American Academy of Pain Medicine and Others Urge Caution in Use of Invasive Procedures for Neck Pain

The American Academy of Pain Medicine and the American Society of Regional Anesthesia and Pain Medicine have adopted new guidelines for the treatment of chronic neck pain. These guidelines stress that invasive procedures such as nerve blocks, steroid injections, and radiofrequency ablation should not be used as frequently as they have been in recent years.

The guidelines are based on hundreds of clinical studies and publications focusing on cervical spine procedures and their outcomes. Also reviewed were the clinical evaluations and imaging used to choose candidates for invasive procedures, the diagnostic value of the methods, and how to reduce the risk of complications from such procedures.

Steven Cohen, MD, co-chair of the guidelines committee and a professor of anesthesiology at Johns Hopkins Hospital, explained, “It is precisely because neck pain and cervical spine procedures are so common, and there is so little high-quality evidence to guide care, that consensus guidelines are needed.”

Among the new guidelines put in place are recommendations that conservative treatment, including physical therapy and non-opioid pain relievers, be used before considering nerve blocks or radiofrequency ablation (RFA). In the case of RFA, it was found that patients didn’t respond to the treatment if the pain originated in a nerve root rather than a joint. For patients who do respond well to RFA, the procedure should only be performed twice a year. The efficacy of RFA may decrease over years of treatment.

Several other recommendations include:

• Using only short-acting steroids for upper neck joint injections
• Taking advantage of fluoroscopy imaging to guide injections to minimize the risk of improper needle placement
• Using muscle stimulation to improve the effectiveness of treatments and reduce complications
• Focusing more on ways to prevent interference with pacemakers and other electrical medical devices

The authors of the newly created guidelines stressed, “Clinical trials evaluating cervical facet blocks and RFA are characterized by widely disparate outcomes, and there is enormous variation in selecting patients and performing procedures. These multi-society guidelines have been developed to serve as a roadmap to improve outcomes, enhance safety, and minimize unnecessary tests and procedures.”

FDA Approves Virtual Reality for Chronic Pain Treatment

The Food and Drug Administration announced Tuesday, November 11, 2021, that it had approved a virtual reality system to be marketed for pain reduction. The prescription-only, virtual reality system, EaseVRx, combines cognitive behavioral therapy with technology to help reduce lower back pain.

The system is designed for home use, with a headset and handheld monitor. It also includes an attachment to the headset that guides patients through controlled breathing exercises using an amplifier. EaseVRx combines visualization, relaxation techniques, attention-shifting, and rehabilitation methods in combination in a series of 56 virtual reality sessions. Each session lasts between two and sixteen minutes that take eight weeks to complete.

Participants in the FDA review reported reductions in the intensity of their pain and drops in the frequency and manageability of pain. The FDA has designated the device as a “breakthrough device,” which indicates it uses innovative technology to address a condition that is debilitating or life-threatening.

A statement released by the Food and Drug Administration stated, “Pain reduction is a crucial component of living with chronic lower back pain. “Today’s authorization offers a treatment option for pain reduction that does not include opioid pain medications when used alongside other treatment methods for chronic lower back pain.”

EaseVRx was developed and is manufactured by AppliedVR, a California firm developing a wide range of virtual reality technologies for medical use.

In a statement made to Newsweek magazine, CEO and co-founder of AppliedVR, Matthew Stoudt, noted, “We are incredibly grateful for the FDA approval because it represents a huge step forward on our journey to pioneer an entirely new category of therapeutics. AppliedVR’s immersive therapeutics have the potential to transform the lives of millions of people experiencing pain, and that mission starts with our first FDA approval for chronic lower back pain.”

Ibuprofen/Acetaminophen Combo for Post-Op Pain Being Considered by FDA

The Food and Drug Administration accepted a New Drug Application earlier this month for a Maxigesic® IV, a combination of ibuprofen and acetaminophen in a liquid solution for infusion. The application requests approval of the combo drug for use in hospitals to control postoperative pain.

Two clinical studies indicate that the IV solution (1000 mg acetaminophen and 300 mg ibuprofen) in the infusion controlled pain in postoperative adults after bunion, orthopedic, or plastic surgery. The treatment had few side effects and was more effective than either medication used alone. Patients were also less likely to need opioid prescriptions to control pain.

Stijn Van Rompay, CEO of Hyloris, stated, “Upon approval, Maxigesic IV will be commercialized by Hikma Pharmaceuticals, a leading supplier of complex, injectable hospital products in the US.” The company hopes for approval in 2022.

Specific Types of Pain Increase Stroke Risk

There are myriad factors that contribute to the possibility of stroke in individuals, particularly as individuals age. However, in a pair of recent studies, researchers have discovered a strong link between certain kinds of chronic pain and an increased risk of stroke.

The results were published in Pain Medicine Journal and indicated that patients suffering from chronic headaches, arthritis, or painful spinal disorders were 30% more likely to have a stroke or heart attack than the regular population. This remained true even after eliminating other conditions that impacted the likelihood of strokes, such as smoking and alcohol use.

This Week’s Pain Fact: Although rare, some individuals suffer from long-term pain following a stroke. It is estimated that less than 10% of patients who suffer a stroke later suffer from resultant chronic, widespread pain that doesn’t respond well to current medications. If the stroke affects the right side of the brain, post-stroke pain is more likely. The most effective treatment thus far has been deep brain stimulation or motor cortex stimulation, which reduces the pain from 50% to 100% percent depending on the individual.