The Benefits and Drawbacks Of Extended Release Opioids

July 29, 2019 / Thomas Cohn, MD

We are always looking for new ways to make painkillers safer for those individuals who suffer from acute or chronic pain conditions, and one such improvement was the shift to extended release opioids. These types of pills were promoted as safer than traditional opioids, and while they are in some aspects, they are far from a perfect solution. In today’s blog, we take a closer look at the benefits and drawbacks of extended release painkillers.

Extended Release Painkiller Benefits and Drawbacks

Here’s a look at some of the benefits of extended release painkillers, as well as some reasons why these benefits may not be a perfect solution to the problem.

Abuse Deterrent – Some painkillers were redesigned, making them harder to crush and snort. While this has been successful in preventing abuse of some opioids, it has led some abusers to try even more dangerous methods to get their quick fix, like in the form of injections with shared needles. Other types of abuse deterrent drugs actually were designed such that if they were crushed, the active ingredient would fail and the user would not be able to experience the drug’s effects, which helped prevent abuse.

Overdose Deterrent – Extended release formulas of some opioids mean that the individual taking the medication gets a mild amount of the drug over an extended period of time, as opposed to a quicker feeling of pain relief that patients might feel with normal formulas of the drug. This also means patients may need less of the drug because it provides longer and consistent relief instead of a stronger relief that fades over time. That being said, some people may be expecting quicker pain relief, and when they don’t achieve that soon after taking the pill, they could end up taking additional pills to quell their pain. This can lead to an increased likelihood of abuse, addiction or accidental overdose.

Easy To Find – Many companies were forced to invest in developing abuse-deterrent versions of their drugs, so there are a number of different ER opioid options. However, since companies needed to invest more time and money into developing these drugs, they are often more costly than the normal pills. Many patients don’t want to spend more on painkillers than they need to, meaning many opt against the extended release options.

Effective – The good news is that for many patients, ER opioids are effective at helping them manage pain. One thing many pain sufferers want is consistency, and a consistent, long-release drug can do all that. This can help them plan their day, including when they need to take the pills in order to participate in physical therapy or other active treatment options. The only issue is, like any drug taken over a long period of time, the body gets used to the drug and a higher dose is needed to achieve the same level of relief. ER opioids are great in the short-term when working towards a longer recovery goal, but like any opioid, should not be viewed as a long term solution if at all possible.

Relearning How To Sleep With Chronic Pain

July 22, 2019 / Thomas Cohn, MD

Chronic pain can make daily tasks seem impossible, and one of the most common areas of your life affected by chronic pain is your ability to fall asleep and stay asleep. For many people, they need to relearn how to achieve quality sleep because it no longer comes naturally thanks to their pain condition. In today’s blog, we share some tips for relearning how to get restful sleep, because quality sleep plays an important role in controlling chronic pain.

Getting A Good Night’s Sleep With Chronic Pain

Here are some tips for falling asleep and staying asleep if you deal with a chronic pain condition.

1. Regular Bed Time – Get in the habit of going to bed around the same time every night. You body has what’s known as a circadian rhythm that helps regulate awake and tired periods for your body, and if you get up and go to bed around the same time, this will help you body find a good circadian rhythm. Even if you struggle to fall asleep right away, going to bed and laying down around the same time at night will help your internal body clock.

2. Lose The Distractions – The bedroom needs to be a place for sleeping, not for reading on your iPad or clicking around on Netflix. Research has shown that the bright lights of screens in dark rooms can stimulate our brain at a time when we want to be winding down. Read or watch TV out in the living room so that the bedroom becomes a place where you focus on achieving quality sleep.

3. Avoid Caffeine and Alcohol – In the hours before bed, avoid certain liquids that can inhibit restful sleep, like caffeine and alcohol. Even though alcohol may help you fall asleep, it disrupts your ability to achieve REM sleep, the deep and quality type of sleep you need to receive. Avoid these liquids as the sun begins to set.

4. Water Intake – If you’re looking for something to drink, go with water, but make sure you’re cognizant about your water intake. If you’re even slightly dehydrated when you go to bed, it can cause your mouth and nasal passages to become dry and lead to disruptive snoring. However, drinking too much water can lead to the need to get up and go to the bathroom in the middle of the night. Play around with your water intake in the hours leading up to bed so you are hydrated when you crawl into bed.

5. Temperature and Noise – Finally, the key to quality sleep is to stay asleep once you’re out. You don’t have a lot of control over this, but you can help by ensuring your bedroom has the right temperature and noise level. Keep the room cool and use blankets to get comfortable, and find out if noise helps or hinders your ability to fall asleep. Some people like white noise machines, others like the drum of a fan, while others need complete silence. See what helps you fall asleep and stay asleep, and then recreate those conditions each night.

For more tips on falling asleep if you have chronic pain, or for help with your specific pain condition, reach out to Dr. Cohn’s office today.

Tips For Managing Chronic Pain During The Summer

July 2, 2019 / Thomas Cohn, MD

The summer should be one of the most enjoyable times of the year in Minnesota, but for many people who deal with chronic pain, the summer heat can make their condition worse. So how can you not only survive, but thrive, during the summer months if you have chronic pain? Consider this blog your playbook to managing your pain condition this summer.

Handling Chronic Pain in the Heat

Here are a number of ways to fight back against your chronic pain condition during the summer:

Exercise During Non-Peak Hours – As we talk about on this blog all the time, exercise is very important to help strengthen key structures and treat chronic pain conditions. However, if you’re exercising when it’s hottest out, it can trigger a flareup or lead to a less than successful exercise session. Wake up early or exercise when the sun goes down to avoid the heat.

Dress For What’s Ahead – Becoming overheated can trigger a pain flareup or make your CRPS worse, so look ahead at the weather and plan accordingly. Wear appropriate clothes for the day and try to be inside when it’s supposed to be the hottest to avoid problems with your pain condition.

Swim – Swimming is one of our favorite exercises during the summer, because not only does it get the heart pumping and strengthen supportive muscle groups, but it also helps to keep you cool. On days when you don’t want to do a traditional workout outdoors, head to the community pool or a nearby lake to do some swimming. If you want help developing a water-based exercise routine to treat your pain condition, reach out to our office today.

Stay Hydrated – Pain conditions can also trigger if you’re dehydrated, as can other problems like an increased risk of muscle strains and sprains. Make sure you bring water if you’re going to be outside for long periods or if you’re going to be sweating.

Stay Inside – Finally, if you don’t have to go outside and take on the heat, stay inside where it’s cool. Do your workout inside where it’s cool, or go for a run indoors on your treadmill. It’s important to stay active even when indoors to help keep healthy blood pumping throughout your body, but don’t go out in the heat if you know it’s going to cause problems for your pain condition.

If you follow these tips, we’re confident that you’ll be able to take control of your pain condition even in these hot months. And if you need additional assistance with any aspect of your pain condition, reach out to Dr. Cohn’s office today.

Could This Be The Next Big Thing In Pain Management?

June 10, 2019June 10, 2019 / Thomas Cohn, MD

Last Sunday in the science section of the newspaper there was an article about research on a new pain drug. The scientists behind the drug are convinced they have the next great drug. The skeptic in me hopes but doubts it. The reason the news has not made the traditional rounds in in all the reputable medical sites that spread news of discoveries. Furthermore, the work to date is only in animals and there has not been definite evidence this will transfer to humans.

The article discusses the work of Dr. Bruce Hammock, an entomologist at University of California-Davis. In the 1970’s he was working on an enzyme that converted a corn ear-worm to an insect. Removing the enzyme essentially killed the insect before it converted to the moth and was able to breed. Overall this was not found to be a cost effective strategy for this insect to be controlled. Since that part of his work did not pan out, he started looking for how the enzyme or related enzymes might occur in other species. especially humans.

Eventually Dr. Hammock found these compounds in humans and they supposedly reduce pain. Of note, he does not specify what these compounds are, but only says they are chemically broken down rapidly in the body naturally. He then found a way to keep them from being broken down in the body as quickly. Dr. Hammock believes this compound can somehow help relieve pain.

Believe It When We See It

The reason to be skeptic is that naturally this compound that reduces the intensity of pain is very transient in the body by the description given. This makes me believe it is likely easily broken down by chemicals in the body and is in a very limited location. This type of compound is very hard to deliver conveniently (like a pill) into the body and be absorbed. It is also likely to be easily broken down no matter what one does. Lastly, the chemical sounds like it may be something that exists in the nervous system, and thus isolated by something like the blood-brain barrier.

The researchers behind this new novel compound are just looking at starting human trials. So far there has been little funding toward the research from what has been said in the regular press. Further, as noted earlier there is no information in the extensive research pain literature on the animal-level studies discussing this compound. If the research was really promising, more money would be involved without question since pain treatment is a billion dollar industry with huge potentials.

The bottom line is that there is research going on in the field of pain medicine trying to develop new treatments and medications. However, whether any of the current research will lead to new drugs is difficult to guess. A lot of treatments have been proposed but most die as they are tested. Human studies usually take between five and 10 years to complete. Only time will tell if this research will ever lead to a new drug that is useful to treat pain.

Work Can Be Exercise

June 3, 2019 / Thomas Cohn, MD

Adding an exercise to a busy person’s life is sometimes difficult. Many people claim that their daily activities give them enough exercise to stay healthy, and in some cases this may be true. Physicians are beginning to recognize that what we do as part of our regular routines may count as exercise. For meeting the goal of aerobic conditioning, the movement we do routinely is helpful.

Aerobic conditioning is one component of exercise. Any activity that increases the heart rate and increases the body’s use of energy is good. A term given to this is “non-exercise activity thermogenesis,” or NEAT. It is also the exertion of daily living for many people. People who are up on their feet and walking all day are performing exercise. Among the professions that are known to have high levels of activities include waitresses, preschool teachers, maintenance workers, and mail carriers that have walking routes. Monitoring step counts on these people, they often have well over 10,000 daily steps.

Daily Activities and Physical Fitness

Regular activities of daily living can also be helpful in aerobic conditioning. During the summer, cutting the lawn and performing yard work keeps many busy for hours on end and adds 5,000-10,000 steps to a day’s routine. Doing household chores such as cleaning, laundry, vacuuming and doing dishes all require standing and motion. When shopping, park a little further away from the nearest door and walk the extra distance. To make it worthwhile, track how much you actually do with a fitness tracker. Good fitness bands that track heart rate and steps are now less than $100, and almost every smart phone has a built-in step counter that can be activated.

If you have chronic pain, aerobic conditioning is just one aspect of needed exercise. Conditioning maintains cardiac health, improves endurance and the ability to perform activity, and increases the body’s own painkilling compounds known as endorphins. However, most with chronic pain need to do more than just conditioning and need to also do routine stretching and strengthening. Physical fitness for everyone requires the combination of the above three routines. “NEAT” is a great way to meet the conditioning component of fitness. Developing a routine to meet stretching and strengthening goals to maintain function and decrease pain can be the focus of time spent exercising beyond aerobic activities.