New research was presented at AAPM 2016, the American Academy of Pain Medicine’s annual meeting, from February 18 to 21 in Palm Springs, California. The features below highlight some of the studies that emerged from the conference.
Antipsychotic Helps Treat Pain
The Particulars: Anecdotal evidence suggests that olanzapine, an atypical antipsychotic, may help control pain in patients with refractory pain. Few studies have explored this possible association deeper.
Data Breakdown: An analysis of 18 trials examining antipsychotic use for pain was conducted for a study. Of these trials, 10 included olanzapine, four included quetiapine, two focused on aripiprazole, and one each focused on risperidone and ziprasidone. Olanzapine was found to be an effective therapy for patients suffering from fibromyalgia and headache or migraine. However, only one of the 10 trials was randomized and controlled with level 1 evidence of efficacy. The other antipsychotics assessed in the analysis either lacked robust study designs or did not demonstrate efficacy in various pain syndromes.
Take Home Pearls: Adding the atypical antipsychotic olanzapine to a patient’s therapeutic regimen appears to help treat refractory pain. The study suggests that olanzapine may work by lessening the patient’s perception of pain.
Epidural Steroids Reduce Low Back Pain Costs
The Particulars: Previous research has indicated that epidural steroid injections are increasingly being used in the treatment of low back pain. However, experts in the field have questioned whether or not use of these drugs is cost-effective.
Data Breakdown: For a study, researchers compared costs over time for patients with radiculitis, sciatica, or lumbago who received steroid injections with costs for those who received standard medical management. When compared with standard medical management, epidural steroid injections were associated with 16.4%, 7.6%, and 4.7% reductions in healthcare expenditures for patients with radiculitis, sciatica, and lumbago, respectively, over 2 years. These reductions were primarily driven by reductions in outpatient spending.
Take Home Pearl: Epidural steroid injections appear to help reduce healthcare expenditures for patients with low back pain when compared with standard medical management.
Smoking, Obesity, & Spinal Cord Stimulation
The Particulars: Smoking and obesity have been shown in previous studies to increase the risk of infection and complications in various types of major surgery. However, few studies have assessed the impact of smoking or obesity on the outcomes of spinal cord stimulation.
Data Breakdown: A retrospective analysis of patients who underwent spinal cord stimulator implantation was conducted to compare outcomes between smokers and nonsmokers. The study also broke down patients into three BMI groups: BMIs of 24.9 kg/m2 and less, BMIs between 25.0 and 29.9 kg/m2, and BMIs of 30.0 kg/m2 and higher. Smokers and nonsmokers had similar pain scores before and after their spinal cord procedures and similar procedural site infection rates. However, smokers were more likely to have lead migration when compared with nonsmokers (22.2% vs 2.1%). Among the three BMI groups, pains scores on a 10-point scale ranged from 7.1 to 8.3 prior to the procedure and between 3.3 and 3.9 after the procedure was completed. Increasing BMI did not appear to correlate with an increased risk for infection or complications.
Take Home Pearl: Smoking and obesity do not appear to affect the efficacy of spinal cord stimulator implantation or to correlate with increased infection rates.
Comparing Pain Scales in Chronic Pain
The Particulars: Prior research has compared multiple pain scales in the emergency setting. However, comparisons of these scales are lacking among patients with recurrent chronic pain.
Data Breakdown: Researchers compared the Visual Analog Scale and Verbal Numerical Rating Scale among patients with recurring chronic pain for a study. Anxiety, depression, and quality of life were also assessed. Linear regression plots on the Visual Analog Scale and the Verbal Numerical Rating Scale correlating with pain was reported to be 0.806 and 0.852 upon admission and discharge, respectively. Nearly 45% of patients had mild to severe anxiety, and about 40% had depression. Most patients graded their state of health as neither good nor bad.
Take Home Pearls: The Visual Analog Scale and Verbal Numeric Rating Scale appear to be comparable systems for assessing pain in patients with chronic pain. Most chronic pain patients do not appear to have depression or anxiety and reported neither good nor bad quality of life.
Regular Lifestyle Behaviors & Migraine
The Particulars: Previous research has shown that regular lifestyle behaviors of sleep, exercise, mealtime patterns, and hydration status independently affect migraine occurrence. Data are lacking, however, on the differences in migraine occurrence between patients who do and do not maintain these regular lifestyle behaviors.
Data Breakdown: For a study, the charts of patients aged 15 and older with chronic or episodic migraine and regularly documented regular lifestyle behavior notes were reviewed. Patients with chronic migraine exhibited fewer regular lifestyle behaviors than those with episodic migraine (6% vs 59%).
Take Home Pearl: Engaging in healthy regular lifestyle behaviors appears to be protective against the development of chronic migraine.
For more information on these studies and others that were presented at AAPM 2016, visit www.painmed.org/annualmeeting.