These 10 Factors Linked To Increased Risk Of Opioid Overdose In Chronic Pain Patients

October 26, 2023 / Thomas Cohn, MD

Chronic pain patients who take opioids as part of their treatment plan always need to take steps to mitigate their risk of dependence or overdose, but that’s especially true for patients facing 10 specific factors, according to a new study out of Canada.

The study, published in the Canadian Medical Association Journal (CMAJ) and led by researchers at McMaster University, found that the risk of fatal and non-fatal opioid overdose by prescription medication increased up to sixfold in patients dealing with certain risk factors or predictors. To get a better understanding of some of the predictors of fatal and nonfatal overdoses in patients managing prescription medications, researchers looked at data from more than 24 million patients across Canada, the US and the United Kingdom. Researchers identified a total of 103 predictors, but 10 stood out from the rest because they showed a risk increase of two to six times compared to patients who didn’t have these factors.

According to the study, the 10 biggest predictors of fatal and nonfatal opioid overdose for patients taking prescription medication are:

High-dose opioids
Use of multiple pharmacies
Multiple opioid prescribers
Fentanyl prescription
Current substance use disorder
Depression
Bipolar disorder
Other mental illness
History of opioid overdose
Pancreatitis

The findings are important because they can help us map out chronic pain care and take different approaches in patients who may be considered high risk. For example, mental health screenings and questionnaires should absolutely become standard practice for patients dealing with a chronic pain condition. As we’ve said many times on the blog in the past, chronic pain is much more than just a physical issue. It also weighs heavily on your mind and your emotions, and if a doctor isn’t working to also control for these aspects, patients may end up depressed, anxious or facing other mental health issues that drastically increase their risk of overdose.

It’s also important that doctors work to provide a comprehensive treatment plan that involves more than just an opioid prescription. Opioids inherently become less effective as our body gets used to the medication, so patients may start to take larger doses to find the same level of relief. Needless to say, this greatly increases their risk of accidental overdose. Treatment tends to be more effective and patients can actually wean off opioids when they pursue other active techniques, like exercise, physical therapy, sleep improvements and better nutrition. Pain is rarely effectively managed through just one specific type of treatment, so find a provider who is willing to develop an individualized treatment plan to give you the best chance of overcoming your pain issue.

Whether you’re considered low-risk, high-risk or somewhere in between, we want to be your resource for overcoming a chronic pain condition. Nobody plans to become addicted to opioids, and it can happen to even the best of us, so be aware of the risk factors and connect with a provider who can help counter these potential predictors. For more information, or to set up an appointment with Dr. Cohn, give his office a call today at (952) 738-4580.

Preventing Common Causes Of Fibromyalgia Flareups

October 19, 2023 / Thomas Cohn, MD

Anyone who suffers from fibromyalgia knows just how disruptive a flareup can be. One minute you’re enjoying your day, the next you’re dealing with pain and fatigue. And while fibromyalgia can be a tricky condition to completely cure, you can significantly reduce the number of flareups you experience if you are aware of some of the most common fibromyalgia triggers.

Below, we take a look at some of the ways you can prevent fibromylagia flareups by addressing some of the most common triggers.

Common Fibromylagia Triggers And Prevention Tips

Here’s a look at some of the most common fibromylagia triggers, and some advice for keeping these triggers at bay.

Sleep Deprivation – Failing to get adequate healthy sleep can seriously increase your risk of a fibromyalgia flareup. Poor sleep has been clinically proven to increase our sensitivity to pain, make a person more susceptible to a flareup. Obviously the issue can be cyclical in nature, with poor sleep leading to fibro flareups, and flareups making it hard to attain restful sleep. Our best advice is to make your bedroom a dark and quiet environment free from light and technological distractions, and strive to go to bed and wake up around the same time in order to make it easier for your body to develop a healthy circadian rhythm.

Routine Irregularity – If your daily routine is regularly upended, it’s easier to become stressed, and stress is a major trigger for fibromyalgia. We’re not saying that you need to do the exact same things every single day to avoid stress triggers, but try to create a healthy sleep and meal schedule. Wake up, eat your meals and go to bed around the same time each day to help your body get in a healthy routine.

Poor Dietary Choices – Unhealthy food choices are oftentimes pro-inflammatory, and inflammation onset can trigger a fibromyalgia flareup. Try to get the bulk of your calories from fruits, vegetables, lean proteins and whole grains. Limit the fatty and sugary foods, as they can lead to reactions inside your body that cause a fibromyalgia flareup.

Stress – Stress is likely the most common cause of a fibromyalgia flareup, and that makes sense because we all experience stress each and every day. We deal with work pressure, social stressors and family drama, and all of that stress and anxiety can lead to muscle tension and a fibromyalgia flareup. Work to eliminate sources of stress from your life, and find healthy outlets to manage it when it manifests. Many people find that exercise, yoga, meditation or reading can help them find some inner balance and reduce feelings of stress.

Illness – People with fibromyalgia tend to have it worse when they get sick, because sickness triggers an inflammatory response within the body, and this inflammation can contribute to a fibromyalgia attack. There’s no way to completely avoid getting sick, but make it a point to develop some healthy habits. Eat a nutritious diet, wash your hands regularly and get your flu shot every year!

If you’re finding it difficult to mange your fibromyalgia flareups, don’t be afraid to lean on a professional for assistance. Dr. Cohn has helped countless patients reduce or eliminate their fibromyalgia flareups by giving them the individualized attention they need to cultivate a treatment program tailored to their individual needs. For more information, or to enlist his help, give his office a call today at (952) 738-4580.

Chronic Pain The Main Reason For Medical Marijuana In Minnesota

October 12, 2023 / Thomas Cohn, MD

Recreational marijuana became legal in Minnesota on August 1, but many patients with chronic pain were legally seeking out marijuana well before this year. That’s because Minnesota is one of many states that allows for the production, purchase and use of medicinal marijuana.

Medicinal marijuana has been recommended as a way to relieve symptoms in patients with a variety of conditions. From easing the symptoms of terminal cancer to providing relief for much less serious issues, medicinal marijuana is currently being pursued by tens of thousands of Minnesotans for their health condition. Recently, we learned that the most common reason why a person sought out medicinal marijuana in Minnesota was due to chronic pain.

“By far, chronic pain is what drives our program,” said David Rak, research manager for the Minnesota Department of Health’s Office of Medical Cannabis.

Medicinal Marijuana For Chronic Pain

According to Rak, nearly 60 percent of patients in Minnesota’s medicinal marijuana program cite chronic pain as their reason for enrollment. Currently, 24,270 of the program’s 41,183 participants are seeking treatment for chronic pain.

Researchers are still working to understand exactly why medical marijuana can help relieve symptoms in patients with chronic pain. However, because chronic pain is so unique to the individual, and because there are so many different types of marijuana, it’s not easy to pinpoint why some patients experience relief why others do not. Some researchers believe medicinal marijuana works by triggering the release of certain natural chemicals in the brain that can provide pain relief, while others suggest that medicinal marijuana can help to reduce inflammation and associated discomfort.

Others swear by the benefits of medicinal marijuana for another reason. As we’ve talked about on the blog in the past, healthy sleep is critical for working to overcome a pain condition, and many patients find that medicinal marijuana helps them fall asleep faster and achieve a more restful sleep.

“Sleep is really an important factor, actually,” said Rak. “If you’re sleeping better and you wake up rested, you’re more ready to start the day. You feel stronger.”

Others love that it has helped them transition away from potentially dangerous opioids. A study by the Department of Health found that 38 percent of patients with intractable pain who had been using marijuana for five months were able to reduce the amount of opioids they were taking as a result of their marijuana use. That same study also found that 42 percent reported a significant reduction in pain intensity after using medicinal marijuana.

So if you have chronic pain, should you consider enrolling in the state’s medical marijuana program, or should you just buy recreational weed and see if it offers the same benefits? For starters, you’ll want to talk with your pain management specialist before beginning either regimen. Odds are they will have some recommendations and additional treatments they’ll propose in conjunction with the medical marijuana program, like exercise or physical therapy.

If you do decide to move forward with marijuana, it’s probably best to go through the state’s medicinal marijuana program. Being enrolled allows your doctor to work with a dispensary pharmacist and decide on a type that will work well for your symptoms and not interfere with any other medications you’re taking. Medicinal marijuana products are also highly regulated and tested to ensure they have a specific amount of THC and CBD, something you may not get if you buy elsewhere. The program used to carry a $200 enrollment fee, but now it is free, although you’ll have to have your chronic pain condition certified by a professional like Dr. Cohn.

For more information about whether or not chronic pain could be a viable complimentary treatment for your chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

Millions Battling Chronic Pain And Concurrent Mental Health Condition

October 5, 2023 / Thomas Cohn, MD

New research from the University of Arizona Health Sciences and published in the journal PAIN found that nearly five million Americans experienced the co-occurrence of chronic pain and a mental health condition like anxiety or depression, leading to functional limitations in their daily life.

As we’ve mentioned on the blog in the past, it’s not uncommon for chronic pain and a mental health condition to develop alongside one another because chronic pain can have a significant effect on your physical, mental and emotional health. If you are forced to miss social events, your career aspirations are limited or you simply find it hard to pull yourself out of bed in the morning because of physical pain, your mental health will also take a hit. For some, that manifests in the form of anxiety or depression.

In a review of data from 31,997 people who participated in the National Health Interview Survey, researchers found that that roughly 38.1 million Americans are dealing with a chronic pain condition, 9.6 million are dealing with a diagnosed mental health condition, and 4.9 million are dealing with co-occurring chronic pain and a mental health condition. Additionally, adults with chronic pain were roughly five times more likely to report anxiety or depression compared to adults without chronic pain.

“The study’s findings highlight an underappreciated population and health care need – the interdependency between mental health and chronic pain,” said the paper’s lead author Jennifer S. De La Rosa, PhD, director of strategy for the University of Arizona Health Sciences Comprehensive Pain and Addiction Center, which funded the study. ”This work is so exciting because it offers the opportunity to use team-based interdisciplinary approaches to medicine, leveraging what is known across disciplines to meet the needs of these individuals.”

Chronic Pain And Mental Health Conditions

Other important findings from the study include:

Nearly 70 percent of people with co-occurring symptoms reported limitations at work.
More than 55 percent of people with co-occurring symptoms reported difficulty taking part in social events
Nearly 44 percent of people with co-occurring symptoms said they had difficulty running errands alone
Among all U.S. adults living with unremitted anxiety or depression, the majority (55.6%) are people who also have chronic pain.

This study only further emphasizes the idea that you can’t simply focus on treating the physical aspects of a chronic pain condition. Pain weighs heavy on your mind, and if you’re only focused on the physical pain, you may find that your mental health is suffering.

Even if you don’t believe your mental health has been affected by a chronic pain, you need to be aware that you’re at a higher risk of certain mental health disorders. You need to trust your care to a provider who will give you the comprehensive care you need to tackle all aspects of your chronic pain condition. Dr. Cohn and his team have done that for years for other patients, and we’d be more than happy to put our experience to work for you. For more information, or for help with a different chronic issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Effective Chronic Pain Treatment Starts With The Brain

September 28, 2023 / Thomas Cohn, MD

A new study published in JAMA Network Open suggests that targeting the brain and a person’s attitudes toward pain may be an effective method for treating chronic pain conditions.

More specifically, the study sought to influence a person’s pain attributions – which are their beliefs about the underlying causes of pain – to help reduce pain severity. For the study, a group of individuals with chronic pain underwent pain reprocessing therapy (PRT), which is a form of treatment that teaches people to perceive pain signals sent to the brain as less threatening. Researchers found that two thirds of people treated with PRT reported being pain-free or nearly pain-free after treatment. Only 20 percent of people in the placebo group said the same.

“Our study shows that discussing pain attributions with patients and helping them understand that pain is often ‘in the brain’ can help reduce it,”said the study’s first author Yoni Ashar, Ph.D., assistant professor of internal medicine at the University of Colorado Anschutz Medical Campus. “This study is critically important because patients’ pain attributions are often inaccurate. We found that very few people believed their brains had anything to do with their pain. This can be unhelpful and hurtful when it comes to planning for recovery since pain attributions guide major treatment decisions, such as whether to get surgery or psychological treatment.”

Pain And The Brain

Researchers concluded by saying that it is important for chronic pain patients to really try to better understand their pain and how their brain is processing pain signals. Prior to PRT treatment, only 10 percent of participants viewed their chronic pain issue as something that was due to a mind or brain process. After PRT therapy, that number increased to 51 percent. The study found that the more participants shifted to viewing their pain as due to mind or brain processes, the greater the reduction in reported chronic back pain intensity.

“These results show that shifting perspectives about the brain’s role in chronic pain can allow patients to experience better results and outcomes,” Ashar said.

This study touches on something we oftentimes convey with our patients, which is that pain isn’t just a physical issue. The brain-pain connection is real, and we oftentimes need to take a step back and reframe how we think about our pain condition in order to give ourselves the best chance to overcome it. It’s easier said than done, but it can be done.

If you want to learn more about your pain condition and the power of reframing how you think about pain, reach out to Dr. Cohn and his team today at (952) 738-4580.