10 New Findings in Pain Management

1. Disk Herniation at the Root of Sciatica:

Two-thirds of adults have back pain in their lifetimes, and ≈10% report back pain that radiates to below the knees. Roughly 85% of patients with sciatica have a herniated intervertebral disk; the pain usually resolves within several weeks with conservative therapy. In patients with sciatica for 6 weeks, pain relief is faster with surgery; however, at 1 year, conservative therapy and surgery outcomes are similar.

2. Patients Know Their Gout, But Not Their Goal:

Most patients with gout, one of the most painful forms of arthritis, have a lot of disease-specific knowledge but know less about the central role of achieving and maintaining a serum urate (SU) goal with urate lowering therapy. Only 14% of questionnaire respondents knew their SU goal. Physicians who treat patients with gout may be underutilizing SU goal information.

3. CDC Opioid Guideline for Primary Care Physicians:

Amid national turmoil regarding misuse and abuse of opioid analgesics the CDC updated a 2014 systematic review to provide PCPs with recommendations for prescribing opioids to adult patients with chronic pain. Key points are: nonopioid therapy is preferred for chronic pain; opioids should be used only when benefits (decreased pain, increased function) are expected to outweigh risks; when opioids are indicated, the lowest possible effective dosage should be used.

4. Muscle Power Fuels Pain, Quality of Life in Knee Osteoarthritis:

Leg muscle power is an independent determinant of pain and quality of life in knee OA and may be a more clinically important measure of muscle function than strength. Study authors recommended new trials to examine the impact of muscle power training interventions on disease severity in knee OA.

5. The Burden of Neuropathic Pain:

Neuropathic pain affected a significant proportion of patients’ work time-more than diabetes, respiratory conditions, and arthritis-in a study that looked at direct and indirect costs, productivity loss, and humanistic impact on patients and their families in Europe. In a subgroup analysis, total annual direct costs per patient were highest for neuropathic back pain and radiculopathy and lowest for fibromyalgia.

6. Unfit Children Are Fit for Pain:

Prepubertal children are at increased risk for pain if they have low levels of cardiorespiratory fitness (various pain conditions), high levels of sedentary behavior (any pain and headache), and low body fat content (any pain, multiple pain, and lower limb pain). The findings could be used to develop strategies to prevent chronic pain in childhood.

7. Primary Care Patients with Drug Use Disorder Self-Medicate Chronic Pain:

Close to one-third of primary care patients who screened positive for drug use disorder reported severe pain and severe pain-related dysfunction. Many who use illicit drugs, misuse prescription drugs, and use alcohol reported doing so to self-medicate pain. Study authors recommended addressing pain when counseling patients about their substance use.

8. Immune Changes and Pain Linked in Older Adults:

Adults may become more sensitive to pain as they age, and inflammation may occur more quickly and at a higher magnitude when older adults experience pain compared with younger adults. Older adults could be at greater risk for chronic pain and may benefit from taking anti-inflammatories soon after an injury or procedure.

9. The Leptin Link: Hunger Hormone Tied to Body Pain:

The appetite-regulatory hormone leptin is associated with self-reported body pain in women and may be a driver of fibromyalgia and other generalized pain states. Substantially higher leptin levels in women may help explain why women generally exhibit greater pain sensitivity than men and are more likely to have a chronic pain disorder. Future research may explore new targets based on leptin pathways in humans.

10. Acetaminophen Users: “Sorry, but I Don’t Feel Your Pain”:

Acetaminophen, taken by close to one-fourth of US adults each week to reduce their pain, also reduced patients’ empathy for other persons’ pain in 2 double-blind, placebo-controlled studies. Empathy regulates prosocial and antisocial behavior, so the reductions in empathy raise concerns about acetaminophen’s broader social effects.