Discontinuation and nonpublication analysis of chronic pain randomized controlled trials.

Introduction: The primary objective of this cross-sectional analysis is to evaluate rates of discontinuation and nonpublication of Randomized controlled trials (RCTs) of therapeutic interventions to treat chronic pain. Methods: Using ClinicalTrials.gov, a sample was obtained which included clinical trials pertaining to chronic pain. Trials were analyzed for publication status and completion status of each trial. If information was unavailable on the trial registry database, or could not be allocated through a systematic search, the corresponding trialist was contacted and data points were gathered. Results: In our final analysis of the 408 RCTs, we found that 281 (68.9%) were published in a peer-reviewed journal and 127 (31.1%) were unpublished trials. Of 112 discontinued trials, 59 (52.7%) reached publication. In addition, 221 of 296 completed trials (74.7%) were published, and 75 (25.3%) remained unpublished after trial completion. The most common listed reason for trial discontinuation was administrative recommendations (41 of 71 trials [57.7%]), while not receiving an email reply to our standardized email from the corresponding trialist was the most common result for trial nonpublication (49 of 88 trials [55.7%]). Clinical trials funded by nonindustry sponsors were more likely to reach publication than industry-funded clinical trials (unadjusted odds ratio 1.86 [95% CI, 1.18-2.95]; adjusted odds ratio 3.01 [95% CI, 1.76-5.14]). Conclusion: The rate of discontinuation of RCTs involving patients with chronic pain is concerning. Chronic pain affects many patients; thus, the importance of having quality data from clinical trials cannot be overstated. Our study indicates that chronic pain RCTs are frequently discontinued and their findings often go unpublished - all of which could provide crucial information to providers and patients regarding the treatment of chronic pain. We offer suggestions to enhance chronic pain RCT completion, thereby reducing the waste of resources in chronic pain research.

Electronic cigarettes and public health awareness: a cross-sectional analysis of Google search inquiries.

The number of American adults who use electronic nicotine delivery systems (ENDS) increased by 3 million people in 2018, up 38.3% from 8.1 to 11.2 million. Search data for ENDS were analyzed against relevant traits including state longitude, tobacco tax rate and national tobacco program funding. Searches increased 88% (95% CI, 70-100) over the last 5 years and peaked on 8 September 2019, after the CDC issued a warning about the link between ENDS and high-profile lung damage cases. Searches aimed at buying ENDS subsequently dropped 25% (95% CI, 20.1-29.6), while health-related ENDS searches spiked to their all-time high, increasing 22% (95% CI, -6 to 55) compared with the first half of 2019. ENDS searches are now more concentrated than 5 years ago, reversing the trend of the early 2010s, likely because certain states have passed laws to curb the use of ENDS. The public prefers searching for 'vaping' over 'e-cigarette' in a phenomenon similar to 'high fructose corn syrup' versus 'sugar'. Consequently, public policy discussions and public education campaigns need to use 'vaping' terms, and more states should enact policies that are strongly associated with lower ENDS usage, many of which we identify.

Public interest in Cannabis during election season: a Google Trends analysis.

INTRODUCTION: Given that 72% of internet users seek out health information using an internet search engine (Google being the most popular); we sought to investigate the public internet search interest in cannabis as a health topic when cannabis legislation appeared on state ballots and during presidential elections. MATERIALS AND METHODS: We searched Google Trends for "cannabis" as a health topic. Google Trends data were extracted during the time period of May 1, 2008 to May 1, 2019 for the United States (US) and select states (18) within the US including: Alaska, Arizona, Arkansas, California, Colorado, Florida, Maine, Massachusetts, Michigan, Missouri, Nevada, North Dakota, Ohio, Oregon, Oklahoma, South Dakota, Utah, and Washington when cannabis was on the ballot. These state elections were referenda, not legislative votes. We then compared the internet search interest for cannabis before and after each election. To evaluate whether any associations with changes in the volume of cannabis internet searches were specific to the cannabis topic, or also occurred with other topics of general interest during an election year, the authors ran additional analyses of previously popular debated policies during Presidential Elections that may act as control topics. These policies included Education, Gun Control, Climate Change, Global Warming, and Abortion. We used the autoregressive integrated moving average (ARIMA) algorithm to forecast expected relative internet search interests for the 2012 and 2016 Presidential Elections. Individual variables were compared using a linear regression analysis for the beta coefficients performed in Stata Version 15.1 (StataCorp). RESULTS: Public internet search interest for "cannabis" increased during the voting month above the previous mean internet search interest for all 18 bills. For the US, observed internet search interest during each Presidential Election was 26.9% [95% CI, 18.4-35.4%] greater than expected in 2012 and 29.8% [95% CI, 20.8-38.8%] greater than expected in 2016. In 2016, significant state-level findings included an increase in relative internet search rates for cannabis in states with higher usage rates of cannabis in the past month (Coeff (95% CI), 3.4 (2.8-4.0)) and past month illicit drug use except cannabis rates (Coeff (95% CI), 17.4 (9.8-25.0)). Relative internet search rates for cannabis from 2008 to 2019 were also associated with increased cannabis usage in the past month (Coeff (95% CI), 3.1 (2.5-3.7)). States with higher access to legal cannabis were associated with higher relative internet search volumes for cannabis (Coeff (95% CI), 0.31 (0.15-0.46)). Of the five additional policies that were searched as topics, only two showed an increase in internet search interest during each Presidential Election. Climate Change increased by 3.5% [95% CI, - 13-20%] in 2012 and 20.1% [95% CI, 0-40%] in 2016 while Global Warming increased by 1.1% [95% CI, - 19-21%] in 2012 and 4.6% [95% CI, - 6-15%] in 2016. CONCLUSION: Based on these results, we expect public interest in cannabis will spike prior to the Presidential election in 2020. Of the five selected control policies, only two showed an increase in internet search interest during both Presidential Elections and neither exceeded the internet search increase of cannabis. These results may indicate the growing awareness of cannabis in the US and mark a possible target for the timely dissemination of evidence-based information regarding cannabis and its usage/side-effects during future elections. Consequently, the results of this study may be important to physicians since they will likely receive an increased volume of questions relating to cannabis and its therapeutic uses during election season from interested patients. We recommend establishing a cannabis repository of evidence-based information, providing physician education, and a dosing guide be created to enable physicians to provide high quality care around the issue of cannabis.