Chronic Pain and Its Impact On The Workforce

April 18, 2019 / Thomas Cohn, MD

Many people have a vested interest in helping to solve the problem of chronic pain, and a new study suggests that you can add employers to the list.

According to a new study published in Integrated Benefits Institute, more than one-third of US workers take prescription pain medications. Interestingly, those workers who take prescription medications take significantly more sick days than those who don’t, and those who have problems with those medications take even more sick days. The study found:

Compared to those who don’t take prescription pills at all, painkiller users took an average of twice as many sick days.
Problematic painkiller users took more than three times the number of sick days on average as a healthy adult.
Prescription pain medications were associated with approximately 261 lost workdays per 1,000 workers per month.

For the study, researchers looked at the amount of time lost at work connected with prescription pain relievers when viewed in the contest of other substance use disorders in the American workforce.

“The high rates of prescription pain medicines among employees indicates a much larger issue for employers than lost productivity,” says IBI researcher Erin Peterson, MPH, the report’s first author. “The significant number of sick day absences by employees who use pain relievers without problems likely doesn’t represent the full impact. As most people abusing opioids started with prescribed medications, this is a very large number of people at risk for developing problematic behaviors associated with pain relievers.”

Chronic Pain and Lost Days of Work

If you suffer from chronic pain, regardless of whether or not you take opioids to help with discomfort, you know firsthand how difficult it can be to get out of bed on some mornings, let alone get through the work day. That’s one of the reasons why it’s so important to work with a pain specialist to get control of your issue or help to minimize the days when pain becomes overbearing. It’s not always going to be easy, but if you truly want to do whatever you can to get your pain under control, it’s worth it.

Dr. Cohn and his team have helped numerous workers get a handle on their pain and thrive in the workplace, and he can do the same for you. To set up an appointment so he can get to the bottom of your pain and chart a course for recovery, click here or give his office a call today. It’s never too late to take back control of your life from chronic pain.

Opioids, Medical Marijuana and Chronic Pain

April 10, 2019 / Thomas Cohn, MD

When it comes to managing chronic pain, we’re always looking for new and better ways to help patients control their discomfort. If you’re a regular follower of our blog, you probably know that we’ve written a number of blogs on opioids and medical marijuana, but a recent study decided to take a look at what happened when these two treatment plans were used simultaneously. You might be surprised at the findings.

According to research presented at the 2019 American Pain Society Scientific Meeting, individuals with chronic pain who used both prescription opioids and recreational marijuana showed higher levels of mental health and substance abuse problems than those who use opioids alone. Now, the study makes a big distinction noting that patients were using marijuana recreationally and not medicinally, but it still shines a light on how problems can occur when people try to supplement their opioids with other substances.

Study Results

Those weren’t the only findings that were of concern according to researchers. The team said that anxiety and depression scores were also significantly higher for patients who used both opioids and recreational marijuana, as were measurements of opioid dependence severity and alcohol and cocaine involvement. Researchers also noted that there was no difference in pain severity or pain disability between the group of individuals just using opioids and those using opioids and recreational marijuana.

“The things psychologists would be most worried about were worse, but the thing patients were using the cannabis to hopefully help with — namely pain — was no different,” said Andrew Rogers, University of Houston, who worked on the study. “Co-use of substances generally leads to worse outcomes. As you pour on more substances to regulate anxiety and depression, symptoms can go up.”

Abhiram Bhashyam, MD, MPP, of Massachusetts General Hospital in Boston, who was not involved with the study, said the findings provide even more evidence that patients shouldn’t assume that recreational marijuana will help with the effects of their chronic pain if they are already on opioids.

“This study provides further evidence that cannabis may not be an effective substitute or alternative to opioids for pain management,” said Dr. Bhashyam. “Studies like these are important for clinicians as patients increasingly ask about opioid-cannabis co-use for managing their pain. We lack robust evidence to provide appropriate guidance due to a paucity of research on this topic at present.”

Both opioids and medical marijuana can be helpful if you’re dealing with chronic pain, but it’s important to realize that there’s a significant difference between regulated medical marijuana and recreational marijuana, so don’t assume that what you pick up on the street will be beneficial in combination with opioids for your pain. As this study suggests, it doesn’t appear to help and it can certainly make some problems worse. If you’re considering medical marijuana or another treatment plan for your pain, consult with a physical medicine specialist first to ensure you’re making the right choice for your individualized condition.

The Importance Of A Support System When You Have Chronic Pain

April 4, 2019 / Thomas Cohn, MD

Whether you’re off pursuing your dreams of being a musician in New York City or trying out for the varsity basketball team, everybody wants to have a strong support system that they can turn to in a time of need. Another group of people who need a strong support system in their life are those individuals with chronic pain, but those with a chronic condition know that a good support system can be hard to find. Today, we share some tips for finding and building a strong support system if you have chronic pain.

Chronic Pain Support System

All of the following tips may not apply to your situation, but we’re confident at least some of them will. Here’s how you can build and learn to rely on a support system if you’re dealing with a chronic illness.

1. Find A Few Close Friends – You probably have one or two really close friends or family members that you can rely on when things get tough, and it’s important to lean on them when you need help. Just because you have a large family or a large network of friends doesn’t mean they are all going to be sympathetic to your cause and be reliable in your time of need. Recognize that not everyone is going to be part of your support system, so focus on the really reliable members of your support system instead of trying to involve a larger network of people.

2. Online Support – The rise of the internet has made it much easier for people to connect with other individuals who are going through the same thing. You can find highly specialized support groups that can allow you to talk to people who know what you’re dealing with. Try a simple google search and see what groups are out there. Find one or two that seem supportive and consider joining.

3. Share Your Experiences – A number of people find it helpful to share their stories with others. Whether you’re talking to your best friend on the phone or writing out your daily struggle on an online forum, it can be extremely helpful to talk about your experiences. Find a place where you can vent or be vulnerable, and let your story be heard.

4. Support Yourself – It’s also important to remember that you are the most important member of your support group, and you need to take care of yourself. You need to be getting regular exercise, eating a healthy diet and partaking in activities that contribute to a healthy physical and emotional well-being. If you have self-destructive tendencies, your support group may fall apart because others may think “Why should I care about them if they don’t seem to care about themselves?” Be your biggest supporter.

5. Professional Help – Finally, don’t be afraid to reach out to a professional for help. Whether you need a chronic pain specialist to help you get a grip on your condition, or you want to talk to a mental health counselor about your feelings and your concerns, please reach out for help. We want to be part of your support team, but we can’t get you help unless you connect with our office. Let us help you.

For more tips on building and maintaining a healthy support system if you have chronic pain, reach out to Dr. Cohn’s office today.

How To Best Treat CRPS On An Individual Basis

March 25, 2019 / Thomas Cohn, MD

crps Complex regional pain syndrome is one of the most vexing and difficult problems in the world of pain medicine. Traditionally it was thought to be a rare disorder that spontaneously affected some people especially after some sort of injury. Since it has been poorly understood, many pain practitioners have very limited experience and interest in trying to treat this condition. Many physicians actively try to avoid working with patients with the problem, others may try a few things but since they have limited knowledge and experience, they often end up giving up on trying to manage the problem. Luckily there are more than a few pain physicians who see the condition a lot and are becoming more successful with its management.

The thought leaders in pain medicine who treat CRPS seem to be some of the physicians who do a lot of work as interventional pain physicians who also take a very active role in diagnosis of their patients besides just providing treatments. The ability to fully evaluate a person is critical in understanding CRPS. The symptoms of CRPS always have a cause; it is not just a bunch of symptoms that lead to a painful extremity. It usually involves a structure in the body such as joint that is malfunctioning or a nerve in the area that is abnormally functioning. Treatment is needed to correct the structure that is not moving in the right way and to relieve the abnormal functioning of the nerves involved in the area.

The Challenges of CRPS

The first challenge is correcting the structural problems that often are orthopedic in nature that are wrong. The abnormal movement sends signals through the nervous system that something is wrong and often is interpreted by the brain as pain. These problems may start as simple degeneration like from a sprained ankle or a worn out knee. Most of the time, correcting the simple problems work, but if there are nerves malfunctioning in the area, possibly damaged by an injury or treatment, or more centrally also in the spine itself, then complex regional pain syndrome – CRPS may be manifested. The major challenge is finding the nerve problems correlated with the symptoms and finding a way to treat them.

Since CRPS often now is thought to involve peripheral nerve injury in the region of pain, then finding the nerve and extinguishing the signal from that location can sometimes effectively treat the problem. If the source of the pain is strictly peripheral, finding the right nerve and blocking that nerve proximal to the damage may stop the pain. In the last 1-2 years, technology has improved and techniques are now becoming available to electrically block isolated nerves in the extremities.

Spinal cord stimulation has been used to treat CRPS for years, and this is blocking signals more centrally at the spine. Now technology is allowing pain practitioners to more precisely block the nerves either as they exit the spine or superficially in the periphery with special implantable devices. Obtaining better pain control then involves the physician fully evaluating a person for all the places that may be contributing to sending painful sensory signals and then trying to find the simplest place to block the abnormal electrical signals such that they do not travel to the brain and signal pain and disaster to the brain. Further it means the physician who is going to be helpful in treating your pain must be fully evaluating the patient as well as working directly with the interventional techniques. A physician who is just providing injections or not fully involved in all aspects of pain management is unlikely to understand and be helpful in controlling symptoms in CRPS.

The understanding and treatment of CRPS is changing and with the right providers, pain control is often being significantly improved. This is not a mystery disease, but unfortunately not many physicians have seen enough of these types of problems to understand and manage the complex issues. Finding the right person is difficult, but the interventional pain physicians who see CRPS a lot, who actually evaluate their patients themselves and do the treatment may be the best source for a successful strategy toward treatment. The solutions sometimes are complex like the disease, but there are more and better treatments that are becoming available.

Could New Opioid Laws Lead To Higher Costs For Patients?

March 14, 2019 / Thomas Cohn, MD

As we explained in a blog post earlier this month, the Food and Drug Administration is going to begin conducting more studies on opioids and forcing drug manufacturers to examine if their products are effective at managing specific chronic pain conditions. While these changes are aimed at helping combat the opioid epidemic, some patients believe the costs for these studies will be passed onto them.

There’s also concerns about cost and access to medications at the local level. Here in Minnesota there has been a bipartisan push to raise registration fees on drug companies to fund treatments and implement more fail-safe addiction policies. A vote on these measures is expected int he coming weeks, but some patients believe these changes forced at the business level will be felt hardest at the consumer level.

Who Funds These Changes?

Cara Schulz, who advocates for patient rights, believes the higher costs and restricted access to medications will affect those who need the drugs the most. Schulz currently takes pain medications to manage discomfort following her stage 4 colon cancer diagnosis.

“I want us to work on ways we can manage addiction, I want people to not be addicted, period. But we can’t say we are going to fix addiction by hurting people who are not addicts and who are just patients trying to be treated by their doctors,” said Schulz, who is in remission.

Instead, Schulz believes the real focus should be on fentanyl and other illicit synthetic substances, not prescription medications. At a minimum, Schulz hopes that patients who meet a certain threshold can earn an exemption so their access to drugs they truly need doesn’t become restricted.

“The method that they’re taking to address this problem puts pain patients and cancer patients squarely in the cross hairs,” she said.

This is something to keep an eye on as we move forward with ways to combat the opioid crisis. With more regulations being forced on big businesses, we have to ensure these costs aren’t just passed down the line to patients. Medication costs are expensive enough in the US, and we won’t be putting the patient first if their medications cost an arm and a leg.