Pain Medicine
RCT: Methotrexate Shows Modest Pain Reduction in Knee Osteoarthritis, More Research Needed – Ann Intern Med
18 Aug, 2024 | 18:01h | UTCStudy Design and Population: This multicenter, randomized, double-blind, placebo-controlled trial evaluated the effects of oral methotrexate on 207 participants with symptomatic knee osteoarthritis (KOA) who had persistent knee pain despite prior treatments. Conducted across 15 musculoskeletal clinics in the UK from June 2014 to October 2017, participants were randomly assigned to receive either methotrexate or placebo over a 12-month period.
Main Findings: At 6 months, methotrexate resulted in a modest reduction in knee pain, with a statistically significant difference of 0.79 points on the NRS compared to placebo (95% CI, 0.08 to 1.51; P = 0.030). Small but statistically significant improvements were also noted in knee stiffness and function. However, the clinical significance of these findings remains uncertain, and potential side effects of methotrexate warrant caution.
Implications for Practice: While methotrexate may offer some symptomatic relief for patients with knee osteoarthritis who do not respond to standard treatments, the modest reduction in pain and improvement in function observed in this study may not justify its routine use given the potential for significant side effects. The small magnitude of benefit suggests that methotrexate should be considered cautiously and only in select patients. Further research is necessary to confirm these findings and to better understand the risk-benefit profile of methotrexate in this population before broader clinical adoption.
Cohort Study: Prenatal opioid exposure linked to modest increase in neuropsychiatric disorders – The BMJ
25 May, 2024 | 19:50h | UTCThis nationwide birth cohort study from South Korea investigated the impact of prenatal opioid exposure on the risk of neuropsychiatric disorders among children. The study followed 3,128,571 infants born between 2010 and 2017 until the end of 2020. Researchers found that infants exposed to opioids prenatally showed a slightly increased risk of developing neuropsychiatric disorders, including mood disorders, attention deficit hyperactivity disorder, and intellectual disability. The increased risk was more pronounced with higher opioid doses, longer duration of use, and exposure during the first trimester of pregnancy. However, this association was not significant in sibling comparison cohorts, indicating a modest overall clinical impact. The study emphasizes the need for cautious interpretation due to its observational design and the specific conditions under which risk increases.
Reference (link to free full-text):
RCT: Triple combination of paracetamol, ibuprofen, and dexamethasone reduces morphine use post-hip arthroplasty – Lancet Rheumatol
11 May, 2024 | 14:18h | UTCStudy Design and Population: The RECIPE trial was a randomized, blinded, placebo-controlled multicenter study conducted across nine Danish hospitals to evaluate the effectiveness of non-opioid analgesic combinations in managing postoperative pain following total hip arthroplasty. A total of 1,060 adults scheduled for surgery were enrolled and randomly assigned to one of four treatment groups, receiving combinations of paracetamol, ibuprofen, and dexamethasone. The study’s primary endpoint was the 24-hour intravenous morphine consumption, with a predefined minimal important difference set at 8 mg.
Main Findings: The trial results indicated significant reductions in 24-hour morphine consumption in the group receiving paracetamol, ibuprofen, and dexamethasone combined, compared to other groups, though none reached the minimal important difference. Specifically, this group consumed a median of 15 mg morphine, which was less than the other groups ranging from 16 mg to 24 mg. However, the differences did not meet the study’s threshold for a clinically important effect. Adverse events were lowest in the combined treatment group, suggesting a better safety profile primarily characterized by fewer incidents of nausea, vomiting, and dizziness.
Implications for Practice: The findings support the use of a combined regimen of paracetamol, ibuprofen, and dexamethasone for reducing morphine consumption post-total hip arthroplasty, which could be significant in clinical settings aiming to minimize opioid use. The improved safety profile also highlights the potential benefits of multimodal analgesia. Further research may explore the optimization of dosing schedules and long-term outcomes to enhance patient recovery and satisfaction.
Reference (link to abstract – $ for full-text):
RCT: Serratus anterior plane block reduces pain and opioid use in rib fracture patients – JAMA Surgery
2 May, 2024 | 23:20h | UTCStudy Design and Population:
This study was a multicenter, open-label, pragmatic randomized clinical trial conducted across eight emergency departments in New South Wales, Australia. The trial included 210 patients aged 16 years or older who had clinically suspected or radiologically confirmed rib fractures. Patients intubated, transferred for urgent surgical intervention, or with major concomitant nonthoracic injuries were excluded.
Main Findings:
In the trial, patients were randomized to receive either a serratus anterior plane block (SAPB) along with standard rib fracture management or standard care alone. The primary outcome was a composite pain score measured 4 hours post-enrollment. The SAPB group showed a significant increase in patients achieving the desired pain score reduction (41% in SAPB group vs. 19.6% in control; RR 0.73, 95% CI 0.60-0.89, P = 0.001). Additionally, SAPB recipients had significantly lower opioid consumption at 24 hours compared to the control group.
Implications for Practice:
The trial’s results support the addition of a serratus anterior plane block (SAPB) to standard rib fracture management for providing effective early pain relief and reducing opioid use. However, it’s important to note that this study did not include a sham group, and patients were aware of whether they received the intervention. This lack of blinding could influence patient-reported outcomes due to placebo effects. Despite this limitation, the reduction in pain and opioid consumption suggests that SAPB is a beneficial component of care for patients with rib fractures.
Reference (link to abstract – $ for full-text):
Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy
29 Apr, 2024 | 12:34h | UTCThis cohort study investigated the association between acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability in children. The study utilized a population-based sample of nearly 2.5 million Swedish children born between 1995 and 2019, with data analyzed up to 2021. Initial findings without sibling controls suggested a marginal increase in the risks of autism and ADHD. However, sibling control analyses, which help adjust for familial confounding, showed no significant associations (HR for autism and ADHD at 0.98, and intellectual disability at 1.01). These results imply that earlier observed risks might be due to unaccounted familial factors, not acetaminophen exposure.
Reference (link to abstract – $ for full-text):
Phase 2 Trials | Selective NaV1.8 inhibitor, VX-548, shows potential in acute postoperative pain management
7 Aug, 2023 | 14:51h | UTCSelective Inhibition of NaV1.8 with VX-548 for Acute Pain – New England Journal of Medicine (link to abstract – $ for full-text)
Video Summary: Selective Inhibition of NaV1.8 for Acute Pain | NEJM
Commentaries:
High-Dose VX-548 Reduces Acute Pain Post-Surgery – HCP Live
High-Dose VX-548 Reduces Acute Pain Over 48 Hours – HealthDay
Commentary on Twitter
Original Article: Selective Inhibition of NaV1.8 with VX-548 for Acute Pain https://t.co/ogmEx6FNKo#surgery pic.twitter.com/0FpipA1xey
— NEJM (@NEJM) August 5, 2023
RCT | Atogepant outperforms placebo in reducing migraines over 12 weeks
2 Aug, 2023 | 13:56h | UTCAtogepant for the preventive treatment of chronic migraine (PROGRESS): a randomised, double-blind, placebo-controlled, phase 3 trial – The Lancet (link to abstract – $ for full-text)
Review | Painful diabetic peripheral neuropathy
20 Jul, 2023 | 10:53h | UTC
Clinical practice guideline for deprescribing opioid analgesics
12 Jul, 2023 | 13:58h | UTCRelated:
RCT | Opioids not more effective than placebo for acute low back and neck pain
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
M-A | The effect of blood pressure lowering medications on the prevention of episodic migraine
12 Jul, 2023 | 13:50h | UTCNews Release: New study shows common blood pressure meds underused for migraine – George Institute for Global Health
RCT | Opioids not more effective than placebo for acute low back and neck pain
5 Jul, 2023 | 01:15h | UTCOpioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial – The Lancet (link to abstract – $ for full-text)
News Releases:
Opioids no more effective than placebo for acute back and neck pain – University of Sidney
Opioid pain relievers do not reduce acute lower back and neck pain, study suggests – The Lancet
Commentary from the authors: Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds – The Conversation
M-A | Metoclopramide effective in acute migraine relief, comparable to most active drugs, superior to placebo
30 Jun, 2023 | 14:51h | UTC
RCT | Acupuncture, doxylamine–pyridoxine, and their combination in nausea treatment during pregnancy
29 Jun, 2023 | 13:56h | UTCAcupuncture and Doxylamine–Pyridoxine for Nausea and Vomiting in Pregnancy: A Randomized, Controlled, 2 × 2 Factorial Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary: Combo treatment eases nausea and vomiting of pregnancy – MDedge
Editorial | Who should judge treatment effects as unimportant?
22 Jun, 2023 | 15:05h | UTCWho should judge treatment effects as unimportant? – Journal of Physiotherapy
Guidelines for the management of trigeminal neuralgia
20 Jun, 2023 | 12:43h | UTCGuidelines for the management of trigeminal neuralgia – Cleveland Clinic Journal of Medicine
Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients
19 Jun, 2023 | 14:05h | UTCPart 1: Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients – Anesthesia and Analgesia (free for a limited period)
Part 2: Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients – Anesthesia and Analgesia (free for a limited period)
See also: Prevalence and Characteristics of Persistent Postoperative Pain After Thoracic Surgery: A Systematic Review and Meta-Analysis – Anesthesia and Analgesia (free for a limited period)
Infographic: Persistent Pain After Thoracic Surgery—What Works, What Doesn’t – Anesthesia and Analgesia (free for a limited period)
Evidence-based clinical practice guideline for deprescribing opioid analgesics
15 Jun, 2023 | 15:08h | UTC
RCT | Cannabis-based medicines show no significant relief for moderate-to-severe cancer pain
15 Jun, 2023 | 15:10h | UTCCannabis‐based medicines and medical cannabis for adults with cancer pain – Cochrane Library
Summary: Cannabis-based medicines for cancer pain – Cochrane Library
Review | The cervical spine in tension type headache
13 Jun, 2023 | 13:58h | UTCThe cervical spine in tension type headache – Musculoskeletal Science and Practice
Commentary on Twitter
The cervical spine in tension type headache
???https://t.co/EFcxBlDO34 pic.twitter.com/y7SyA3T7qt
— Physio Meets Science (@PhysioMeScience) June 1, 2023
Systematic Review | Impact of physical therapies on pain, function, and life quality in myofascial pain syndrome
6 Jun, 2023 | 14:07h | UTC
M-A | Efficacy and safety of duloxetine in chronic musculoskeletal pain
5 Jun, 2023 | 13:09h | UTC
ACR Guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis
2 Jun, 2023 | 12:33h | UTCNews Release: New Guideline Introduces Recommendations for Integrative Approach to RA Treatment – American College of Rheumatology
Systematic review | Analgesic use in sports
2 Jun, 2023 | 12:17h | UTC
Review | Medication-assisted recovery for opioid use disorder
2 Jun, 2023 | 12:03h | UTCMedication-assisted recovery for opioid use disorder: A guide – Journal of Family Practice
Review | Deprescribing interventions for gabapentinoids in adults
1 Jun, 2023 | 12:05h | UTC