Chocolate and Chronic Pain

April 30, 2018 / Thomas Cohn, MD

New research presented at the Experimental Biology 2018 annual meeting found that chocolate may have some benefits for chronic pain sufferers.

According to the findings, dark chocolate (minimally 70% cacao, 30% organic cane sugar) can positively affect some factors that contribute to or that make chronic pain worse. Researchers say that dark chocolate has been associated with:

Decreased stress levels
Decreased inflammation
Improved mood
Improved memory
Increased bacterial immunity

“For years, we have looked at the influence of dark chocolate on neurological functions from the standpoint of sugar content – the more sugar, the happier we are,” said principal investigation Lee S. Berk, DrPH. “This is the first time that we have looked at the impact of large amounts of cacao in doses as small as a regular-sized chocolate bar in humans over short or long periods of time, and are encouraged by the findings. These studies show us that the higher the concentration of cacao, the more positive the impact on cognition, memory, mood, immunity and other beneficial effects.”

Dark Chocolate and Chronic Pain

Now, simply sitting in your recliner and munching away on a king size dark chocolate bar isn’t going to cure your rheumatoid arthritis, but in small doses when paired with other treatment modalities like exercise, weight loss and a healthy diet, you may notice some improvements in your condition.

The study looked at a lot of medically-dense responses in the body and brain, and they found that aside from an anti-inflammatory response, dark chocolate also increased brain neuroplasticity. Simply put, neuroplasticity is a good thing that affects our recall, memory and sensory perception. Researchers hope to pursue future studies that will take a closer look at exactly why dark chocolate has this cause-and-effect relationship with the brain and body, but currently they are pleased with what they’ve found so far.

So again, while a candy bar of dark chocolate a day isn’t a good substitute for a chronic pain management plan, adding a small intake of dark chocolate into your diet may help improve your mood and limit some symptom expression. So the next time you’re at the store, pick up a bar of Hersey’s Special Dark and reward yourself with a bite after you’ve completed a physical therapy session or another active pain management treatment. Not only will it taste good, but it can have whole body benefits!

Medical Marijuana For Stress, Anxiety and Depression

April 26, 2018 / Thomas Cohn, MD

In a first-of-its-kind study, researchers at Washington State University examined how people’s self-reported levels of stress, anxiety and depression were affected by smoking different amounts and strains of cannabis at home.

The study, published in the most recent version of the Journal of Affective Disorders, found that smoking marijuana can significantly reduce levels of depression, anxiety and stress in the short term, but they also believe it may contribute to worse overall feelings of depression in the long term.

“Existing research on the effects of cannabis on depression, anxiety and stress are very rare and have almost exclusively been done with orally administered THC pills in a laboratory,” said Carrie Cuttler, clinical assistant professor of psychology at WSU and lead author of the study. “What is unique about our study is that we looked at actual inhaled cannabis by medical marijuana patients who were using it in the comfort of their own homes as opposed to a laboratory.”

Medical Marijuana and Stress

For the study, researchers tracked the varying concentrations of the chemical compounds tetrahydrocannabinol (THC) and cannabidiol (CBD) in different strains of medical marijuana. Patients smoked set amounts of different strains and self-reported feelings of stress, anxiety and depression twenty minutes after smoking. The study was conducted from the comfort of the participants’ home in hopes of mitigating any stress that may come with being in a lab setting. Here’s what else the study found:

One puff of cannabis that was high in CBD and low in THC was optimal for reducing levels of depression.
Two puffs of any type of cannabis was sufficient to reduce symptoms of anxiety.
10 or more puffs of cannabis high in CBD and high in THC produced the largest reduction in stress.
Women reported a significantly greater reduction in anxiety following cannabis use.

Researchers say their findings help to shine a light on the importance of monitoring both CBD and THC levels.

“A lot of consumers seem to be under the false assumption that more THC is always better,” Cuttler said. “Our study shows that CBD is also a very important ingredient in cannabis and may augment some of the positive effects of THC.”

Cutter and colleagues used a multilevel modeling system to analyze more the different strains and the reported levels of anxiety and stress.

“This is to my knowledge one of the first scientific studies to provide guidance on the strains and quantities of cannabis people should be seeking out for reducing stress, anxiety and depression,” Cuttler said. “Currently, medical and recreational cannabis users rely on the advice of bud tenders whose recommendations are based off of anecdotal not scientific evidence.”

This is fascinating research, and any study that improves our knowledge of treatment modalities and can better help patients manage their physical or mental conditions is wonderful. WSU has more cannabis studies planned in the future, and hopefully they’ll continue to better our understanding of the effects of the substance in individual patients.

Opioids Are On Trial

April 23, 2018 / Thomas Cohn, MD

In a federal courtroom in Ohio a mammoth court case is being assembled. The victims of opioid abuse are going to be fighting the drug manufactures and distributors of opioids. The battle is for payment for the cost opioids have had on the communities. The injured parties range from individual communities to the federal government, and they are seeking money to cover the cost of all the problems related to the opioid epidemic. Simply put, this is the opioid equivalent to the tobacco lawsuit that sought damages for the effects of smoking. The case is being heard in federal district court in Cleveland, Ohio.

The Court Case

The plaintiffs are suing for relief from all the companies responsible for placing opioid medications into the community. The suit has wide ranging claims from that drug companies created a public nuisance, to that they used deceptive advertising. Others are claiming that companies violated consumer protection laws of many states. Further claims go as far as to suggest that the pharmaceutical companies, wholesalers and distributors acted like a criminal enterprise and had predatory practices to create sales and addiction.

The opioid epidemic is now killing more people than motor vehicle accidents. The big drug manufacturers of opioid medications have a long history of trying to persuade the public that these drugs are safe and rarely cause problems with addiction. They have spent huge sums to create a market for their products. The current cost to the public from the opioid epidemic is now running at $500 billion dollars a year. The costs are being paid by everyone in society. The medical costs are huge and stressing budgets at every level of government. Police and first responders are spending millions on everything from drugs to reverse overdoses to the expense of taking care of the dead. Furthermore, jails are becoming packed due to drug-related crimes, and the loss of productive members to society is staggering.

This is an extremely complex case that is moving forward in court. It is likely that this litigation will go on for years. There will probably be a settlement at some point but there will be no winners. Opioids do have some uses but they have been over-prescribed and have caused huge problems of addiction. As a pain practitioner, my wish is that more money is spent on pain research and non-opioid management. Hopefully we will stop losing lives and money to addiction and gain better pain treatment.

Opioid Prescriptions Dropped Significantly in 2017

April 19, 2018April 19, 2018 / Thomas Cohn, MD

New data shows that the number of prescriptions for opioid painkillers filled in the United States last year fell drastically, representing the biggest drop in 25 years.

The decline comes amid prescription restrictions and public education campaigns to help spread awareness of how opioids, when used incorrectly, can have harmful side effects. The report on the findings, which was released Thursday, shows a nine percent average drop nationwide in the number of prescriptions for opioids filled by retail and mail-order pharmacies.

Each state and Washington D.C. had at least a five percent decrease in opioid prescriptions. Declines were higher than 10 percent in 18 states, including all of New England, West Virginia and Pennsylvania.

“We’re at a really critical moment in the country when everybody’s paying attention to this issue,” said Michael Kleinrock, research director at IQVIA Institute for Human Data Science, which released the report. “People really don’t want them if they can avoid them.”

Drop In Opioid Prescriptions

Opioid prescriptions have been rising steadily since the mid-1990’s, with use peaking in 2011. The US far outpaced levels of other wealthy countries where national health systems are more strict about narcotic control. Overdoses and deaths from prescription opioids have been soaring in recent years, but advocacy groups, physicians and patients have been fighting back with increased educational strategies.

With all this said, opioids still do play an essential role in pain management for patients with chronic conditions. We are not against opioids when they are part of an integrated pain management plan, the problem becomes when doctors don’t take the time to educate their patients about their risks or conduct follow up checks to ensure patients aren’t in over their heads with their medication.

The downturn in opioid prescriptions is both good and bad. It’s a good sign that pill-mill doctors are getting exposed for what they are, but there’s also a decent chance that some chronic pain patients are struggling to get access to the medications they dearly need. It’s a double-edged sword, and there’s no perfect solution, but we should continue to push patient education so every person who takes a painkiller for their issue knows exactly what to expect and how to avoid a potentially serious issue.

A Doctor’s Tips For A Successful Diet

April 9, 2018 / Thomas Cohn, MD

Eating right has always been a challenge, and losing weight sometimes seems to be impossible. With everything in life, change is hard and finding the right path is never easy. There are more diets available and more advice than one can ever fathom. Being the right weight is not magic, but it is work and a lifestyle commitment.

If you want to be successful, one must commit to change. So many times people say they are unhappy with where they are currently but in the next breath they are comfortable with how everything is and are not willing to consider alternatives. Furthermore, most people who ask for advice do not trust anyone who might have legitimate information. If the advice is sensible and simple it seems even less trustworthy.

Steps To Take

So the first step in changing one’s weight is to understand whether you feel it is problem and whether what you are eating is affecting your life. If you are totally happy with how you feel and with your health, than you have no reason to change. Life is likely to stay the same for you.

A person’s weight is dependent on a complex array of variables from genetics, to exercise to what we eat. There are things we can change and things that maybe outside of our control like our genetics and medical conditions. However, we can control what we eat, how we perceive our food and we can also control our activity level. So weight management is about our interactions with food.

The temptation is always for people to look for a quick fix. In pain management everyone just wants a pill or quick solution. Once people realize the answer may be complex, the light goes on. If the answer was simple, the problem would likely not exist. Education is one of the best paths toward the solution.

Weight gain was a slow problem that crept up on me. Every year my baseline weight increased. Initially it was ok. When my pants were no longer fitting in the waist and I needed a new wardrobe, it became something I needed to understand. The first issue was as we all grow older, our bodies change. For me I had reached a time when there was a hormone change in my body and that caused a slowing of my metabolism. The old school teaching was calories in and calories out must be balanced. So I just tried to exercise more. Initially that may have worked, but only for a short period of time. However, exercising for hours a day does not work to burn off all the calories taken in by eating more than needed. Running or walking a mile only will burn off 100 calories. The not so obvious answer then was I needed to change my diet, and I probably need to do more than I have already done.

New Dieting Goals

The new goals with dieting are to be sensible about eating. The important things to remember are the quality and quantity of food. There are a million diets with tons of rules. Most of the diets are complicated, require special foods, and are difficult to follow for a long period of time. In reality, simpler is better.

First, remember a portion size is a ½ cup for most foods. Measure out that amount and it is not very much food. A small size French fries at MacDonald’s is likely 2 portions. A ½ cup of pasta is the size of a single scoop of ice cream. If one sticks with appropriate single sizes of portions one will not be over eating – staying to the right quantity. Next buy your own fresh food and cook it to make your meals. Eat fresh vegetables, fruits, lean meats, fish, and try some vegetarian meals since the calories will be less and healthier. Keeping the refined sugar down, as well as limiting bread and pasta helps most tremendously.

Typical meals tend to change as one begins to improve your diet. Most dietitians recommend that everyone should eat breakfast. This prevents the body from thinking it is starving and turning all intake into fat for storage. Breakfast can be a piece of fruit, Greek yogurt for diary and protein, and oatmeal or granola cereal (for more protein, fiber, and a bit of carbohydrates). Lunch is a green salad with a low fat dressing, and 4 ounces of protein. Dinner is a portion of vegetables, 5-6 ounces of lean meat, and fruit or a salad. It is okay to have a small portion of brown rice, pasta or potato, but not with butter or a fatty sauce. If you have no recipes, get yourself a cook book. Lastly, donate or throw out all of the snacks and junk food that is sitting around your home and tempting you to eat. Also, stop buying lots of processed food, and when you eat out, eat the same types of meals that you would cook on your own.

Finishing Strong

If you are serious about making a lifestyle change, then you may be successful. Some people are very self-motivated and can change if they set their minds to do something. For most of us, working with a partner and holding each other accountable often is easier and more successful. Another couple of helpful keys are to record everything you eat daily and keep a record of how much you actually eat. You must weigh out your portions and be accurate with them, and it also helps to weigh yourself once a week. Tracking your activity with a fitness tracker will also help monitor about how much you are burning, but they are notoriously overly ambitious in how many calories they are estimating that you are burning.

Starting a diet does not need to be complex. It requires one to shop from the outside edges of the grocery store. Eat fresh fruit, vegetables and lean protein sources in controlled portion sizes. Reduce the amount of simple carbohydrates – sugars, pastas, and breads. Track your portion size, your intake, and weight. Increase your activity level and move moderately for at least 30 minutes a day. Drink more water also, as this may decrease your appetite. Lastly commit to change and keep at it.1-2 lbs of weight loss a week is excellent progress.