FDA Increases Rules for Opioid Prescribing to Cut Down on Abuse

September 16, 2013September 27, 2016 / Thomas Cohn, MD

The FDA recently decided to tighten the labeling requirements for opioid medications. Over the past decade, opioid medications have become increasingly prescribed for pain conditions. Unfortunately, these medications have also become highly abused in the US. From multiple fronts, there has been a push to control the use of opioids and improve their safety.

A Brief History of Opioids

Opioids are strong analgesic medications used for a variety of pain control situations. Initially, they were used to treat short-term, acute pain related to surgery, injury, and illness. Eventually, opioids also became a pain relief option for terminal illnesses such as cancer. As pain became a concern in quality of life, and considered a “fifth” vital sign, opioid medication prescriptions blossomed. As opioid popularity increased, opioid prescription abuse also swelled. Now both the FDA and DEA are working to stem abuse and improve the appropriateness of prescribing by physicians.

Opioid Abuse and Pain Management

Pain is extremely challenging to manage and treat. The complexity of pain has spawned it’s own medical specialty – Pain Management. Twenty years ago, finding a physician who knew anything about pain management was a rarity. Currently, there are some pain specialists, but still very few board certified specialists in the US. Medical school training programs still do not have formal pain education, and most medical residencies have no pain medicine training or experience at all. Pain fellowships train only a small number of physicians yearly.

Pain management is complex, requiring specialized knowledge, and the ability to find a variety of solutions for difficult problems. Opioid medications have been easy to prescribe and often a simple solution to a variety of pain problems. The FDA is trying to change the wave of opioid use through changing the labeling of medications, warning physicians and patients that these drugs may be dangerous. Unfortunately, this is likely to be an overly simplistic solution to a complex problem.

A Better Solution to Opioid Abuse

Improving opioid prescribing is important, but the better starting point may be improving the understanding of pain by doctors as well as patients. Doctors need more training, starting in medical school and progressing throughout residency and practice. Patients would also benefit from the help of physicians trained and specializing in pain medicine. Pain is complex and opioids are only a small part of a solution. It will take multiple efforts to decrease opioid abuse, and improve appropriate prescribing. The FDA is starting the effort, but it will require concerted effort by doctors and the medical community to increase knowledge of opioid use and its potential dangers.

Do Women Feel More Pain than Men?

September 11, 2013September 27, 2016 / Thomas Cohn, MD

Over the past few years, some studies have contended that women report more pain intensity than men. But there is no definitive answer to the question of whether or not women feel more pain than men.

Women may report more pain than men, but women are also generally more likely to go to the doctor for medical problems. For many men there is a stigma attached to seeing a doctor for pain – many would prefer to “tough it out.” One of the most common reasons people go to the doctor is pain. Since women tend to report their problems more than men, it’s easy to assert that women feel more pain than men.

Everyone Feels Pain Differently

However, this connection may be correlation, not causation. In practice, pain is very subjective, and every person describes his or her pain differently. By definition, pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The regions of the brain responsible for perception of pain are right next to critical emotional areas of the brain. For any painful condition, every person will report a different experience. As a result, it is impossible to compare men to women in their perception of pain.

To make sense of this oft-debated topic, we can make a few general statements about men, women, and how they feel pain:

Women go to the doctor more often than men,
Women tend to report their emotions more readily than men.

Since pain is subjective, each situation is unique and different and cannot be compared. Some people tend to hide their pain and emotions, while others want everyone to know their problems.

Do Men Feel More Pain than Women?

While some believe women feel more pain than men, others assert that women are much tougher than men, since no man has ever given birth. Again, the truth is that some people are tough and just grin and bear it while others scream every time they stub a toe. Men may be slightly more stoic at times, but once they have pain, they are usually no different than women.

Managing Foot and Ankle Pain After Surgery

September 9, 2013September 27, 2016 / Thomas Cohn, MD

Foot and ankle surgery is common for deformities such as fractures and sprains. Pain is an unavoidable part of surgery recovery. That being said, there are methods you can use to manage the pain. Understanding the significance of the pain, the cause, and the severity is the key to correct management.

Injuries to the ankle and foot, as well as any resulting surgery, causes acute pain that can be directly correlated to the damaged structured. After surgery, pain is related to damage and inflammation of tissues. As structures heal, the pain will resolve quickly.

Pain from Foot & Ankle Surgery

Surgery for the foot and ankle is similar to an injury – it causes damage to tissue but it is done to correct an abnormality in order to reduce problems in the future. Pain related to surgery is from the incisions and tissue manipulation, which stimulates the sensory nerves and inflammation. Post surgery, treating pain with anti-inflammatory medications along with analgesics is often necessary.

Pain is normal, but should be easy to control and will dissipate as healing progresses. Icing for the first 2 days after surgery and keeping the foot elevated keeps the inflammation, swelling, and pain under control. The most important thing to do post-surgery is to follow the doctor recommended activity restrictions. This will improve your recovery speed.

Hypersensitivity and CRPS

Damage to the foot and ankle in about 5% of cases can cause severe, abnormal pain with hypersensitivity. When this occurs, special pain management is necessary. Sympathetic hypersensitivity, know as Complex Regional Pain Syndrome (CRPS – “crips”) causes severe extremity pain and despite normal treatment, it still hurts.

This condition requires a high level of intervention with medications, special therapy, and nerve blocks before and after any surgery and recovery requires the skills of an experienced team of an orthopedic surgeon and a pain management specialist. Many physicians “give up” when they see these issues with ankle and foot injuries, but when treated aggressively and correctly, these injuries can be significantly corrected. Having the best team to treat foot and ankle issues reduces or eliminates long-term problems.

4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.