What research would you like to see most?

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kstarm

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You just received 8 bajillion dollars to conduct whatever pain related research you would like to do, or have someone else do for you. What research study would you most like to see completed?


(upcoming fellowship has a mandatory research component, and I am curious what SDNers think on the topic)

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If giving people money cures their pain and how much it takes for a 50% reduction in their pain
 
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You just received 8 bajillion dollars to conduct whatever pain related research you would like to do, or have someone else do for you. What research study would you most like to see completed?


(upcoming fellowship has a mandatory research component, and I am curious what SDNers think on the topic)

Nonbiased / non-industry sponsored long term study of opioid management of back pain following pts, using i) functional indices and ii) NRS. The ideal study would follow a significant number of people for at least 5 - 10 years.
 
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If giving people money cures their pain and how much it takes for a 50% reduction in their pain

:laugh:

Oxycodone = cash. Just need to figure out the exact conversion to = a 50% VAS drop. I'd bet it's an exponential scale. Easy to get that first 10-20%, but progressively harder to get to 50.

I'd like to see a study where CPPs on disability and/or opioids are all followed and tracked by PIs to document/videotape true functional status and compare it to what is claimed at office visits with a pain doc.
 
Find an objective way to measure pain. This would change the landscape of pain management and you would be quoted even more than Lex quotes himself :laugh:
 
Many patients and workers claim, "years ago x occured and i have had pain since."

X usually is a back or neck injury that was not a fracture, and an MRI later is normal. We often label these a muscle strain.

This type of patient then seeks disability or opiates

I feel like i have never seen this hold back an athlete or someone who ons their own business, or a young physician.

If we could objectively prove that a muscle strain can or cannot result in chronic pain, that could be a game changer

Or maybe a survey showing that physicians, athletes enterpreneurs, never have x occur to them could be a good start to get funding for an fMRI studybfor the above
 
a true diagnostic test for objectively quantifying pain and differentiate that from coping dysfunction, malingering....

why is that 99% of my work comp and personal injury patients are cured and no longer need pain management visits after they settle....
 
a true diagnostic test for objectively quantifying pain and differentiate that from coping dysfunction, malingering....

why is that 99% of my work comp and personal injury patients are cured and no longer need pain management visits after they settle....

well there's your diagnostic test, it's the gold standard-- cut them off and see if they get better!
 
1. Research into how to block the pain pathways (e.g., possibly similar to tramadol) without eliciting undesirable side effects.
2. Research into how opioids may possibly be used long term for chronic pain without the development of tolerance or dependence.
3. Research into possibly novel mechanisms and substances (e.g.,cannabinoids) that may have antinociceptive properties.
4. Research into the cost/benefit analysis of criminalizing drugs.
 
Figure out the true nature of neuropathic pain so we might be able to develop more precise drug therapy (if it's even possible to be so selective).

Figure out the nature of myofascial pain. Based on my US trigger point thing, I suspect sticky connective tissue overgrowth since blowing open the tissue planes (and a whole variety of physically disruptive modalities-- like exercise) seems to help, but WTF do I know.

Figure out how to get doctors from various specialities on the same page in terms of patient physical diagnosis and selection for therapies. Part of the problem here could be that good old Upton Sinclair saying about how difficult it is to convince a man of something if his salary depends on believing the opposite.
 
Research into finding a drug that will effectively relieve pain over the long term, without significant tolerance, dependence, or addiction, with minimal side effects at a reasonable cost.


(And with it, I'd like to have the fountain of youth, the meaning of life, and a winning Megamillions ticket, too.)
 
Research into finding a drug that will effectively relieve pain over the long term, without significant tolerance, dependence, or addiction, with minimal side effects at a reasonable cost.


(And with it, I'd like to have the fountain of youth, the meaning of life, and a winning Megamillions ticket, too.)

For all of the above except megamillions: its called exercise, people just don't like it
 
Does psychotherapy work on bat**** crazy pain patients?
 
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something that actually works for discogenic pain
 
Compare long vs short acting opioid regimen with respect to development of tolerance. My hypothesis would be that tolerance develops faster and more consistently with short acting opioids for a variety of reasons.

This would not be that difficult of a study to do unlike most of the suggestions :D
 
is there an inverse correlation between IQ of physicians and dosages of short acting opioids they prescribe
 
Compare long vs short acting opioid regimen with respect to development of tolerance. My hypothesis would be that tolerance develops faster and more consistently with short acting opioids for a variety of reasons.

What are the reasons you postulate would cause increased tolerance with short-acting drugs?
Particularly if the patient didn't take the short-acting drugs 24/7 and so the opioid wasn't always in their bloodstream.
 
What are the reasons you postulate would cause increased tolerance with short-acting drugs?
Particularly if the patient didn't take the short-acting drugs 24/7 and so the opioid wasn't always in their bloodstream.

I'm just talking about constant pain, not intermittent pain with occasional use...

- I think with short-acting, ppl take higher doses on average because, as the med wears off, they become sensitized and require a higher dose to compensate.
- Short acting is more appealing for getting high and emotional coping. I think this is less compatible with a constant dose.
- Overall, if you look at all the drugs, short acting has a higher street value so these guys will claim a higher "tolerance". Although this is not physiological, it is still relevant.
 
Does psychotherapy work on bat**** crazy pain patients?

Do you mean the somatic amplifiers with a history of abuse / FMers ?

I typically try to refer those peeps to chronic pain groups : mindful meditation with a tai chi component ( covered under my socialized medicine plan - so they can't whine / complain about cost).

This is an excellent question - who is a good candidate for psychotherapy / a mindful approach in respect to our chronic pain population ?

The BBHI-2 is an excellent tool for teasing this issue out - buts you got to pay for that playa.
 
Here are a few relatively simple research projects for a fellow that can be done in a year.

Retrospective study in states that have medical marijuana.

Poll patients as to whether they have used medical marijuana, and whether it helps, how it helps. also see how many of those are on opioids and how many come off when told they violate federal regulations....

Another quick follow up study would be to find patients that have not used medical marijuana but are intending to do so. Do a Disability score and functional assessment before use and then after a period of time of use and see if there are any improvements in either.
 
You just received 8 bajillion dollars to conduct whatever pain related research you would like to do, or have someone else do for you. What research study would you most like to see completed?


(upcoming fellowship has a mandatory research component, and I am curious what SDNers think on the topic)

Please do this study. I think the findings would be phenomenal and very telling.

Take patients that are on Morphine equivilants of over 200mg/day (maybe less....) and in a randomized, double blinded way, increase, decrease, or keep the same the dose by 10-20% (probably 20%), and see if ANY patient can tell a difference. I bet you there would be NO correlation to what the patient said, and the dose given.

And if that is the case, then how telling would that be about opioid therapy.
 
That's basically settled, sorry
We'd all like it not to exist, since we don't have good treatments for it, like we do for facet pain, but u can't just pretend it doesn't exist.

Then how about why there is no real difference in MRI appearance of 50 year-olds who have back pain and those who don't? Or just about any age.
 
So does a hang nail. Does it deserve an 80K fix?

you ever see how much it costs to get a pedicure or a manicure? i think i gotta get me a nail salon franchise
 
a study on why smart guys/gals would go through so many years of training, so much social loss in their twenties and early thirties, to go into a field where salaries are doomed to decrease over time despite escalation in effort, constant threat of litigation with personal assets at risk, only to find themselves on student doctor websites, griping about their life, their work and the need for more studies...
 
a study on why smart guys/gals would go through so many years of training, so much social loss in their twenties and early thirties, to go into a field where salaries are doomed to decrease over time despite escalation in effort, constant threat of litigation with personal assets at risk, only to find themselves on student doctor websites, griping about their life, their work and the need for more studies...

lol!
 
a study on why smart guys/gals would go through so many years of training, so much social loss in their twenties and early thirties, to go into a field where salaries are doomed to decrease over time despite escalation in effort, constant threat of litigation with personal assets at risk, only to find themselves on student doctor websites, griping about their life, their work and the need for more studies...

I'll be subject #1...
 
discogenic pain can be real

there is such a thing as chemical radiculitis, although it may be better termed chemical sciatica as it rarely goes below the knee

I apologize if I missed something, maybe I misunderstood you...haven't you seen young patients who have pain with sitting and leaning forward, gets better with walking and standing, new onset of HIZ and annular tear on MRI?
 
discogenic pain can be real

there is such a thing as chemical radiculitis, although it may be better termed chemical sciatica as it rarely goes below the knee

I apologize if I missed something, maybe I misunderstood you...haven't you seen young patients who have pain with sitting and leaning forward, gets better with walking and standing, new onset of HIZ and annular tear on MRI?

Yes, with some or all of these features. The problem is that there is always some confounding secondary gain issue leading me to doubt their story. I just don't see many of these patients for whatever reason. Maybe because we're non-narcotic. I would see them more frequently in my old practice which was a mill of sorts.
 
Yes, with some or all of these features. The problem is that there is always some confounding secondary gain issue leading me to doubt their story. I just don't see many of these patients for whatever reason. Maybe because we're non-narcotic. I would see them more frequently in my old practice which was a mill of sorts.

I see plenty of discogenic pain exactly as described above. But not always as patients.
Some friends, some coworkers, some colleagues. Unsure where secondary gain or other problem would be coming from in those cases, but they all are working full time and appear to be well adjusted and I think that's why they are not patients.
 
I see plenty of discogenic pain exactly as described above. But not always as patients.
Some friends, some coworkers, some colleagues. Unsure where secondary gain or other problem would be coming from in those cases, but they all are working full time and appear to be well adjusted and I think that's why they are not patients.

Did you examine and inject any of these folks?

I should probably clarify what I said-- these are the cases for which no alternative answer was found. For most of the cases fitting the "discogenic" pattern, I take them back for a shot-in-the-dark epidural and before finishing do an exam under fluoro. Very often the pain is focused over the L5 spinous process or uni/bilateral PSIS, and goes away with a quick diagnostic TP. Now unless specifically asked to do an ESI, I will often take these folks back to do diagnostic TPs under ultrasound. They often get much better with 1-2 procedures.

Re: Chemical radiculitis

I believe I have experienced this myself. At the insistence of my wife I was doing a bridge over an exercise ball and felt a crack in my back. It didn't hurt at the time, and I figured maybe I just crunched some interspinous ligaments, a facet joint, or something. The next day I noticed a spot on my ribcage just below the nipple no larger than a quarter that felt like it was sunburned, but only when I touched it. This took 3 weeks or so to resolve. I never had any "shooting" or "radiating" pain all the way around the chest. Just that one spot. Hasn't come back since.
 
Did you examine and inject any of these folks?

I should probably clarify what I said-- these are the cases for which no alternative answer was found. For most of the cases fitting the "discogenic" pattern, I take them back for a shot-in-the-dark epidural and before finishing do an exam under fluoro. Very often the pain is focused over the L5 spinous process or uni/bilateral PSIS, and goes away with a quick diagnostic TP. Now unless specifically asked to do an ESI, I will often take these folks back to do diagnostic TPs under ultrasound. They often get much better with 1-2 procedures.

Re: Chemical radiculitis

I believe I have experienced this myself. At the insistence of my wife I was doing a bridge over an exercise ball and felt a crack in my back. It didn't hurt at the time, and I figured maybe I just crunched some interspinous ligaments, a facet joint, or something. The next day I noticed a spot on my ribcage just below the nipple no larger than a quarter that felt like it was sunburned, but only when I touched it. This took 3 weeks or so to resolve. I never had any "shooting" or "radiating" pain all the way around the chest. Just that one spot. Hasn't come back since.

I have and found axial LBP without exacerbation on extension. I do not do epidurals for axial low back pain because they do not treat this entity and are not supported in any guidelines unless there is radicular pain or hug the buggy canal stenosis.
 
Did you examine and inject any of these folks?

I should probably clarify what I said-- these are the cases for which no alternative answer was found. For most of the cases fitting the "discogenic" pattern, I take them back for a shot-in-the-dark epidural and before finishing do an exam under fluoro. Very often the pain is focused over the L5 spinous process or uni/bilateral PSIS, and goes away with a quick diagnostic TP. Now unless specifically asked to do an ESI, I will often take these folks back to do diagnostic TPs under ultrasound. They often get much better with 1-2 procedures.

.

If you're fixing most cases of what would otherwise be described as discogenic back pain with 1-2 TPI, you should move back to NYC and charge cash. You could be making 5 million a year!!
 
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If you're fixing most cases of what would otherwise be described as discogenic back pain with 1-2 TPI, you should move back to NYC and charge cash. You could be making 5 million a year!!

Ha ha... If only it were that simple. Since we don't rx narcotics, our patient population is cherry picked to do well with procedures. I hardly see any "discogenic" cases that don't wind up being facets or myofascial. The few cases that might be the genuine article also looked like young people trying like hell for disability or drugs. Strangely enough, the one guy fitting this description who I was asked to do a discogram on in the last year came up negative at his two most deteriorated discs! Zero pain on injection, zilch.
 
Ha ha... If only it were that simple. Since we don't rx narcotics, our patient population is cherry picked to do well with procedures. I hardly see any "discogenic" cases that don't wind up being facets or myofascial. The few cases that might be the genuine article also looked like young people trying like hell for disability or drugs. Strangely enough, the one guy fitting this description who I was asked to do a discogram on in the last year came up negative at his two most deteriorated discs! Zero pain on injection, zilch.

it certainly could be your population.

however, might i suggest that it could also be that you dont have a good intervention for true discogenic pain, so you try everything else in the book and convince yourself that discogenic pain doesnt really exist?

i have heard this party line before. mister MXCVNSSTSX is one of those non-believers in discogenic pain.

its as if you refuse to believe that there is some sort of pain out there for which there is no good injection. if you let yourself believe this, then there is no patient out there who isnt a candidate for an injection. take a look in the mirror, dude. you cant really respect what you see if you believe you are "fixing" discogenic pain with a trigger point injection.

MAYBE GRC blocks hold some promise. Maybe some sort of biologic may help a bit. im not convinced.

its ok to tell a patient you cant help them with a needle
 
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