Journal Watch May 2018

To Treat Pain, You Need to Treat the Patient: People in chronic pain are some of the most difficult patients to treat. They have complex circumstances that medicine can't always remedy. Pain can be amplified, by depression and anxiety, genetics and quality of life. Genetics can also play a role in how people experience pain. Clinicians and researchers at UW Medicine's Center for Pain Relief found that an in-depth questionnaire can help immensely. Their work to create a pain assessment adaptable to any primary care clinic was recently published in the Journal of General Internal Medicine.

New approach for treating neuropathic pain: Neuropathic pain is the chronic, pathological pain that continues even when the cause of pain is removed. Causes include damage to nerve cells and medicines used to treat cancer. Scientists have discovered a novel therapeutic that appears to interrupt the signaling cascades in the body required for multiple forms of neuropathic pain.  Pain

MIV-711 Reduces Bone, Cartilage Disease Progression in Patients With Knee Osteoarthritis: MIV-711 significantly reduces bone and cartilage disease progression in patients with knee osteoarthritis, according to a study presented here on April 27 at the 2018 Osteoarthritis Research Society International (OARSI) World Congress. However, the primary endpoint for knee pain was not reached, most likely due to the short duration of the study.

Love hurts: Spats with spouse may worsen chronic pain, other symptoms: For patients with chronic conditions like arthritis or diabetes, arguments with a spouse may have physical repercussions, according to researchers. They found that in two groups of older individuals -- one group with arthritis and one with diabetes -- the patients who felt more tension with their spouse also reported worse symptoms on those days. Annals of Behavioral Medicine 

Fremanezumab Linked to Fewer Monthly Migraine Days: For episodic migraine patients, reduction in number of migraine days with monthly dosing, single dose. JAMA

Psychological Therapies May Help Older Adults With Chronic Pain: For older adults with chronic pain, psychological interventions have small benefits, including reducing pain and catastrophizing beliefs, according to a review published online May 7 in JAMA Internal Medicine.

Adding Chiropractic to Usual Care Beneficial for Low Back Pain: For active-duty military personnel, the addition of chiropractic care to usual medical care is associated with improvements in low back pain intensity and disability, according to a study published online May 18 in JAMA Network Open.

COMPLEMENTARY & ALTERNATIVE MEDICINE

Substance in Chinese medicine can cause cardiac arrhythmia: A medicinal plant frequently used in Traditional Chinese Medicine (TCM) -- Evodia rutaecarpa -- contains substances that can cause cardiac arrhythmia. Pharmacological Research

Acupuncture possible treatment for dental anxiety: Researchers have found evidence that acupuncture could help people who experience dental anxiety. European Journal of Integrative Medicine

Cannabidiol significantly reduces seizures inpatients with severe form of epilepsy: Cannabidiol (CBD), a compound derived from the cannabis plant that does not produce a 'high,' was shown in a new large-scale, randomized, controlled trial to significantly reduce the number of dangerous seizures in patients with a severe form of epilepsy called Lennox-Gastaut syndrome. This study also is the first to offer information on cannabidiol dosing for patients with treatment-resistant epilepsy. NEJM 

Many Oncologists Discuss, Recommend Medical Marijuana:Many oncologists recommend medical marijuana (MM) clinically despite not feeling sufficiently knowledgeable about its utility, according to a study published online May 10 in the Journal of Clinical Oncology.

Marijuana Use Not Linked to Risk of Arrhythmias After Acute MI: For patients with acute myocardial infarction (AMI), marijuana use is not associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) or cardiac arrest, according to a study presented at the annual meeting of the Heart Rhythm Society.

FDA ACTION

• Launched legal action to stop two stem cell clinics from providing unapproved treatments that have caused serious, long-term harm to some patients.

• Approved non opioid treatment, Lucemyra, for opioid withdrawl

• Approves novel preventive treatment for migraines, Aimovig, one a month injections

• Approves the first epoetin alfa bioseimilar, Retacrit, for the treatment of anemia

• Permitted marketing of Hemospray, a new device used to help control certain types of bleeding in the gastrointestinal (GI) tract.

• Approved Tafinlar (dabrafenib) and Mekinist (trametinib), administered together, for the treatment of anaplastic thyroid cancer (ATC) that cannot be removed by surgery or has spread to other parts of the body

PREVENTION

Vigorous exercise reduces tiredness in testicular cancer survivors:High-intensity interval training reduces tiredness and improves self-esteem for testicular cancer survivors, according to a study published in the British Journal of Cancer 

Youth tackle football participation linked to earlier onset of cognitive and emotional symptoms: Starting to play tackle football before age 12 could lead to earlier onset of cognitive and emotional symptoms among athletes who were diagnosed with CTE and other brain diseases postmortem, according to a new study. Annals of Neurology h

Exercise beats genetics in determining amount of body fat: With obesity now a global epidemic, there is increased focus on risk factors that contribute to weight gain, especially in postmenopausal women. Although many women may blame genetics for their expanding waistlines, a new study shows that as women age they are more likely to overcome genetic predisposition to obesity through exercise. Menopause

Aerobic+ Strength Exercise Doesn't Slow Cognitive Decline: An aerobic and strength exercise program does not slow cognitive impairment among people with mild-to-moderate dementia, according to a study published online May 16 in The BMJ.

High Occupational Exercise Level Tied to Early Mortality in Men: High-level occupational physical activity linked to 18 percent increased risk of early death in men only. Among women, there was a trend toward an inverse association between occupational physical activity and early mortality. British Journal of Sports Medicine

Shower Cream, Body Lotion Combo Improves Atopic Dry Skin: A shower cream and a body lotion with physiological lipids are effective in improving skin hydration in patients with dry skin, according to a study published online May 10 in the Journal of Cosmetic Dermatology.

Resistance Exercise May Reduce Depressive Symptoms in Adults: Resistance exercise training (RET) is associated with reduced depressive symptoms among adults, according to a meta-analysis published online May 9 in JAMA Psychiatry.

USPSTF: Decision to Undergo PSA Screening Should Be Individual: The U.S. Preventive Services Task Force (USPSTF) concludes that the decision to undergo periodic prostate-specific antigen (PSA) screening for prostate cancer should be an individual one for men aged 55 to 69 years. These findings form the basis of a final recommendation statement, published in the May 8 issue of the Journal of the American Medical Association. 

Good Evidence That HPV Vaccines Protect Against Cervical Pre cancer: Human papillomavirus (HPV) vaccines protect against cervical precancer in adolescent girls and young women, according to a review published online May 9 in the Cochrane Library. 

Some water-filter pitchers much better attoxin removal: Scientists  compared three popular pitcher brands' ability to clear dangerous microcystins from tap water. They found that while one did an excellent job, other pitchers allowed the toxins -- which appear during harmful algal blooms (HABs) -- to escape the filter and drop into the drinking water. The purifier that filtered water fastest, and which was made entirely of coconut-based activated carbon, removed 50 percent or less of the microcystins from the water. But the purifier that filtered water slowest -- and which was made from a blend of active carbon -- rendered the microcystins undetectable in drinking water. The study appears in the journal Water Science Technology: Water Supply. "In general, the cheaper the pitcher, the worse job it did filtering out the toxins.”

 NUTRITION/SUPPLEMENTS/VITAMINS

Eggs not linked to cardiovascular risk, despite conflicting advice: Eating up to 12 eggs a week does not increase cardiovascular risk factors in people with pre-diabetes or type 2 diabetes, new research finds -- despite conflicting dietary advice continuing around the world. The American Journal of Clinical Nutrition

Symptoms of Osteoarthritis Lessened With Simple Changes to the Diet:One gram of fish oil a day could help reduce the pain of patients with osteoarthritis (OA), according to a study published in Rheumatology. In analysing 68 previous studies in the field, researchers found that a low-dose supplement of fish oil could result in pain reduction for patients with OA and help improve their cardiovascular health. Essential fatty acids in fish oil reduce inflammation in joints, helping to alleviate pain. The researchers also found that a reduction of weight for overweight and obese patients and the introduction of exercise tailored to mobility could also help ease the symptoms of OA.

Expert consensus finds that higher protein intake benefits adult bone health: In seniors with osteoporosis, dietary protein intake above currently recommended levels may help to reduce bone loss and fracture risk, especially at the hip, provided calcium intakes are adequate. Osteoporosis International

Healthy diet may lower risk of hearing loss in women: Patterns of healthy eating may lower risk of hearing loss by 30 percent. The Journal of Nutrition

Better Diet Quality Associated With Larger Brain Volume: Better diet quality, including high intake of vegetables, fruit, whole grains, dairy, nuts, and fish, and low intake of sugar containing beverages is associated with larger brain volume, gray matter volume, white matter and hippocampal volume according to a study published online May 16 in Neurology.

Exceptional Glycemic Control With Very Low-Carbohydrate Diet: For children and adults with type 1 diabetes mellitus (T1DM), consuming a very low-carbohydrate diet (VLCD) is associated with exceptional glycemic control, according to a study published online May 7 in Pediatrics.

Folic Acid May Cut Stroke Risk in High-Risk Hypertensive Patients: Hypertensive patients may lower their stroke risk with folic acid supplements, according to a study published in the May 15 issue of the Journal of the American College of Cardiology. 

Seafood Recommended 1 to 2 Times/Week for Cardiac Benefit: Benefits of seafood consumption include reduced risk of cardiac death, coronary heart disease, stroke. Circulation

TREATMENT

“Drug Holidays” May Lead to Bone Fractures for Patients With Osteoporosis: Patients with osteoporosis who take bisphosphonates for long periods typically are advised to temporarily discontinue the drugs to prevent rare but serious side effects. However, a recent study has found that 15.4% of patients who take “drug holidays” experience fractures. During a 6-year follow-up period, the yearly incidence of fractures ranged from 3.7% to 9.9%, with the most fractures occurring during the fourth and fifth years. Endocrine Practice 

Use of Pimavanserin in Combination With SSRIs Is Safe for Patients With Parkinson’s Disease: Treatment of Parkinson’s disease-related psychosis with pimavanserin (Nuplazid) is safe when used in combination with selective serotonin reuptake inhibitors (SSRIs), according to a study presented here at the 2018 Annual Meeting of the American Geriatrics Society (AGS).

Alternative treatment for mild asthma: People with mild asthma are often prescribed a daily treatment regimen, but up to 80 per cent do not follow the routine, using inhalers only when they have an asthma attack. Now the researchers have found an as-needed combined-drug inhaler is a viable treatment option- an inhaler with a combination of budesonide, a steroid that controls inflammation, and formoterol, a beta2-agonist. NEJM

Stroke prevention drug combo shows promise: If you've had a minor stroke or a transient ischemic stroke (TIA), taking the clot-preventing drug clopidogrel along with aspirin may lower your risk of having a major stroke within the next 90 days, according to new research. NEJM

Randomized trial finds ibuprofen not a safe alternative to antibiotics for UTIs: Ibuprofen, given instead of antibiotics to women with uncomplicated urinary tract infection (cystitis), leads to longer duration of symptoms and more serious adverse events related to the spread of the primary infection, according to a new study. PLOS

Commonly prescribed heartburn drug linked to pneumonia in older adults:Researchers have found a statistical link between pneumonia in older people and a group of medicines commonly used to neutralize stomach acid in people with heartburn or stomach ulcers. Although Proton-pump inhibitors (PPIs) are still a valuable group of medicines, research is indicating that PPIs are not as completely safe for older people as previously thought. Journal of the American Geriatrics Society

Low Dose Vaginal Estradiol Improves Menopause Linked quality of life: For menopausal women with moderate-severe vulvovaginal symptoms, treatment with low-dose vaginal estradiol is associated with improved menopause-related quality of life, according to a study published online May 7 in Menopause.

Chronic Aspirin Exposure Linked to Melanoma Risk in Males:Chronic acetylsalicylic acid (ASA; aspirin) exposure is associated with increased risk of malignant melanoma (MM) in men, but not women, according to a letter to the editor published online March 27 in the Journal of the American Academy of Dermatology. 

Clopidogrel+ Aspirin Cuts Ischemic Events in Stroke, TIA: However, combination is associated with increased risk of major hemorrhage within 90 days. NEJM 

Sustained Use of Oxymetazoline Cream Efficacious for Rosacea:Oxymetazoline is safe and effective for the treatment of moderate-to-severe persistent erythema of rosacea, according to a study published in the June issue of the Journal of the American Academy of Dermatology

OTHER

Asthma and hay fever linked to increased risk of psychiatric disorders: A new study is the first to find a significant link between asthma, hay fever and a broad spectrum of psychiatric disorders. Over 15 years, 10.8 percent of patients with allergic diseases developed a psychiatric disorder, compared to only 6.7 percent of those without allergies. Monitoring the mental health of patients with allergies could help doctors care for their patients more effectively. Frontiers in Psychiatry

Intimacy in later life does not slow memory loss: Research shows that sexual activity and emotional closeness are unrelated to the rate of cognitive decline Older people who enjoy a sexually active and emotionally close relationship with their partner tend to perform better at memory tests than sexually inactive older adults on a short-term basis, but this is not the case over a longer period of time. This is according to a study using data from more than 6000 adults aged 50 and over. Archives of Sexual Behavior