The equipment to perform IDB, a technique that uses cooled radiofrequency to destroy culprit nociceptive nerves in degenerative spinal discs, was first developed by Baylis Medical Company in Canada and was approved by the U.S. Food and Drug Administration in 2007. Dr. Gofeld, who performed the first procedures in Canada, explained that patients who benefit have the following features:
Funding: Kimberly Clark Corporation
Feb. 18, 2016, PALM SPRINGS, Calif. – Cleveland Clinic researchers have found new evidence that modulating neuroinflammation with stem cell transplants may prove to be an effective strategy to treat both opioid tolerance (OT) and opioid-induced hyperalgesia (OIH). The latest results in this line of inquiry, which may have the potential to transform opioid therapy for pain, are on view today at the 32nd Annual Meeting of the American Academy of Pain Medicine.
The investigators found that the development of OT and OIH was effectively prevented in rats by either intravenous (IV) or intrathecal mesenchymal stem cell (MSCs), which were transplanted before morphine treatment. Furthermore, established OT and OIH were significantly reversed when the timing of the transplants followed repeated morphine injections.
“We have demonstrated that MSC transplantation promises to be a potentially safe and effective way to prevent and reverse two of the major problems associated with opioid therapy,” said Jianguo Cheng, MD, PhD, professor of anesthesiology and director of the Cleveland Clinic Pain Medicine Fellowship Program.
“This emerging therapy has enormous potential to profoundly impact clinical practice. It may improve the efficacy of opioid therapy, reduce the risk of opioid overdose and save lives,” he said.
Neuroinflammation that involves activation of microglia and astrocytes in the central nervous system contributes greatly to OT and OIH. Both OT, in which higher doses become necessary, and OIH, a heightened pain response, can limit effectiveness and compromise safety during opioid therapy to treat pain. The anti-inflammatory and immune modulatory properties of MSCs have been previously demonstrated. Last year, the same scientific research team reported that intrathecal MSC transplant reduced OIH and OT in rats. For the current study, the investigators further tested the anti-tolerance and anti-hyperalgesia effects of MSC, this time by IV application and in mice as well as rats.
The IV transplant was given seven days before or 14 days after the initiation of daily morphine injections to test both the preventive and therapeutic effects of MSCs. Investigators evaluated OT and OIH by foot withdrawal thresholds in response to mechanical or thermal stimulation. They also examined multiple safety parameters, including normal locomotion, body weight gain, liver and kidney function, and vital organ pathology exams.
Using immunohistochemistry, they found that the treatments significantly reduced the activity of microglia and astrocytes in the spinal cord. The analysis of safety measures revealed no abnormalities in the animals’ vital organs or functions. The investigators are planning a preclinical investigation in preparation for clinical trials.
Poster 233 – Intravenous Transplantation of Bone Marrow–Derived Mesenchymal Stem Cells Attenuated Activation of Glial Cells and Reversed Opioid Tolerance and Opioid-Induced HyperalgesiaFunding: US Department of Defense Grant and Cleveland Clinic Anesthesiology Institute Research Fund
Feb. 18, 2016, PALM SPRINGS, Calif. – New research suggests that sphenopalatine ganglion block (SPGB) relieves disabling headache from dural puncture faster than the usual care of epidural blood patch (EBP) and lacks the potential for rare but profound complications that can accompany EBP. A non-invasive treatment with minimal side effects, SPGB is a highly effective treatment for accidental postdural puncture headache (PDPH) in obstetric patients, according to results from a retrospective analysis on view today in a scientific poster at the 32nd Annual Meeting of the American Academy of Pain Medicine.
At 24-48 hours, both treatments were similarly effective; however, SPGB was associated with greater headache relief at 30- and 60- minutes post-treatment, said lead author Preet Patel, MD, a research fellow at Rutgers – Robert Wood Johnson (RWJ) Medical School in New Brunswick, N.J. He said advantages of SPGB include its relative ease of administration and lower complication rates.
“One of the advantages of SPGB is that you will know relatively quickly if it is providing headache relief for your patient,” Dr. Patel said. “If the block is not effective within the first three hours, you can switch to the more invasive EBP.” And if it does work, he said, the new mothers can avoid the complications that can appear days or weeks later with EBP and enjoy a quicker recovery, “which is absolutely critical in this population.”
Disabling headache from dural puncture can follow the administration of spinal anesthesia. According to the International Headache Society, PDPH worsens with sitting upright, improves with reclining and is accompanied by neck stiffness, tinnitus, photophobia or nausea. When conservative measures such as oral medications or caffeine fail to relieve the often-severe headache pain, EBP is the usual treatment choice. Unfortunately, EBP can lead to significant complications on rare occasions, including motor and sensory deficits, meningitis, hearing loss,
Horner’s Syndrome and subdural hematoma (Snidvongs & Shah JRSM Short Reports 2012;3:68, Beilin & Spitzer A A Case Rep 2015;4:163-5, Kardash et al Reg Anesth Pain Med 2002;27:433-6).
Dr. Patel described the history of SPGB use for headache relief, including migraine and cluster headache, going back for over 100 years but said it had not been previously adequately studied for PDPH treatment.
The investigators reviewed 72 records over 17 years of women without a previous history of primary headaches who had experienced PDPH during childbirth. Thirty-three women received SPGB (with EBP available upon request), and 39 women received routine EBP. The women were similar in age, height, BMI and potential risk for suffering complications from general anesthesia.
Feb. 18, 2016, PALM SPRINGS, Calif. –- In an example of a successful private-public partnership, the creators of a technologically advanced national registry to collect data on the experience of pain sufferers and their responses to treatment are reporting significant growth across the globe. The results are on view today in a scientific poster at the 32nd Annual Meeting of the American Academy of Pain Medicine (AAPM).
The Stanford-developed and implemented Collaborative Health Outcomes Information Registry (CHOIR) is an open-source web application, created to assess patients and simultaneously to support clinic staff by integrating the pain registry into the clinic workflow. A key component of CHOIR is the National Institutes of Health (NIH)-funded PROMIS system. PROMIS stands for Patient Reported Outcome Measurement Information System, a system of item banks that capture a wide range of physical, psychological and social functioning domains. The ultimate aim is data-based and coordinated care that is available just-in-time to the clinician and that is centered on the patient.
Since the program’s rollout in August 2012, more than 7,500 unique patients have completed surveys, via email or in clinic using iPads, the study authors reported. Furthermore, more than 210,000 NIH PROMIS assessments were captured, including items addressing global health, mood, function, sleep and social functioning. The study’s lead author said that the data collected by CHOIR are particularly powerful in aggregate.
“We have demonstrated the feasibility of using CHOIR to assess specific patient-reported outcome measures while the survey is being completed,” said Ming-Chih Kao, M.D., Ph.D., clinical assistant professor within the Stanford University School of Medicine in Palo Alto, Calif. “This, in particular, has enabled targeted measurement of relevant subsets of patients so that the results are highly relevant and the patient burden remains minimal.”
Furthermore, he added, “In CHOIR we found that large-scale patient-reported outcome capture has revealed patterns and signals that would otherwise be hidden.”
Dr. Kao described the growth of CHOIR sites to include new pain medicine clinics, non-pain specialties and expansion into Canada, Australia and Israel. In addition, “as pain medicine specialists, we have also worked with the AAPM to expand the platform to the perioperative setting, including preoperative clinic and acute pain settings,” he said.
The need to improve patient outcome registries is one of the goals set by the Institute of Medicine (IOM) in its 2011 report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The IOM report documented more than 100 million Americans who suffer chronic pain at costs in medical expenses and lost productivity that reach up to $635 billion a year. Dr. Kao praised the power of the CHOIR open platform in which participants may contribute to and benefit from the sharing of programs, algorithms and data. “Over the past year, our experience in engaging stakeholders at institutions across different nations revealed common unmet needs in 21st century healthcare delivery and research,” he said. “Remarkably, these common needs cut across differences between patient populations, between cultures and between healthcare systems.”
American Academy of Pain Medicine