Pain Management

Posted on Pain Management

E-health reduces patient pain and opioids in a clinical study. Would you use such a service? If so, why?


E-health reduces patient pain, opioids in clinical study

An online “e-health” program helped more people with chronic pain reduce their opioid medications and pain intensity than a control group that had only regular treatment in a recent clinical study.

In the study published in the journal Pain, about 400 participants who had been prescribed long-term opioid treatment for their pain were divided into two groups: one received treatment as usual and another received treatment and access to a self-guided, e-health program. Of the e-health group, more than half, 53.6%, were able to reduce their opioid medications by 15% or more after six months compared to 42.3% of patients in the control group.

“These were very encouraging findings: not only were they reducing opioids but also their pain was not becoming worse,” said Washington State University nursing associate professor Marian Wilson and the study’s lead author. “Some people are hesitant to stop their opioid medication because they fear their pain will increase, but we found that at least on average in this population, they could reduce their opioids a bit and not have increased pain symptoms.”

An estimated 50 million people in the U.S. have chronic pain and about 18 million are prescribed long-term opioid treatment. Since opioid use risks include addiction and even accidental death, researchers are searching for alternatives to help these patients.

At the start of this study, all the participants rated their chronic pain at an average intensity of 5 or 6 on a 0 to10 point scale with 10 being the most extreme pain. Chronic pain can arise from a range of conditions that have no cure, and the study participants had a range of diagnoses including arthritis, back pain, fibromyalgia and migraines.

At the end of the study, 14.5% of the e-health group reported that their pain was reduced by 2 points or more. Only 6.8% in the control group had the same level of pain decrease. The researchers also observed the patients improved their pain knowledge, confidence managing pain and coping skills.

For this study, the researchers used a psychologist-designed e-health program, called Goalistics Chronic Pain Management. This self-guided course aims to help people manage their own pain and its many impacts on their lives. The program contains a mix of pain tracking tools, cognitive therapy, exercise tips and relationship advice as well as information about opioid use and risks.

The program provides content similar to what a patient might receive from a psychologist who specializes in pain, a treatment that isn’t easily accessible for everyone, said Wilson.

While similar programs exist, the researchers chose this one because it is widely available in the U.S. and delivered fully online. Wilson also tested the Goalistics program in previous research providing preliminary data for this study’s large, randomized trial.

Since pain is such an individualized experience, the authors argue that patients can benefit from self-management programs so they can track their pain levels and experiment with different strategies.

 “The idea is to put the patient in the driver’s seat because we can give them a prescription for opioids, and that will work for a little while, but over time for chronic pain, it’s not usually going to be the solution to fix all their troubles,” she said.

Wilson added that chronic pain patients often have mood, social and physical functioning issues that also need attention.

The findings provide more evidence that online self-management programs are beneficial for chronic pain patients, and a variety of agencies, including the Centers for Disease Control and Prevention, support their widespread use.

At the time of this study, the e-health program had a monthly $30 fee. While relatively inexpensive compared to treatment by a pain psychologist, these types of programs are not covered by most insurance in the U.S. Other countries including Canada and Australia provide similar programs to patients for free, and Wilson is currently working on a project that aims to achieve greater access in the U.S.

Posted on Pain Management

Patients with chronic pain value empathic doctors who validate concerns and communicate clearly

Patient satisfaction with medical care for chronic low back pain: A pain research registry study
Patient satisfaction with medical care for chronic low back pain: A pain research registry study

Researchers measured the associations among process, outcomes and patient satisfaction within general medical care for chronic low back pain provided through an ongoing patient-physician relationship. They also used two models to measure factors associated with patient satisfaction, including studying a subgroup of participants experiencing chronic low back pain treated by the same physician for more than five years.

Among 1,352 participants, only physician empathy and communication were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy and communication remained linked to patient satisfaction in the multivariable analysis.

Physician empathy and physician communication were strongly associated with patient satisfaction with medical care for chronic low back pain. Researchers argue that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

What is Known on This Topic: Despite medical advances in managing chronic pain experienced by millions of Americans, little research has been conducted on how patient-physician interaction impacts the process of delivering medical care for chronic low back pain and, ultimately, patient satisfaction.

What This Study Adds: Patients with chronic pain highly value empathic physicians who validate their concerns and often ill-defined symptoms, as well as physicians who make efforts to more clearly communicate treatment plans and expectations to patients.

Posted on Fibromyalgia, Pain Management

The Best Diet for Fibromyalgia and Other Chronic Pain Relief

The Best Diet for Fibromyalgia and Other Chronic Pain Relief | NutritionFacts.org


Anti-inflammatory diets can be effective in alleviating fibromyalgia and other chronic pain syndromes. The duo of inflammation videos I mentioned are Foods That Cause Inflammation and Which Foods Are Anti-Inflammatory?


Posted on Pain Management, Women's Health

March is Endometriosis Awareness Month – Endometriosis: how to diagnose and manage this complex condition

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients. The review is timely, as March is Endometriosis Awareness Month. Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life. "Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs," writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors. Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. "Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated," the authors conclude. "Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada," say the authors.

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.

The review is timely, as March is Endometriosis Awareness Month.

Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.

“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.

Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. 

“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.

“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.

Posted on Pain Management, Rheumatoid arthritis

NB Folks with RA – Taking care of your teeth could help prevent chronic joint pain

research illustration


Proposed model for the role of periodontal inflammation in rheumatoid arthritis (RA). Periodontal inflammation is associated with a chemical change in supragingival bacteria caused by an enzyme released as part of an immune response mechanism known as NETosis. This chemical change ‘decorates’ bacterial antigens with a molecular tag. Periodontitis and inflammation can cause breaches of the mucous membrane lining inside the mouth, releasing the tagged bacterial antigens into the blood. As a result, antibodies that target these molecular tags are activated, and they bind or trap the tagged antigens, forming molecules known as immune complexes. Immune complexes and plasmablasts deposit in joint tissue, also known as synovium, and contribute to its inflammation. Repeated episodes of oral bacteremia cause a heightened autoimmune response, affecting join tissue. CREDIT Image courtesy of Dana Orange and Bill Robinson

 Regular visits to the dentist might help keep joint pain at bay, too.

When Rice University computational biologist Vicky Yao found traces of bacteria associated with periodontal disease in samples collected from rheumatoid arthritis patients, she was not sure what to make of it.

Her finding helped spark a series of experiments that confirmed a connection between arthritis flare-ups and periodontitis. The study is published in Science Translational Medicine.

Tracing this connection between the two conditions could help develop therapies for rheumatoid arthritis, an autoimmune inflammatory disease that attacks the lining of the joints and can cause heart-, lung- and eye-problems. The approach that led to the study could prove fruitful in other disease contexts, such as cancer.

“Data gathered in experiments from living organisms or cells or tissue grown in petri dishes is really important to confirm hypotheses, but, at the same time, this data perhaps holds more information than we are immediately able to derive from it,” Yao said.

Yao’s hunch was confirmed when she took a deeper look into data collected from rheumatoid arthritis patients by Dana Orange, an associate professor of clinical investigation and a rheumatologist, and Bob Darnell, a professor and attending physician at Rockefeller University and the Howard Hughes Medical Institute.

Yao was collaborating with Orange and others on a different project that tracked changes in gene expression during rheumatoid arthritis flare-ups.

“Orange, working with Darnell, collected data from arthritis patients at regular intervals while, at the same time, monitoring when the flares happened,” Yao said. “The idea was that perhaps looking at this data retroactively, some pattern would become visible giving clues as to what might cause the arthritis to flare up.

“While I was working on that project, I went to this talk that I thought was really cool because it pointed out that in the data that gets ignored or thrown out, you can actually find traces of microbes. You’re looking at a human sample but you get a snapshot of the microbes floating around. I was intrigued by this.”

When she looked into it, Yao found that the germs in the samples that changed consistently across patients prior to flares were largely ones associated with gum disease.

“I was curious about this tool that allowed you to detect microbes in human samples. It was sort of like, for free, you’re getting an extra perspective on the data,” Yao said. “At the time, I hadn’t worked much on microbial data at all. Since then, Dana leveraged all this expertise and got together with people studying these bacteria.

“One of the things that came up when we were discussing this was, how cool would it be if you could prescribe some kind of mouthwash to help prevent rheumatoid arthritis flares.”

Yao’s focus since joining Rice in 2019 has shifted to cancer research. The discovery of meaningful information in data that would usually be ignored or discarded inspired Yao to take a similar approach in looking at data from cancer patients.

“I got really interested in what else we can find mining for microbial signatures in human samples,” Yao said. “Now, we’re doing something similar in looking at cancer.

“The hope here is that if we find some interesting microbial or viral signatures that are associated with cancer, we can then identify productive experimental directions to pursue. For instance, if having a tumor creates this hotbed of specific microbes that we recognize, then we can maybe use that knowledge as a means to diagnose the cancer sooner or in a less invasive or costly way. Or, if you have microbes that have a very strong association with survival rates, that can help with prognosis. And if experiments confirm a causal link between a specific virus or bacteria and a type of cancer, then, of course, that could be useful for therapeutics.”

One of the better known examples of a pathogen associated with cancer is the human papillomavirus (HPV). Yao used this well-documented connection to verify her approach.

“When we did the same exercise looking at cervical cancer tumor samples, we consistently detected the virus,” she said. “It’s a nice proof-of-principle finding that shows that the presence of specific pathogens can be meaningful for certain types of cancer.

“I’m really interested in using computational approaches to bridge the gap between available experimental data and ways to interpret it. Computational analysis is a way to help interpret data and prioritize hypotheses for clinicians or experimental scientists to test.”