 Annual Scientific Meeting, which was held on Aug 1–3 in Adelaide. A/Prof Franco’s talk covered the WHO ladder for managing cancer pain, opioid switching/rotation, two specific opioids (TARGIN® tablets [modified release oxycodone/naloxone] and methadone) and novel techniques. This Breakfast Session was sponsored by Mundipharma, and we hope you find this summary enlightening.
Issue 52 (2018)
This issue contains research from the US VA (Veteran’s Affairs) healthcare system reporting on the success of integrating an interdisciplinary chronic pain care intervention into primary care. Other papers in the issue focus on this topic, looking at changes in pain intensity following discontinuation of long-term opioid therapy, and the value of ACT (acceptance and commitment therapy) in individuals at risk of chronic pain and opioid use following orthopaedic surgery.
Issue 51 (2018)
This issue begins with research in rats showing that postoperative pain was increased with a high-fat diet, particularly
in males, with some effects not depending on weight gain. Research from the US has explored associations between medical marijuana use and both medical and nonmedical prescription drug use. Another of the research papers selected for this issue found that the use of IV remifentanil PCA during labour reduced conversion to epidural analgesia by about half compared with IM pethidine (meperidine). The ability of psychological interventions delivered by physiotherapists to improve health outcomes is addressed in research concluding this issue.
SPEAKER SERIES How the management of breakthrough cancer pain is evolving (2018)
This review is a summary of a Menarini-sponsored educational meeting on BTcP presented by Dr Andrew Davies from the Royal Surrey County Hospital, United Kingdom. Dr Davies’ presentation included how supportive care fits in with palliative care, clinical features of BTcP, the Association of Palliative Medicine (APM) recommendations for the treatment of BTcP, the use of rapid onset opioids, and some of the ongoing controversies such as addiction and abuse.
CPD Credit: CPD participants may claim this under Knowledge and skills ‘Journal readings’ activity at 1 credit per hour.
ANZCA acknowledges the traditional custodians of Country throughout Australia and recognises their unique cultural and spiritual relationships to the land, waters and seas and their rich contribution to society. We pay our respects to ancestors and Elders, past, present, and emerging.
ANZCA acknowledges and respects Māori as the Tangata Whenua of Aotearoa and is committed to upholding the principles of the Treaty of Waitangi, fostering the college’s relationship with Māori, supporting Māori fellows and trainees, and striving to improve the health of Māori.