For chronic pain research, 2020 has offered a host of study opportunities. It has also added a new twist: COVID-19. From new treatments for pain to troubling pain research studies on the lingering effects of COVID-19, these are 13 insights from chronic pain research in 2020.
1. Tai chi and yoga effectively reduce back pain
This review of studies found that tai chi and yoga could effectively reduce back pain and improve quality of life for some patients. For young men in their 20s, tai chi was more effective at reducing the symptoms and impacts of back pain than yoga. Two studies in particular looked at acute lower back pain in veterans as this population suffers from back pain in disproportionate amounts.
Cheryl Krause-Parello, Ph.D., co-author, noted the importance of finding effective solutions for this population.
“Our review provides emerging evidence that movement-based mind-body interventions could benefit veterans and others experiencing chronic low back pain.”
Researchers also looked at qigong but did not find enough scientifically-valid data to draw conclusions.
2. First stem cell treatment for pain a success
In one of the first pain research studies of the year, researchers successfully developed a potential new pain treatment using stem cells. At the University of Sydney, researchers used stem cells to develop pain-killing neurons. These pain-killing neurons were injected into mice, relieving pain in just one dose (with zero side effects).
Associate Professor Greg Neely, a leader in pain research at the Charles Perkins Centre and the School of Life and Environmental Sciences, noted the promise of this single-dose treatment:
“Nerve injury can lead to devastating neuropathic pain and for the majority of patients there are no effective therapies. This breakthrough means for some of these patients, we could make pain-killing transplants from their own cells, and the cells can then reverse the underlying cause of pain.”
3. Higher-dose opioids do not relieve chronic pain
Evidence against the effectiveness of opioids in dealing with chronic pain continues to mount. Researchers looked at the prescribing data for 50,000 veterans in the central Minneapolis and Virginia VA systems. They found that increasing the patient’s opioid dose did not yield more pain relief. This was compared to vets whose dose stayed the same.
Lead author Dr. Corey Hayes noted in a University of Arkansas for Medical Sciences report that:
“What we found … was that the pain relief the provider and the patient are going for really isn’t there when they increase their doses. You don’t see the benefit, but you do see the risk. Our overall message is, when you’re thinking about increasing the dose, you need to realize the risk it brings, too.”
4. Obesity increases the use of opioids for pain
In addition to the known dangers of opioids, researchers at the Boston University School of Public Health have found that a higher BMI is correlated to an increased use of opioids. The roots of this issue are complex. It speaks to the difficulty that underlies the opioid crisis. And, many people seeking pain relief are doing so due to conditions that are either caused or exacerbated by obesity.
Dr. Tuhina Neogi, senior author of the JAMA Open Network study, noted that instead of exploring other treatments to address obesity as the underlying cause of pain, opioids are often seen as the only option, noting:
“These data also highlight the urgent need for better pain management approaches and options for millions of Americans. The lack of sufficient medication options, woeful underutilization of physical therapy (which is well-supported by high-quality evidence for these conditions), and challenges in supporting weight loss efforts have led to prescription of opioids in management of painful musculoskeletal conditions where little evidence exists to support their use.”
5. Pain research has a lingering sex bias
One hundred years after women were granted the right to vote and the same year the first female vice president was elected in the U.S., a review paper revealed that pain research still demonstrates a considerable sex bias.
As researchers continue to base hypotheses and tests on male rodents, Jeffrey Mogil, the author of the paper, noted that we aren’t really getting a full picture of the biology of pain:
“The pain literature is biased such that, because of the overwhelming use of male animals in experiments, we are increasingly learning about the biology of pain in males. And wrongly concluding that this is the biology of pain. It’s only the biology of pain in males.”
6. Middle-aged people now report more pain than the elderly
In a twist that fits right into the challenging year that 2020 has been, researchers are finding that middle-aged people without a four-year degree are now reporting more pain than elderly people.
Why is this significant? It points to a trend of distress among a less well-educated population. It also cites a lack of access to adequate treatment for pain. Further, this predicts challenges in the years to come as these same people age.
Sir Angus Deaton of Princeton University, who has long studied pain across demographics, notes that:
“Pain undermines quality of life, and pain is getting worse for less-educated Americans. This not only makes their lives worse, but will pose long-term problems for a dysfunctional healthcare system that is not good at treating pain.”
7. COVID symptoms create lasting misery for “long haulers”
The research on the long-term effects of COVID-19 will begin to roll in as the pandemic persists. For example, researchers are now finding that some people who contracted the virus in the early days of the pandemic are suffering ongoing health challenges. This was true even after they tested negative.
These “long haulers” can experience fatigue, lung damage, and other lasting symptoms that make their recovery slow and painful. So far, only the most severe cases that required hospitalizations have presented with lingering symptoms. But, as Nahid Bhadelia, an infectious-diseases clinician at Boston University School of Medicine in Massachusetts, notes, research needs to focus on the repercussions of severe infection to provide better treatment:
“We need clinical guidelines on what this care of survivors of COVID-19 should look like. That can’t evolve until we quantify the problem.”
8. Telemedicine for chronic pain is better than undermanaging pain
In the beginning of the COVID-19 pandemic, primary care physicians, doctors, and pain specialists scrambled to implement safe, effective, and legal telemedicine options.
An examination of these efforts in May found that there are some inherent challenges to pain management over the internet. However, the harmful impacts of undermanaging pain conditions were more serious. Additionally, the effects of managing pain via telemedicine have been found comparable to in-person pain management. Pain management research articles will continue to explore this delicate balance in the years to come, informing our continued telemedicine efforts.
9. COVID-19 has negatively impacted chronic pain management
When the world went on lockdown in the early part of 2020, many chronic pain patients lost access to regular healthcare for a period of time. This gravely impacted not only the treatment of physical pain symptoms but also the psychological aspects of pain.
The isolation of pain patients during the COVID-19 lockdowns has increased the psychological symptoms of chronic pain. This includes depressive thoughts and suicidal ideation. Additionally, some chronic pain treatments work to suppress the immune system, a potential disaster during a breakout of infectious disease.
Pain physicians have had to figure out ways to balance the risk of harm from both undertreatment or inappropriate treatment of chronic pain during 2020. This balance has also included non-negotiable treatments, such as refilling intrathecal pain pumps.
10. COVID-19 survivors at increased risk for chronic pain
Two of the biggest risk factors for chronic pain are multiple periods of acute pain and ICU time. As many as 77% of patients hospitalized in the ICU are at risk for developing chronic pain, especially those patients reporting severe pain and distress.
Emergency treatment of COVID-19 itself increases a person’s risk of chronic pain. Respiratory support (intubation) and immobilization contribute to an increased risk of chronic pain. The mental aspect of dealing with a life-threatening illness increases the risk, too. COVID-19 itself carries with it a host of pain conditions, even for those who are not hospitalized.
What is clear after less than a year of treating COVID-19? Its effects are widespread and will require further attention in the research going forward.
11. Cannabidiol (CBD) showing promise in treating chronic pain
Although it maintains its status as a Schedule 1 drug in the U.S., cannabidiol (CBD) has been legalized in all 50 states in the U.S. and is slowly gathering research on its effectiveness in treating chronic pain. Some highlighted studies include a 30% decrease in fibromyalgia pain and improved quality of life and better sleep in patients with generalized chronic pain.
Concerns remain about the quality of available CBD products and the safety for certain populations (i.e., pregnant women). Ongoing pain management research is needed to verify these positive outcomes for pain patients.
12. Tricyclic antidepressants most effective at treating neuropathic pain
Researchers have long studied tricyclic antidepressants for chronic pain. Although the mechanism of relief remains a mystery, in one study this medication appears to be the most effective choice for managing neuropathic pain.
This study looked the effectiveness and the “dropout rate” (which occurs usually due to side effects) of four medications for neuropathic pain. Nortriptyline was the most effective. Coming in second on the study was duloxetine, a serotonin-norepinephrine reuptake inhibitor.
Although the results were close, the slight edge of these two medicines has implications for prescribing. Richard Barohn, MD, lead researcher and executive vice chancellor for health affairs at the University of Missouri noted that:
“There was no clearly superior performing drug in the study. However, of the four medications, nortriptyline and duloxetine performed better when efficacy and dropouts were both considered. Therefore, we recommend that either nortriptyline or duloxetine be considered before the other medications we tested.”
13. Yoga and meditation reduces chronic pain
Finally, we end our research the way we began: with some mindful movement and deep breaths. Another study was added to the overwhelming body of evidence that says yoga and meditation really do relieve chronic pain. Not only did eight weeks of yoga reduce pain, but it also improved mood and increased function.
And this, says Cynthia Marske, DO, an osteopathic physician and director of graduate medical education at the Community Health Clinics of Benton and Linn County, is the important difference between curing and healing:
“Curing means eliminating disease, while healing refers to becoming more whole. With chronic pain, healing involves learning to live with a level of pain this is manageable. For this, yoga and meditation can be very beneficial. Many people have lost hope because, in most cases, chronic pain will never fully resolve. However, mindful yoga and meditation can help improve the structure and function of the body, which supports the process of healing.”
Find help with chronic pain
Chronic pain research in 2020 added to what we know about existing treatments, explored new challenges brought about by COVID-19, and stepped into the future of telemedicine and chronic pain. The future of pain research studies will surely be guided by our experiences this year in terms of managing the lingering effects of COVID-19 and figuring out the best way to support chronic pain patients as a whole.
If you are struggling with a chronic pain condition during this challenging time, help is available. Find a pain specialist in Arizona or Texas by clicking the button below or look for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.