In The News: November 2011
Fast-Track Hip Replacement Found to Be Effective, Safe
Patients who undergo a total hip replacement (THR) can be fast tracked to discharge in two days compared with the standard three to six days. According to a study conducted by the Hospital for Special Surgery in New York City, earlier discharge could help reduce hospital-acquired infections, lessen hospital costs, and improve patient satisfaction. The study compared two groups of patients—149 underwent THR with a fast-track protocol, and 134 underwent THR followed by traditional discharge at four days. Patients on the fast track had a physical therapy session on the day of surgery. The main difference was that pain medication was discontinued in the fast-track cohort one day after surgery, whereas in the traditional group pain medication was discontinued on day two. At one year, there were no differences in complications or readmissions between the two groups. Researchers cautioned that although the fast-track protocol is safe and effective, it is not for higher-risk patients who may suffer from inflammatory arthritis or medical comorbidities such as heart attack, pulmonary embolism, or deep-vein thrombosis.
Smoking Linked with Chronic Pain
Smokers are much more likely than non-smokers to report problems with persistent musculoskeletal pain. Researchers at the University of Kentucky School of Public Health surveyed more than 6,000 women, categorizing respondents according to age and smoking status, with smokers classified by their amount of daily cigarette intake. Respondents also were asked about pain symptoms if they had been diagnosed with musculoskeletal disorders. The study found that daily smokers were two times more likely to report pain than non-smokers, and those who smoked a pack or more per day were most likely to report a high degree of chronic pain. The authors noted that smoking-induced coughing increases abdominal pressure and back pain, and nicotine may decrease pain thresholds by sensitizing pain receptors.
Researchers Create Bioengineered Spinal Disc Implants
A biologically based spinal disc implant that could someday spell relief for people with lower back and neck pain has been created by engineers at Ithaca University (New York) and doctors at Weill Cornell Medical College (New York City). The discs, which have been successfully implanted in animals, have the same structural components and behave like real discs. They consist of two polymers—collagen, which wraps around the outside of the disc, and a hydrogel called alginate in the middle. The implants are seeded with cells that repopulate the structures with new tissue. As opposed to artificial implants that degrade over time, the implants appear to improve as they mature in the body due to the growth of the cells. For patients with degenerative disc disease, surgeons traditionally perform a discectomy—removal of the spinal disc—followed by fusion of the spine. The surgery prevents pain but often limits mobility. Researchers claim the new discs could create a “huge advantage” over traditional implants because they integrate and mature with the vertebrae. They suggest that major surgery would become less invasive, safer, and result in fewer long-term side effects.
Pain Med Addiction Prevalent Among Chronic Pain Patients
A study published in the Journal of Addictive Diseases has found that 35 percent of patients undergoing long-term pain therapy with opioids such as morphine, OxyContin, Percocet, and Vicodin suffer from addiction. A sample of outpatients undergoing opioid therapy for non-cancer pain was identified through interviews with 705 participants from August 2007 to December 2008. Researchers claim that pain medication addiction often occurs in people under 65 with a history of substance abuse. “Since most patients will not know if they carry the genetic risk factors for addiction,” they concluded, “improper or illegal use of prescription pain medication can become a lifelong problem with serious repercussions for users and their families. We hope our research will aid the development of newer classes of medications that don’t negatively impact the brain and therefore avoid addiction entirely.”