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COVID Long Haulers Prescribed Opioids at Higher Rates

with Lillie Rosenthal, DO

Osteoarthritis Treatments: Are Medications Needed for Better Quality of Life?

A PPM Brief with Padma Gulur, MD, Kevin Byram, MD, and Philip Conaghan, PhD

Chronic Pain Can Disrupt Medication-Assisted Treatment for Opioid Use Disorder

Opioid-agonist treatment utilizing methadone or buprenorphine maintenance therapy can be effective in treating opioid use disorder (OUD). However, individuals diagnosed with OUD often experience lapses in medication-assisted treatment (MAT) that can lead to full relapses.

CDC Opioid Prescribing Guideline Updates Are in the Works: Will the Changes be Enough?

Even before it was released five years ago, the CDC Guideline for Prescribing Opioids for Chronic Pain1 was at the center of controversy, with pain advocates and practitioners fearing that the recommendations would be misconstrued by policymakers as black and white rules with no room for individualized care and professional judgment.

Women with Psoriatic Arthritis Experience Higher Disease Activity and Different Treatment Response

Women with peripheral psoriatic arthritis showed higher levels of disease activity and lower remission rates compared to men, based on data from more than 1,000 patients.

A Message from the PPM Editors

The Language of Chronic Pain: How Clinicians Can Help Patients Describe What They are Feeling

Several initiatives have attempted to help clinicians and patients communicate more effectively about pain.

Pain Assessment and Treatment in Geriatric Populations

Assessing and treating pain in people with dementia poses unique challenges. Typically in pain management, assessment relies on patients’ report of their pain, explains Theresa Mallick-Searle, MS, RN-BC, ANP-BC, a nurse practitioner in the Division of Pain Medicine at Stanford Health Care.

Pain Interventions: Practice Advisory Issued for the Use of Gadolinium-based Contrast Agents

Iodinated contrast agents are necessary when administering pain interventions, such as nerve blocks and other injections, however many patients have hypersensitivity reactions to these agents.

Naloxone Nasal Spray: FDA Approves Higher Dose for Opioid Overdose

with Timothy J Atkinson, PharmD, BCPS, CPE

JAK Inhibitors and Drug-Drug Interactions: Managing Medications for Rheumatoid Arthritis

with Kevin Byram, MD

People with Rheumatoid Arthritis Should be Assessed for Anxiety, Depression as Pandemic Continues

with Don L. Goldenberg MD While the ongoing COVID-19 pandemic continues to challenge the mental health of the population at large, providers should be especially attuned to patients with rheumatoid arthritis (RA) as new data shows they may be at increased risk for anxiety and depression.

Health Apps Help with Medication Management, but How Can Pain Specialists Use Them More Effectively?

with Tiziano Marovino, DPT The adoption of digital solutions and health apps to deliver medical care has expanded during the COVID-19 pandemic, with new technology providing viable options to manage chronic illness – including chronic pain.

The Biden Administration Plan for Treating Opioid Use Disorder in the US: Is There One?

In late January 2021, just about a week after President Biden took office, more than a dozen major medical groups, including AMA and ASRA, published a letter to the Department of Health and Human Services urging that the new administration “take steps to eliminate federal policies that inhibit access to vital treatment” to the nation’s other ongoing crisis, the opioid epidemic.1 The

Gout: Two New Studies Show Benefits of DECT and Ultrasound for Diagnosis and Monitoring

with Jasvinder Singh, MD

WHO Updates Pain Management Protocols for Children

The World Health Organization has issued updated guidelines for the management of chronic pain in children and adolescents aged 0 to 19 years.

X-Waiver for Buprenorphine Prescribers: HHS Eases Restrictions on Treating Opioid Use Disorder

Important Update: Within days of this announcement, the new White House Administration reversed the guideline, returing buprenorphine waiver policies to their prior settings. See The Washington Post report.

Hydroxychloroquine as a COVID Preventive Still in the News

Emerging Medications for Treating Uveitis and Inflammation in Ankylosing Spondylitis

A PPM Brief UCB, a biopharmaceutical company specializing in neurology and immunology, recently presented data from two ongoing clinical trials. The data were based on studies of certolizumab pegol and the experimental drug bimekizumab. Here, a quick review.

Breakthrough Virtual Reality Therapy Targets Fibromyalgia and Chronic Low Back Pain

Virtual reality has been used for many years to treat acute pain, often during or after in-patient medical procedures, especially among children, but the therapy has been less studied in correlation with chronic pain. Now, the FDA has awarded breakthrough designation for EaseVRx, a virtual reality therapy in development by Los Angeles-based startup AppliedVR.

COVID Long Haulers: Symptoms and Connections to Post Viral Fatigue and Organ Damage

with medical review by Don L. Goldenberg

Pandemic Care: How Healthcare Providers Can Prevent PPE Headaches

Personal protective equipment (PPE) has become an aspect of everyday life for clinicians. While specific PPE differs based on procedure and availability of equipment, respirators are often worn for extended periods of time – sometimes combined with protective eyewear and water-resistant gowns.

Ankylosing Spondylitis: The AS-WIS Screening Tool

Axial spondyloarthritis (axSpA) most commonly affects younger adults, with the average age of onset 28 years – right in the prime working years, which adds to the disease’s already significant burden.1,2

FDA Releases Updated Guidelines for the Development of Drugs to Treat OUD Disorder

COVID-19 has been getting all the attention this year but, unfortunately, that doesn’t mean other health crises have gone away – including in the pain management field. Some are getting worse.

Cannabis Users May Need More Anesthesia During Surgery – and More Pain Meds After

As more states have legalized marijuana for medical and/or recreational purposes – especially after the state measure ballots, cannabis use has become more common across the United States with the CDC reporting that 22.2 million Americans use the substance each month.

COVID-19 Reinforces Racial Disparities in Healthcare

One of the first patterns to emerge in the initial chaos of the SARS-CoV-2 pandemic was the prevalence of racial disparities in both confirmed cases and deaths.1 Writing in The Lancet this fall, editor-in-chief Richard Horton argued that COVID-19 is not a pandemic, but rather a “syndemic” – a deadly confluence of epidemics that interact and worsen the effects of one another.

Could Chronic Pain Increase Risk of Cognitive Decline?

Chronic pain is common in elderly patients, including those with neurodegenerative conditions such as Alzheimer’s disease. However, recent data point to a potential link by which the presence of chronic pain actually may increase one’s risk for developing Alzheimer’s disease (AD) and similar cognitive problems in later life. However, recent data point to a potential link by which the presence of chronic pain actually may increase one’s risk for developing Alzheimer’s disease and similar cognitive problems in later life. (Image: iStock)

Commentary: VA Shows the Way to Treat Low Back Pain

An estimated 65% of Veterans suffer from chronic pain, more than three times the rate of the general population.1 At the same time, Veterans are twice as likely to die from accidental prescription opioid overdose compared to non-Veterans.2

Psoriatic Arthritis: Neuropathic Pain and Fibromyalgia Links

A PPM Brief

For Some Patients with Rheumatoid Arthritis, Oral Analgesics May Not Improve Quality of Life

A PPM Brief Over the past 20 years or so, a better understanding of the pathologies behind rheumatoid arthritis (RA) has led to new therapies that have largely revolutionized treatment and outcomes.1 However, getting control of the underlying inflammatory process with RA does not necessarily mean controlling all the symptoms of the disease.

Using Digital Technology to Improve the Outlook for Chronic Low Back Pain

Chronic musculoskeletal pain conditions, such as low back pain (LBP), are highly prevalent and costly, not to mention the most common noncancer indication for an opioid prescription in the United States.1 Nonspecific low back pain (NLBP) affects approximately 30% of the world’s population and results in significant direct and indirect health care costs.2 Most cases are tho

Disparities in Follow-up Care After Nonfatal Opioid Overdoses

A PPM Brief with Austin Kilaru, MD, an emergency physician at Perelman School of Medicine

The Role of Psychological Factors and Mindfulness in Fatigue-Related Disability

A PPM Brief Adults with rheumatoid arthritis or ankylosing spondylitis reported less fatigue-related disability when they engaged in mindfulness or other meaningful activities, based on data from 143 patients.

Additional Links Found Between Fibromyalgia and CRPS

A PPM Brief Individuals with fibromyalgia (FM) and/or complex regional pain syndrome (CRPS) reported more pain triggers and intensifiers, pain-related diagnoses, depression, anxiety, somatic symptoms, and bodily changes than both patients with other pain conditions and pain-free controls, in a new survey.1

FDA Approves Neurostimulation System to Treat Chronic Low Back Pain

with Ramon Cuevas-Trisan, MD

Both Patient and Provider Expectations Influence Treatment Effectiveness

The success of medical treatments, particularly those for chronic pain, depend in some degree on the expectations of the patient. But the provider’s expectations and communications to the patient about those expectations matter, too.

Chronic Pain, Opioid Dispensing, and Mental Health: A Complex and Potentially Dangerous Combination

Chronic pain prevalence, opioid use – and related deaths and disorders – continue to plague clinicians and policymakers as they struggle to find solutions for safe and adequate pain management to those suffering.

New Capsaicin Patch Helps to Reduce Diabetic Peripheral Neuropathy of the Feet

FDA approved a new capsaicin drug for treating diabetic peripheral neuropathy (DPN) of the feet in July 2020. Qutenza, from Averitas Pharma – the US subsidiary of the German pharmaceutical company Grünenthal – is a cutaneous patch that delivers prescription-strength capsaicin (8%) directly to the skin.

Pain Redefined: Inside the IASP’s Updated Definition

In July 2020, the International Association for the Study of Pain (IASP) updated its 40-year-old definition of “pain.” PPM talked to members of the Task Force behind the rewrite, published in Pain.1 Here’s a quick look at what changed:

COVID Poses Obstacles and Opportunities for Improving Pain Management

While social distancing has made it difficult to provide routine care – much less implement integrated care – the pandemic has pushed the medical industry to think creatively about healthcare delivery – and this may be an unforeseen benefit, as argued by pain researchers in a recent commentary.

The Connection Between Borderline Personality Disorder and Chronic Pain: Implications of Stress and COVID-19

Studies have shown that mental health disorders and chronic pain are inextricably connected.1 There is a bidirectional relationship between these conditions stemming from common neurological processes.2 Research indicates that individuals suffering from chronic pain have greater incidences of depression, anxiety, substance misuse, and personality disorders.3 Whi

New Evidence Highlights the Importance of Glycemic Control in Patients with Osteoarthritis

Clinicians are aware that diabetes mellitus (DM) and osteoarthritis (OA) often co-exist, but they may be unaware that the link is not necessarily through body weight.

Vitamin D and Diabetic Peripheral Neuropathy: The Research Continues

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes, affecting up to 50% of patients and often resulting in foot and hand muscle weakness, balance disturbance, and neuropathic pain. The pain is often severe and leads to depression, anxiety, sleep disorders, and reduced quality of life. Diabetic neuropathy involves both small and large nerve fibers.

Could an App-Based Cognitive Assessment for Patients with Multiple Sclerosis Improve Care?

As many as 1 million people in the United States are affected by multiple sclerosis (MS), a chronic condition that causes the body’s immune system to attack the CNS, often leading to pain.1 Many individuals with MS and related pain also experience cognitive dysfunction.

COVID-19: Clinical Considerations for Using Telemedicine with Pain Patients

with Christopher Eccleston, PhD, director of the University of Bath’s Center for Pain Research

New Studies Solidify the Efficacy of Ixekizumab in the Treatment of Psoriatic Arthritis

Psoriatic arthritis (PsA) is a form of inflammatory arthritis that affects up to 30% of individuals with psoriasis, or 0.25% of the total population.1 Early recognition and intervention is crucial, as the disease is frequently progressive with significant disability, and the process of joint damage begins at, or even before, the clinical onset of disease.1 Treatment of PsA

Pilot Brain Stimulation Study Falls Short of Reducing Back Pain

with David Cosio, PhD, ABPP

What Clinicians Need to Know About New FDA Respiratory Warnings on Gabapentin and Pregabalin Products

with Jeffrey Fudin, PharmD

Managing Pain and Related Symptoms during Coronavirus

A few tips for clinicians on managing pain and related symptoms during coronavirus. Editor's note: This article was published early in the COVID crisis (April 2020) – see updated resources for more current approaches.

Microbiome Disruptions and Opioid Dependence: What are the Links?

Research on the gut microbiome has increased significantly in the past decade, with many scientists suggesting that disruption of the microbiome plays a key role not only in gastrointestinal illnesses, but also in emotional and behavioral health, and more recently, in pain prevalence.

Melatonin for Pain

A PPM Brief

Presidential Candidates Barely Acknowledge the Opioid Crackdown's Threat to Pain Patients

During last October’s Democratic presidential debate in Ohio, billionaire hedge fund manager and then-candidate Tom Steyer erroneously claimed that “72,000 people died of opioid overdoses last year.” The

Researchers Continue to Investigate Fibromyalgia-Foot Pain Correlation

Research is showing a growing correlation between fibromyalgia and trigger point pain in the foot. Plus, how pregabalin, orthotics, and dry needling may help reduce chronic foot pain.

Music as a Pain Intervention for Fibromyalgia

with Eduardo Garza-Villarreal, MD, PhD, and Stéphane Guétin, PhD Music may be more than what some call the gateway to the soul—studies continue to show that it can offer many therapeutic benefits. In pain management, research has shown how listening to music can relieve a variety of pain conditions—termed music-induced analgesia (MIA).

New Strategies for Treating Pediatric Sickle Cell Disease

A PPM Brief with Farzana Pashankar, MD, MRCP

Using L-glutamine for Sickle Cell Disease Crises

A PPM Brief

Are REMS Effective for Preventing Overdose Deaths from Extended-Release and Long-Acting Opioids?

Few data are available that can accurately assess the impact of the Risk Evaluation Management Strategies (REMS) program for extended release/long-acting (ER/LA) opioids since its introduction by the FDA in July 2012.

Can Rheumatoid Arthritis Be Modified with an Anti-inflammatory Diet?

Control of inflammation has been identified as one of the most important methods of achieving treatment goals in patients with rheumatoid arthritis (RA). Indeed, research has indicated that an anti-inflammatory diet can lower inflammation and control symptoms, and this type of diet is commonly recommended for patients with RA on various patient counseling websites.

New Editorial Advisors Join Practical Pain Management

Daily Cannabis Users May Use Opioids Less Often

Pain patients have become more interested in cannabis as an alternative to opioids.

Does Neuropathic Pain Augment Risk of Developing Chronic Widespread Pain?

Researchers examined neuropathic pain in relation to risk of developing chronic widespread pain, fibromyalgia.

Ubrogepant Shows Positive Results for Acute Treatment of Migraine; Gains FDA Approval

Allergan's ubrogepant, branded UBRELVY, approved as first oral CGRP receptor agonist for acute treatment of migraine in adults with or without aura and the first FDA-approved gepant.

High Level of Psychiatric Disorders Found in Individuals with Chronic Pain

The relationship between somatic sense perception levels and comorbid psychiatric diseases in chronic pain patients.

Endocannabinoid System and TENS

A PPM Brief Researchers out of Brazil recently published findings investigating the involvement of the endocannabinoid system in TENS-induced antinociception of cancer-related pain. The animal study involved intraplantar injections of Ehrlich tumor cells in male Swiss mice, followed by 20 minutes of low- and high-frequency TENS to the paws.

Could a Spicy Food Diet Reduce Pain Sensitivity?

A PPM Brief In a unique clinical trial examining the long-term effect of spicy food on pain sensitivity, a group of anesthesiologists at the Army Medical University in China found that a long-term spicy diet may in fact reduce pain thresholds.

Fentanyl and its Analogues Lead to Wooden Chest Syndrome

Opioid overdose is the leading cause of death in the US population, and mortality from F/FAs is increasing.

Flexion Announces FDA Clearance of FX201 for Knee OA

FX201 is an investigational, locally administered gene therapy candidate that may reduce joint inflammation, particularly for osteoarthritis.

Potential Body of Knowledge for Rheumatoid Arthritis and Spondyloarthritis Grows

Survey results note the need for more continuing education among providers and patients.

Primary Care Physicians Could Use More Training on Patient Misuse and Abuse of Prescriptions

A look at physician perspectives and diagnostic insights on the evolving opioid crisis.

Self-Management Combined with Telecare Improves Pain and Mood Symptoms

Automated surveys/modules and comprehensive nurse-led symptom management were trialed in a VA clinic.

Opioid Prescribing and Tapering: Don’t Raise the Bridge; Lower the River

The author outlines some major issues the HHS missed in their new opioid tapering and opioid discontinuation guideline.

HHS New Clinical Guide Supports Concerns Over Abrupt Discontinuation and Tapering of Opioids

Whether or not opioids are tapered, safe and effective nonopioid treatments should be integrated into patients’ pain management plans.

REYVOW Approved for Acute Treatment of Migraine

Lilly's REYVOW (lasmiditan) receives FDA approval and becomes the first and only medicine in a new class of acute treatment for migraine.

Multi-Site Pain May Be Associated with Fractures in Elderly

Risk is independent of falls and other confounders.

Canadian Guideline Proposes Best Practices for Injectable Opioid Agonist Treatment

Recommendations may help those patients unable to tolerate oral OAT for opioid use disorder.

Opioids and Pain Management in the Construction Industry

An unrelenting crisis affects those in the manual labor workforce.

Low Serum Cholesterol Levels Associated with Increased Nerve Lesions for T2D

A common treatment for dyslipidemia, findings could aid in better potential therapies.

FDA Approves HADLIMA, RINVOQ for Arthritis

The anti-TNF biosimilar was shown to reduce related pain symptoms in accordance with ACR20

Did the CDC Opioid Guidelines Lead to a Drop in Opioid/Benzodiazepine Coprescription?

With CDC recommending avoiding coprescription, researchers investigated the fallout.

A Review of Naloxone Coprescription Mandates in Two States

Virginia and Vermont had higher dispensed naloxone prescriptions in the first month of implementation.

In The Pipeline: New Chronic Back Pain Approach—Surgery And Stimulation

Founded in 2015, SynerFuse will begin Phase I testing starting in 2019.

Two Studies Report Reduction in Opioid Prescriptions

At some clinics, new patient opioid treatment is being refused and, in the emergency room, opioid prescribing is decreasing.

FDA Warns of Potential Cybersecurity Concerns with Medtronic Insulin Pumps

MiniMed 508 and Paradigm devices may be vulnerable to hacking.

FDA Approves Botox for Pediatric Patients with Upper Limb Spasticity

Botox becomes first neurotoxin treatment approved to date for pediatrics with the condition.

Heron Therapeutics Announces Positive Results of HTX-011 in Hernia Surgery

As part of the HOPE Project, the agent may reduce postoperative opioid prescriptions.

FDA Approves Lilly’s Galcanezumab for Episodic Cluster Headache

Emgality becomes the only CGRP antibody indicated for the preventive treatment of the disorder

FDA Grants Marketing Authorization for Neuromodulation Device for Acute Migraine

Nerivio Migra is slated to launch in the United States later this year.

Machine Learning Approaches Could Lead to Objective Pain Measures

Researchers have developed an algorithm that may be able to predict pain intensity

The Unpleasantness of Pain, Brain Circuits, and the Emotional Response

Animal study could lead to better understanding of the neurobiology surrounding pain.

Teva Pharmaceuticals Presents Data on Efficacy and Safety of Fremanezumab

12-month study demonstrates reduced monthly chronic and episodic migraine attacks.

Neuroplasticity and the Potential to Change Pain Response

Can mindfulness in connection with brain neuroplasticity impact pain response?

Does the HEAL Initiative Research Plan Misunderstand the Complexity of Pain Care?

With relatively little public fanfare, the US National Institutes of Health (NIH) launched an integrated set of research initiatives, called Helping to End Addiction Long-term (HEAL), one year ago to “provide scientific solutions to the opioid crisis.”1 Funding for this initiative was put into place for FY2019 at $502 million, of which approximately $170 million is focused on th

EMA Recommends Buprenorphine Implant Device

Trial shows better patient response to Sixmo than sublingual buprenorphine.

FDA Approves Romosozumab for Post-menopausal Osteoporosis

Evenity lowered vertebrae fractures risks in two trials.

Too Little, Too Late: US Government Backtracks on Opioid Discontinuation

An Editorial (see additional contributors' comments below) Jeffrey Fudin, PharmD, and Jeff Gudin, MD, PPM Co-Editors-At-Large:

FDA Tightens REMS Program on Transmucosal Immediate-Release Fentanyl

Outgoing FDA Commissioner Scott Gottlieb, MD, on new steps to strengthen the agency’s safety requirements aimed at mitigating risks associated with breakthrough fentanyl pain products.

FDA Warns of Increased Risk of Death with Gout Medicine Uloric

The agency will be limiting the approved use of Uloric to those not treated effectively or who experience severe side effects with allopurinol.

FDA Recaps 2018 Efforts, Lays out 2019 Policy on Opioids

The agency released its regulatory agenda for continuing to address opioid abuse

FDA Accepts BLA for Eptinezumab; Approved in February 2020 as Vyepti

Another CGRP-targeting drug, this one from Alder Biopharmaceuticals, will enter the market for episodic and chronic migraine prevention.

Religious Coping and Perceived Pain

Appropriate religious interventions may attenuate chronic low back pain.

National Academy of Medicine Launches Opioid Collaborative

Comprised of several working groups, the first meeting of the committee is set for April 2019.

Non-Addictive New Opioid Could Help Deter Abuse

PPL-103 was shown to block dependency qualities in mice.

HHS Inter-Agency Task Force Calls For Patient-Centric Pain Management

The members offer multimodal treatments to consider. Draft recommendations have a 90-day public comment period.

New Eye-Tracking Device from AlgometRx Targets Stimuli Reactions

Research into the brain is hoped to determine biomarkers for pain response.

Responses to External Threats and Sustained Pain Travel Via Different Neural Circuits

New study outcomes in mice suggest that common pain measurement tools may be inadequate.

FDA Calls for OTC Naloxone Development

The agency has paved way for greater access to the opioid overdose-reversal drug.

Pediatric Pain Assessment & Caregiver Perception

with Tina L. Doshi, MD, MHS A recent replication and extension study out of Yale University1 further examined potential biases in adult observer ratings of children’s pain.

Patient Education Fails to Improve Outcomes for Patients with Low Back Pain

Further investigations into instructional interventions and its impact on pain chronification are necessary.

Novartis Receives FDA Breakthrough Therapy Designation for Crizanlizumab

In the prevention of vaso-occlusive crises in sickle cell disease patients, the inhibitor led to fewer rates of healthcare visits

Comparing the Effects of CBT on Insomnia and Fibromyalgia Pain

Cognitive behavioral therapy may help those living with fibromyalgia and experiencing insomnia.

Physicians and the Pursuit of Happiness

A PPM Brief

Native Communities in Need of Healthcare Hit Hardest by Government Shutdown

In a January 8 NPR segment, Kerry Hawk-Lessard, executive director of Native American Lifelines, explained how the ongoing partial government shutdown is preventing her group from providing health services, including medication-assisted treatment for Opioid Use Disorder, to metropolitan-based American Indians. The partial government shutdown of 2018-19 is hitting Native communities harder than others.

Opioid Taper Patterns and Techniques

Consider taking this 9-question online survey regarding best practices for opioid tapering.

HHS Inter-Agency Task Force Urges New Ways to Limit Opioid Use and Addiction

A PPM Brief (Updated February 21, 2019)

The Future of Pain Management: A Sneak Preview

In the next issue of PPM, pain experts will share their vision for what’s ahead in pain practice. Here are a few highlights.

NIDA Releases 2018 Statistics on Opioid, Tobacco, and Cannabis Use Among High Schoolers

Opioid misuse has seen record lows in high schoolers, while marijuana use remains stable for 2018.

State Study Shows Chronic Opioid Users Often Receive Dangerous Combinations

An Idaho study points to the continued need for prescriber-pharmacist communication especially when multiple opioid prescribers are involved.

Investigating Food Insecurity among Chronic Pain Patients

Chronic pain patients who use food banks may have a fear of running out of food.

FDA Warns: Use Only Approved Medications in Intrathecal Pumps

A PPM Brief

GeoPain App Allows Patients to “Paint” Pain on 3D Models for Efficiency

The GeoPain app allows patients to be clear and precise when describing their pain.

FDA, AcelRx Announce Approval of Dsuvia, with Disclaimers

FDA approves Dsuvia (sufentanil) sublingual tablets.

Federal Opioid Legislation Passed

In scope-changing regulatory news, President Trump used the one-year anniversary of declaring a national opioid public health emergency to sign into law the “Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act,” or for short, the SUPPORT for Patients and Communities Act).

FDA Awards Grants to 5 Pediatric Medical Device Consortiums

FDA has awarded five grants to advance the development of pediatric medical devices.

CDC Reports Increasing Rates of Opioid Use Disorder in Pregnant Women

The rate of opioid use disorder among pregnant women has quadrupled over a 15-year span from 1999 to 2014.

As More Physicians Earn Buprenorphine Certification, Opioid Scripts Decrease

Buprenorphine uptake increases as more physicians receive waivers.

Lilly's Emgality Joins the CGRP Club

FDA approves third migraine prevention medication in the new CGRP class: Lilly's Emgality.

FDA Approves Final Opioid Analgesic Risk Evaluation and Mitigation Strategy

FDA REMS now apply to immediate-release opioid analgesics.

New Quality Improvement Guide for Primary Care Opioid Prescribers

Nearly $200 million in new CDC funds will go to territories, tribes, NGOs, and states to help support opioid awareness and response programs.

Teva's AJOVY Joins Migraine Prevention Meds on the Market

A PPM Brief

Chronic Pain Primary Reason for Misused Prescription Opioids

SAMHSA releases latest statistics on substance misuse including for prescription opioids, heroin, fentanyl, and more.

FDA Approves New Dosage of Buprenorphine/Naloxone Sublingual Film

Agency is taking steps to advance development of new FDA-approved treatments for opioid dependence.

Small Trial Shows Ketamine Activates the Brain’s Opioid System

Stanford scientists discover that ketamine's antidepressive effect is tied to the opioid system in the brain.

FDA Says “Everything is on the Table” Regarding the Development of New Pain Drugs

As the US Congress prepares to return to session after Labor Day, FDA Commissioner Scott Gottlieb, MD, has taken the opportunity to outline his agency’s work on the opioid crisis over the past 8 months.

FDA to Re-Examine Rational Opioid Prescribing, Starting with Acute Pain

FDA tackles opioid epidemic by focusing on rational prescribing practices for the treatment of acute pain.

Buprenorphine Injectable for OUD on its Way

Pennsylvania-based biotech company Braeburn has a PDUFA target date of December 26, 2018 for its buprenorphine injectable aimed at treating opioid use disorder (OUD) in adults.

CGRPs: Your Patients Want To Know More

A new survey shows that migraine sufferers are largely unaware of the new preventive CGRP medication class.

Cleveland Clinic Calls for Partners in Integrative and Lifestyle Interventions

Numerous studies have shown the powerful impact that lifestyle medicine can have on patients as part of an integrative approach.

New Pain Assessment Tool for Chronic Low Back Pain

A new pain assessment tool may be coming soon to clinical trials for better, individualized treatment approaches.

FDA Issues Draft Guidance on Measuring Efficacy of Medication-Assisted OUD Treatment

Agency is encouraging developers to innovate against opioid misuse.

Time to Tip the Scales in Pain Research and Care for Women

PPM's latest special report addresses Pain Research & Care in Women, including:

FDA Assesses Transmucosal Immediate-Release Fentanyl Products

A PPM Brief

U Michigan Launches Cannabis Study on Chronic Pain

Resource for Your Practice - A PPM Brief

One-Size-Fits-All Approach to Pain Care is Growing Tiresome

A PPM Brief

FDA Redirects Opioid Efforts toward Patients in Need, Provider Education

As pressure and questions mount regarding how to safely care for patients living with chronic pain, FDA Commissioner Scott Gottlieb, MD, released a statement on balancing access to opioids for those patients in need with the agency’s efforts to prevent misuse and abuse of opioids.

NIH Finds Methadone and Buprenorphine Effective in OUD After Overdose

Very few patients receive proper medication-assisted treatment following an overdose, posing many questions.

Opioid Prescribing Patterns across the United States

A McKinsey report reveals how geography, patient assessment, and a lack of standard approaches is affecting the opioid crisis.

Teva Changes Course in Headache Care

Teva Stops Chronic Cluster Headache Research; Continues Pursuit of Episodic Cluster Headache Treatment and Migraine Prevention

Alliance Offers Patient-Centered Opioid Prescribing Recommendations

In a whitepaper titled “Principles for Patient-Centered Opioid Prescription Guidelines,”* the Alliance for the Treatment of Intractable Pain argues that the CDC Guidelines for Prescribing Opioids for Chronic Pain “must be withdrawn and rewritten” to recognize both the indispensable role that opioids play in chronic pain

IV Tramadol May Fill Acute Care Gap in Post-Operative Pain

IV Tramadol, an opioid alternative, may fill post-operative acute pain care gap between acetaminophen, NSAIDs and narcotics.

SAMHSA Releases Update to Opioid Overdose Toolkit

New update to the agency's opioid toolkit means better prescribing guidelines and resources for practitioners and their patients.

Opioid-Selling Websites Warned

A PPM Brief

Naloxone Injection, Syringe System Recalled

A PPM Brief

AMA Says Physicians are the Ones Making Progress in the Opioid Crisis

Statistics from a new AMA report show physicians are leading the charge to lower opioid prescriptions.

Commentary: Make the Easy Choice for Care

One commentator addresses the misconceptions that persist among the declared opioid public health emergency.

FDA Calls for Innovative Technologies to Treat Opioid Use Disorder

FDA will accept submissions of digital health devices to better combat opioid addiction, misuse, and treatment.

ACP Releases Positions on Women’s Health

The ACP looks to support women's healthcare, and the FDA continues to improve women-centric medical devices.

Should Chronic Pain be Redefined?

An updated description of "pain" may account for the individual's intersubjective experience.

Amgen/Novartis Move Successful Endpoint Results of Erenumab to First Migraine Preventive Approval in US

with Lawrence Robbins, MD, and representatives from Amgen/Novartis

Canadian Clinicians Release New Practice Guideline on Prescribing Benzodiazepines

For the treatment of insomnia, benzodiazepines should be carefully prescribed.

FDA Approves First Non-Opioid Treatment to Manage Withdrawal

A PPM Brief

Lilly, Teva Meet Endpoints for Cluster Headache & Migraine; Amgen/Novartis Gain FDA Approval of Aimovig

Amgen/Novartis have been awaiting an FDA decision on their collaborative erenumab (Aimovig), a calcitonin gene-related peptide (CGRP) monoclonal antibody for the prevention of migraine since they submitted a BLA for the novel treatment last July. Announced late in the day on May 17, 2018, FDA has granted approval to Amgen Inc.

Synthetic Opioid Addiction May be More Prevalent due to Brain Reactions

A PPM Brief

Four AAPM Board Members Appointed to New US HHS Task Force

The Task Force's inaugural public meeting will be held in late May 2018 from Washington, DC

Morphine Sulfate Oral Solution Approved

ANI Pharmaceuticals Announces Approval of Morphine Sulfate Oral Solution for acute and chronic pain.

Studies Continue to Target Opioids and Their Alternatives in Chronic Pain Management

Focus on opioid use disorder sparks more research into the long-term effects of opioid therapy, tapering, referrals, and opioid alternatives

Braeburn Pharma Announces OUD Resource

The company’s mission is to advance a portfolio of next-generation therapies on opioid addiction.

FDA, AAPM Open Talks on Evidence-Based Opioid Prescribing

FDA and US administrative tone regarding opioid use for chronic pain management and treatment takes a turn; talks opened for developing evidence-based opioid prescribing guidelines.

Could Hunger Alter Responses to Chronic Pain?

Hunger activates a neural pathway that inhibits the perception and response to pain.

Nerve Block for Regional Analgesia Supplements Pain Management Toolkits

Pacira's approved expanded indication of Exparel (bupivacaine liposome injectable suspension) for upper extremity surgeries provides an extended-duration, nonopioid anesthetic alternative.

NIH to Increase Opioid and Pain Research by $500 Million

NIH HEAL initiative will aim to reduce over-prescription of opioids, as well as misuse and addiction, and accelerate development of non-opioid therapies

CDC Opioid Overdose Death Rates Over-Reported by Half

Miscounting prescription and illicit opioids together resulted in the CDC overdose rate to be too high.

Can Somatic Symptoms Affect Women’s Pain Syndromes?

Connecting psychological and somatic pain symptoms to women's pain syndromes such as dysmenorrhea and noncyclic pelvic pain

Defining Pain Chronification

An international group of clinicians reviews what primary care and non-pain experts need to know about pain chronification

Knowledge of Outpatient Prescribing Inconsistent

Survey of surgical program directors reveals knowledge gap in state policies regarding opioid prescribing.

Opioid Withdrawal Product Moves Toward Market

An FDA committee has recommended approval of lofexidine, a selective alpha 2-adrenergic receptor agonist that reduces the release of norepinephrine, for the mitigation of opioid withdrawal symptoms

Purdue and Shionogi Release Promising PAMORA Study Results

Symproic may ease opioid-induced constipation in patients with nonmalignant chronic pain without analgesia interference.

Three Approaches Found Effective for Pain Catastrophizing

CBT, ACT and multimodal approaches are shown to be best approaches to help patients from pain catastrophizing.

White House Opioid Addiction Summit: An Update

Can the Trump administration proposals, including federal funding and public health education, end the opioid addiction, abuse, and misuse epidemic in the United States?

Lidocaine Topical Approved for Shingles Pain

Non-opioid analgesic lidocaine patch may relieve post-herpetic neuralgia (post-shingles pain) for up to 12 hours.

Purdue Pharma LP Supports Pain Assessment Research

Purdue Pharma LP, leading opioid manufacturer, aims to help healthcare providers better understand and assess chronic pain through research grants in virtual reality, cognitive functioning, and electroencephalograph alpha activity

FDA Continues Removal of Kratom Products / Restates Concerns Over Usage and Abuse

Recent FDA seizures of kratom show safety and public health risks for opioid treatment.

Pain After Pediatric Traumatic Brain Injury: Not All in the Head

Patients with traumatic brain injury or post-concussion may experience pain far beyond headache pain, so a full body workup is warranted.

Gene Expression Study of Rheumatoid Arthritis Could Help Further Treatments

Indications of three distinct and differing synovial subtypes mean that pain may differ between patients.

Adults with Knee Arthritis Less Active than General Population

Better interventions are needed to prevent physical inactivity among geriatrics with and without knee pain

Cardiovascular Risk Among Individual Pain Medicines: Is There a Difference?

A recent study differentiates cardiovascular risk among individual NSAIDs, leading to new safety protocols

Could Care Structure Change Opioid Practice?

A rural primary care office tested pain management and opioid weaning through a proposed office model.

Digital Pain Markers for Chronic Pain on the Horizon

New 10,000-person study by Evidation Health (Discover project) aims to better understand real-life chronic patient outcomes.

Treating the Complexities of Fibromyalgia Improves Pain Management

With Irwin Jon Russell, MD While widespread musculoskeletal pain and joint tenderness is the hallmark of fibromyalgia, mood and cognitive changes are often present as well. However, there are other common comorbidities that typically arise with fibromyalgia (FM) that deserve equal attention.

Sleep Disturbances Aggravate PTSS and Chronic Pain Among Youth

Sleep is a good mediator between children with PTSD and chronic pain, needing further examination

Sphenopalatine Ganglion Stimulation Possible Tool for Cluster Headaches

For frequent sufferers of cluster headaches, SPG stimulation may be an effective therapy to lessen pain and improve quality of life.

The Link Between Restless Legs & Chronic Back Pain

Chronic back pain symptoms that mimic restless legs syndrome may be "restless back" and treatable with dopaminergic drugs.

Chronic Pelvic Pain Resolved Best With Interdisciplinary Approach

Patients with chronic pelvic pain experienced less pain severity, improved quality of life, and lower health care utilization at an interdisciplinary treatment center.

FDA Sheds Additional Light on Opioid Compounds in Kratom

The FDA reports of opioid compounds found in kratom, underscoring its health risk as an addiction treatment.

Perfectionism Worsens Pain Experiences in Pediatric Patients

Perfectionism appears linked to teens’ chronic pain-related dysfunction, requiring appropriate therapy to address fear and catastrophizing.

Another Benefit of Bariatric Surgery May Be Improved Pain Sensitization

Patients having bariatric surgery experienced significantly improved pressure pain thresholds and greater overall pain relief, leading to better central sensitization.

FDA, FTC Send Warning over Illegal Opioid Cessation Products

The illegal distribution and marketing of alleged opioid addiction and withdrawal products has drawn federal attention.

Can Physician Burnout Impact Patient Outcomes?

Researchers assessed the potential relationship between practitioner burnout and patient-reported pain relief.

Biologics in the Pipeline Offer Promise for Atopic Dermatitis

Biologics, monoclonal antibody therapies that promise targeted treatment for atopic dermatitis, are emerging as the treatment to follow as clinical trials are completed.

Psychological Flexibility May Lead to Better Response to Pain Treatments

Psychological Flexibility fostered with guided ACT therapy improves responsiveness to chronic pain treatment.

FDA Limits Use of Prescription Cough/Cold Opioids in Pediatric Population

Prescription cough and cold medication containing opioids such as codeine and hydrocodone to be indicated only for those over age 18.

Illinois to Allow Medical Marijuana for the Treatment of Intractable Pain

Patients with diagnosed intractable pain will now qualify for medical cannabis treatment in Illinois.

MyDx Cannabis Formula Trial for Pain Management Gets Under Way

CDC Confirms: Opioid Dosage Guidelines Not Meant for Addiction Treatment

In an effort to reduce opioid misuse and deter abuse, CDC clarifies dosing thresholds listed in its 2016 Guidelines are not meant for addiction treatment.

Better Approach to Pain Assessment Places Emphasizes on Function

Using a multidimensional approach to assessing pain, like the CAPA tool, will assure better pain care than relying on the numerical pain scale.

New Software Resource for Pain Practices

Technology designed for chronic pain care providers' practices to improve communication, documentation, and record-keeping.

Sickle Cell Pain Delayed with Crizanlizumab

Significant time delays found among subgroup populations in first on-treatment for chronic pain associated with sickle cell disease pain

FDA Approves Spinal Cord Stimulation System

Spinal cord stimulators continue to grow as a treatment for chronic pain.

As Nerve Pain Prescriptions Spike, Pipeline Turns to Relieving Osteoarthritic Pain

Centrexion Therapeutics is dedicating $67 million to Phase 3 studies for relieving chronic knee pain due to osteoarthritis.

Opioid Receptor Structure Findings May Lead to More Selective, Safer Pain Medication

The race to unravel the kappa opioid receptor to find adverse-free alternatives to chronic pain treatment is gaining traction.

Shorter Opioid Misuse Assessment Tool Highly Effective in the Pain Setting

A brief self-assessment, the COMM-9, is effective as an opioid monitoring tool use with equal accuracy in the pain management setting.

IV Acetaminophen for Post-Op Pain Control

A randomized pediatric trial examined the effect of the opioid-sparing medication on appendectomy patients.

Substance Use Disorder and Patient Confidentiality, Disclosure Rule Updated

SAMHSA has updated its final rule on substance use disorder and patient confidentiality, easing practitioners' ability to share patient information with caregivers and providers.

Can Spa Therapy Get Patients Back to Work?

Patients with chronic low back pain participated in a spa and exercise therapy trial to determine the program's effect on pain scale and return to work.

New State Laws Tackling Opioid Prescribing Take Effect in 2018

Michigan and North Carolina legislation taking effect in 2018 places new prescribing and filling requirements on physicians and pharmacies.

Gabapentinoid Use on the Rise, Despite Lack of Long-Term Safety Data

Prescribed opioid alternatives such as pregabalin and gabapentin have risen significantly since 2002.

Insider's View of Smokers' Perceptions and Resolve to Quit

There is a complex relationship between chronic pain, yet long-term health matters more than perceived lost pleasure to most smokers.

Best to Avoid Sending Pain Prescriptions By Phone Text

Pain Prescribing By Phone Best Avoided despite the ease of texting and expediency of placing an order.

Managing Red Flag Behaviors for Opioid Use in Patients with Chronic Pain

Consensus on best practices for addressing red flag behaviors in pain patients who seek long-acting opioids.

Preclinical Vaccine May Block Euphoric, Addictive Effects of Opioids

An experimental heroin analog may provide a new tool in the prevention of opioid addiction and improvement of withdrawal symptoms.

Your Most Relied-On Pain Care Articles of 2017

As the year comes to a close, Practical Pain Management

Why Evidence-Based Medicine is Not Going Away, Despite Alleged Ban of the Term

After the alleged Trump ban on evidence- and science-based terminology, clinicians weigh in on the importance of their approach in practical medicine.

FDA Issues More Policies to Facilitate Innovation in Regenerative Medicine

FDA expanded their policy guidance on the use of stem cells and tissue products in regenerative medicine

Topical Analgesics May Reduce or Eliminate Prescribed Opioid Use

Half of pain patients discontinued use of opioids, and another 30% were able to transition off all pain medication, according to OPERA study authors

In the Pipeline: Conus genus Venom Offers Vast Clinical Potential for Pain Reduction

Cone snail venom offers new therapeutic - and opioid alternative - possibilities for neutralizing chronic pain.

Expert Panel Report on Urine Drug Monitoring for At-Risk Chronic Pain Patients

Consensus recommendations for the best way to employ urine drug monitoring when prescribing opioids for patients with chronic pain in primary care.

Use of Methamphetamines Raises Risk of Heart Failure

Patients who use street drugs, particularly meth are at increased risk for heart failure and should be directed to rehab programs.

Hydrostatic Pressure Mimics Walking to Result in Formation of Cartilage

Researchers presented a methodology for stimulating new tissue formation based on cyclical hydrostatic pressure, perhaps leading to cartilage regeneration as a means to restore joint health.

New Golimumab Approval May Improve Function in Patients with Psoriatic Arthritis and Ankylosing Spondylitis

IV infused golimumab may improve function and disease management in patients suffering from inflammatory and joint pain.

Methadone, Pain Management & Overdose

In 2015, PPM published “Methadone for Pain Management,”1 which cited that one-third of opioid-implicated deaths were caused by methadone.

Caffeine Demonstrates Surprising Opioid-Dependent Effect on Fibromyalgia Pain

Patients who take opioids and drink coffee less pain-related symptoms and depressiion, and higher physical function than patients taking opioids who avoid caffeine.

Non-Invasive Medical Device May Improve Opioid Withdrawal Success

The first, wearable, noninvasive neurostimulation device, the Bridge, reduced symptoms of opioid withdrawal to achieve 89% success in transitioning to long-term care.

In the Pipeline: Pain Management Formulations

New pain management formulations may impact opioid prescribing and usage: Scripps looks into the G protein and beta-arestin pathways, including fentanyls's role, Daiichi Sankyo releases MorphaBond ER, and FDA moves forward two buprenorphine products to treat opioid use disorder.

Study to Test Efficacy of Interactive Wearable Device to Improve Pain Outcomes

An interactive wearable device with an app will be studied to its efficacy in reducing chronic pain to lessen reliance on medication.

Warning Over Kratom: What's the Real Impact for Pain Practitioners?

Novartis’s Cosentyx Demonstrated Phase III Clinical Efficacy in Reducing Psoriatic Arthritis Pain

Investigational biologic from Novartis (Cosentyx) may reduce joint pain and tenderness in patients with psoriatic arthritis.

Tenapanor Moves toward Approval for IBS-C Treatment

A second Phase 3 trial of tenapanor (T3MPO-2)1 shows promise for relieving symptoms in patients with constipation-predominant irritable bowel syndrome (IBS-C).

First Transmucosal Opioid for Treating Moderate to Severe Pain in a Medical Setting Enters Path to Approval

A new sufentanil sublingual tablet may provide clinicians and patients with simpler means of dosing and drug delivery.

Multiple Risk Factors May Lead to Gallstones and Kidney Stones in Patients with IBD

A new study shows significant correlations between irritable bowel diseases (IBD) such as Crohn’s disease and colitis, and risk of developing gallstones and kidney stones.

New Medications, Updated Guidelines, Promise Targeted Treatment for Eczema

Two new therapies promise improved management for the pain and itching associated with eczema by targeting the inflammatory response of atopic dermatitis.

Managing IBS with Diarrhea as a Microbiome Condition Lessens Misery

Only 1/3 of adults with inflammatory bowel disease seek medical attention, yet a new approach for IBS with diarrhea using an anti-bacterial seems likely to address symptoms more effectively than usual care.

Treating Pain in Chronic Pancreatitis

Pain is the most common report among chronic pancreatitis (CP), and it is often severe, leading to detrimental effects on quality of life, Darwin L. Conwell, MD, MS, explained at the 2017 World Congress of Gastroenterology.1 CP pain “can be constant or intermittent,” Dr. Conwell told Practical Pain Management (PPM). Dr.

Diarrhea, Bloating, Abdominal Pain May Appear Together But Should Be Evaluated Individually

While patients commonly present with a triad of complaints—chronic diarrhea, bloating, and abdominal pain, each symptom should be addressed separately according to a Mayo Clinic professor who presented at the World Congress on Gastroenterology.

Study Examines Adverse Effects of Low Dose Antidepressants for Chronic Pain

Pain practitioners may consider prescribing antidepressants for chronic pain patients who may be able to tolerate the side effects.

A Closer Look at the Interrelationship of Fibromyalgia and GERD

Interviews with Don Goldenberg, MD, and Michael R. Clark, MD, MPH, MBA

New Neuro-Stim Device Lessened Abdominal Pain in Adolescents

Electrical nerve stimulation lessens in pain in adolescent patients with abdominal pain disorders.

Seeking an Optimal Opioid Prescribing Pattern Based on Type of Surgery

Devising a prescribing guideline for post-surgical use of opioids.

New Opioid Program Raises Concerns for Chronic Pain Patients

Express Scripts launches an Advanced Opioid Management Program intended to limit new opioid prescriptions to no more than a week of short-acting formulations, which all but ignores pain specialists discretion and individual patient needs.

Polymyalgia Rheumatica and Steroid Side Effects: New Findings

Patients with polymyalgia rheumatica are not at greater risk of developing diabetes, osteoporosis, or fractures from long-term steroid therapy than patients without PMR, according to the results of a new study.

Bariatric Surgery for Obesity Improves Symptoms of Arthritis

Weight loss surgery may help overweight patients suffering from arthritis of the knee, new study finds.

Gabapentinoids for Chronic Low Back Pain? Not So Fast

Gabapentinoids are not a good substitute for opioids in the management of chronic low back pain that does not include neuropathic pain, study finds.

FDA Approves Syndros, First Liquid Form of Cannabinoid Dronabinol

New form of synthetic cannabinoid, Syndros, has received FDA approval for the treatment of cachexia and nausea and vomiting in AIDS and cancer patients.

New Indication for Movantik: Cancer Survivors With Chronic Pain

The FDA has expanded the indication for Movantik to include cancer survivors on opioid therapy for pain management who develop opioid-induced constipation.

Washington Declares War on Opioid Epidemic, Fraudulent Doctors

The government is declaring war on the opioid epidemic. Practical Pain Management takes a look at what that will mean for physicians and pain patients, and how to weather this storm.

Specific Brain Activity May Identify Patient Responsiveness to PTSD Treatment

Patients with post-traumatic stress disorder who improved following prolonged exposure therapy showed similar brain activity patterns following emotional tasks, indicating an ability to predict responsiveness.

New NDA for Non-Opioid Pain Medication

New Drug Application filed for IV meloxicam from Recro Pharma, Inc. Agent uses NanoCrystal platform to enhance bioavailability of the NSAID at lower doses.

Opioid Prescriptions Not Optimized for Post-Surgical Pain

While most patients received an opioid prescription to manage post-surgical pain, fewer than 10% of patients filled and used the full prescription.

Prevalence of Diabetic Peripheral Neuropathy in Youth Nears That of Adults

Youth with diabetes are developing diabetic peripheral neuropathy at rates similar to that of adults, necessitating more aggressive screening and earlier management.

Rexista, Generic Oxycodone, Fails Hurdle Toward Approval

FDA tables NDA for new oxycodone extended-release opioid Rexista (oxycodone), citing safety concerns.

FDA Approves First, Injectable Treatment for Lupus

GlaxoSmithKline received approval to market a once weekly, subcutaneous injectable version of belimumab for patients with SLE, which can be self-administered.

MultiGen 2 Radiofrequency Generator Gains FDA Clearance

A MultGen 2 Radiofrequency Generator gains FDA clearance to provide greater efficacy in ablation procedures to give patients greater pain relief for 1 year.

FDA Adds Immediate-Release Opioids to REMS Program

The FDA is expanding the Risk Evaluation and Mitigation Strategies program to include IR opioid formulations (which already includes ER and LA opioids), and the training program will be expanded to all health professionals involved in patient pain management.

Yoga and Physical Therapy Yield Similar Results for Low-Back Pain

Findings from a new study on patients with back pain demonstrated that yoga and physical therapy yielded similar improvements in pain relief and improved functionality.

New Sickle Cell Disease Approval

The first new treatment for sickle cell disease has been approved by the FDA, L-glutamine (Endari).

Patients With Mental Disorders Get Half of All Opioid Prescriptions

A new study reports that 50% of opioid prescriptions are being written for patients with co-morbid mental illness. Mental health experts believe CBT and other therapies may be preferred in this population.

Update in Drug Development News

Highlights of drug development news in pain management. Cara CR845, Sorrento's RTX TRPV1 agonist, and Daiichi Sankyo's microgabalin for PHN

Published Perspectives on Pain Illuminate the Chronic Pain Treatment Divide

Pain specialists don't always agree on the best use of opioids for pain management. A recent issue of JAMA presented two opposing views.

Electric Stim Armband May Reduce Migraine Pain

Pilot study holds promise for a new electrical stimulation device, Nerivio Migra device Theranica, Ltd, worn on the arm that is aimed at managing migraine pain.

USC Online Degrees Provide Much-Needed Pain Education

University of Southern California is launching 2 online programs in pain management to close the knowledge gap.

Updated Opioid Guidelines Released for State Medical Boards

The Federation of State Medical Boards has released an updated guidelines for safe opioid prescribing. This follows on the heels of a growing concern over over-prescribing of opioids, and misuse, abuse, and diversion.

Older Hospitalized Patients Respond Well to Non-Opioid Alternatives for Pain

In one of the first studies to consider opioid use in hospitalized elderly patients, most will respond well to alternative methods of pain relief when it is offered.

DNA-PK Enzyme Drives Middle-Age Weight Gain

Researchers have identified DNA-PK as the enzyme responsible for mid-life weight gain and loss of exercise capacity. They also found that inhibiting DNA-PK prevented weight gain in mice, increased fitness levels, and reduced the incidence of obesity and pain.

Ketamine Not Effective Against Postoperative Delirium, Pain in Older Adults

Intraoperative ketamine does not seem to decrease the incidence of delirium or improve pain control after surgery. Study was small and used single dose versus IV infusion.

Dysport (abobotulinumtoxinA) Gets FDA Approval for Lower Limb Spasticity

The FDA has expanded the approved use of Dysport for the treatment of spasticity in adults. Spasticity is often a result of traumatic brain injury, multiple sclerosis, and stroke.

Opioids Over-Prescribed Following Cesarean Delivery

Women are often over-prescribed opioids following a C-section, leading to the increase risk of misuse and diversion. New studies have shown that around-the-clock Tylenol or NSAID may be just as effective, with opioids reserved for breakthrough pain.

Tanezumab Gets Fast Track Designation From FDA for Chronic Pain Conditions

FDA grants fast-track status to tanezumab, an investigational monoclonal antibody under development by Pfizer and Lilly that inhibits nerve growth factor in patients with osteoarthritis, low back pain, and cancer pain.

Key (and Possible Cure) to Cancer-Related Bone Pain Found

A key molecular pathway that drives cancer-related bone pain has been identified by researchers at Saint Louis University (SLU). The researchers observed that increases in sphingosine 1-phosphate are a key component in the development of pain.

Changing Obesity Measurement: Waist-to Height-Ratio

Waist-to-height ratio may be a better measurement of obesity and risk of metabolic syndrome than body mass index (BMI). Obesity is a common risk factor in many chronic pain conditions, including neuropathic pain, musculoskeletal pain, and headaches.

Repeated Corticosteroids Injections Not Beneficial for Knee OA Longterm

In a study comparing repeated injections of intra-articular triamcinolone versus saline on long-term effects of pain and cartilage volume, corticosteroids offered no significant clinical improvement over placebo.

Recall of Zimmer Biomet's Spinal Fusion Stimulators

Zimmer Biomet recals two of their Implantable Spinal Fusion Stimulators (SpF Plus-Mini and SpF XL IIB) due to higher than expected levels of harmful chemicals.

Galcanezumab Appears Effective in Preventing Migraines

Findings from initial clinical trials support the efficacy of galcanezumab,a once monthly, self-administered injectable monoclonal antibody, for treatment of migraines.

FDA Approves Kevzara to Treat Moderate to Severe Rheumatoid Arthritis

FDA approves Kevzara (sarilumab) for the treatment of adults with moderately to severely active rheumatoid arthritis

Precision Medicine Tool Improves Predictability of Opioid Use Disorder

An algorithm based on genetic markers and independent risk factors associated with opioid use were designed to provide a patient risk stratification system to aid in clinical opioid prescribing and management.

FDA Approves Actemra (tocilizumab) for Giant Cell Arteritis

Actemra (tocilizumab) now approved for treatment of giant cell arteritis

New Treatment Plan Leads to Better Pain Control for Acute Sickle Cell Crisis

New guidelines may help physicians better manage pain in adult and children with sickle sell disease (SCD) .

Minimally Invasive SI Joint Fusion May Lessen Pain, Improve Quality of Life

Minimally invasive sacroiliac (SI) joint fusion was associated with significant improvements in pain relief and disability when compared to conservative treatment or SI joint denervation.

Changing Opioid Prescribing Patterns for Post-Extraction Dental Pain

The rates of prescribing immediate-release opioids after dental extractions have declined in recent years, reflecting changes in patient preference and increased awareness of safe opioid prescribing practices among dentists.

Statin Side Effects Arise in Response to Heightened Awareness

The nocebo effect, coined for occasions when patients report symptoms only after they have been made aware side effects may arise, is common among patients who take statins.

Reversing OA—New Treatment on the Horizon

Results of a small study found that removing senescent cells following trauma helps reduce pain and attenuates healing for osteoarthritis.

FDA Bans Use of Tramadol and Codeine in Children

FDA bans use of codeine and tramadol in children and breastfeeding women.

Drug Needling Offers Effective Treatment for Hip Pain

A new study demonstrates the successful treatment of hip pain with dry needling as an effective alternative to the traditional use of cortisone shot, and a chance to avoid unnecessary side effects,

Survey Finds Patients Are Harmed by CDC’s Opioid Guidelines

New survey of pain patients and healthcare providers found that most patients had an unfavorable impression of CDC Opioid Prescribing Guidelines, which were release in March 2016.

Safe Use, Storage, and Disposal of Opioids

AMA releases new recommendations for safe storage and disposal of prescriptions opioids.

Virtual Reality Lessens Pain in Hospitalized Patients

Findings from the first study to test the effectiveness of lessening pain with virtual reality technology found it to be effective in a variety of pain types.

Persistent Postoperative Opioid Use Seen in Approximately 6% of Patients

Smoking, substance use, and mental health issues appear to raise a person's risk of persistent opioid use after surgery, according to a new study published in JAMA.

Painful Diabetic Neuropathy: What Is Best Rx—Pain Reduction or Improved Quality of Life?

The management of diabetic peripheral neuropathy raises interesting issues of what matters most: reduction in pain or improvement of quality of life factors.

FDA Approves Qudexy ER (topiramate) for Migraines

FDA approved once-daily Qudexy XR, Upsher-Smith, to prevent migraines in adults and adolescents over 12 years of age.

ACA Repeal and Replace: How Will Chronic Pain Patients Fare?

Physicians and chronic pain patients react to the proposed Republican repeal of the Affordable Care Act.

FDA Approves Ocrevus, a New Treatment for MS

There is a new treatment for patients with relapsing multiple sclerosis (MS) and primary progressive MS. The US Food and Drug Administration (FDA) announced the approval of Ocrevus (ocrelizumab, Genentech). This intravenous infusion is the first new treatment for primary progressive MS, according to a press release from the FDA.

Home Rehabilitation After Knee Surgery as Effective as Hospitalization

Interviews with Justine Naylor, PhD, and Andrew Fleischman, MD

Doctors Call for More Transparency at the FDA

Draft guidelines to improve transparency at the FDA are released.

Can Cone Snail Venom Be the Next Treatment for Neuropathic Pain?

Cone snail venom shows promise in early animals studies as a treatment for chemotherapy-induced neuropathies.

Exercises Lessen Pain After Cancer Surgery

Exercise plans that are tailored to the individual, to be conducted at home, reduce pain and enhances recovery in patients being treated for cancer.

Distinct Pain Signature Seen in People With Fibromyalgia

Researchers used fMRI to map pain responses in people with fibromyalgia to shed light on the neurophysiology of this condition.

Pulsed Ultrasound Doesn't Promote Bone Healing or Lessen Pain

Low intensity pulsed ultrasound (LIPUS) fails to promote bone-healing, or offer beneficial effects on function or pain relief.

Having Psoriasis and Depression May Lead to Psoriatic Arthritis

Psoriasis patients diagnosed with major depressive disorder appear at increased risk for psoriatic arthritis (PsA).

Quick Access to Physical Therapy May Improve Low Back Pain Outcomes

Rapid access to physical therapy may improve outcomes for patients with acute back pain.

Knee Osteoarthritis Impacted By Quadricep Strength

Quadriceps strength may be useful in predicting loss of function in people with or at risk for knee osteoarthritis.

American College of Physicians Releases New Guidelines for Low Back Pain

The American College of Physicians' new guidelines make a strong case for the use of nonpharmacological therapies as a first-line option for treating nonspecific low back pain in patients.

Spinal Cord Injury: Patient Characteristics May Inform Future Opioid Misuse

In patients with a traumatic spinal cord injury (SCI), researchers identified characteristics that may guide who is most likely to misuse pain medications.

Pain Catastrophizing: A Serious Problem for Teenagers With Chronic Pain

A new study has examined what role pain catastrophizing behaviors could have on the functional outcomes of patients living with chronic pain and has found age could be a significant factor.

Oral Fluid Testing for Codeine Improves Accuracy of Clinical Monitoring

Evaluating oral fluid samples revealed that hydrocodone is an important metabolite of codeine, which may be useful in monitoring medication use by pain patients and for drug testing.

Chronic Osteomyelitis May Increase Risk for Fibromyalgia

New study suggests patients suffering from chronic osteomyelitis (COM) may be at increased risk of developing fibromyalgia (FM).

Approaching Pain Variability in Patients With Fibromyalgia Improves Outcomes

Recognizing clustering patterns of pain symptoms in patients with fibromyalgia may predict better outcomes

Undetected Pain Common in Teens With Eating Disorders

Adolescents who present with chronic pain may also have an eating disorder that goes undetected for twice as long as teens whose primary complaint is an eating disorder.

ADA Releases New Guidelines on Managing Diabetic Peripheral Neuropathy

The American Diabetes Association (ADA) has released new guidelines on the management of diabetic peripheral neuropathy (DPN), but cautioned against use of opioids.

Specialized Physiotherapy May Help Reduce Pain, Lessen Progression of Scoliosis

The Schroth method of personalized physical therapy exercises may correct curvature, improve pelvic alignment, and lessen pain in teens with scoliosis.

Anti-Muscarinic Drugs May Reverse Peripheral Neuropathy

Researchers found a specific muscarinic receptor that may be able to prevent, and even reverse, the effects of peripheral neuropathy common in conditions, such as diabetes.

Rotator Cuff Tendinopathy Found Associated with CVD Risk

A new epidemiological study reports a possible connection between diagnosis with rotator cuff tendinopathy and an increased cardiovascular disease risk.

FDA Approved Vantrela ER (hydrocodone) With Abuse-Deterrent Formula

Vantrela ER (Hydrocondone biartrate extended-release) tablets, with a proprietary abuse deterrence technology, received FDA approval.

Olanzapine: An Effective Agent for Preventing Nausea

When faced with complaints of nausea and vomiting, common symptoms reported by patients with advanced malignancy, clinicians have had few appealing options given the usual treatments come with untenable, adverse side effects.

Opioid Overdoses Deaths Higher in Rural Than Urban Areas

Preventable deaths due to opioids are far higher in rural counties compared to urban counties, and now significantly outweigh the overall national death rate.

FDA Releases Guidance Document for Naming Biologics

The US Food and Drug Administration has released a new guidance document recommending a new naming system for current and future biological products.

CDC Guidelines and Potential Conflict of Interest

New report in studies the organizations that submitted criticisms over the CDC guidelines for opioid management of chronic noncancer pain.

Low Vitamin D May Prompt Frequent Headaches

While well known as a significant factor in overall health, Vitamin D deficiency may contribute to more frequent headaches, especially in patients underexposed to sunlight.

Longterm Use of OTC Analgesics May Lead to Hearing Loss

The number of people affected by hearing loss is rising, with the numbers doubling between 2000 and 2015. A new study suggests a small but noticeable loss of hearing among women who regularly took OTC pain relievers for 6 years or more.

High-Risk Patients More Likely to Receive Long-Term Opioid Therapy

New epidemiological evidence suggests that patients who are at higher risk for long-term opioid abuse may be the same patients who are prescribed opioid medications for an extended period of time.

FDA Approves Arymo ER (morphine sulfate), New Abuse-Deterrent Opioid

Arymo ER (morphine sulfate) has been FDA approved for the management of severe pain.

Botox Injections Provide Pain Relief for Knee Osteoarthritis

New data support significant benefit from botulinum toxin A as a single-dose injection to relieve pain and improve mobility in refractory knee osteoarthritis.

Commentary on the ICER Psoriasis Drug Cost Report

Practical Pain Management commentary in which Drs. Fudin, Wegrzyn, and Kwon discuss topics related to the recent report on plaque psoriasis therapies published by the ICER.

How Cost-Effective are Drugs for Plaque Psoriasis?

Managing moderate-to-severe plaque psoriasis in patients often calls for the use of systemic therapies, and the market of available drugs for this condition has widened dramatically in recent years.

Weight Training Beneficial for Breast Cancer Survivors

New research is challenging the notion breast cancer survivors at risk or diagnosed with lymphedema should stay away from upper body resistance training.

Prevention of Acute Sickle Cell Crisis: Review of the NEJM Report

Review of the phase 2 results of crizanlizumab, a novel pharmaceutical agent for the prevention of vaso-occlusive crises in patients suffering from sickle cell disease.

International Study Finds Back Pain and Mental Health Closely Tied

According to a major international epidemiological study, back pain and mental health appear highly associated, particularly in countries with low median incomes.

Young Vets Experience the Most Severe Pain

Learn more about the results of the first national survey comparing pain in veteran and nonveteran populations.

Victims of Abuse Have Worse Pain Outcomes

Physicians should screen for abuse and traumatic events among their chronic pain patients, and focus therapy on both the physical and mental conditions.

Bacteria Found in Gum Disease Linked to RA

A team from Johns Hopkins has discovered Aggregatibacter actinomycetemcomitans, a bacteria seen in gum disease, may be triggering inflammation in patient with rheumatoid arthritis.

MACI, New Agent to Repair Damaged Cartilage, Approved by FDA

FDA approves MACI, the first tissue-engineered autologous cellularized scaffold product for use to repair damaged knee cartilage.

Spike in Naloxone Prices Worries Prescribers

Prices for opioid rescue drug naloxone are rising substantially. In a new editorial, doctors are calling for legislative support to stop price gouging.

New Drug Shows Promise for Preventing Painful Sickle Cell Crises

Crizanlizumab, a new monoclonal antibody underdevelopment, could be an effective treatment for preventing sickle cell-related pain crises in patients.

New Research: Augmented Reality May Relieve Phantom Limb Pain

New research suggests virtual reality and gaming may relieve phantom limb pain.

Autism Gene Improves Understanding of Reduced Pain Sensitivity

New research suggests that reduced pain sensitivity in individuals with autism can be linked to a specific gene that appears as the key pathway for chronic pain, and offers hope for development of medications designed to more directly target pain.

Evidence Grows for Use of Complementary Treatments for Pain Patients

A new systematic review of research has determined complementary therapies could be beneficial to patients suffering from pain conditions.

Study Finds Rising Rates of Children Hospitalized for Opioid Poisonings

While much focus has been placed on the rising rates of deaths related to opioid use, a new analysis of hospital records shows signficantly higher rates of children being hospitalized for opioid poisonings, as well.

Facing Addiction: Surgeon General's Call to Action

US Surgeon General Vivek Murthy, MD, MBA, releases report on alcohol, drugs, health—calling for a cultural shift to end the stigma and a focus on effective treatments and recovery programs.

FDA Fast Tracks New Injection for Morton's Neuroma

The FDA has fast-tracked a novel, nonopioid injection therapy for Morton's neuroma, a painful nerve condition that currently lacks any FDA approved therapies.

Ultrasound Can Guide Accurate Gout Diagnosis

The diagnosis of gout can involve a painful aspiration of the synovial fluid. Now research suggests that ultrasound may be a less painful alternative for the diagnosis of gout.

PRECISION Trial Shows Celecoxib Less Hazardous Than Ibuprofen and Naproxen

A new study found celecoxib (Celebrex) safer than other NSAIDs for low-risk cardiovascular patients with osteoarthritis and rheumatoid arthritis.

Opioid Prescriptions Decreases After Major Insurer Changes Its Opioid Prescription Policy

New study finds that implementing new CDC guidelines and educating prescribers can have a positive effect on opioid prescribing, reducing the number of short-acting prescriptions.

Tai Chi Helps Relieve Chronic Neck Pain

New research shows tai chi has comparable efficacy to conventional rehabilitation exercises for treating chronic nonspecific neck pain in patients.

FDA Approves Etanercept for Moderate-to-Severe Psoriasis in Children

The Food and Drug Administration has approved etanercept for the treatment of psoriasis in pediatric patients.

Placebo Effect's Sweet Spot

Researchers discover area of the brain responsible for the placebo effect.

ASRA Pushes for Medical Cannabis Rescheduling

The American Society of Regional Anesthesia and Pain Medicine (ASRA) is calling for the rescheduling of cannabis to a Schedule II classification.

JAMA Study Finds Non-TNF Drugs Highly Effective for RA Patients

New JAMA study suggests non-TNF biologics provide better patient outcomes for rheumatoid arthritis patients than tumor necrosis factor (TNF) inhibitor drugs.

FDA Approves New "Burst" Device for Spinal Cord Stimulation

The US Food and Drug Administration (FDA) has approved BurstDR device, a new form of spinal cord stimulation (SCS) with evidence of superior clinical benefits over traditional SCS therapy in the treatment of chronic pain.

FDA Clears Diagnostic Device for Traumatic Brain Injuries

FDA clears new Ahead 300 device for assessing traumatic brain injury.

FDA Approves Amjevita, a Biosimilar of Humira

The US Food and Drug Administration (FDA) has approved Amjevita (adalimumab-atto), a biosimilar to the popular immunosuppressant Humira (AbbVie Inc.). Amjevita is the fourth biosimilar to be approved by the FDA, as a new wave of biosimilars begin to make their way into the pharmaceutical market.

FDA Launches Search and Rescue Program

FDA launches new online resource for clinicians prescribing opioid medications called Search and Rescue. Goal is to reduce misuse and abuse.

Analysis Supports Alternative Therapies for Common Pain Problems

Yoga, acupuncture, and tai chi, all found effective for the treamtment of common pain conditions.

FDA Approves New Biosimilar to Etanercept

FDA approves etanercept-szzs or Erelzi, a tumor necrosis factor biosimilar to etanercept or Enbrel.

Exploring the DEA’s Position on Medical Marijuana

DEA denies petitions to reclassify marijuana. Agency notes concerns over safety and addiction, but will not interfere with current states that have legalized marijuana.

Opioid-Naive Patients at Low Risk of Opioid Reliance After Surgery

New study shows most opioid-naive patients at 1 year follow-up were able to get off their post-operative opioid medications.

People with Sickle Cell Trait at Greater Risk of Rhabdomyolysis

New study in the New England Journal of Medicine shows soldiers with sickle cell trait at increased risk of exertional rhabdomyolysis.

Opioid Antagonist Could Improve Cancer Survival

New study reveals terminal patients taking methylnaltrexone survive longer, which may reveal new insights about cancer.

Biologic Generic Drugs Are as Safe and Effective, says Review

New literature review finds generic versions of biologics, or biosimilars, are just as safe and effective as brand name drugs.

Pain Level is a Predictor for Opioid Addiction

New research suggests moderate to severe pain is a risk factor for opioid use disorder.

Genetic Marker Helps Explain Opioid Sensitivity

New literature review finds A118G genetic mutation linked with reduced opioid efficacy.

High Saturated Fat Diet Bad for Knee OA

New research shows a diet with high fat inake could worsen knee osteoarthritis progression.

FDA Approves First Ever Synthetic Joint Implant

New synthetic joint implant approved by the FDA can reduce osteoarthritis pain in the great toe and improve function.

HHS Announces New Opioid Reform Policies

Health and Human Services announce new initiatives to combat the opioid abuse epidemic, including expanding access to buprenorphine.

New Kappa-Opioid Receptor Agonist Curbs Pain, Avoids Side Effects

New kappa opioid receptor agonist drug in development could help manage pain minus side effects typical to opioids.

There Is a Role for Epidural Spinal Injections

Learn more about the proper role of epidural steroid injections in the treatment of back and neck pain.

AMA Delegates Vote to Add Naloxone to Opioid Rx

AMA delegates approve new policy that encourages physicians to co-prescribe naloxone to patients at risk of an opioid overdose.

Does Pregabalin Raise the Risk of Birth Defects?

A new study finds a link between pregabalin exposure during the first trimester to increased risk of major birth defects. Learn more about the implications of the study.

Teva Temporarily Pulls Zecuity Migraine Patch

Teva pulls Zecuity (sumatriptan) patch from market following reports of serious burns and scarring.

Genetic Markers for Addiction in Rats

New study sheds light on potential genetic markers of addiction. Future research may help develop a genetic screen for addiction.

FDA Alert: Antacid With Aspirin Linked to GI Bleeds

FDA issues warning about risk of gastrointestinal bleeding from over-the-counter antacid formulas that contain aspirin.

Opioids: Balancing Pain Relief With Risks

Opioids can be lifesaving for the right patient and life threatening for the wrong patient. Learn more about how to prescribe opioids safely and responsibly.

Prince Died of Fentanyl Overdose

Autopsy confirms that the pop star Prince died of a accidental fentanyl overdose. Question remain regarding his pain treatment and recovery plans.

Duke Researchers Test New Pain Targets

A potential new class of drugs that simultaneously block pain and itch have been discovered by a team of researchers at Duke University in Durham, North Carolina.

FDA Approves Buprenorphine Implant for Opioid Addiction

FDA approves implantable formulation of buprenorphine Probuphine for the long-term treatment of opioid dependence and addiction.

Phulchand Prithvi Raj, MD, Pioneer in Pain Management, Dies at 84

Phulchand Prithvi Raj, MD, lovingly known as Raj, died surrounded by his loved ones on February 27, 2016. He was 84.

Blocking Intracellular Glutamate May Halt Neuropathic Pain

Like a strong microscope, researchers are looking deep within neurons in the spinal column to find keys to the management of neuropathic pain. Learn more about metabotropic glutamate 5 receptor (mGlu5R).

Fentanyl Patches Overused in Vulnerable Populations

Study finds fentanyl patches often prescribed to opioid-naive and elderly patients, raising their risks of adverse drug events.

Endorphin Analogs May Offer Alternative to Opioids

Developing a pain treatment that can provide effective analgesia and avoid unwanted side effects still stands as the holy grail of pain pharmacology, but researchers may be getting close. The key could lay in a neurochemical already naturally produced in the body—endorphins.

New Guidelines for Treatment of Migraine with Botox

Botox and other botulin toxins get green light from a new guideline for chronic migraine therapy.

Genetic Screening May Improve Methadone Safety

New research points to a possible genetic marker for screening patient before starting methodone therapy. The marker could prevent adverse events, like overdose and toxicity, in patient being started on methadone for pain management.

New Federal Bill to Allow Partial-Fill of Opioid Rx

Learn more about a bill introduced to Congress that would help reduce the amount of unused prescription opioids left in households—stemming the risk of misuse and abuse by limiting access to unused medications.

Buprenorphine Offers Hope to Vets Who Suffer from PTSD, Pain, SUDs

Substance use disorder, including opioid use disorder, often goes hand in hand with chronic pain and PTSD among veterans. Treatment with a combination of buprenorphine/naloxone at a dose that is used to treat opioid dependency appears to help treat all 3 conditions.

Cryoablation Therapy Cools Phantom Limb Pain

Learn more about how cooling nerves (cryoablation therapy) can help treat phantom limb pain in amputees.

Mindfulness Meditation Improves Chronic Low Back Pain

90 Minutes a week of mindfulness meditation reduced low back pain in older adults. Learn more about new study.

FDA Proposes Abuse-Deterrent Guidelines for Generic Opioids

To reduce abuse and misuse of opioids, the FDA is setting a standard for companies to develop generic opioids using abuse-deterrent technologies, but there are still challenges to face.

FDA Issues New Labeling for Immediate-Release Opioids

The FDA has made significant changes to labeling requirements for immediate-release opioids, similar to what already exists for extended-release/long-acting (ER/LA) products.

Responses and Criticisms Over New CDC Opioid Prescribing Guidelines

Criticism and defense of the CDC Opioid Prescribing Guidelines.

CDC Issues Final Guidelines for Opioid Prescribing

CDC releases new guidelines for opioid prescribing in non-cancer chronic pain patients aimed to curb opioid epidemic of misuse, abuse, and overdose.

Opioids Overprescribed for Low-Risk Procedures

Dentists and surgeons likely to overprescribe opioids after low-risk procedures, according to two new studies in JAMA.

Pain and Fatigue Dominate Pediatric Lupus

Fatigue and pain predominate symptoms in childhood-onset systemic lupus erythematosus. Learn more about health-related quality of life issues of SLE.

Link Between Migraine and Parkinson’s Found

Learn more about the link between migraine and movement disorders, like Parkinson's disease.

Interview with AMA Task Force Chair Patrice A. Harris, MD, MA

Patrice A. Harris, MD, MS talks with Practical Pain Management about the AMA's educational outreach to reduce opioid abuse and misuse.

Diabetes Patients May Be At Increased Risk of Tendinopathy

People with type 2 diabetes are at increased risk of developing tendinopathy.

AMA Survey Finds Doctors Widely Support Prescription Drug Monitoring Programs

As policy makers take aggressive action to combat opioid-related overdoses and deaths, a large majority of practitioners appear to be in favor of Prescription Drug Monitoring Programs (PDMPs), as well as bettering access to training, according to a new survey by the AMA

AAPM Raise Concerns Over CDC Opioid Guidelines

AAPM responds to the revised CDC Opioid Guidelines: More work needs to be done.

New Guidelines for Post-Op Pain Management

New guidelines from the American Pain Society hope to improve post-operative pain management.

Senator Warren Pushes for Medical Marijuana Research

Senator Warren urges the Centers for Disease Control and Prevention to increase efforts to explore the use of medical marijuana as an alternative to addictive narcotic pain killers that claim thousands of lives each year.

FDA Alert: Recall of IV Morphine Made by Pharmakon

Pharmakon issues recall of lot of IV Morphine due to "over-potent" dosage.

The Latest Legal Developments in the Medical Marijuana Debate

Controversy surrounds medical marijuana, but recent action by the federal government may open up the road to increased research.

New Option for Gout Patients

Learn more about new treatment options for gout. Lesinurad shows benefit when be taken with concurrent xanthine oxidase inhibitors.

War on Opioid-Abuse

The FDA, NIH, and Congress are beefing up programs to help address the opioid abuse epidemic, including call for more pain education in medical schools.

New Brain ‘Channel’ Key to Preventing Opioid-Induced Respiratory Depression

Respiratory depression is a major risk facing patients taking high doses of opioid drugs. A new study sheds light on how opioids affect breathing, something that could help develop future life-saving therapies.

FDA Approves Onzetra Xsail Migraine Medication

The US Food and Drug Administration (FDA) announced the approval of Onzetra Xsail (fast-acting sumatriptan nasal powder) for the acute treatment of migraine in adult patients with or without aura, according to Avanir Pharmaceuticals.

Acupuncture Improves Pain in Pediatric Patients

Acupuncture for children? Learn how this ancient technique can provide relief from chronic pain and nausea in children.

Many Pain Patients Risking OTC Overdoses

National survey shows that consumers do not follow labels when taking over-the-counter pain medications (Advil, Motrin, Tylenol), putting them at increased risk for adverse events and death.

Children With Migraines Often Go Untreated

Despite evidence-based guidelines, a new study has found that many children with acute migraines go under diagnosed and untreated.

FDA Orders Seizure of Supplements Containing Kratom

Federal agents seize supplement containing kratom, a synthetically-derived opiate from Southeast Asia.

New Look at Sickle Cell Patients With Chronic Pain

New research is looking into how acute pain from sickle cell disease becomes chronic.

FDA Approves Zurampic for Gout

The FDA has approved a new treatment for gout, Zurampic (lesinurad) to reduce the build up of uric acid in the blood.

Chondroitin Outperforms Celecoxib for Slowing OA

Chondroitin sulfate was found to be more effective than celecoxib (Celebrex) at reducing the long-term progression of knee osteoarthritis structural changes over a 2-year period.

Tracking Pain: There' s an App for That

Learn how smartphone apps are helping physicians improve pain management for patients with chronic pain.

New Ibuprofen Skin Patch Being Developed

University of Warwick researchers have invented a new ibuprofen patch, which would present a novel delivery method that could improve patient safety, particularly for those taking high daily doses.

Algovita SCS System Approved

FDA approves Algovita Spinal Cord Stimulation System for the treatment of various types of neuropathic pain.

FDA Approves Narcan Nasal Spray to Prevent Opioid Overdose

FDA approves new Narcan (naloxone) formulation to prevent accidental opioid or heroin overdose. Nasal spray eliminates need for needles.

Monotherapy Best Option for Low Back Pain

Acute back pain is best treated with an NSAID—even in the emergency department. Adding additional medications does not improve outcomes, and can raise risks.

Pot for Pain? 80% of Docs Surveyed by PPM Say Yes

The vast majority of respondents to Practical Pain Management poll of readers recommend medical marijuana for their pain patients.

FDA Approves Belbuca (buprenorphine) Patch

Belbuca (buprenorphine), a new film formulation of buprenorphine that is placed on the inner cheek, has recently been approved by the US Food and Drug Administration.

FDA Approves Vivlodex (meloxicam)

The FDA has approved Vivlodex capsules (meloxicam) for treatment of osteoarthritis. The new formulation contains microparticles of meloxicam that reduce the dose of NSAID needed.

ASAM Releases Guidelines for Opioid Addiction Treatment

ASAM releases guidelines for treating opioid use disorders. Learn more about how to treat opioid addiction.

Telemedicine Offers Migraine Care to Remote Areas

An interview with Timothy R. Smith, MD Migraines are one of the most common neurological diseases affecting millions of Americans. Unfortunately, in the United States many patients live in rural or remote areas far from a formal health care center, which makes in-office visits to their doctor infeasible.

Oral Contraceptives Play Positive Role in Rheumatoid Arthritis

An interview with Rainer H. Straub, MD For over 10 million American women taking oral contraceptives (OC), the intention is safe birth control. However, there could be another positive, tangent effect: managing early rheumatoid arthritis (RA) symptoms.

FDA Alert: Tramadol Use in Children

FDA issued a warning about the use of tramadol for pain management in children recovering from tonsil or adenoid surgery.

Novel Migraine Drugs on the Way

Novel migraine drugs that block calcitonin gene-related peptide (CGRP) have shown promise in preliminary testing. Learn more about these investigational products.

Native Vertebral Osteomyelitis: New Treatment Guidelines for Rare Spinal Infection

When patients have recalcitrant low back or neck pain, it can be difficult for clinicians to make an appropriate clinical decision, especially if additional symptoms begin to point to a more serious ailment, like Native Vertebral Osteomyelitis (NVO). NVO is the most common form of hematogenous osteomyelitis in patients over 50 years of age.1

Severe Joint Pain Linked to DPP-4 Inhibitors for Diabetes

Reviewed by Forest Tennant, MD, DrPH

White House Budget: Increased Funds for Opioid Addiction Prevention

Obama Administration increases 2016 budget to reflect need for more funding to prevent opioid overdoses.

Survey: Many Doctors Confused About Opioid Abuse

How well do physicians understand the risks of opioid abuse and misuse? A new study gives primary care providers a mixed grade—with most physicians misunderstanding basic facts about opioids.

FDA Approves OxyContin for Pediatric Patients

The FDA has approved the use of OxyContin, an extended-release form of the opioid oxycodone, for pediatric patients. However, the decision comes with specific guidelines to ensure the patient is safely switched to the medication.

Genetically Modified Yeast Strains Produce Opioid Drugs

Standford University researchers investigate developing genetically modified yeast strains to produce opioids.

Online Therapy Improves Access to Pain Patients

An online cognitive behavior therapy program may provide wider access to pain patients, but how effective is it compared to face-to-face counseling?

How Glutamine Can Aid Acetaminophen Overdose

Acetaminophen overdose is one of the most common types of drug overdoses. Learn how the body’s most important antioxidant, glutathione, needs more fuel during an overdose—that fuel being more glutamine.

Brain Drain: Lymphatic Drainage System Discovered in the Brain

New discovery of a lymphatic drainage system in the brain may have therapeutic implications for patients with chronic pain. Learn more about this exciting discovery.

DEA Schedules Annual Take-Back Date

Save the date. September 26th will be the DEA's annual Take-Back unwanted prescription medication. Learn more about collection sites and times.

Sports Overuse Injuries on the Rise

For a high school athlete in the midst of strenuous, competitive season, the physical stress of a tenacious schedule of games or an intense daily practice regimen can take a toll on the body.

Dopamine's Crucial Role in "Priming" Chronic Pain

A newly published study found that dopamine is integral to how pain becomes chronic. Learn more about how this discovery may help treat fibromyalgia and other chronic pain conditions.

Lowering Inflammation Through Diet, Exercise, and Vitamin D

Commentary by Catherine Duggan, PhD

FDA Strengthens Warning on NSAIDs

The Food and Drug Administration (FDA) announced that it will be strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

Abatacept: Safe and Effective for Treating Juvenile Idiopathic Arthritis

New study finds abatacept (Orencia) safe and effective long-term treatment for patients with juvenile idiopathic arthritis.

Low-Dose Indomethacin (Tivorbex) Now Available

FDA-approved low-dose indomethacin (Tivorbex) from Iroko Pharmaceuticals is now available for the treatment of moderate to severe pain in adults.

Cancer 'Pain Signal' Sparks Research Into Pain Rx

New research shows a prevalence of a certain enzyme, which may offer a key to developing future drugs to stop cancer pain at its source. Learn more about how TMPRSS2 may be used one day to help fight cancer pain.

Low Back Pain Guidelines Not Always Followed By Clinicians

When a patient hurts their back, they look to their doctor for help. But the advice they get may depend on the gender of the clinician—and may not following standard guidelines.

Post-Stroke Pain Helped By Weekly Brain Stimulation

An interview with Masahito Kobayashi, MD, PhD New hope for patient with central post-stroke pain. Preliminary findings suggest that weekly sessions of non-invasive repetitive transcranial magnetic stimulation may provide longterm pain relief.

Senza SCS System Approved

FDA approves first spinal cord stimulator, Senza System, that does not cause paresthesia.

Predicting Postop Shoulder Pain

Learn how a patient's genetic make-up influences their experience of pain and how it may be possible to prevent chronic postoperative pain before it develops.

Can Comorbidities Predict Gout Severity?

The severity of gout may be predicted by the number of comorbidities. But excess uric acid may also be protective against Alzheimer's disease. Learn more about gout's comorbidies.

Treating Gout: Allopurinol Found Safe During Acute Attacks

A new study has shown that it is safe to treat patients suffering acute gout flareups with urate lowering therapy, such as allopurinol.

Phone Counseling Improves Spine Surgery Outcomes

Incorporating pre- and post-op phone counseling improves patient adherence to rehabilitation and exercise programs after lumbar spinal surgery

Weighing Overdose Risk Among Veterans

Overdose rates are increasing among injured veterans on chronic opioid therapy.

Abuse-Deterrent Guidelines Issued by FDA

The FDA has released guidelines for industry to encourage makers of opioids to develop abuse-deterrent formulations.

Parents Play Role in Child's Postop Pain

Parents' attitudes about pain influence their children's overall outcomes.

Tramadol May Increase Hypoglycemia Risk in Patients

Recent studies have raised concerns about tramadol, a popular pain therapy, including its effects on blood glucose levels (hypoglycemia) and addiction potential.

Naloxegol Descheduled by DEA

AstraZeneca has announced that naloxegol (Movantik) has been descheduled by the Drug Enforcement Agency (DEA).

Meniscal Surgery May Raise Risk for Osteoarthritis

When damaging tears form on the knee's meniscus cartilage, meniscal surgery is a common solution. But according to new research, meniscal surgery may cause more harm than good, including an increased incidence of osteoarthritis (OA).

FDA Approves New Formulation of Zohydro

The U.S. Food and Drug Administration (FDA) has approved a new formulation of Zogenix's Zohydro ER (hydrocodone bitartrate). The extended release capsules include BeadTek, which is designed to provide abuse-deterrent properties "without changing the release properties" of the hydrocodone, noted a press release from the company.

Survey of Opioid Prescribing Raises Interesting Questions

Concerns about prescription drug abuse and addiction may affect opioid prescribing habits of primary care physicians.

Pain Medications and Pregnancy

As a result of recent reports raising concerns about the safety of prescription and over-the-counter (OTC) pain medicines used during pregnancy, the US Food and Drug Administration evaluated research studies published in the medical literature and determined they are too limited to make any recommendations at this time. The agency recommends that clinicians:

New "Pathway" Provides Mute Button to Curb Chronic Pain

Adenosine may provide new pathway or mute button to curb chronic neuropathic pain.

New Study Links Headaches to Bariatric Surgery

As weight loss surgeries become more common, doctors have found these procedures could be related to the leakage of spinal fluid that is known to result in severe headaches.

Preoperative Fears Affect Postoperative Recovery

Clinicians are starting to become aware that a patient's mental health right before surgery effects postoperative recovery, especially when it comes to pain management. Catastrophizing is a psychological disorder that causes patients to ruminate, exaggerate, and feel helpless over their pain.

Purdue's Hysingla (single-entity hydrocodone) Receives FDA Approval

The U.S. Food and Drug Administration has approved Hysingla ER (hydrocodone bitartrate), an extended-release (ER) opioid analgesic to "treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate."

Genetically Modified Yeast Strains Produce Opioid Drugs

Standford University researchers investigate developing genetically modified yeast strains to produce opioids.

Postoperative Pain Keeps Patients Awake, Extends Hospital Stays

It has been shown that pain impacts a person’s quality of sleep—and poor sleep may affect pain perception. So imagine undergoing major knee or hip surgery and then having postoperative pain. Not surprisingly, researchers found that people who reported poor sleep following surgery also had more pain, especially in the first 24 hours after the operation. But what does this mean for recovery?

FDA Approves New Labeling for Embeda

The US Food and Drug Administration approved new labeling for Embeda (morphine sulfate and naltrexone hydrochloride). Embeda is the third extended release (ER) opioid analgesic to be approved that specifically describing the product’s abuse-deterrent properties.

Left Unchecked, Pain and Depression Worsen Outcomes in Hemodiaylsis Patients

Being depressed and in pain often leads to poor adherence to medical treatments. But for patients requiring chronic hemodialysis, pain and depression were directly linked to missed treatments, hospitalizations, and even death.

Irritable Bowel Syndrome in Teens

Adolescents with irritable bowel syndrome (IBS) experience lower pain threshold levels (hyperalgesia) similar to adult patients with the condition.

FDA Expands Relistor's Indication

The Food and Drug Administration has expanded the indication for methylnaltrexone bromide (Relistor) to include OIC in patients with noncancer pain

Debating Best Surgical Technique for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a debilitating chronic pain condition affecting the trigeminal nerve, where patients experience intense facial pain, which can become intractable.

Medical Marijuana Reduces Opioid Overdoses in Some States

A new study has found that lower opioid overdose death rates were associated with implementation of state medical marijuana laws, although the reason why remains unclear.

FDA Approves Movantik for Opioid-induced Constipation

The US Food and Drug Administration has approved Movantik (naloxegel) as an oral treatment of opioid-induced constipation in adults with chronic non-cancer pain.

DEA Allows Return of Unused Prescriptions to Pharmacies

Starting October 9, 2014, the Drug Enforcement Agency (DEA) has announced that they will allow consumers to drop-off unused prescription medications like controlled substances, including opioid, to their local pharmacies.

Central Canal Spinal Stenosis

Adding corticosteroids to epidural lidocaine injections in patients with central canal lumbar spinal stenosis did not increase efficacy, raising the question of whether steroids should be used in this setting, researchers reported in the New England Journal of Medicine.1

How Best to Intervene for Problem Drug Use?

The the epidemic of prescription drug misuse and abuse has raised awareness among primary care physicians and pain specialists about the need to screen patients before prescribing addictive medications. This is especially important when dealing with patients in chronic pain. It is estimated that between 1.9 million people in the U.S.

Acetaminophen Found Ineffective for Treating Low Back Pain

Doctors commonly recommend acetaminophen as a first-line treatment for many types of aches and pain, but a new study finds the drug may be wholly ineffective in aiding patients with acute low back pain.

Novel Treatments for Psoriatic and Rheumatoid Arthritis Show Efficacy

Two arthritis medications have shown efficacy in clinical trials—a phase II trial of brodalumab in the treatment of psoriatic arthritis and a phase III trial of tofacitinib in the treatment of

FDA Approves Targiniq ER for Severe Pain

The US Food and Drug Administration (FDA) has approved Targiniq ER (oxycodone and naloxone, Purdue Pharma), as a treatment for severe pain. This is the second approval of a long-acting, extended-release opioid with “abuse deterrent” properties since the FDA issued industry guidelines in 2013.

DEA Redesignates Tramadol Schedule IV Drug

The Drug Enforcement Administration (DEA) has officially changed tramadol from a non-classified drug to a schedule IV drug, effective August 18, 2014.1 First approved by the US Food and Drug Administration (FDA) in 1995, tramadol (Ultram) is a centrally acting opioid analgesic.

Blood Tests May Help Diagnose Concussions

Tau protein levels and other types of biomarkers may help doctors better diagnose concussions and even monitor symptoms, according to new research. A recent study looked at professional hockey players in Sweden, monitoring their tau protein levels after physical exertion and concussion injuries.

Music Helps Soothe Pain Symptoms

It has long been known that music can be used to calm and relax people. A new study also shows that music therapy can be used to reduce postoperative pain.

Low Back Pain Reduces Enjoyment of Food

People with chronic low back pain appear to lose their enjoyment of eating, resulting in a blunting of feelings of satisfaction, satiety, and pleasure. This can lead to a cycle of over-eating and weight gain, which than contribute to continued low back pain. Innovative new research is now examining how pain influences eating behaviors that led to obesity.

Can Respiratory Rates Indicate Pain?

Do unconscious patients experience pain? And if so, how does one measure pain in a non-responsive patient? According to Canadian researchers, respiratory rates (RR) of traumatic brain injury (TBI) patients may be one vital sign used to monitor pain levels in conscious and unconscious patients in the intensive care unit.

Spinal Cord Stimulation May Help for Low Back Pain

Spinal cord simulation (SCS) is proving itself a safe and effective method of treating some chronic back pain patients who have failed at least 6 months of conventional treatment, according to the results of a newly published study in the journal Pain Medicine.1

Marijuana Trials Leave RA Patients in Doubt

Medical marijuana, although effective for some types of pain, does not appear to relieve chronic pain in patients with rheumatoid arthritis.

Heart Disease Risk Tool Tailored to Rheumatoid Arthritis Patients

It has been known that people with rheumatoid arthritis are twice as likely to develop heart problems than the general population. But pinpointing patients who need stepped-up heart disease prevention efforts has been a challenge for physicians who treat rhuematoid arthritis.