WHAT'S
NEW -- December 1998
This
month's "What's New" section abstracts are from
new research studies presented at the 17th Annual Scientific
Meeting of the American Pain Society Meeting, that took place
in San Diego, California November 5-8, 1998. More than 950
scientific abstracts were presented at this meeting of international
pain specialists. We have chosen just a few that we found
interesting and potentially useful to patients and pain health
care providers.
Gabapentin
(Neurontin) Relieves Migraine Headache
A
multicenter controlled clinical trial by Dr. Magnus-Miller
and colleagues demonstrated that gabapentin is superior to
placebo in reducing the frequency of migraine headaches when
administered as a daily prophylactic medication in chronic
migraine sufferers. The dose of gabapentin in the study was
titrated [increased] to a maximum of 2400mg per day over a
4-week period, after which the dose remained constant for
8 weeks.
Editor's
Comments: Clinical experience with gabapentin has shown that
some patients may require up to 6000mg per day before experiencing
pain relief. The effective dose varies among individuals,
ranging widely between 300mg/day and 6000mg/day. See next
abstract.
 
Serum
(Blood) Gabapentin Levels In Chronic Pain Patients
A
study by Dogra and colleagues assessed whether the amount
of gabapentin in the blood correlates with gabapentin dose
in chronic pain patients successfully treated with gabapentin.
They concluded: "This study showed the difficulty of
correlating serum gabapentin levels to total daily dose and
duration of use of gabapentin."
Editor's
Comments: These results come to no surprise to pain specialists
since for most drugs used to treat chronic pain conditions
there is no correlation between dose, serum level, and pain
relief.
Intramuscular
Injection Of Botulinum Toxin Type A (Botox) In Chronic Low
Back Pain Associated With Muscle Spasm
Knusel
and colleagues presented a multicenter controlled clinical
trial assessing the efficacy and safety of injecting Botox
(Botulinum Toxin Type A) directly into lumbar paraspinous
muscles in spasm; these patients had chronic low back pain,
no patholology of the spine, and evidence of muscle spasm.
The study found that the highest dose (240 units of Botox)
injection was superior to placebo injection for reduction
in muscle spasm and the treating physician's assessment of
the patient. Further controlled trials will be performed in
the near future.
Editor's Note: Pain physicians have been using "Botox
injections" for the treatment of chronic myofascial pain
disorders, including myofascial low back pain, for several
years. This is the first placebo-controlled study to compare
Botox to placebo. This type of treatment promises pain relief
for chronic pain patients with a well defined muscle spasm
component.
Pain
Relief With Jaw Relaxation, Music, And Their Combination
M.
Good and colleagues presented a well-controlled study demonstrating
significant postoperative pain relief following abdominal
surgery using jaw relaxation and music. This scientific study
of 500 patients revealed the benefits of these "alternative
treatments" during the first 2 days after surgery, both
during ambulation (movement) and at rest. Interestingly, 91%
of these subjects stated they would use the tape again for
pain and would recommend it to others.
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