INNOVATIONS in Pain Theory, Research, & Practice

Understandings of pain and its clinical management are constantly changing. Additionally, new treatments and new applications of existing treatments are constantly being explored and introduced. The resources on this page explore those innovations and, when possible, provide practice recommendations. These would be of interest and importance for physicians, as well as pharmacists, dentists, nurses, nurse practitioners (NPs) or physician's assistants (PAs), and other healthcare providers.

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Opioid Antagonists, Naloxone & Naltrexone — Aids for Pain Management

An Overview of Clinical Evidence

By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, March 2009.

Achieving effective, durable, and safe pain relief, especially in patients with chronic and/or severe pain conditions, can be challenging. For many types of pain, prescription opioids are among the most effective analgesics. However, a growing body of evidence suggests potential benefits of opioid antagonists — particularly low- or ultralow doses of naloxone and naltrexone — for enhancing the pain relieving efficacy of opioid analgesics, such as morphine and others. This is somewhat unexpected because antagonists displace opioids from their neuroreceptors and block opioids from attaching to and activating those receptors.

Opioid antagonists also may reduce tolerance to and physiologic dependency on opioid analgesics, and lessen certain opioid side effects. Furthermore, low-dose naltrexone has been successfully tested by itself as monotherapy for the management of several pain-related conditions, including Crohn’s disease, irritable bowel syndrome, and fibromyalgia.

This peer-reviewed, evidence-based report describes naloxone and naltrexone pharmacology and the theoretical foundations of opioid antagonists in pain management. It includes summaries of 17 studies investigating opioid-antagonist therapy for pain in adult humans.

Download PDF: http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf (260 KB, 16-pages) 

Opioid Antagonists in Pain Management [Journal Article]

By: Stewart B. Leavitt, MA, PhD, Practical Pain Management, 2009(April);9(3):10-21.

This 10-page cover-feature article (59 references) appeared in the April 2009 edition of the peer-reviewed medical journal Practical Pain Management (PPM). Essentially, it is the publicly published version of the above report, with only minor editing.

Download PPM article PDF: http://pain-topics.org/pdf/OpioidAntagonistsPPM2009.pdf (347 KB, 11-pages)

Vitamin D for Chronic Pain

By: Stewart B. Leavitt, MA, PhD, Practical Pain Management, 2008(Jul/Aug);8(6):24-42.

Download PDF: http://pain-topics.org/pdf/vitamind-PPM-JulAug2008.pdf (1.1 MB, 13-pages)

This 13-page feature article, including 138 references, appeared in the July/August 2008 edition of the medical journal Practical Pain Management (PPM). In sum, extensive clinical evidence and expert commentary supports the opinion that recommending adequate vitamin D intake for helping patients with chronic musculoskeletal pain and fatigue syndromes should be more widely recognized and acted upon. In many cases, contributing factors are nonspecific or undetermined. Even in cases where a specific etiology has been diagnosed, the potential for vitamin D deficit as a factor contributing to and/or prolonging the pain condition should not be ruled out. Supplemental vitamin D has a highly favorable benefit to cost ratio, with minimal, if any, risks. In all likelihood, it would do no harm and probably could do much good. Article is reprinted here by permission of the journal.

Vitamin D – A Neglected 'Analgesic' for Chronic Musculoskeletal Pain

An Evidence-Based Review & Clinical Practice Guidance

Inadequacies of vitamin D have been linked to chronic musculoskeletal pain of various types, muscle weakness or fatigue, fibromyalgia syndrome, rheumatic disorders, osteoarthritis, hyperesthesia, migraine headaches, and other somatic complaints. It also has been implicated in the mood disturbances of chronic fatigue syndrome and seasonal affective disorder.

Supplemental vitamin D can help to resolve or alleviate these problems in many patients who have been unresponsive to other therapies. Vitamin D therapy is easy for patients to self-administer, is well tolerated, and is very economical.

Practitioner Briefing...

By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

7-page briefing summarizes key background information and practice recommendations from the full report (see below).

Download PDF: http://pain-topics.org/pdf/vitamind-briefing.pdf (260 KB, 7-pages)

Full Report...

By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

50-page, peer-reviewed report provides an extensive discussion of vitamin D and its application for chronic pain syndromes. It responds to questions practitioners may have regarding why, when, how, and for whom to recommend vitamin D supplementation.

Download PDF: http://pain-topics.org/pdf/vitamind-report.pdf (770 KB, 50-pages)

Updated Evidence on Vitamin D for Pain...

The above ground-breaking research reviews on the potential benefits of vitamin D for patients with chronic pain were published in 2008. What has happened since that time? This News/Research UPDATES blogpost summarizes relevant research on the subject published during late 2008 through 2009.

See Blogpost at: http://updates.pain-topics.org/2010/01/vitamin-d-for-pain-update-of-research.html

Vitamin D: A Champion of Pain Relief [Patient Brochure]

By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

6-page brochure for patients and/or their caregivers explains in easy-to-understand language what vitamin D is and how it works. In a question-and-answer format it describes how inadequate vitamin D intake may play a role in muscle, bone, or joint pain, as well as the potential benefits of and what to expect from vitamin D supplementation. Patients are advised that they should not discontinue other prescribed therapies for pain and to consult their healthcare providers when starting a vitamin D supplementation program.

Download PDF: http://pain-topics.org/pdf/vitamind-brochure.pdf (200 KB, 6-pages)

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