Hey guys! Lately I have learned some really exciting stuff about how we are starting to treat pain. Research is taking us further every day. We are getting better at treating things like irritable bowel syndrome, phantom limb pain, fibromyalgia, and all kinds of chronic pain. 

Takeaways:

• Irritable bowel syndrome can be effectively treated with cognitive behavioral therapy (CBT).
• We are slowly gaining a better understanding of Parkinson’s associated pain. At this point in time, it is treated with anti-inflammatory pain medications.
• Pain neuroscience education should be used alongside physical therapy and exercise for an extended period of time to reduce pain.
• Being exposed to alcohol from a young age increases the risk of developing chronic pain as an adult.
• Phantom limb pain can be significantly reduced with a high frequency nerve block.

Innovative cognitive behavioral therapies for irritable bowel syndrome: processes, predictors, platforms, and outcomes

Irritable bowel syndrome (IBS) is estimated to affect 15% of the global population. It is the most common visceral and gastrointestinal pain disorder. It is characterized by frequent abdominal pain, diarrhea, and/or constipation. Due to the fact that there is no specific diagnostic test and that the symptoms are often vague, it can be difficult to diagnose. Cognitive behavioral therapies (CBT) are supported by research as an effective way to treat IBS. This study looked at the effectiveness of CBT on the treatment of IBS.

Findings:

• CBT treatments have evolved over the past few decades. They originally only used techniques like biofeedback, progressive muscle relaxation, cognitive restructuring, and problem-solving.
• Research has shown that people with IBS tend to struggle with intense worry and rumination in response to negative events. This can also be described as “cognitive rigidity”. 
• CBT for IBS focuses on reducing this cognitive rigidity by addressing deep cognitive biases. 
• Studies have shown that CBT delivered via therapist, telephone, and/or web-based remains effective at reducing symptom severity for up to 24 months

Lackner, Jeffrey M.*. Innovative cognitive behavioral therapies for irritable bowel syndrome: processes, predictors, platforms, and outcomes. PAIN 165(7):p 1464-1471, July 2024. | DOI: 10.1097/j.pain.0000000000003186 

Noninvasive neuromodulation of subregions of the human insula differentially affect pain processing and heart rate variability: a within-subjects pseudo-randomized trial

• This study explored the effects and mechanisms of Low-Intensity Focused Ultrasound (LIFU) on pain reduction. 
• Results:
  • It targets the anterior and posterior insulas of the brain. The posterior insula can inhibit nociceptive signals (fancy way of saying pain signals). The anterior insula can decrease pain by lowering the reactivity of the nervous system to stimuli. 
  • LIFU increased heart rate variability which is seen as a positive effect.
  • LIFU may be used more commonly in the future for reducing pain.

Legon, Wynna,b,c,d,*; Strohman, Andrewe,f; In, Alexandere; Payne, Brightona,d. Noninvasive neuromodulation of subregions of the human insula differentially affect pain processing and heart-rate variability: a within-subjects pseudo-randomized trial. PAIN 165(7):p 1625-1641, July 2024. | DOI: 10.1097/j.pain.0000000000003171 

Pain in Parkinson Disease: a deep phenotyping study

• Parkinson’s Disease (PD) is the second most frequent neurodegenerative disorder. It is characterized by motor symptoms, but it is common for people to also experience pain. It affects up to 85% of people with PD.
• There is currently no consensus on the pain management of PD.
• This study was done to gain a better understanding of PD associated pain which can lead to better pain treatments in the future.
• Findings:
  • PD pain is nociceptive, episodic, manifests as recurring attacks, and usually occurs at night. It is mostly localized in the feet. 
  • It can be treated with anti-inflammatory analgesics. It presents as painful toe cramps due to dystonia (involuntary muscle contractions)
  • It is associated with restless leg syndrome and frequent bed turning.
  • Nocturnal pain can potentially lead to sleep disorders
  • More studies are needed to determine the best course of treatment.

Salabasidou, Elena; Binder, Tobias; Volkmann, Jens; Kuzkina, Anastasia; Üçeyler, Nurcan*. Pain in Parkinson disease: a deep phenotyping study. PAIN 165(7):p 1642-1654, July 2024. | DOI: 10.1097/j.pain.0000000000003173 

June 2024 Pain Journal

The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose- response meta analysis

• Chronic spinal pain (CSP) is pain affecting the lumbar and cervical regions for at least 3 months
  • Cause of CSP is unknown and most treatments have modest effects on reducing pain.
• Current research suggests that the biopsychosocial model should be used to treat CSP.
  • Studies show that biopsychosocial interventions in primary care have more beneficial effects on pain intensity and disability when compared with active physical interventions
• Pain neuroscience education (PNE) is commonly used in the biopsychosocial model when treating CSP
  • PNE aims to explain the neurophysiological mechanisms underlying the pain experience. It also explains the multidimensional nature of pain and explains how behavioral changes can impact the pain experience.
  • The goals are to reframe beliefs surrounding pain, reduce the perception of threat, and change the perception of pain and disability.
  • When combined with exercise, PNE can decrease pain and disability.
• Results of study:
  • 200 minutes of PNE can reduce pain.
  • 150 minutes of PNE can reduce disability.
  • Exercise alone is less effective than exercise done in combination with PNE for pain reduction.
  • To achieve really noticeable pain reduction, you may need up to 500 minutes of PNE.
  • The short term benefits of PNE show a reduction in pain and disability. More studies are needed to determine the long term benefits of PNE.
  • PNE should be broken down into multiple sessions and used alongside exercise and physical therapy

Núñez-Cortés, Rodrigoa,b; Salazar-Méndez, Joaquínc,*; Calatayud, Joaquínd,e; Malfliet, Anneleenf,g,h; Lluch, Enriquea,f; Mendez-Rebolledo, Guillermoc,i; Guzmán-Muñoz, Eduardoc; López-Bueno, Rubénd,e,j; Suso-Martí, Luisd. The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose–response meta-analysis. PAIN 165(6):p 1196-1206, June 2024. | DOI: 10.1097/j.pain.0000000000003126 

Adolescent ethanol exposure promotes mechanical allodynia and alters dopamine transmission in the nucleus accumbens shell

• Over 10% of the adolescent population consumes heavy amounts of alcohol. This can exacerbate pain sensitivity during adulthood after abstinence from alcohol.
• Both pain and alcohol exposure can promote neuroadaptations (changes that occur in the brain’s structure and function in response to repeated exposure of a substance).
• There is a part of the brain called the nucleus accumbens. This structure is responsible for integrating pain and processing alcohol use disorder (AUD).
• Most of this research was done on rats.
• Study results:
  • Being exposed to alcohol early in life increases pain sensitivity and changes how dopamine works in the brain.
  • Early alcohol exposure increases dopamine levels which become lower after alcohol withdrawals.

Kelley, Abigail M.; Del Valle, Eric J.; Zaman, Samin; Karkhanis, Anushree N.*. Adolescent ethanol exposure promotes mechanical allodynia and alters dopamine transmission in the nucleus accumbens shell. PAIN 165(6):p e55-e64, June 2024. | DOI: 10.1097/j.pain.0000000000003097 

Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial

• Fibromylagia is a chronic pain condition that involves impaired sleep, cognitive disturbances, and fatigue
  • It affects 2-4% of the global population.
  • Pharmacological treatments have shown modest effects.
• Traditional cognitive behavioral therapy (T-CBT) is the standard psychological treatment for fibromyalgia.
  • It involves teaching coping strategies to manage pain while improving mood and quality of life.
  • This includes cognitive restructuring techniques, stress management techniques, applied relaxation, physical exercise, and pacing: balancing exercise and rest
• Exposure based cognitive behavioral therapy (Exp-CBT) is a newer form of CBT
  • It aims to reduce behavioral avoidance.
  • It puts emphasis on systematic exposure to pain triggers
• This study compared T-CBT and Exp-CBT and found that both types of CBT can reduce pain in people with fibromyalgia. The amount of pain reduction varies for each person. Further studies are needed.

Hedman-Lagerlöf, Mariaa,*; Gasslander, Nilsb; Ahnlund Hoffmann, Alicea; Bragesjö, Mariaa; Etzell, Amandab; Ezra, Simonb; Frostell, Elsac; Hedman-Lagerlöf, Erikc,d; Ivert, Carolinec; Liliequist, Björnc; Ljótsson, Brjánnc; Hoppe, Johanna M.b; Palmgren, Josefinc; Spansk, Edwardb; Sundström, Feliciab; Särnholm, Josefinc; Tzavara, Georgiab; Buhrman, Monicab; Axelsson, Erlande,f,g. Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial. PAIN 165(6):p 1278-1288, June 2024. | DOI: 10.1097/j.pain.0000000000003128 

Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT study

• Opioid and nonopioid pain medications are commonly prescribed to adolescents
  • Even short term prescriptions increase the risk of future abuse.
• More frequent use of opioids and nonopioid pain medications is linked to female sex, low socioeconomic status, pain in multiple sites, and psychological distress. 
• Childhood interpersonal trauma such as sexual abuse, emotional abuse, and exposure to physical violence has been associated with the increased use of pain medications
  • Childhood trauma is associated with pain and psychological distress
• A trauma informed treatment approach may help guide clinicians to the most effective and least harmful treatment for each patient

Baumann-Larsen, Monicaa,b,*; Storheim, Kjerstia,c; Stangeland, Helleb,d; Zwart, John-Ankera,b; Wentzel-Larsen, Tored,e; Skurtveit, Svetlanaf; Dyb, Greteb,d; Stensland, Synne Øiena,d. Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study. PAIN 165(6):p 1317-1326, June 2024. | DOI: 10.1097/j.pain.0000000000003131 

Primary 3-Month Outcomes of a Double-Blind Randomized Prospective Study (The QUEST Study) Assessing Effectiveness and Safety of Novel High-Frequency Electric Nerve Block System for Treatment of Post-Amputation Pain

• There are 2.3 million people in the United States with lower limb amputations
• Chronic post amputation pain and phantom limb pain are common in those with amputations.
• Study done to assess how effective a high frequency nerve block is for post-amputation and phantom limb pain
• Done on 180 people with unilateral lower-limb amputations experiencing severe post-amputation pain
• A device called Altius was used
• Results:
  • After 30 minutes of use, 24.7% of the participants in the treatment group experienced at least 50% pain relief.
  • 120 minutes after treatment, 46.8% of the participants in the treatment group experienced at least 50% pain relief
  • There was a decrease in opioid use

Kapural, L., Melton, J., Kim, B., Mehta, P., Sigdel, A., Bautista, A., Petersen, E., Slavin, K., Eidt, J., Wu, J., Elshihabi, S., Schwalb, J., Garrett Jr, H. E., Veizi, E., Barolat, G., Rajani, R., Rhee, P., Guirguis, M., & Mekhail, N. (2024). Primary 3-month outcomes of a double-blind randomized prospective study (the quest study) assessing effectiveness and safety of novel high-frequency electric nerve block system for treatment of post-amputation pain. Journal of Pain Research, Volume 17, 2001–2014. https://doi.org/10.2147/jpr.s463727