UF Pain Research and Intervention Center of Excellence

Successful pain management often requires a multidisciplinary approach, combining physical therapy, psychotherapy, drug therapy, and interventional techniques. To optimize patient outcomes, clinicians must be well-versed in both pharmacological and non-pharmacological treatments for pain, including the potential risks, benefits, and effectiveness of interventional procedures.

Check out this comprehensive listing of the benefits and risks of interventional pain procedures!

The Rise of Interventional Pain Procedures: Key Considerations | PAINWeek In recent years, the field of pain management has witnessed a significant surge in the development and utilization of interventional procedures. These techniques offer promising alternatives for patients where traditional pain management methods fail. However, the increased adoption of these invasiv...

A new research article published in Annals of Internal Medicine investigates older adults in nursing homes who take opioids and antidepressants, specifically, opioids that are processed by an enzyme called CYP2D6. The focus of the study was to find the health risks that present themselves when taking these medications together.

The article, “Clinical and Adverse Outcomes Associated With Concomitant Use of CYP2D6-Metabolized Opioids With Antidepressants in Older Nursing Home Residents : A Target Trial Emulation Study” which was co-authored by Roger Fillingim and Siegfried Schmidt, alongside faculty and researchers from both the University of Florida as well as Ohio State University, can be accessed here!

https://www.acpjournals.org/doi/10.7326/M23-3109?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

PT-IN-MIND is a new approach at treating patients with chronic musculoskeletal pain who have been on long-term opioid treatment. This involves combining physical therapy (PT) with mindfulness practices in a way that's integrated and specifically tailored for these patients.

In a new study protocol published at BMJ Open, Jason Beneciuk, alongside multiple researchers, many from the University of Utah, propose a 12-week trial to see if this combined treatment approach can be successfully implemented in a real-world setting.

https://bmjopen.bmj.com/content/14/7/e082611

Time-restricted eating is when you only eat during a certain window of time each day. A recent study examined the ways which time-restricted eating (TRE) affects sleep in adults.

In the research article, “The effects of time-restricted eating on sleep in adults: a systematic review of randomized controlled trials” researchers including Stephen Anton analyzed data from several studies to compare how TRE affects sleep.

The studies showed mixed results but suggested that TRE might improve sleep quality, meaning people felt more rested and had fewer disturbances during the night.

Learn more about the study, which has been published at Frontiers in Nutrition!

https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1419811/full

A new study focuses on pain experiences in black older adults who have dementia and their caregivers. It aims to understand if missing pain reports happen randomly or if certain factors influence the missing data.

The article, “Missing at Random or Not?: Evidence on Pain in Black Older Adults With Dementia and Their Caregivers”, found that that missing pain reports were not random. Certain characteristics, such as the severity of dementia or caregiver stress levels, sometimes led to missing pain data.

The results suggest that targeted interventions are needed to help caregivers better assess and report pain in older adults with dementia. This could improve pain management and overall care quality for this population.

The article, which has been co-authored by Star Booker, has been published in Research in Gerontological Nursing!

https://journals.healio.com/doi/10.3928/19404921-20240628-01

ENIGMA-Chronic Pain is a global project aimed at understanding how chronic pain affects the brain. Researchers from different countries, including Yenisel Cruz-Almeida and Pedro Valdes-Hernandez from PRICE, collaborated and shared their brain imaging data. They used advanced techniques like MRI to look at brain structures and activities in people with chronic pain.

The project plans to include more diverse populations and chronic pain conditions to get a broader understanding as well as explore how treatments can reverse brain changes associated with chronic pain.

Check out more on ENIGMA-Chronic Pain at PAIN.

https://journals.lww.com/pain/fulltext/9900/enigma_chronic_pain__a_worldwide_initiative_to.664.aspx #:~:text=Through%20a%20worldwide%20collaboration%20of,between%20chronic%20pain%20and%20comorbid

Exercise is often recommended as a treatment for chronic non-specific low back pain (CNSLBP) because of its multifaceted benefits and its ability to address both physical and psychological aspects of the condition. Adding specific breathing techniques to these exercises may improve outcomes however, no studies have compared the effects of identical exercises with and without these breathing techniques.

Steven Pratscher, alongside researchers from both Finland, Switzerland and Belgium studied the efficacy of exercise with and without breathing techniques amongst 30 participants in a recent pilot study and found that synchronized breathing with movement-controlled exercise was potentially more effective for improving various outcomes of CNSLBP.

Learn more about the study, “Identical movement control exercises with and without synchronized breathing for chronic non-specific low back pain: A randomized pilot trial” which has been published in the Journal of Back and Musculoskeletal Rehabilitation.

https://pubmed.ncbi.nlm.nih.gov/39031339/ -view-affiliation-1

In what ways do an individual's psychological and social states influence the knee osteoarthritis (OA) pain experience? Researchers from the University of Otago in New Zealand worked closely with Roger Fillingim to characterize the pain experience of individuals with knee OA. Using a smartphone-based ecological momentary assessment (EMA), they explored the relationships between momentary psychological, social, and lifestyle factors and knee OA pain.

86 community-dwelling volunteers living with knee OA used the smartphone app to report their pain three times a day for two weeks as well as their social and psychological states, such as their stress, fatigue and mood. It was found that although pain levels and symptoms varied among individuals, those who had more fluctuations in pain, fatigue and negative emotions tended to experience worse overall symptoms.

The overall potential of real time tracking of these factors via app however, could provide insights into managing pain more effectively as well as help develop more individualized treatment approaches!

The article has been published in PAIN Reports and can be accessed here!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249513/

In a new study recently published at JAMA, it was found that individuals with endometriosis, which affects about 11% of reproductive-aged individuals, are at a significantly increased risk of ovarian cancer.

https://www.contemporaryobgyn.net/view/study-links-endometriosis-to-increased-risk-of-ovarian-cancer

Access the full study here.
https://jamanetwork.com/journals/jama/fullarticle/2821194?guestAccessKey=9570cb60-051f-4c10-9a64-0fe9e9fe6ad1&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071724

Also, be sure to check out PROMPT, a study being undertaken at PRICE aimed at better understanding the treatment and pain experience for endometriosis.

https://price.ctsi.ufl.edu/2024/05/23/prompt/

Study links endometriosis to increased risk of ovarian cancer Women with ovarian endometriomas or deep infiltrating endometriosis face a significantly higher risk of ovarian cancer, highlighting the need for increased awareness and research into these associations.

How does pain influence the way we interact with each other and our world socially?

Elizabeth Losin, a PRICE affiliate from Pennsylvania State University, recently co-authored a review article which has been published in the Journal of Pain and covers this topic!

The article, “Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives”, explores how social factors influence pain and how pain, in turn, affects social interactions.

The team of researchers, who coordinated their review from around the world, examined how various social factors impact pain, as well as how pain influences social dynamics at different levels, from an interpersonal level which includes social comparison, empathy and relationships, to a community level which includes intimate groups and task groups, all the way to the societal level, which is impacted by cultural and political systems.

The review raises interesting points and considerations to take into account in terms of the social aspects of pain within the biopsychosocial framework and suggests that integrating social factors into pain research and management can lead to better prevention strategies and more equitable treatment outcomes.

Check out the full article here!

https://www.sciencedirect.com/science/article/pii/S1526590024005492

Congratulations to PRICE affiliate Margarete Ribeiro Dasilva who has been awarded a well-earned promotion within the UF College of Dentistry.

Aside from the new role, Dr. Dasilva has been working closely with Roger Fillingim to investigate the potential of cold laser therapy after being awarded a $3.3M National Institutes of Health (NIH) grant earlier this year!

Learn more about the “Photobiomodulation for the Management of Temporomandibular Disorder Pain.” project below!

https://dental.ufl.edu/2024/01/11/ribeiro-dasilva-and-fillingim-awarded-3-3m-for-tmd-pain-treatment-study/

Congratulations!

In a new study titled, “Sex Differences in Gut Integrity in a Sample of Cannabis Users and Non-Users From the Miami Adult Studies on HIV (MASH) Cohort" researchers including Javier Tamargo looked at how cannabis use affected the gut health of men and women differently.

The researchers studied a group of people with and without HIV who either used cannabis or did not. By measuring various markers of gut integrity, which is a way of assessing how well the gut is functioning and how well it keeps harmful substances from leaking into the bloodstream, they were able to find that

- There were noticeable differences in gut health between men and women.

- Cannabis users had different gut health markers compared to non-users.

- These differences were influenced by whether the individuals were male or female, suggesting that s*x plays a role in how cannabis affects gut health.

Overall, the study highlights the importance of considering both s*x and cannabis use when looking at gut health, especially in people living with HIV!

The article has been published in Current Developments in Nutrition. Congratulations!


https://www.sciencedirect.com/science/article/pii/S2475299124013386

Happy ! Celebrate the safely today!

Falls are the leading cause of injury for adults age 65 or older. Over 14 million older adults, which equates to every 1 in 4, fall every year. A new pilot study in Pilot and Feasibility Studies however, aims to see if a home-based program can help older adults reduce their risks of falling.

The study, ‘Protocol for a home-based self-delivered prehabilitation intervention to proactively reduce fall risk in older adults: a pilot randomized controlled trial of transcranial direct current stimulation and motor imagery’, which is headed by Clayton Swanson, Sarah Vial, Todd Manini, David Clark and Kimberly Sibille, combines two methods in its approach.

The transcranial Direct Current Stimulation (tDCS), which is a technique that uses a low electrical current to stimulate the brain

Motor Imagery (MI), which involves mentally practicing movements without actually doing them.

During the study, two groups of older adults at risk of falling are separated, with one group using the combined methods while the other does not. By incorporating a widely accessible non-invasive brain stimuli involved in motor control as well as mental exercises, the researchers hope to address a major concern for older adults that can lead to serious injuries.

The study is currently in the pilot phase, meaning it's a preliminary investigation to see if this approach is practical and effective. If successful however, it could lead to larger studies and eventually a new method for helping older adults stay safe from falls.

https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-024-01516-1

How does body composition and BMI relate to pain and pain sensitivity relate in older adults? In the article, ‘Body composition and body mass index are independently associated with widespread pain and experimental pain sensitivity in older adults: a pilot investigation’, Alisa Johnson, Jessica Peterson, Yenisel Cruz-Almeida, Heather Vincent and Todd Manini recruited older adults to better understand this link.

By measuring the presence and extent of widespread pain as well as pain sensitivity through surveys and common tests such as applied pressure and using heat and cold to help ascertain pain thresholds, researchers analyzed the collected data to identify any correlations or associations between body composition, BMI and the pain measures.

It was found that body composition and BMI independently affect both the presence of widespread pain and the sensitivity to pain in older adults. suggesting that maintaining a healthy body composition and BMI could potentially help manage pain in older adults.

The article has been published in Frontiers in Pain Research. The PDF can be accessed here!

https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1386573/pdf?isPublishedV2=true

Osteoarthritis is a common and painful condition that affects joints. In a study published this past April, members of PRICE, sought to understand the changes in joint structure, sensitivity to touch, and brain function that occur in a rodent model of osteoarthritis. These individuals included Kyle Allen, Marcelo Febo, Yenisel Cruz-Almeida, Pedro Valdes Hernandez and Jacob Griffith.

During the study, rodents were surgically induced with osteoarthritis in the knee joints to mimic human conditions. The structure of the joint was assessed for changes in sensitivity as well as brain function.

It was found that induced rodents suffered increased sensitivity to touch, indicating heightened discomfort and pain. They also suffered from damage to the cartilage, formation of bone spurs, and inflammation as well as changes in brain functioning.

The study concluded that osteoarthritis not only affects the joints but also has significant impacts on how pain is perceived and processed, involving changes in the brain. This suggests that osteoarthritis is a complex condition that affects the entire body, not just the joints.

The article, “Surgical Rodent Model of Osteoarthritis Alters Joint Structure, Tactile Sensitivity, and the Brain” has been published in The Journal of Pain. Follow the link to learn more!

https://www.jpain.org/article/S1526-5900(24)00237-2/abstract

Diet tips that can help manage OA aches and pains as well as assist in joint swelling and pain!

https://www.webmd.com/osteoarthritis/video/video-oa-diet-tips

Congratulations to Pedro Valdes Hernandez, who has received a five year Career Development K01 NIH/NIA grant towards supporting research focused on the application of deep-learning techniques to develop brain age biomarkers. These biomarkers are poised to revolutionize the way chronic pain is categorized, offering a more nuanced and precise approach to understanding different types of chronic pain conditions. By leveraging advanced deep-learning algorithms, the project aims to uncover distinctive brain age patterns associated with various chronic pain syndromes, potentially leading to more personalized and effective treatment strategies!

Congratulations to PRICE affiliate Adam J. Woods who will be leaving University of Florida to serve as the next Dean of The University of Texas at Dallas School of Behavioral and Brain Sciences!

A 2016 study revealed that nearly half of White medical students and residents believed Black patients were less sensitive to pain than their White counterparts. These misconceptions were based on unfounded beliefs about biological differences in pain experience, leading to the underestimation of pain in Black patients and inadequate pain treatment.

Pain perception bias refers to the tendency for individuals to perceive and interpret pain differently based on various internal and external factors. These biases can be influenced by personal experiences, cultural background, psychological state, and even the expectations set by healthcare providers. Understanding pain perception bias is crucial in medical settings, as it can impact diagnosis, treatment, and patient outcomes.

Key factors contributing to pain perception bias include:

Cultural and Social Influences: Cultural norms and social attitudes towards pain can shape how individuals express and manage pain.

Psychological Factors: Anxiety, depression, and stress levels can alter pain perception, often amplifying the experience of pain.

Previous Experiences: Past encounters with pain can influence how future pain is perceived and reported.

Expectation and Suggestion: Expectations set by healthcare professionals or through personal beliefs can modulate the intensity and nature of pain felt by a patient.

Gender and Age: Research indicates that gender and age can influence pain perception, with variations in how pain is experienced and expressed across different groups.

Recognizing and addressing pain perception bias is essential for providing equitable and effective pain management and ensuring that all patients receive appropriate care tailored to their individual needs.

https://www.painweek.org/media/news/cultural-competence-pain-management

Cultural Competence in Pain Management | PAINWeek “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” - Martin Luther King Jr. Disparities in how pain is perceived and managed among different racial and ethnic groups are a pressing issue in healthcare. A 2016 study revealed that nearly half of White medical ...

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New research from the McKnight Brain Institute of the University of Florida explores how S-palmitoylation, a reversible lipid modification, affects the function of NaV1.7 channels, which play a key role in pain sensation. Researchers discovered that NaV1.7 channels are modified by S-palmitoylation and identified two specific sites (cysteine 1126 and cysteine 1152) that influence the channel's properties.

The findings from the results shown in both rat and human subjects suggest that S-palmitoylation plays a significant role in regulating NaV1.7 activity and opens up possibilities for developing new pain treatments by targeting S-palmitoylation in NaV1.7 channels!

MBI-led study in PNAS Nexus highlights the role of the protein palmitoyl acyltransferase in modulating the activity of NaV1.7, a key player in chronic pain. The study, part of research aimed at discovering new nonopioid-based therapies for pain management, is our latest MBI Research Snapshot.

“What these findings illustrate is that we can tweak the activity of this key pain channel to curb neuronal excitability in a manner akin to dialing down the volume k**b of pain across diverse chronic pain conditions,” said senior author Dr. Rajesh Khanna, a University of Florida professor of pharmacology and therapeutics.

Read more: bit.ly/3RlePOk

Chronic pain can make individuals biologically older than their actual age. This is known as biological aging and occurs via changes in DNA. A recent study conducted by Larissa Strath, Yenisel Cruz-Almeida and Javier Tamargo examined how high-impact pain affected biological aging in middle-aged and older adults in the U.S.

Using 13 different epigenetic clocks to estimate biological age, it was found that people with high-impact pain showed signs of faster aging at the DNA level and experienced greater limitations in daily activity. The results indicate that effective management of chronic pain may actually help slow down an accelerated aging process!

The research article, “High-impact pain is associated with epigenetic aging among middle-aged and older adults: Findings from the Health and Retirement Study”, has been published in The Journals of Gerontology Series A Biological Sciences and Medical Sciences!

https://pubmed.ncbi.nlm.nih.gov/38855906/ #:~:text=High%2Dimpact%20pain%20was%20associated%20with%20accelerated%20epigenetic%20aging%20compared,compared%20to%20low%2Dimpact%20pain

A new publication at the Journal of Pain seeks to examine how different social and demographic factors influence people's ability to cope with chronic low back pain.

By studying factors such as pain resilience alongside age, gender, education level and income, alongside other factors, researchers from The University of Alabama, Washington University in St. Louis, as well as Larissa Strath at the University of Florida, found multiple interesting points!

* Older adults and women tended to report lower pain resilience.

* Higher levels of education and income are associated with better pain resilience. This generally means that individuals with more education and higher income might have better access to resources that help manage pain.

* Married individuals or those in long-term relationships often show greater resilience, likely due to emotional and social support from their partners.

Overall, the study highlighted the importance of taking sociodemographic factors into account when developing individualized pain management programs.

Check out the article, “The Impact of Sociodemographic Factors on Pain Resilience among Adults with Chronic Low Back Pain” here!

https://www.jpain.org/article/S1526-5900(24)00040-3/abstract

A new article was recently published in Brain, Behavior & Immunity – Health, by co-authors Angela Mickle, Jared Tanner, Lisa Antoine, Cynthia Garvan, Song Lai, Rene Przkora, Jeffrey Edberg, Roland Staud, David Redden, Burel Goodin, Catherine Price, Roger Fillingim, and Kimberly Sibille, titled “Disentangling factors contributing to individual differences and health disparities in chronic pain and whole person health with measures of allostatic load” Click here to read more about this developing line of investigation:

https://www.sciencedirect.com/science/article/pii/S2666354624000723?via%3Dihub

For here's an interesting article exploring the link between lower back pain and cycling, as well as steps and precautions to take towards preventing it!

https://www.cyclingweekly.com/fitness/lower-back-pain-dont-blame-the-bike-32094

Lower back pain: causes and prevention for cyclists Although cycling is a low-impact sport, many cyclists still suffer with back pain. We take a look at why this is and what can be done

How does taking certain medications together affect pain management? Can mixing different pain medications together bring on worse results than taking a single one?

Some opioids are processed in the body by an enzyme called CYP2D6. Certain medications can block this enzyme. These medications are known as CYP2D6 inhibitors.

In a recent study, researchers at the University of Florida, including Roger Fillingim, found that individuals who took CYP2D6 inhibitors with opioids were more likely to visit the emergency department for pain-related issues compared to those who didn’t mix the two medications!

Although the main call to action of the study is towards prescribers of pain medication to consider the efficacy of prescribing certain pain medications together, the following link lists examples of CYP2D6 inhibitors.

https://go.drugbank.com/categories/DBCAT002624

The full article, titled, “Use of CYP2D6 Inhibitors with CYP2D6 Opioids: Association with Emergency Department Visits for Pain” has been published in Clinical Pharmacology & Therapeutics.

https://pubmed.ncbi.nlm.nih.gov/38797987/ #:~:text=Our%20findings%20suggest%20patients%20with,due%20to%20inadequate%20pain%20control

A new study recently published in Journal of Pain Research aims to assess the effectiveness of a Mediterranean Ketogenic Nutrition Adherence Program and its potential to assist in managing pain in older adults with mild cognitive impairment.

The Mediterranean Ketogenic Nutrition Adherence program involves a hybrid dietary approach that combines both the Mediterranean diet and the ketogenic diet that involves avoiding high-carb foods and emphasizes healthy fats, lean proteins, nutrient-dense foods and non-starchy vegetables.

In the study, participants were randomly divided into two separate groups and had their pain levels measured. What was found was that, while adhering to the diet program, both groups experienced significant reductions in pain!

The article, “Addressing Pain Using a Mediterranean Ketogenic Nutrition Program in Older Adults with Mild Cognitive Impairment” which was co-authored by Yenisel Cruz-Almeida, can be found here!

https://www.tandfonline.com/doi/full/10.2147/JPR.S451236

How much do psychological and behavioral factors influence the experience of chronic knee pain in individuals with osteoarthritis? Researchers including Burel Gooden from the Washington University in St. Louis and Daniel Kusko from The University of Alabama at Birmingham alongside Roger Fillingim and Kimberly Sibille, aimed to better understand this relationship.

During the study, it was found that individuals with higher levels of depression, anxiety and activity avoidance experienced worse pain and disability while individuals who had better coping mechanisms, stronger social support and more positive attitudes tended to experience less pain and overall functioning.

The study highlighted that focusing not just on physical treatment but also on improving mental health and adopting positive behaviors can significantly alleviate pain and enhance quality of life and called for approaches that included psychological support and strategies that help boost resilience!

The study has been published in The Journal of Pain and can be viewed here!

https://www.sciencedirect.com/science/article/abs/pii/S152659002400124X

Join us for our monthly Pain and Aging Journal Club this coming Friday!

Rachel Ho will lead the discussion on the article, "An Ecological Momentary Assessment Study of Pain Intensity Variability: Ascertaining Extent, Predictors, and Associations With Quality of Life, Interference and Health Care Utilization Among Individuals Living With Chronic Low Back Pain", which explores how pain intensity varies over time for people with chronic low back pain and how this variation affects their lives.

Follow the link below to learn more and join us in person or online via Zoom on Friday, May 24th from 11:30pm to 1pm!

https://price.ctsi.ufl.edu/2024/05/21/pain-and-aging-journal-club-may-2024/