Category Archives: CNS/Neurology

New Study Shows Spinal Cord Stimulation Reduces Opioid Use For Chronic Pain

ONE YEAR AFTER IMPLANT, 93 PERCENT OF PATIENTS WHO CONTINUED SCS THERAPY HAD LOWER AVERAGE DAILY MORPHINE-EQUIVALENT DOSES THAN PATIENTS WHO HAD THEIR SCS SYSTEM REMOVED

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New research has found spinal cord stimulation (SCS) therapy can be key to reducing or stabilizing the use of opioids in patients battling chronic pain. In a new study, researchers examined opioid usage data from more than 5,400 patients both prior to and after receiving an SCS system implant. In an SCS system, an implanted device similar to a pacemaker delivers low levels of electrical energy to nerve fibers, interrupting pain signals as they travel to the brain to reduce the sensation of pain. Researchers have found that average daily opioid use declined or stabilized for patients receiving a successful SCS system compared to patient use of opioids prior to an implant.

In addition, while opioid usage was not different for the two groups at time of implant, patients who underwent a successful SCS implant had significantly lower opioid use one year after their implant. Patients who had their SCS system removed saw their opioid use increase again over time.

In 5,400-patient study, average daily opioid use declined or stabilized in patients receiving SCS system, while patients who had SCS system removed had higher opioid use over time.  The study, which the researchers believe makes a compelling case for considering SCS therapy earlier in the chronic pain care continuum, were presented at the 2017 North American Neuromodulation Society (NANS) annual meeting by Ashwini Sharan, M.D., director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience at Jefferson and president of NANS.  The study was sponsored by Abbott (NYSE: ABT), a global leader in the development and manufacture of SCS systems and therapy options, such as the company’s proprietary BurstDR™ stimulation.

Currently, more than 2.1 million people in the U.S. suffer from substance abuse related to opioid pain relievers, while worldwide an estimated 15.5 million people are now classified as opioid dependent. Chronic pain is often a driver of opioid use as patients seek relief and improvements to their quality of life. Fortunately for patients, SCS therapy has been clinically proven to offer meaningful relief to patients suffering from chronic pain.  There is potential to improve outcomes by implanting SCS systems earlier, before chronic opioid use, according to authors.

“Given the epidemic of opioid addiction and abuse, these findings are important and confirm that spinal cord stimulation therapy can offer strong benefits for patients struggling with chronic pain,” said Sharan. “Based on these results, we concluded it may be possible to improve outcomes by offering our patients spinal cord stimulation earlier, before opioid dependence and addiction can occur.”

ABOUT THE STUDY:
For their analysis, the research team assessed private and Medicare insurance claims data from 5,476 patients who received an SCS system to treat chronic pain associated with a host of conditions (excluding pain related to cancer). The data were collected between January 2010 and December 2014. The data confirmed that many patients are often prescribed increasing dosages of opioids prior to receiving an SCS system. The researchers also found:
• SCS therapy is effective for patients at any level of opioid usage prior to implantation.
• Opioid use declined or stabilized in 70 percent of patients who received an SCS system.
• Among patients who had their SCS system explanted, opioid use was higher at one year compared to those who continued with SCS therapy.

The researchers further suggested patient outcomes could be improved if SCS were implanted earlier in recognition of the clinical practice to provide increasing dosages of opioids over time. These conclusions help build upon prior research, such as results of a large multicenter randomized controlled trial in patients with failed back surgery syndrome (FBSS) that showed trends in opioid reduction or cessation among SCS patients. In addition, new technologies released in the U.S. in 2015 and 2016 hold promise to improve outcomes further and may reduce common complications resulting in explant such as the undesired changes in paresthesia, issues with charging, pain at the implantable pulse generator (IPG) site, and loss of pain relief.

SOURCE: Displayed with permission from PRNewswire for Journalists

Ingredient In Red Bull Helps Treat Psychotic Episodes

Many of us have relied on energy drinks like Red Bull or Monster to pull all-nighters in college, alleviate hangovers, or as a pick-me-up before hitting the gym. These 20-ounce sugar-laden drinks are not the healthiest beverages to consume, but researchers now suggest they may possess medicinal properties. A study presented at the annual meeting of the International Early Psychosis Association found taurine, an additive in energy drinks, can significantly help with psychosis.

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Image courtesy PIXABAY CC00 Lic

“Although taurine supplementation did not improve cognition, it appears to improve core symptoms and depression in patients with FEP,” concluded the authors. (FEP is an individual’s first episode of psychosis.)

Taurine is a naturally occurring amino acid in the body that aids a variety of functions. It helps control cardiovascular function, and has been found to both protect the paths of neurons in the brain, and help stimulate the creation of new neurons via neurogenesis. The amino acid is also known to have a calming effect on the brain.

Keeping this in mind, the team of researchers sought to observe if taurine could be utilized to stabilize the neurological activity occurring in people experiencing their first episode of psychosis. A total of 86 participants, aged 18 to 25, who had been previously diagnosed as suffering from a mental disorder with psychosis as a symptom, were recruited for the study. Every day for 12 weeks, half of the participants got four grams of taurine along with their antipsychotic medication, while the other half got a placebo.

Signs of early or FEP include hearing, seeing, tasting or believing things that others don’t; sudden decline in self-care; and trouble thinking clearly or concentrating, according to the National Alliance on Mental Illness. These warning signs often point to a person’s deteriorating health, requiring a physical and neurological evaluation to help identify the problem. The severity of the participants’ symptoms was measured using the Brief Psychiatric Rating Scale (BPRS) and the Calgary Depression Scale for Schizophrenia (CDSS). The researchers also used a scale called the MATRICS consensus cognitive battery (MCCB) to measure changes in cognition.

After 12 weeks, those who received taurine has significantly improved scores on the BPRS, indicating a reduction in psychotic symptoms. They also experienced a significant decrease in depression, although there were no notable changes in cognition. The researchers suggest taurine could potentially act as an effective nutritional therapy in treating FEP.  However, they caution: “The use of taurine warrants further investigation in larger randomised studies, particularly early in the course of psychosis.”  Previous research supports taurine’s ability to aid symptoms in mental disorders. Its been used as an alternative to lithium, by blocking the effects of excess acetylcholine that contributes to bipolar disorder.

Researchers are still a long ways away from prescribing taurine to help with psychosis. It clear that the substance could potentially play an influential role in treating mental illness. But the dose used in the experiment is equivalent to drinking about four 250-millimeter cans of Red Bull in one sitting every day: This is not recommended, and for most people, it’s likely to lead to more problems than it would solve.

Source: Trial finds Red Bull additive taurine improves symptoms of young people suffering first episode psychosis. International Early Psychosis Association Meeting in Milan, Italy. 2016.

By Lizette Borreli, Displayed with permission from Medical Daily
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