Opioids and the Pain Recovery Process

Pain stagesPatients who deal with pain can be stratified into a three general categories: acute, sub-acute and chronic in terms of the length of symptoms. This is not an absolute, but a general system. Acute pain is the time immediately associated with an injury or surgery and during the first three months of treatment. Sub-acute is the period of time roughly three to six months after the initial injury. The most difficult time is the chronic period after six months when injuries may be permanent and long-term strategies will need to be determined. Determining treatment options during each period is challenging.

Acute Pain

The acute pain phase is hopefully the only time a person will have problems. It is the period right after injury or surgery, and for most people this is a very short period of time, lasting several days to a week. Many people are able to pass through this period with minimal problems and are on to healing and recovery without the use of any significant medications. With more major problems, symptoms are more prolonged, and more extensive use of treatments are necessary from therapy or long-term medications. Furthermore, everybody has a different need for management and finding the correct strategy may be quite complex.

This also is a period where a person with a tendency toward addiction psychologically or physically can develop a problem. Up to 15-20 percent of the population may be at risk for addiction to opioids. For those people, even within a few doses, the brain starts abnormally seeking the dopamine release stimulated by these drugs. The injury may heal, but the brain continues to desire opioids. This is one of the main times when people develop addiction and start a downward spiral. It is extremely difficult to predict who will develop an addiction and that is the reason for medical practitioners to try to limit exposure. The crisis in drug abuse has pushed the need to reduce the exposure and risk for everyone.

Sub-Acute Pain

The sub-acute phase of pain management is the period of time between three and six months after a medical problem. A management strategy needs to be developed at this point to determine what the diagnosis and prognosis is for the condition. At this point, a specialist is often appropriate so that the best strategy can be determined. Finding the correct person to treat a problem that is not resolving is often the most difficult issue. Physicians are often lacking knowledge and experience to solve the more difficult medical problems.

Fortunately, 90 percent of physicians can guide you through the medical maze. If you are one of those with a particularly difficult problem, you will need one of the best physicians in that field. These physicians are often not in prestigious places like universities or major medical centers, but are the hardworking private practitioners. They often have been in practice for a number of years and they have enough experience to determine what is the best path forward for the complex issues and are not constrained by a single strategy. During this time, hopefully a patient can be transitioned away from opioid-type medications and toward a comprehensive strategy.

Chronic Pain

The last phase is when a problem turns chronic. That time period is after six months. Sometimes, if the initial treatment has not been successful, this is the period when a skilled physician needs to be found to fully diagnose the issues and develop a new strategy. These skilled experts can clarify and define issues others have not seen. They are also the ones who will act as a guide through the maze of medical issues and not give up. If you listen and work with them, it is likely that a positive outcome will be achieved.

Chronic pain problems may or may not be well served with opioid medications. There are far more down sides to these medications than positives. They may seem helpful, but often are treating the anxiety associated with pain more than the pain itself. Opioids increase the sensitivity in the nervous system to painful stimuli and suppress the body’s own pain fighting ability. Everyone will become tolerant to opioids and up to 20 percent of the population will develop an addiction. With over 140 deaths/day and over 60,000 deaths/year associated with opioid addiction, it is a very limited treatment option. Most pain physicians therefore are reluctant to use these medications and push every other option. If they are used, then strict compliance rules are mandated for safety. Break any of the established rules and the option disappears, possibly permanently. If these medications are maintaining high levels of function such as full-time gainful employment, then they may be reasonable.

If you use opioids either short-term or for a long span of time, expect strict rules. These drugs are notoriously dangerous, and they often have a narrow range of safe dosage. Any improper usage can lead a provider to stop prescribing. Addiction, death and damage to the patient or others are always a concern. Further, if there is a better treatment available, then prescribing opioids may be a poor choice for both the patient and prescriber.

If you are told this is not the best treatment for you, there is probably a good reason and you should try every other option offered. Often a person in pain has poor insight into their own behavior and listening to others is necessary. Pain can be extremely complex, and often there is no solution but only management options.  For chronic pain, sometimes one needs to look at your own situation and determine a different path to follow in life such that life can be more enjoyable.

Fibromyalgia – Not Just In Your Head

The problem with invisible illnesses like fibromyalgia or CRPS is that people who don’t understand the condition often think someone is faking the condition or making it up for attention. The fact of the matter is that these are real conditions that plague hundreds of thousands of individuals in the United States each and every day. Because symptoms come in waves and patients can have good days and bad days, outsiders think that symptom prevalence can arise or decrease at “convenient times.”

Let me tell you this – there is nothing “convenient” about these illnesses. Some of the strongest people I’ve seen carry around the weight of these invisible diseases every day. Nobody wants to be bothered by painful flare ups or joint discomfort. They want to be pain free, and oftentimes they’ve undergone countless different treatment options to no avail.

Understanding Fibromyalgia

In an effort to help more people understand these invisible illnesses, we’ve decided to share an infographic that helps to shine a light on one of the more common chronic conditions – Fibromyalgia. So take a couple of minutes and give the infographic a closer look, so the next time someone opens up about their pain, you’ll have a better understanding of what they might be going through.

The following infographic is from MBA-Healthcare-Management.com

fibromyalgia

More Findings On The Daith Piercing

daith piercing survey resultsAs you’re probably aware if you read this blog, we’ve been helping push patients who have undergone the Daith Piercing for headaches to Dr. Chris Blatchley’s website. Dr. Blatchley has been attempting to conduct one of the foremost studies on the Daith Piercing, and he recently completed his findings. You can see the full results from Version 1 of the study by clicking here. If that link is no longer working, head to his website and look for a link to the survey results.

Before we get into some of the findings in Version 1, Dr. Blatchley reached out to us to see if we could help direct people to take a second version of the Daith Piercing survey. This will again help us learn more about pain pathways and how the piercing may help some individuals with certain types of headaches and migraines. So if you haven’t yet taken the second version of the Daith Piecing Survey, please click here and consider taking a couple minutes to help advance our medical knowledge.

Daith Piercing Survey Results

As we mentioned above, you can take a closer look at the full report by clicking the above link, but here are some of the takeaways in bullet point form:

  • More than 1,250 individuals completed the survey.
  • 98.5 percent of survey respondents were women.
  • 90% had seen a family doctor and 40% a medical specialist. 44% had underwent a brain/MRI scan.
  • Roughly 80 percent of patients said they were either “Delighted” or “Very Happy” with the results from the Daith Piercing in terms of headache relief at measured intervals after receiving the piercing (first 30 days, 1-3 months, 4-6 months, etc.).
  • Only 2.6% of respondents said they were “Very Unhappy” with the piercing, with the most common reason why being that it did not provide them with headache relief.
  • Interestingly, the side the piercing was on was split almost right down the middle. 51 percent got the piercing in their right ear, while 49 percent got it in their left ear.
  • About 20 percent of respondents had both ears pierced with the Daith technique.
  • The majority of respondents reported a decrease in symptoms of headache frequency after undergoing the piercing, and many of these decreases occurred quickly after the piercing was administered.

For more information about the study, or to check out the results, I urge you to head over to Dr. Blatchley’s site. Hopefully Version 2 of the study will be as enlightening as the first version.

Minnesota Researching Opioid Alternatives

opioid abuse alternativesEven if you’re not a chronic pain sufferer, you’ve probably heard about the “opioid crisis” here in America. Overdoses and accidental deaths from pain medications have skyrocketed in recent years, and things are only getting more divisive as we try to put an end to overdoses. There are too many competing interests working against one another. For example:

  • You have a government officials who are supported by money from big pharma.
  • You have big pharma, who is making a lot of money through the increase in prescription medications.
  • You have some overworked doctors who jump right to pain pills instead of taking more time to find solutions.
  • You have some chronic pain patients who take the idea of opioid regulation as a personal offense.

That’s simply too many interests pulling in too many directions, and chronic pain patients are suffering because of it. However, Minnesota has recently taken some tangible steps to look for alternatives to opioids.

Opioid Alternatives

Earlier this month, leading medical minds met in St. Paul to talk about some alternatives to pain management to help combat the opioid epidemic. They discussed a range of possibilities, including such options as:

  • Electrotherapy
  • Radio-frequency ablation
  • Cryogenics
  • Implantable spinal cord stimulators
  • Epidural injections
  • Medical gadgetry
  • Chemical compisitions
  • Physical therapy techniques

The goal of the meeting was to help lawmakers understand that they have the ability to influence how research funding can be allocated for some of these alternatives, and that the future of these pain management techniques are worth exploring.

Dr. Clarence Shannon, an anesthesiologist who works in the University of Minnesota Pain Clinic in Minneapolis, spoke about the summit and how it’s important to test out potential treatment options before jumping to opioids.

“It’s a stair-step approach that I like to use: nonsteroidals, anti-epileptics or neuropathic medications. We’ll try radio-frequency ablation if we can. We’ll do nerve blocks. And then we’ll move up to the things like the implantable devices,” Shannon said.

These alternatives aren’t perfect solutions, and while they do have some drawbacks, the downsides are much less threatening to a patient’s health than the negative consequences of opioids. Medical devices may cost more, may be more prone to malfunction and may require battery changes, but those downsides are worth it if they can protect us against opioid abuse and overdose.

A Good Start

The pain management summit was a good start, but we need to also focus on getting everybody on the same page. We need to the government to look at the bottom line in terms of lives saved and not dollars earned. We need to take the burden off doctors so they don’t feel the need to fall back on opioid prescriptions without first exhausting some other options. We need chronic pain patients to realize that searching for alternatives does not mean the government is going to come and take away their prescriptions that they are using responsibly to manage their pain.

We need to work together to find a solution, or we can’t expect anything to change. Hopefully Minnesota can be at the forefront of that change.

Chronic Pain Management When Soldiers Return Home

military painChronic pain is a widespread problem for millions of Americans, but it may be even more of an issue for our returning servicemen and veterans. According to a recent study, a survey of one of the Army’s leading units revealed that 44 percent of deployed soldiers suffered from chronic pain, and 15 percent reported regular use of opioids to manage the condition.

Even though soldiers have easier access to comprehensive medical care, these figures are much higher than expected. A survey of the general population suggests that an estimated 26 percent of Americans suffer from some chronic pain condition, while four percent actively use opioids to manage the condition. This means a service member is more than 1.5 times more likely to suffer from chronic pain than an average civilian, and nearly four times as likely to be taking opioids on a regular basis.

Chronic Pain and Military Members

Other findings from the chronic pain survey include:

  • 50 percent of male veterans and 75 percent of female veterans report that pain is the most common physical complaint.
  • More than 40 percent of returning service members with chronic pain also reported having PTSD or post-concussive symptoms.

One of the biggest obstacles facing veterans with pain or mental health issues is that they don’t want to ask for help. People don’t really like to ask for help in the first place, and when you combine it with the mentality of a soldier who is supposed to be tough and selfless, it often leads to situations where they believe asking for help is a sign of weakness, which it’s absolutely note. If you are suffering from chronic pain or you just feel like you haven’t been in a healthy frame of mind lately, reach out to Dr. Cohn or another healthcare provider for assistance.

Creating A Plan To Treat Chronic Pain In Soldiers

Here’s a look at the recommendations provided by the Pain Management Task Force for helping soldiers get the care and treatment they deserve.

  • Provide tools and infrastructure that support and encourage practice and research advancements in pain management.
  • Build a full spectrum of best practices for the continuum of acute and chronic pain, based on a foundation of best available evidence.
  • Focus on the warrior and family.
  • Synchronize a culture of pain awareness, education, and proactive intervention.

The last point is key. We need to focus on shifting the culture of pain awareness and treatment from one where chronic pain patients feel shamed or scared for seeking help towards one that encourages everyone to seek active treatment for their pain. If you need help, speak up.