Publications
The Journal of Pain • Volume 9, No. 11, November 2008
APS members and subscribers to The Journal of Pain may view this issue online at www2.jpain.org. Abstracts and table of contents of each issue of The Journal of Pain are available for online viewing.
The following news highlights summarize selected articles in the November 2008 issue of The Journal of Pain, the peer-reviewed scientific journal of APS.
Note: The opinions and ideas expressed in articles appearing in The Journal of Pain do not necessarily reflect those of the editor and publisher or of the American Pain Society.
Study Shows High Rate of Chronic Pain in Women Separated from Abusing Partners
Judith Wuest, Marilyn Merritt-Gray, Marilyn Ford-Gilboe, Barbara Lent, Colleen Varcoe and Jacquelyn C. Campbell, University of New Brunswick, University of Western Ontario, University of British Columbia and Johns Hopkins University
Many women separated from abusive partners still experience high-disability chronic pain after almost two years, according to Canadian researchers writing in The Journal of Pain, the peer review journal of the American Pain Society.
Despite ample evidence that chronic pain is a serious problem in women with a history of abuse, little is known about the severity and patterns of chronic pain in this population. The authors studied 292 abused women who had been separated for at least 20 months. They sought to describe patterns of chronic pain severity, define the relationship between chronic pain severity and disability, and document the pattern of use of select pain medications.
In the study, 35 percent of the women who survived intimate partner violence (IPV) showed high disability chronic pain and they experienced pain, on average, at three or more sites. Nearly half of those with chronic pain in the sample said they had swollen and painful joints. The authors noted that chronic stress caused by IPV may inhibit how the body naturally adapts to stress and causes imbalances in cortisol levels. Also, proinflammatory cytokines may lead to an increased autoimmune/inflammatory response and eventually cause chronic pain. Since IPV involves repeated trauma, many women sustain serial injuries before previous trauma can heal. Chronic pain also can be exacerbated by post-traumatic stress syndrome and elevated anxiety that interferes with cognitive skills for managing pain.
More than half of the women studied were unemployed, suggesting that chronic pain hampers the ability to maintain employment regardless of age or level of education. The authors reported that less than 25 percent of women with high-disability pain were taking opioids and, despite the prevalence of high-disability pain in this sample, opioid use in this group was the same as women in the general population.
They concluded these findings combined with high rates of unemployment and PTSD "raise questions about how well chronic pain is being managed" among victims of IPV."
Study Documents Rise in Opioid Prescribing for Non-cancer Pain in Medicaid vs. Private-pay patients
Jennifer Brennan Braden, Ming-Yu Fan, Mark J. Edlund, Bradley C. Martin, Andrea Devries, and Mark D. Sullivan, University of Washington School of Medicine and University of Arkansas for Medical Sciences
A review of more than 4 million insured patients, with private coverage and Medicaid, showed that rates of opioid use did not differ widely between non-cancer pain conditions but there were higher rates of opioid use among Medicaid patients.
In this study, researchers examined general trends in prescription opioid use in patients covered by HealthCore private insurance and Arkansas Medicaid. They sought to determine if increases in opioids use are limited to particular non-cancer pain (NPC) conditions and how patterns of use differ between NCP conditions and among those with multiple pain conditions.
Trends reported in the study suggest an increased tendency to prescribe long-term opioid therapy, especially for those with multiple pain conditions, which also have been associated with greater psychopathology than single pain conditions. The presence of a comorbid mental disorder may predict opioid use among individuals with chronic pain.
The authors concluded that higher rates of opioid use in the Arkansas Medicaid patients likely reflects the greater disability and disease burden of this population, and added it's also possible this disadvantaged population has less access to nonopioid rehabilitative therapy for NCP compared with privately insured individuals.
Flexible Dosing of Pregabalin Effective for Postherpetic Neuralgia
Brett R. Stacey, Jeannette A. Barrett, Ed Whalen, Kem E. Phillips and Michael C Rowbotham, Oregon Health and Sciences University
Flexible dosing of the antidepressant pregabalin was shown to be effective for treating postherpetic neuralgia (PHN), as evidenced by performance in alleviating allodynia (touch pain), which can be very disabling and is commonly associated with postherpetic neuralgia.
Patients with PHN reporting moderate to severe allodynia have more intense overall pain and are often are activity-restricted due to pain from physical contact - even from wearing clothing.
Researchers at Oregon Health and Sciences University evaluated 269 patients with postherptic neuralgia in a four-week randomized trial. They compared flexibly dosed pregabalin with a fixed dose of the drug (330 mg/d) and placebo. The trial was designed to prospectively evaluate the time to onset of pain relief in the three groups of patients with PHN.
The study results showed the median times to onset of pain relief were 3.5 days for flexible-dose pregabalin and 1.5 days for the fixed dose. A median time to relief for the placebo group could not be calculated because only 31 percent of the patients in this group met the predefined pain relief criterion during the study treatment time of 28 days.
The researchers concluded that the trial results confirm previous studies showing that pregabalin administered twice a day is highly effective and well tolerated. With flexible dosing from 150 to 600 mg/d, the clinician can adjust doses for optimal efficacy and tolerability according to individual patient needs.
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