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.

The Landscape of Addiction in 2017

addiction opioidsOne of my favorite activities is reading. I read a wide variety of things, some of the most interesting things come from magazines that are not medical. Time magazine regularly has interesting stories of health.  Science, a bi-weekly publication, routinely has articles on a wide range of subjects that challenge the core of what one thought was fact. National Geographic regularly throws in medical stories. A couple years ago they had a great summary on marijuana, and recently now they had a great article on addiction. Medical journals are often a somewhat dry and boring read, but they do allow one to keep up-to-date with current research. Sometimes these other magazines have extremely valuable information as well.

The September 2017 National Geographic lead story is on The Science of Addiction. The problem is more than just opioids, it is a vast variety of problems from smoking to gambling and including all kinds of drugs. Addiction is a very complex process in the brain, and is definitely a disease and not a moral failing. Different types of addictions may affect a variety of brain regions. The processes involve disruptions in pathways responsible for learning, emotion, desire, regulation, and cognition among many neural events. It can change chemical, hormonal, and electrical paths in the brain. Addiction becomes abnormal learning in the brain with the reward being the addictive activity.

Addiction And Our Brains

All addiction has its roots in the primitive regions of the brain. They have to do with our need to survive, and they all involve our senses like sight, smell and taste. Critical in addiction is the neurotransmitter dopamine and that stimulates brain motivation. Those lacking dopamine often are depressed. Further, Parkinson’s disease has a lack of dopamine, and when given to some patients, it causes problems with an addiction like gambling. When something is addictive, it stimulates the dopamine pathways in the brain and is a very positive reward. The dopamine reward is so strong in the brain, people lose the control of impulses and the ability to inhibit behavior even if it is self-destructive.  

Since there are many things that are now considered true addictions, it is likely there are many different strategies to treat them. For drugs, often there are medications that can block the pleasure from the drug and prevent withdrawals. For alcohol, there are drugs that make drinking nauseating. There are also numerous counseling strategies and psychological-type interventions to deal with the behavioral components of addiction. There are also some new novel strategies including electrical and magnetic stimulation of specific areas of the brain to treat addiction.

The problem of drug addiction or any type of addictive behavior is caused by abnormal function and rewards in the brain. Pain and the problems associated with the medications taken can cause addiction, but this isn’t always the case. Taking opioid medications does lead to dependence and tolerance of the drugs that cause them to lose effectiveness. Opioids can also change a person’s sensitivity to pain and make a person perceive pain sensations more intensively. Therefore, in general, opioid medications have many downsides.

Lastly, opioids can be addictive and cause typical addiction issues in pain patients, but it is in only in a small percentage, somewhere between 5-20%. In most chronic pain patients, addiction and problems with opioids are generally not a typical problem. Treatment in pain patients is the same as with any other person who has opioid problems, and is often best handled by a pain care specialist.  If you are a pain patient on opioids, and taking your medication has become the focus of your life, then it is probably time for one to be treated for addiction and be off of these medications.

A Doctor Who Understands Your Pain

spine pain cohnI have been known to preach a little about the work it takes to control pain. It is not about taking a pill or just going to therapy and it will all be better. I often offer advice and I rarely cut people a lot of slack. I also do not like opioid medications, but that is for obvious reasons related to effectiveness and addiction. But most people wonder if I actually understand pain. The answer is yes, I deal with my own issues daily, but my patients are not paying to listen to me complain. The reality is I had to learn what works for me to manage my issues.

My Pain Story

My story started in medical school. Keeping in shape was important just to have the energy to spend countless hours in class and studying. At one point, a housemate convinced me to try weightlifting. The second time I tried I had the weights in the wrong position, lost my balance, and took out my back. I probably herniated a disc in my lower back, but there were no scans available then. I did therapy and over months it became manageable most of the time, not slowing me down if I was generally careful and not doing stupid things.

In my mid forties, 20 years later, my back started to become more noticeable. I had regular low back pain, and it started to frequently radiate down the leg. I gave up on running since that set it off, and just tried to keep in reasonable shape. This worked until I was in my late forties, and then finally I had a MRI scan that showed a significant slippage at the bottom of the spine, a disc that was pretty much shot and a lot of narrowing where the nerves exit the spine. The radiologist that read the scan had only one question for me, and that when was I thinking about having surgery. Surgery had not crossed my mind since my issue was pain. I decided to follow the advice I had given others; If there was no weakness and no loss of bowel or bladder control, surgery was not the answer.  

Conservative management was my goal. I had a couple of lumbar epidurals that brought down the worst pain and I did a few physical therapy sessions and they gave me a ton of exercises. The exercises were repetitive, and they seemed to be focused on the same muscles, doing all of them took about 40 minutes and they were boring. As the pain improved, I gave up on the program. Within 18 months the pain was again bad and I had another epidural, but I thought I needed to condense the exercise program. I narrowed it down to a set of core exercises that were all different parts of my core muscles, and I added a stretching regimen. Core work was about 10-20 minutes depending on what I did, and stretching was only about 5-10 minutes at the most.

My kids were hockey players, and my daughter had scoliosis and had exercises and a balance board. When I tried the balance stuff, I was terrible and it proved to me I needed to work more on core. I also felt since I was getting old, general strengthening would be a good thing to add to my workouts to reduce muscle loss. Lastly, I needed to also throw in general aerobic conditioning to maintain cardiac health.

Finding What Works For Me

The workout for the last few years has been pretty consistent. I start every day pretty early to get it done. After I climb out of bed, I stretch for a couple of minutes, and my dog gets a belly rub while I loosen up my back. After that comes core work that includes planks on a balance board, sit-ups, leg lifts and upper body/core with rubber tubing. I use a universal gym machine for additional strengthening and a roman chair device for abdominal work and pull-ups. Cardiac/aerobic workouts rotate between an elliptical, bike and rowing machine doing intervals. The rowing machine is the most recent addition. It supposedly works 85 percent of all your muscles, and it really seems to loosen things up and get the body moving well without stressing things out. During the summer I get outdoors and bicycle. Since I have a big dog, she gets twice a day walks daily year around.

As with everyone, as we get older, we all start to gain weight. I like to eat, and often enjoy snacking on junk food. Eventually my wife convinced me that I needed to change my habits. I had to stop eating as much carbohydrates, eat more vegetables and protein, and get rid of sugary drinks and snacks. I am no where near the weight I was in college, but I think I probably have more upper body muscle and some extra gut, but I have lost a few pounds.

For most people with back pain, sleep is a huge problem. Like many, I never feel well rested. I used to be a stomach sleeper, but with my back, extension is the worst position and that is absolutely out.  Side or back sleeping is feasible. Multiple pillows are my best friends keeping my knees bent while on the back, between the legs while on the side, and adjusted under my neck to keep that in a neutral position. A good memory foam pad adds to the comfort level to help relieve pressure points. I am not a deep sleeper, and after four hours stiffness often wakes me up. Instead of fighting it, I get up and stretch for just a few seconds, and then go back to bed and I can sleep for several more hours. For me, sleeping over 7.5 hours just hurts my back, so I get moving after that amount of time. To fall asleep, I do not do work right before bed, I do some reading and try to clear my mind of anything serious.

Like everyone else who has back pain, I have to take care of my back. It is not easy to do, but it is a priority to stay healthy.  It would probably help me if I could figure out how to get more sleep at night since some experts say this is good for general health. Maybe I should try to meditate, but this would also take time, and I am not yet into that either. I may spend to much time exercising, but a large part of it is walking my dog, and someone has to do it. Eating a more healthy diet has reduced my weight slightly. To lose more weight, another major change and reduction in calorie intake would be necessary and no fun. Life is a matter of balancing multiple options. If you have pain, one of the best treatment options is a comprehensive exercise program. There will never be a magic solution for pain, it will always require lifestyle choices.

Two Reasons Why Smoking And Chronic Pain Don’t Mix

smoking chronic painAs someone who has dealt with both acute and chronic back pain, I understand why patients want to control certain aspects of their life. Chronic pain can lead to anxiety and stress, and oftentimes patients just want 5-10 minutes where they can turn their brains away from their pain and feel a little relief.

Unfortunately, some people turn to cigarettes for this relief, and while it may offer you short-term relief, it’s making it hard for you to achieve long-term relief from your chronic pain.

Smoking has been linked to cancer, but today we’re going to focus on its impact on your chronic pain. I understand where the smoker’s head is at, but here are two reasons why smoking is seriously jeopardizing your likelihood of ever solving your chronic pain problem.

Why Smoking Worsens Your Chronic Pain

Smoking does a number of different things to your body, but one specific side effect of smoking is the impairment of oxygen-rich blood to your bones and soft tissues. Think of it like watering your garden during a week-long drought. If you water your garden once during the middle of the week, the plants will get some nutrition, but they will also suffer because they need more water. If you watered your garden 3-4 times throughout the week, your plants would never be without nutrition and thus could grow and prosper.

The same thing happens when you smoke. Some oxygenated blood reaches the lower back, but more would help your body heal faster. Giving up smoking will ensure that more healthy blood reaches areas of pain, decreasing your likelihood of a flare up.

Along a similar vein, the second reason why smoking makes it harder to recover from a chronic pain situation is because smoking has been linked to fatigue and slower healing rates. Exercise is a great way to combat chronic pain, but if you are tired or unable to exercise for longer periods due to your smoking habits, your chronic pain is more likely to linger. Similarly, blood vessel restriction means that your body can’t always get the nutrients to heal as quickly. Chronic pain can easily become cyclical if smoking slows your body’s ability to heal, or if it contributes to the onset of other painful conditions, like arthritis or degenerative disc disease.

It’s easier said than done, but if you can kick the habit for a healthier one, odds are you’ll be amazed at the health improvements you’ll see. We understand the desire to find some control in what seems like an uncontrollable situation, but turning to cigarettes only makes the problem worse.