Category Archives: Pain Management

IV APAP of Little Benefit for Cardiothoracic Post-op Pain

IV APAP of Little Benefit for Cardiothoracic Post-op Pain – Pain Medicine Newsby Kenneth Bender – Aug 2019

This is an amazingly honest negative evaluation of IV Tylenol, which some people claimed was just as effective as opioids. But this study is a reality check and brings more science and less hype to the overcrowded field of opioid/pain studies.

Intravenous acetaminophen provided little benefit in multimodal analgesia regimens for cardiothoracic postoperative pain and posed a risk for hypotension, according to a study of outcomes in a real-world population.

I’m thrilled to hear it stated so definitively after so many years of hearing how great of a pain killer Tylenol is.  Continue reading

Most People Don’t Feel Euphoric From Opioids

Most People Don’t Actually Feel Euphoric When They Take Opioids, Study Finds | Live Science –  By Nicoletta Lanese – Oct 2019

Opioids are known to spark feelings of euphoria in users, but does everyone really share the same experience?

Opioids jump-start the brain’s reward system, provoking a burst of pleasurable feelings along with a dizzying drug-induced high. At least that’s what scientists used to think

But mounting research suggests that the average person doesn’t actually reach this euphoric state on opioids, particularly not the first time they try it. In fact, people who are not addicted to opioids may feel subjectively worse after taking the drug, according to cognitive neuroscientist Siri Leknes.    Continue reading

Long-term opioid therapy for chronic pain

Long-term opioid therapy in chronic noncancer pain. NIH – Feb 2015 – a systematic review and meta-analysis of efficacy, tolerability, and safety in open-label extension trials with a study duration of at least 26 weeks (that’s 1/2 year).

This study confirms what pain patients all know: long-term opioids are effective for long-term pain, require few increases, and only rarely result in “opioid use disorder”. 

The efficacy and safety of long-term (≥ 6 months) opioid therapy (LtOT) in chronic noncancer pain (CNCP) is under debate.A systematic review with meta-analysis of the efficacy and harms of opioids in open-label extension studies of randomized controlled trials (RCTs) has not been conducted until now.   Continue reading

Testosterone for severe knee Osteoarthritis

Total serum testosterone and WOMAC pain and function among older men and women with severe knee OA – Freystaetter – – Arthritis Care & Research – Wiley Online LibrarySep 2019

I’m just showing the abstract here, but a watermarked pre-publication version of the full article is available at: https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.24074

Objectives

We investigated if serum total testosterone (T)‐level is associated with knee pain and function in men and women with severe knee osteoarthritis (OA).   Continue reading

Neurosteroid Hormone Therapy for Chronic Pain

Hormone Therapy for Chronic Pain: Are Neurosteroids the Answer?By Forest Tennant, MD, DrPH, Ingrid Hollis, Lynn Kivell Ashcraft and Kris Walters – Oct 2019

What every person living with chronic pain should know about steroids, replenishment, and more.

While pain medication may provide you with you symptomatic, temporary relief so that you can function, hormone administration as part of a pain management plan can help to bring about the healing of damaged nerves and other tissues.

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OTC Pain Medications: The Pros and Cons

OTC Pain Medications: The Pros and Cons – Pharmacy Times – by Kathleen Kenny, PharmD, RPH – Aug 2017

OTC pain medications are, by far, the most widely used of the OTC medications.

Two types of OTC pain medications are available.

  1. The first is acetaminophen (N-acetyl-p-aminophenol, or APAP), and
  2. the second is nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, and aspirin.

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NGF Inhibitor leads to rapid joint destruction

NGF Inhibitor Reduces Joint Pain but Raises Risk for Deterioration – Pain Medicine News – Oct 2019

Tanezumab, an investigational monoclonal antibody that inhibits nerve growth factor, improved joint pain and physical function in patients with osteoarthritis, in a placebo-controlled clinical trial.

Although the agent demonstrated efficacy relative to placebo in study participants who had not obtained relief with conventional agents, the investigators characterized the improvement with tanezumab as modest, and found that it was associated with an increased incidence of rapidly progressive osteoarthritis (OA) and a requirement for total joint arthroplasty.

Such adverse effects would doom any other medication, but this one keeps getting promoted only because it’s not an opioid.  Continue reading

Joint Injections: Are They Worth the Risk?

Joint Injections: Are They Worth the Risk? | Medpage Today – Oct 2019

Patients no longer allowed to receive effective pain medications (opioids) may become desperate enough to allow these procedures despite the known dangers.

Intra-articular injections of corticosteroids for relief of the pain of hip or knee osteoarthritis (OA) may have adverse long-term consequences, researchers suggested.

I’ve been warning about this for years, especially when they are done near the spine: The Pain Industry’s New & Dangerous Fall-Back

You can see all my previous posts about this hazard using the tag epidural-injectionContinue reading

Little evidence of opioid-induced hyperalgesia

Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis – Br J Anaesth. – 2019 Jun

Opioid-induced hyperalgesia (OIH) is well documented in preclinical studies…

It’s such a trendy topic that I’m sure many researchers are looking for evidence that chronic pain patients only need high doses because they are suffering from “opioid-induced hyperalgesia”, which has still NOT been proven in humans.

…but findings of clinical studies are less consistent.

This isn’t surprising to most pain patients, who know the difference between their increasing pain and hyperalgesia.  Continue reading

Non-Opioid Medication May Reduce Pain

Novel, ‘Non-Habit Forming’ Medication May Reduce Low Back PainNancy A. Melville – Apr 2019

A novel, “non-habit-forming” neurosteroidappears to be effective and well tolerated in the treatment of chronic low back pain, new research suggests.

In a double-blind, randomized controlled trial of almost 100 Iraq/Afghanistan-era veterans, those treated with a pharmaceutical-grade tablet formulation of pregnenolone showed “significant and meaningful reductions” in low back pain intensity ratings at 6 weeks compared with their peers who received matching placebo, investigators report.

I’m excited about this because pregnenolone is an over-the-counter supplement available to us all.
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