Timberwolves Star Speaks Out In Favor Of Medical Marijuana

November 15, 2017 / Thomas Cohn, MD

Medical marijuana has been a hot topic on this blog and in the national news. Minnesota currently allows individuals to apply for a medical marijuana license if they meet a certain number of health characteristics set forth by the state. We’ve made our position about medical marijuana known on several occasions, but we’ll refresh it here briefly if you didn’t check out those other blogs.

We believe the medical marijuana is certainly an avenue worth pursing, but we need to learn more about the compounds inside marijuana before rushing it to the market. It’s certainly shown some promise, but if we want it to be truly effective, we need a better scientific understanding of each individual compound in different strains of marijuana. We should consider putting more money into researching and learning about the medicinal properties of marijuana.

Now, a high profile athlete in Minnesota is speaking out in favor of medicinal marijuana. He may not be championing medical marijuana for chronic pain, but he has seen it work first hand.

Karl Anthony Towns Talks Medical Marijuana

Minnesota Timberwolves star Karl Anthony Towns recently spoke out in favor of removing marijuana from the listed of banned substances for NBA players, agreeing with a sentiment pushed by former NBA commissioner David Stern.

“I agree with David Stern with marijuana,” Towns told ESPN “You could use the [chemical] properties in it to make a lot of people better.”

NBA players deal with pain and discomfort on a regular basis throughout the season, and Towns believes marijuana could help some players deal with that discomfort.

“That’s something that Adam Silver has to do. That’s out of my control, but maybe legalizing marijuana. Not fully legal, where people are chimneys, but using [marijuana] as a beneficial factor as an athlete, as a person living daily.”

Towns has already seen how medical marijuana can be used to help certain individuals. His girlfriend’s nephew is autistic, and a medical dosage has helped the boy and the family with the condition.

“I’ve seen nothing but benefits for him,” Towns said. “And I’m very happy that he finds comfort. He finds that normalcy every day. Just like a father, a mother, a parent with a child, you’d do anything for your child.”

It sounds like Towns is in the same boat. He has seen the benefits of medicinal marijuana in his life, but he understands that simply legalizing it without researching the science behind the drug could lead to unintended consequences. We should be pouring more money into chronic pain research if we really are committed to helping people manage their pain.

Minnesota Getting $16.6 Million To Fight Opioid Epidemic

November 10, 2017 / Thomas Cohn, MD

Minnesota is set to receive $16.6 million in federal grants that will be given to foundations and organizations committed to fighting the opioid epidemic.

More than 30 different agencies will receive grants from the federal fund, and the goal is to reach and help more than 110,000 Minnesotans who are seeking treatment for opioid dependency. Most of the money will go to existing programs to launch new efforts or expand current efforts in combating the opioid crisis.

“These grants are designed to build on what we are doing,” said Minnesota Human Services Commissioner Emily Piper.

The Opioid Problem In Minnesota

According to health data, there were nearly 2,500 opioid-related overdoses last year, and 376 of those overdoses were fatal. There were more than 3.5 million prescriptions written for opioid painkillers in Minnesota in 2016.

The federal grant will go to a number of specific places and programs, including:

More widespread availability of naloxone, a key substance in helping save people who have overdosed on painkillers.
Expanding medication-assisted treatment.
Increasing aid and resources on American Indian reservations.
Adding opioid-specific care providers throughout the state.
Establishing a program to help unborn and newborn babies of mothers with opioid dependencies.

There has also been a push for more regulation at the national level from Minnesota lawmakers. A presidential opioid crisis commission recommended that President Trump support two bills proposal by Minnesota Senator Amy Klobuchar. The first would require more monitoring of drug prescriptions and the second would attempt to reduce the number of opioids that are being illegally distributed through the US mail system.

Combating Sleep Problems Associated With Chronic Pain

November 7, 2017 / Thomas Cohn, MD

Sleep for individuals with chronic pain is often a major struggle. Unfortunately, just like the cause of pain itself, it is a difficult and multifaceted problem with different issues contributing to sleep struggles. Pain and discomfort at night are the leading complaints, but often it is more complicated and usually not a simple issue to solve.

Underlying medical problems may also be contributing to sleep disturbances, and not addressing these may prevent adequate solutions. Addressing sleep problems often requires intervention from multiple specialists.

The Importance Of Sleep Hygiene

Sleep problems can range from simple to complex problems. Starting with the simple issues is always important. First is trying to discover what are the difficulties with sleep and what habits and patterns for sleep occur with a person. Sleep hygiene is one of the leading areas of problems. One of the most common problems is the consumption of caffeine or similar stimulants during the day. Most people are sensitive to caffeine, and it is found in many drinks, especially various sodas and teas. Drinking these after the lunch hour for many can affect sleep. The use of alcoholic beverages can also interrupt sleep, initially it may make one tired, but as it wears off, the body awakens and one may be running to the bathroom.

Sleep hygiene also includes the habits one has in the bedroom. Currently, the most common problem is screen time including computers, tablets, television and phones prior to sleep. Watching a screen tends to activate the brain and wake a person up, and the color spectrum produced with lots of blue light is also awakening. Turning off the all the screens one hour before bedtime is advised. The bedroom should be reserved for sleep. Doing work in bed and spending time in bed not sleeping gives the brain the wrong signals to stay awake. Lastly, most people sleep better in a cool room, being to warm leads to restlessness.

Your Mattress and Sleep

The most common question that is asked to me is should I get a new bed and what bed should I get? Anyone who has shopped for a bed knows this is an expansive proposition. Before buying a new bed, try to get everything right in the bedroom first, from the room temperature to the sleep hygiene. If the bed is old, first try a mattress topper with 3-4 inches of quality memory foam. A good topper is far cheaper then a full mattress and may be perfect solution. A new bed is only needed if your mattress is ancient and beyond salvage.

Since beds can be extremely expensive, start with determining your budget and then look at your options from memory foam mattresses to adjustable air bladder types like the Sleep Number bed. The mail order memory foam mattresses are often extremely affordable, comfortable and are reported to be a good quality. Everyone has a different preference for a bed, but if it is rock hard, it will not provide uniform body support and probably cause more pain. A bed that is too soft will probably also be uncomfortable and not provide adequate support to the body. The first recommendation would be try a memory foam type mattress for a new bed. If your budget is less constrained, the ability to change a bed’s hardness and support with an air bladder type bed is wonderful. Adjustable bed frames that can raise the head or feet is a further luxury.

The last issue with chronic pain and sleep is once you have optimized the sleep environment, what else can be done? The first concern is to see if there another medical concern preventing sleep. A sleep specialist often best evaluates these issues, and those who are neurologists often have the broadest understanding of all the issues. They can address problems from restless legs, sleep apnea to interrupted sleep by pain. They can be extremely helpful in determining the best medication routine for improving sleep. If a safe simple solution is not working, a sleep specialist is extremely important in determining the path forward.

Opioids and the Pain Recovery Process

October 30, 2017 / Thomas Cohn, MD

Patients 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.

Minnesota Researching Opioid Alternatives

October 19, 2017October 25, 2017 / Thomas Cohn, MD

Even 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.