Journal Watch September 2018

 CHRONIC PAIN

Prevalence and Profile of High Impact Chronic Pain: Almost 11 million U.S. adults have “High Impact Chronic Pain.” That is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores. These people report more severe pain, more mental health problems and cognitive impairments, more difficulty taking care of themselves, and higher health care use than those who have chronic pain without these activity restrictions. Chronic pain is a common problem, affecting about 40 million U.S. adults, but its impact on people’s daily lives has been difficult to define. Journal of Pain

About One in Five U.S. Adults Have Chronic Pain: Higher prevalence of chronic pain, high-impact chronic pain for women, older adults, rural residents. About 20.4 percent of U.S. adults have chronic pain and 8.0 percent have high-impact chronic pain, according to research published in the Sept. 14 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Mindful People feel less pain: Some people are more mindful than others, and those people seemingly feel less pain. In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F). Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region. Pain

Pharmacovigilance Needed for Rheumatology Patients: American College of Rheumatologists urges health care providers to monitor for adverse events

Chronic Pain May be a Contributor to Suicide:Chronic pain may be an important contributor to suicide, with 8.8 percent of suicide decedents having evidence of chronic pain, according to a study published online Sept. 11 in the Annals of Internal Medicine.

Total ankle arthroplasty offers patients greater range of motion and less pain: New research reveals patients with end-stage ankle arthritis can expect enhanced quality of life within six months of surgical reconstruction. The Journal of Bone and Joint Surgery 

Why do women getmore migraines?: Estrogen and other sex hormones may be responsible for the higher prevalence of migraine in women: Differing levels of sex hormones, especially estrogens, may explain why many more women than men suffer from migraines. A study provides evidence that these hormones affect cell mechanisms that control responses to migraine triggers, offering a possible pathway to more effective, personalized treatments.  Frontiers in Molecular Biosciences

COMPLEMENTARY & ALTERNATIVE MEDICINE

Anxiety and Complementary Health Approaches: Researchers are studying a variety of complementary health approaches to see whether they might be helpful for occasional anxiety or anxiety disorders. There is some evidence that mindfulness and other forms of meditation, music, relaxation techniques, and melatonin may be efficacious for anxiety, especially anxiety associated with medical procedures or chronic medical problems. However, there is not enough evidence on other complementary health approaches for anxiety to draw definitive conclusions about their efficacy. NCCIH Digest provides a summary of current research on several complementary health approaches for anxiety, including mind and body practices and natural products.

Hypnosis Doesn’t Cut Pot Op Pain in Breast Cancer Surgery: Hypnosis before general anesthesia does not reduce postoperative breast pain among patients undergoing minor breast cancer surgery, according to a study published online Aug. 17 in JAMA Network Open. However, those who perceived that they received hypnosis had significantly reduced fatigue and anxiety.

Cannabis extract helps reset brain function in psychosis: Research from King's College London has found that a single dose of the cannabis extract cannabidiol can help reduce brain function abnormalities seen in people with psychosis. Results from a new MRC-funded trial, published in JAMA Psychiatry, provide the first evidence of how cannabidiol acts in the brain to reduce psychotic symptoms.

Medical cannabis effective in treating a wide range of health conditions: Utilizing new mobile application technology, researchers found that medical cannabis provides immediate symptom relief across dozens of health symptoms with relatively minimal negative side effects. Frontiers in Pharmacology & Medicines

Tai Chi Effective at Reducing Number of Falls in Older Adults: Tai chi is more effective than conventional exercise at preventing falls among high-risk, older adults, according to a study published online Sept. 10 in JAMA Internal Medicine. 

Cannabinoid in Breast Milk Up to Six Days After Marijuana Use: Most breast milk samples have measurable Δ-9-tetrahydrocannabinol (Δ9-THC) up to about six days after maternal use, according to a study published online Aug. 27 in Pediatrics.

FDA ACTION

• Approved Lenvatinib for hepatocellular carcinoma

• Approved Migalastat for Fabry Disease

• Approves first targeted RNA based therapy polyneuropathy of hereditary transthyretin-mediated amyloidosis

• Approved the Natural Cycles app that helps women avoid pregnancy by tracking their body temperature and menstrual cycle- “fertility awareness”

• Approves new dosage strength of buprenorphine and naloxone sublingual film as maintenance treatment for opioid dependence

• Warns that it has found a second impurity in three lots of Torrent Pharmaceuticals' valsartan drug products.

• Recalled Montelukast Tablet Bottles for asthma because they contained the wrong medicine.

• Warns of dangers of liquid Nitrogen in food, drinks

• Issued a warning on type 2 diabetes medicine, SGLT2 Inhibitor, which caused genital infections (Fournier’s gangrene) in some patients.

• Extends EpiPen Expiration Dates to tackle shortage

PREVENTION

Amount of Physical Exercise Affects Mental Health Burden: Those who exercised had 1.49 fewer days of poor mental health in past month vs. those who did not. The Lancet Psychiatry

Recommendation for Annual Urinary Incontience Screening: The Women's Preventive Services Initiative (WPSI) recommends annual urinary incontinence screening for women and referral for further evaluation and treatment if indicated, according to a clinical guideline published online Aug. 14 in the Annals of Internal Medicine.

Air pollution reduces global life expectancy by more than one year: Air pollution shortens human lives by more than a year, according to a new study from a team of leading environmental engineers and public health researchers. Better air quality could lead to a significant extension of lifespans around the world. Environmental Science & Technology Letters

Effects of Aspirin for Primary Prevention in People with Diabetes: The use of low-dose aspirin led to a lower risk of serious vascular events than placebo among persons with diabetes who did not have evident cardiovascular disease at trial entry. However, the absolute lower rates of serious vascular events were of similar magnitude to the absolute higher rates of major bleeding, even among participants who had a high vascular risk. The use of low-dose aspirin did not result in a lower risk of gastrointestinal tract cancer or other cancer over the mean follow-up of 7.4 years, but further follow-up is needed to assess any longer-term effects on cancer reliably. NEJM

Exposure to ToxicMetals May Up Cardiovascular Disease Risk: Exposure to arsenic, lead, cadmium, and copper is associated with elevated risk of clinical cardiovascular disease outcomes, according to a review and meta-analysis published online Aug. 29 in The BMJ.

Chronic Vaping Exerts Biological Effects on Lung: Chronic vaping exerts biological effects on the lung, some of which are mediated by the propylene glycol/vegetable glycerin (PG/VG) base, according to a study published recently in the American Journal of Respiratory and Critical Care Medicine.

Monitoring at home yields better blood pressure control: People with high blood pressure are more likely to get it under control if they record blood pressure readings at home and share the data with their healthcare provider. At-home monitoring gives providers a better sense of patients' true blood pressure readings, leading to more customized treatment and better hypertension control. Combining at-home readings with traditional provider care saves money by reducing medications and doctor and emergency department visits. American Heart Association's Joint Hypertension 2018 Scientific Sessions.

Lifestyle changes reduce the need for blood pressure medications Men and women with high blood pressure reduced the need for antihypertensive medications by making lifestyle changes. A 16-week program, focused on the DASH diet, weight management and exercise, resulted in the most dramatic declines in blood pressure. American Heart Association's Joint Hypertension 2018 Scientific Sessions

New blood pressure app: Researchers have invented a proof-of-concept blood pressure app that can give accurate readings using an iPhone -- with no special equipment. "By leveraging optical and force sensors already in smartphones for taking 'selfies' and employing 'peek and pop,' we've invented a practical tool to keep tabs on blood pressure.” An app could be available in late 2019. Scientific Reports

People With High Levels of Aldosterone Have an Increased Risk of Developing Diabetes Increased levels of aldosterone, already associated with hypertension, can play a significant role in the development of diabetes, particularly among certain racial groups, according to a study published in the Journal of the American Heart Association.

Obstructive Sleep Apnoea Linked With Higher Risk of Gout: People with obstructive sleep apnoea (OSA) have a higher risk of developing gout, even beyond the first years after being diagnosed with the sleep disorder, according to a study published in Arthritis & Rheumatology.

Breast cancer screening does not reduce mortality: Fewer and fewer women die from breast cancer in recent years but, surprisingly, the decline is just as large in the age groups that are not screened. The decline is therefore due to better treatment and not screening for breast cancer. International Journal of Cancer

Chronic Vaping Exerts Biological Effects on Lung: Chronic vaping exerts biological effects on the lung, some of which are mediated by the propylene glycol/vegetable glycerin (PG/VG) base, according to a study published recently in the American Journal of Respiratory and Critical Care Medicine.

Poor Shared Decision-Making for Lung Cancer Screening: Physicians universally recommended screening, with almost no discussion of harms. The quality of shared decision-making (SDM) about the initiation of lung cancer screening (LCS) is poor, according to a study published online Aug. 13 in JAMA Internal Medicine.

Breastfeeding Linked to Lower Risk of Stroke Post-Menopause: Breastfeeding is associated with a lower risk of stroke among older women, with a stronger correlation for longer duration of breastfeeding, according to a study published online Aug. 22 in the Journal of the American Heart Association.

NUTRITION/SUPPLEMENTS/VITAMINS

Consuming More Protein After Weight Loss May Reduce Fatty Liver Disease: Increasing the amount of protein in the diet may reduce the liver’s fat content and lower the risk of diabetes in people with nonalcoholic fatty liver disease (NAFLD), according to a study published in the American Journal of Physiology--Endocrinology and Metabolism.

Effects of N-3 Fatty Acid Supplements in People with Diabetes: Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n−3 fatty acid supplementation and those who were assigned to receive placebo. NEJM

Changes in breakfast and dinner timings can reduce body fat: Modest changes to breakfast and dinner times can reduce body fat, a new pilot study in the Journal of Nutritional Sciences reports. 

High Quality Diet Linked to Lower Mortality in Cancer Survivors: For cancer survivors, a high-quality diet is associated with a reduced risk of overall and cancer-specific mortality, according to a study recently published in JNCI: Cancer Spectrum. 

High, Low Carbohydrate Diets Linked to Increased Mortality: Increase in mortality when carbohydrates were exchanged for animal-derived fat or protein. Both high and low percentages of carbohydrates in diets are associated with increased mortality, according to a study published online Aug. 16 in The Lancet Public Health.

TREATMENT

Nerve Stimulation Improves Quality of Life in Patients With Depression People with depression who are treated with nerve stimulation experience significant improvements in quality of life, even when their depression symptoms do not completely subside, according to a study published in The Journal of Clinical Psychiatry.

No safe level of alcohol, new study concludes: There is no safe level of drinking alcohol, concludes a new study. It shows that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12 percent of deaths in males between the ages of 15 and 49. "Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss." While the study's authors say that moderate drinking may safeguard people against heart disease, they found that the potential to develop cancer and other diseases offsets these potential benefits, as do other risks of harm. The report urges governments to revise health guidelines to suggest lower levels of consumption.

 Multiple sclerosis drug slows brain shrinkage, study finds: Results from a clinical trial of more than 250 participants with progressive multiple sclerosis (MS) revealed that ibudilast was better than a placebo in slowing down brain shrinkage. The study also showed that the main side effects of ibudilast were gastrointestinal and headaches. NEJM

Single-Dose Drug Can Shorten Flu Symptoms by About 1 Day: A single dose of a new influenza drug can significantly shorten the duration of the illness in teens and adults, according to a study published in the New England Journal of Medicine. Two multicentre, double-blind randomised trials found that baloxavir marboxil shortened the duration of flu symptoms by about 1 day and more quickly cleared the virus compared with placebo in otherwise healthy teens and adults.

Behavioural Intervention Prevents Cognitive Decline in Patients With Mild Cognitive Impairment A behavioural intervention reduced the risk of future memory loss in black patients with mild cognitive impairment (MCI)  reduced the risk of cognitive decline by 88% compared with Supportive Therapy. To test whether it was possible to help people set goals and engage in a more active lifestyle researchers used a treatment called Behavioural Activation, which helps participants increase cognitive, physical or social activity by guiding someone through goal setting and action planning. JAMA Neurology

New Guidelines for the Evaluation, Treatment of Perimenopausal Depression: The North American Menopause Society (NAMS) expert panel was convened by NAMS and the Women and Mood Disorders Task Force of the National Network of Depression Centers (NNDC) to conduct a systematic review of the existing literature, and develop clinical guidelines for the evaluation and treatment of depression during the perimenopause. Women’s Health and Menopause.

Resistant Hypertension Diagnosis, Tx Guidelines Updated: A correct diagnosis of resistant hypertension is necessary to avoid overmedicating, according to a scientific statement from the American Heart Association published online Sept. 13 in Hypertension. 

Single, Fixed-Dose Combo Pills Improve Hypertension Outcomes: Single-pill, fixed-dose combination (FDC) treatment may be more effective for improving blood pressure control in older patients, according to a study recently published in PLOS Medicine. 

Prospect of a new treatment for rheumatoid arthritis An international research group has completed testing a new drug to treat rheumatoid arthritis. The drug is effective in patients with moderate to severe forms of the disease who have shown an inadequate response to conventional disease modifying drugs. The Lancet

No Apparent Short-Term Cancer Risk From Recalled Valsartan: Users of valsartan contaminated with N-nitrosodimethylamine (NDMA) seem not to have increased cancer risk, according to a study published online Sept. 12 in The BMJ. For single cancer outcomes, risk for colorectal, uterine cancer increased, but not significantly so.

Long-Term PPI Use Linked to Pneumonia Risk in Older Adults: Among older adults in primary care, use of proton pump inhibitors (PPIs) is associated with greater risk of pneumonia in the second year of treatment, according to a study published in the July issue of the Journal of the American Geriatrics Society.

OTHER

Hospital Groups Launch Own Generic Drug Company: Three U.S. health care foundations and seven hospital groups have formed a generic drug company to combat high prices and chronic shortages of medicines. The company, Civica Rx, will start with 14 widely used hospital drugs, including generic pills, patches, and injectable drugs for treating infections, pain, and heart conditions, board chairman Dan Liljenquist said, the Associated Press reported. "The mission of Civica is to make sure these drugs remain in the public domain, that they're available and affordable to everyone," Liljenquist added. 

Situation Framing, Language Can Influence Decision-Making: How a situation is framed and the language used to describe risks can influence patients' decision-making, according to an article published in Physicians Practice. Docs should provide risks of both having treatment and not having treatment to minimize loss aversion 

BPA replacements in plastics cause reproductive problems in lab mice: Twenty years ago, researchers made the accidental discovery that BPA had leached out of plastic cages used to house female mice in the lab, causing an increase in chromosomally abnormal eggs. Now, the same team is back to report that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice. Current Biology