Why Chronic Pain Patients Feel Targeted By Opioid Crackdowns

pain pill overdoseAs opioid overdoses continue to rise in the US, the government, lawmakers and medical personnel are all trying to figure out the best way to reduce these unnecessary deaths. Obviously restricting access to opioids would reduce the number of people who can get their hands on them, and in turn reduce overdose deaths, but it would also unfairly target people who need the pills. People like those suffering from chronic pain. So it’s understandable to see why when lawmakers propose strict rules for who can access these medications that chronic pain sufferers feel like they are being targeted and singled out.

It’s a tough balance to strike, and unfortunately it seems that as a nation we are more focused on what is easy and cheap instead of what will really address the root problem. Putting a band-aid over a large gash might stop some bleeding, but the wound won’t close correctly without stitches. Simply restricting access opioids and painkillers might stop some abusers from getting the pills, but it won’t solve the whole problem. We need to put some stitches in place.

Solving The Opioid Crisis

We’re not going to sit here and pretend we have all the answers for solving the problem of opioid addiction and overdose, but like we said above, simply restricting access is not going to solve the problem, and many innocent people who rely on those medications may no longer be able to access them. Instead, here are some steps that will help address the root problem.

1. Doctor Education – The vast majority of doctors understand that opioids do not address the root problem, but sometimes they are confused by a diagnosis or have seen other treatments fail and they fall back on them. Other doctors cut corners and prescribe pills freely and dangerously. We need to provide better understanding at the top level of how these drugs should be used, how to spot signs of abuse and how to ensure patients are safely taking their medications so that overdoses don’t occur.

2. Systemic Pressure – This problem will be harder to solve, but in many cases doctors are told to see as many patients as possible. If a doctor is feeling overwhelmed or rushed to see a number of patients, they can sometimes fall back on easy solutions like opioids. Doctors need to take their time with each and every patient and ensure they are giving them the best care possible. It’s possible the best care will involve opioids, but it should also involve therapy, exercise and regular abuse checks.

3. Patient Education – Patients also lack understanding of opioids and their abuse potential. Opioids are not a magic pill that will cure your pain, but they can provide temporary relief so other rehab techniques like exercise, swimming or physical therapy are more bearable. Opioids are a passive treatment, and they need to be paired with an active treatment option for best results. Patients also need to learn the warning signs of abuse for themselves and for loved ones who may have access to their pills.

4. Pill Technology – Medical researchers are looking into new abuse-deterrent opioids. They are creating pills that can’t be crushed or that become gooey if a user tries to extract the solution for injection. Other pills come in an extended release form and can’t be manipulated to give an elevated or intense high. More research into abuse deterrent options could prove useful.

Simply saying we need to restrict access to opioids will not solve the problem, and many chronic pain sufferers will be affected instead of those who are actually abusing the pills. That’s why so many patients feel targeted by these proposals. It won’t be easy to reverse this trend, but if we put in the time and money, it can be done.

Shared Reading Helpful For Chronic Pain Patients

Shared Reading Chronic PainNew research suggests that shared reading may help ease discomfort and provide cognitive benefits for individuals battling chronic pain.

Shared reading, as the researchers defined, was the act of of gathering with others and reading short stories, poetry or other literature out loud. Researchers said by reading literature that triggers memories of experiences throughout life, like happy childhood memories or relationships, patients can experience benefits similar to or that outweigh the effectiveness of cognitive behavioral therapy for chronic pain.

Shared Reading And Chronic Pain

There are hundreds of different treatment options for chronic pain, because chronic pain is unique to the individual. Some people experience pulsing pain in their lower back, others battle waves and waves of headaches, while others have nerve damage that sends pain signals to the brain when their is no painful stimulus present. What works for one person will not always work for another, and unfortunately that’s the problem that many pain sufferers are running in to. In turn, they are looking into alternative options, one of which is shared reading.

For their study, researchers compared the benefits of shared reading to cognitive behavioral therapy, which is a technique that aims to change the way people think and behave in order to better manage physical and mental issues related to chronic pain. To do this, patients with severe chronic pain were asked to participate in either five weeks of CBT or 22 weeks of shared reading. At the conclusion of the five weeks of CBT, individuals in that group joined the shared reading group for the remainder of the 22 weeks. The shared reading sessions incorporated literature that was designed to prompt memories of family, relationship, work experiences or other happy memories throughout their lifetime. Participants were required to report their pain severity and emotions before and after each session, and they were asked to record their pain and emotions twice a day in a personal journal.

Study Results

At the end of the study, researchers wrote:

  • While CBT helped to manage a person’s emotions, shared reading appeared to help patients address the painful emotions that might be contributing to chronic pain.
  • Pain severity and mood improved for up to two days after shared reading sessions.

“Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” researchers wrote. “The encouragement of greater confrontation and tolerance of emotional difficulty that sharing reading provides makes it valuable as a longer-term follow-up or adjunct to CBT’s concentration on short-term management of emotion.”

Researchers want to conduct future studies with larger sample sizes, but it’s an interesting approach to treating chronic pain. We’ll certainly keep tabs on shared reading as a potential treatment option.

Would Mandatory Opioid Registry Checks Solve Painkiller Abuse?

Mandatory Opioid ChecksThe Minnesota legislature has a proposed law to make checking the Minnesota Prescription Monitoring Program database (PMP) mandatory prior to prescribing any opioid medication. The purpose of the law is to help identify people abusing medications and to prevent the explosion of overdose-related deaths.

Unfortunately, this is another oversimplification of the opioid problem in our country. Abuse of opioids is a very real problem. The solution is much more complex then checking a database for the number of prescriptions being taken. Mandating this step will only have a very minor effect on the problem of opioid abuse.

Opioids Abuse And The Database

Opioid abuse is a very complex problem. There are many people who have very difficult to treat pain problems that are dependent on these medications, and they take them on a very reliable basis without abuse. Currently, most pain physicians, including my practice, have a variety of steps they take to reduce the potential for abuse. One of the easiest is to look at the PMP database. We sometimes find abnormalities of behavior there, but it is not that common. Most often we find the patient is using both an opioid and a drug for anxiety that can cause a significant interaction. Then we need to advise a patient on these issues.

Other steps taken include a comprehensive medical exam for appropriate problems to be treated and finding alternative treatment plans. Believe it or not, the worst problem is obtaining insurance company approval for more expensive options with better outcomes and less risks to the patient. Other steps taken include drug testing, checking state criminal databases and evaluating psychological stability before prescribing. For those wondering, our practice does check the PMP for everyone for each refill.

Mandatory Checks?

Mandatory checking of the PMP does not significantly help solve the opioid abuse problem. It is only a feel good step for politicians to say they are doing something. The problem runs much deeper. First off, a lot of people who are abusing opioids should probably never have been placed on the medication. The next step is that they should not be on them for any length of time – they may be okay for a very acute problem – but then they need to be stopped. Addiction is a medical condition. It is tough to treat and programs to help with addiction need funding and staff, and this needs to be promoted.

If the legislature wants to have a positive role in the addiction crisis, then they should be mandating insurance coverage for alternative treatments for pain besides opioids. Alternative treatments include everything from prolonged physical therapy, massage, chiropractic, and different medications, to comprehensive pain programs and implantable pain control devices. Obtaining insurance approval, especially from Medicaid or Medicare, is time consuming and often almost impossible. Physicians are extremely frustrated by the obstacles put up by insurance companies when better and cheaper alternatives are routinely denied in managing pain.

The last difficulty in understanding pain and the opioid crisis goes beyond the problems of addiction. Pain is extremely complex and one of the main tools to control symptoms is opioid medication. This is the same tool we have used for over 150 years. A third of the world population struggles with pain problems. Virtually no dedicated funding goes to research on pain compared to other medical problems. Our knowledge level in regards to pain as a disease is at the level where cancer was in about 1950. If the world wants to tackle the problem of opioid abuse, it really needs to fund research on all aspects of pain to solve the issues suffered by a third of the world population.

CRPS – The Pain Is Real

Complex Regional Pain SyndromeRecent findings suggest that individuals with complex regional pain syndrome deal with a great amount of pain during every day activities. According to some pain scale rankings, CRPS ranks higher on the pain scale than childbirth, cancer and even amputation.

For those of you unaware of what complex regional pain syndrome is, CRPS is categorized as a chronic condition that typically affects one limb, usually arising out of a trauma. CRPS involves a disruption in the way sensory signals are processed and deciphered along the central nervous system, leading to extreme pain even when no traumatic experience is happening. Actions like putting on your socks or brushing against a door frame can trigger inflammation and painful sensory signals.

Treating CRPS

According to the National Institutes of Health, CRPS typically affects women, and the average age of a CRPS sufferer is 40 years old. The issue with CRPS is that since it involves a communication breakdown in the central nervous system, it can be extremely hard to diagnose correctly. One report suggests that the average CRPS sufferer searched for answers for four years before receiving the appropriate diagnosis. Part of the problem is medical oversight, but this is due in large part to it being such a rare condition, and the fact that research dollars are being spent elsewhere.

So how do we work to treat and prevent this problematic condition? For starters, education is key. That’s the main reason we shared a large infographic about CRPS on the blog earlier this week. Both patients and healthcare providers need to be aware of the problem of CRPS. It can be treated and managed, but only with an accurate diagnosis. People should not have to wait four years to get to the bottom of their health problem.

Funding For CRPS

We also need to be spending more research dollars on understanding chronic conditions. Chronic pain affects roughly 30 percent of Americans, and the toll it takes on the healthcare system as a whole is billions of dollars, yet funding to better understand the condition and help those who suffer day in and day out continues to be lacking.

St. Paul CRPS Pain Doctor

If you’re dealing with chronic pain, and you’re struggling to get answers about your condition, set up a consultation with a Minnesota Pain Specialist. We won’t stop until we get to the bottom of your condition, because our goal is to help you live a pain-free life. Contact us today for more information.

Pain, The Brain, and the Emotional Link Between The Two

Pain in the Brain and Emotional LinkThe definition of pain is always worth remembering, especially when one spends their days trying to treat this vexing problem. For the record, by the International Association for the Study of Pain, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The take home message is that pain is always subjective. Pain is always considered unpleasant and therefore is also an emotional experience. The definition purposely avoids tying pain to a noxious stimuli and activity of sensory receptors for nocioception. Pain is always a psychological state.

As a specialist in medicine, learning is never done. Several weeks ago, I was again at a major national meeting. This time it was for the annual meeting for Physical Medicine and Rehabilitation, which brings together practitioners in this specialty from around the world. This is my specialty, and practitioners in this discipline have an extremely broad range of practice. One of the few common threads is we tend to treat people who have had some sort of “injury” to their body, and our goal is to restore function. Pain and the comprehensive management of the problems associated with it are always a major topic.

The Brain and The Emotional Pain Link

Pain is so complex because it is an event that occurs in the brain. If a patient is complaining of pain, one always is trying to determine what are the associated emotional components. When the symptoms have not resolved quickly with management, then the emotional components often become more important than the actual stimuli that are occurring. By the time a patient is seen by a pain specialist, the emotional components of pain are often some of the most important to treat to solve the overall problems. The hardest thing for most patients to understand is that pain is an emotional experience, and if pain is ongoing, many patients become anxious about the pain and depressed. Furthermore, if depression, anxiety, or personality issues are pre-existing conditions to pain, then treating the psychological problems often become a necessity to successfully treat pain.

In the brain, the regions that are responsible for interpretation of pain are actually in the same area as those for anxiety, stress, and sensations associated with depression. If there are a lot of signals for pain, they can secondarily stimulate stress, anxiety and depression regions. If there is significant anxiety and depression, pain often becomes intolerable. Pain and the associated emotional problems often appear inseparable. Further, many feel that if someone wants to treat the emotional aspects of pain, then it must not be real and its all in their own heads.

If the patient has ongoing issues with anxiety, stress and depression, the body interprets emotional pain as physical symptoms. Treating the peripheral issues often provides no relief of pain because there is still an emotional experience occurring. Both the patient and the physician become frustrated since the experience of pain is so complex with multiple levels of meaning. Further, addressing psychological issues that may have existed for years is often more daunting then treating a simple structural issue that caused noxious stimuli, but once the two start interacting, often they become inseparable.

Pain is an emotional experience. Treating both the emotional aspects of pain, the stress, anxiety and depression often is the only way to improve the function of a person. Having a patient recognize the importance of the emotional aspects of pain and start addressing these issues can be miraculous in successful pain management. Often the toughest discussions with a patient are how pain affects a person emotionally and the quality of their life. Recognizing stress, anxiety and depression is often equally important in effectively treating other body symptoms.