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Latest Pain-Topics News/Research UPDATES
Confusion Over Why Youths Misuse Rx Opioids
The misuse of prescription opioid analgesics among youths has garnered significant news-media coverage and created much concern, but there has been inadequate attention focused on the underlying motives for such behaviors. A new study among adolescent students revealed that most of the alleged medication misuse was for treating legitimate pain; however, there are some confusing aspects of this investigation that muddle the interpretation and usefulness of outcomes. Learn more>
November 2013 – Pain Product Announcements & Warnings
Featured Items: hydrocodone (Zohydro ER) approved as a single-entity product; FDA announces plan for hydrocodone combination products reclassification; diclofenac capsules (Zorvolex) approved as new NSAID formulation; tocilizumab (Actemra) subcutaneous formulation approved for RA; certolizumab pegol (Cimzia) approved for active psoriatic arthritis; methotrexate (Otrexup) self-injection device approval. Read more>
Other Recent Pain-Topics UPDATES of Interest...
> Yoga for Neck Pain? Maybe.
> Dubious Study Disclaims Vitamin D for Back Pain
> October 2013 – Pain Product Announcements & Warnings
> Calculating Benefits & Harms in Pain Research
> Pain Control & Patient Satisfaction Differ
> FDA Issues ER/LA-Opioid Prescribing Changes
See Table of Contents for ALL UPDATES>
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RECENT Continuing Education (CME) Postings
Biologics in the Treatment of Crohn's Disease
From: PRIME Education, Inc.; 2013.
Educational monograph reviews the efficacy and safety of biologic drugs used to treat moderately-to-severely active Crohn’s disease in adult patients. Current best evidence and agents approved for induction and maintenance therapy in Crohn’s disease are reviewed and summarized. See details>
ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care
This 3-part educational program meets requirements defined by the FDA’s blueprint for ER/LA Opioid REMS education. Discussions include patient assessment, prescribing considerations and potency variations in ER/LA opioids, and opioid-drug interactions. See details>
NEW in Clinical Concepts
Preventing Acute Pain from Becoming Chronic
By: Clark MR. Chronic Pain Perspectives; 2013.
The author suggests ‘4 Perspectives’ helping to identify risks of developing chronic pain: the disease itself, behavioral patterns, patient intrinsic traits, and life stressors. Each is discussed as a modifiable risk factor that can be addressed in patient-centered manner. See details>
Placebo Analgesia: Psychological & Neurobiological Mechanisms
Patient responsiveness to placebo analgesia is evaluated from 3 different perspectives —psychological mechanisms, neurobiological pathways, and potential molecular targets. Scientific evidence of the rationale for placebo effectiveness is discussed, along with the overall role that a placebo analgesia component plays in overall pain relief. See details>
Self-Management of Chronic Pain
Monograph describes several commonly-used models of patient self-management and reviews evidence on the efficacy and acceptability of self-management interventions. Techniques for healthcare provider facilitation of patient self-management interventions also are discussed. See details>
NEW Pain Treatment Guidelines/Reports
Guidance on the Management of Pain in Older People
Document reviews a range of nonpharmacologic, pharmacologic, and interventional therapies alone and in combination to identify the best evidence on pain management in older adults. See details>
Nonpharmacologic Management of Hip and Knee OA
Eleven evidence-based recommendations for the nonpharmacologic core management of hip and knee osteoarthritis (OA) emphasize tailored patient therapy with shared decision-making and consideration of patient preferences. See details>
Opioid Rx & Safety
Opioid Overdose Prevention Toolkit
From: U.S. Substance Abuse and Mental Health Services Administration (SAMHSA); August 2013.
Special 5-part program helps reduce fatal opioid overdoses by providing education for clinicians, patients, communities, first responders, overdose survivors and family members. The importance of ready access to naloxone for reversing overdose effects is stressed. See details>
Differences Between Opioids: Pharmacological, Experimental, Clinical, & Economical Perspectives
Pain experts from Europe evaluate differences between opioid agents, comparing the pharmacological characteristics and cost factors for each. The article also describes experimental studies and discusses choosing specific opioid agents. See details>
NEW in Pain Disorders
Current Practices & Advances in Pediatric Pain Management
Paper reviews evidence-based pediatric pain assessment and treatment approaches. Differences between pain management adults and pediatrics are discussed, including dosing and administration, and adverse events with non-opioid analgesics, adjuvant drugs, and opioid agents. See details>
Management of Chronic Pain in the Elderly
Article provides guidance for a more age-specific approach to the assessment and management of geriatric chronic pain. Discusses physiologic changes in aging by specific body system and their impact on the pharmacodynamics and pharmacokinetics of commonly-used analgesics. The use of multiple modalities in an individualized patient care plan is emphasized. See details>
NEW in Pain & Addiction
What to Do When Pain and Addiction Coexist
The management of chronic pain in patients with addictive disorders adds psychosocial and biological complexities that require the attention of clinicians in multiple disciplines. The author discusses a multidimensional pain management model, assessment tools, adjunctive therapies, a 12-step program for pain, and self-care options for managing biopsychosocial aspects of pain and addiction. See details>
Recent Resources for Patients
Headaches and Complementary Approaches
Fact sheet reviews definitions and characteristics of the most common types of headache. Complementary approaches for headache therapy are discussed, including relaxation training, biofeedback, acupuncture, Tai Chi, cognitive-behavioral therapy, massage (including craniosacral therapy), spinal manipulation, and diet supplementation. See details>
U.S. FDA - Patient Network Website
Interactive website provides education on how medications and medical devices move from the drawing board to the marketplace. Also helps patients determine whether medical products are safe and effective, and encourages them to become involved by contributing their ideas and concerns about the development and regulation of these products. See details>
NEW Focus on CRPS/RSD
History, Diagnosis & Treatment of CRPS/RSD
This 2 part article briefly reviews the history of complex regional pain syndrome (CRPS) — also known as reflex sympathetic dystrophy (RSD) — and physiologic mechanisms for its confusing symptoms. Diagnostic considerations and treatments are discussed, including pharmacotherapy, interventional modalities, and psychotherapy. See details here>
Treatment of CRPS/RSD in Adults: A Systematic Review
This review examines randomized controlled trials (RCTs) to identify successful therapeutic interventions for complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). Studies showing strong evidence for physiotherapy, drug therapy, and interventional treatments are described, as well as 15 treatments for which there is a lack of evidence. See details>
NEW in Non-Opioid Therapies
Role of Glucosamine in the Treatment for Osteoarthritis
Controversial review of research concludes that glucosamine sulfate can reduce symptoms of osteoarthritis; however, differences in glucosamine product quality and dosing affect outcomes. See details>
NEW Books to Note
Stories of Hope
Living in Serenity with Chronic Pain and Chronic Illness
From: Chronic Pain Anonymous; 2012.
This book was written by members of the Chronic Pain Anonymous, or CPA, 12-Step fellowship to help explain how the tools and principles of the program can serve as catalysts for emotional, mental, and spiritual transformation. Readers discover how it is possible to live in happiness and contentment, one day at a time, regardless of the nature of their chronic pain or illness. See review>
Understanding and Treating the Complex Patient
From: IASP Press, Giamberardino and Jensen, eds.; 2012.
In the 23 chapters of this expansive and well-illustrated text, the editors have carefully assembled a collection of evidence-based articles examining the nature, modalities of diagnosis, and treatment of complex clinical situations involving multiple concurrent diseases that variously influence patients’ experience of pain. See review>
Pain & Disability Assessment Tools
Pain Catastrophizing Scale
Questionnaires for adults, spouses, and children assess catastrophic thinking as it relates to a patient’s experiences of helplessness and magnification of pain. Full instructions for administration are provided and the instrument is available in multiple languages. See details>
Spanish Versions of Opioid-Risk Assessment Tools Available
Now available in Spanish: SOAPP-R and COMM. See details>
Making Sense of Pain Research [Series]
Improving pain practice requires better research. However, healthcare professionals, and certainly patients, usually have had little specific training in evaluating research. This UPDATES series on “Making Sense of Pain Research” helps to close the education gap, teaching readers how to understand and interpret the often mysterious and complex language of research to assess its quality and validity. See listings>
Help for Safely Using Opioid Pain Relievers
Extensive, REMS-compliant, educational activity for patients and their caregivers focusing on the proper and safe use of opioid pain relievers. Provides an understanding of opioids and their risks. Vital instruction is provided on recognizing opioid problems and on being prepared for emergencies. Go to Opioids911.org>
IASP Announces Global Year
Against OROFACIAL PAIN
The International Association for the Study of Pain (IASP) has proclaimed 2013-2014 the Global Year Against Orofacial Pain. This frequent form of pain is perceived in the face and/or oral cavity, and is caused by diseases or disorders of regional structures, by dysfunction of the nervous system, or through referral from distant sources. The IASP offers press releases, fact sheets examining the many aspects of orofacial pain, and other resources for healthcare providers and the public. Learn more here.
Calling All Practitioners
Please Respond to Survey on MEQ Dosing
This survey seeks to assess how medical practitioners typically calculate opioid analgesic conversions to morphine equivalent (MEQ) doses. Anonymously submitted information gathered via 12 brief questions will be analyzed for future publication. Please go to the survey: Click Here
Purdue Announces PERFORM® Program
This new Patient Evaluation Resources for Opioid Risk Management (PERFORM®) website from Purdue Pharma provides information and tools to assess and address risks of medication misuse, abuse, and addiction in patients who may require opioid therapy for pain. This is a healthcare professional-only website requiring free registration. Go to: www.PurduePERFORMOnline.com.
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Thank you, for visiting, and we hope to see you here often.
Stewart B. Leavitt, MA, PhD, Executive Director