The Importance Of Complementary Medicine

April 27, 2017 / Thomas Cohn, MD

As we talked about in our blog post on Tuesday, there’s no simple way to treat chronic pain. No magic pill is going to cure your pain. Instead, you need to have a comprehensive and multifaceted approach to controlling your chronic pain. Sometimes, that approach includes complementary medicine options.

We are a traditional pain clinic, but it would be wrong to simply ignore the benefits of some complementary options. We’ve talked about the benefits of acupuncture on our blog in the past, and our most viral post isn’t exactly a traditional medicine method.

Complementary Medicine Benefits

Mindfulness, acupuncture and other complementary medicine methods are key components to finding the best way to treat chronic pain, and that’s a sentiment shared by our friends at Burning Nights CRPS. In fact, they believe in the benefits of complementary approaches so much that they designed a wonderful infographic to help inform others. Take a look at the infographic below, and be sure to check out their site for more helpful information on how to best beat chronic pain!

4 Key Components For Combating Chronic Pain

April 25, 2017 / Thomas Cohn, MD

Battling chronic pain is no easy task, but it gets easier if you know the best way to tackle the condition. Today, we share four ways to help combat chronic pain, and we explain how these factors can help you conquer your daily discomfort.

The 4 Keys To Conquering Chronic Pain

There is no magic pill that will get rid of your chronic pain. If you want to reduce your daily pain, focus on these for areas.

1. Exercise – If there’s one thing we can recommend when it comes to conquering chronic pain, it’s regular exercise. As someone who struggles with back pain, I find that it is best controlled when I’m actively working on strengthening the area. We know that chronic pain can make it difficult to exercise, but try to find an activity that works for you, whether it be running, cycling, walking or swimming!

2. Mindfulness – A recent article published on Medscape suggests that mindfulness probably won’t help you with back pain. It’s true that mindfulness alone won’t magically cure your back pain, but we’ve found that patients who try to eliminate stress in their life and who focus on putting pain behind them instead of feeling sorry for themselves seem to respond better to treatment. Mindfulness isn’t something you can just achieve, but there are a number of activities you can participate in to help push pain out of your mind. From speaking with a therapist, to taking a Tai Chi class, to simply making it a point to get out of bed and not let pain slow you down, treating your mental health is just as important as your physical health when it comes to conquering chronic pain.

3. Diet – Your diet also plays an important role in chronic pain expression. A number of chronic pain flare ups are caused by inflammation, and that inflammation can be triggered by certain foods in our diet. Try to eat a wide range of fruits, vegetables, proteins and fish, and stay away from the sugars and saturated fats. Sometimes a diet change is all you really need.

4. Professional Assistance – Finally, don’t try to take on your chronic pain on your own. Medical professionals can help you get to the bottom of your condition and devise a number of different treatment methods to suit your needs. You wouldn’t try to fix your own cavity or fill your own taxes (Okay – some of you are probably brave enough to do your own taxes, but I prefer to hand it all over to a professional), so don’t try to combat your chronic pain all alone. We’ve studied this stuff for decades, let us help!

How Unregulated Opioid Use Can Lead To Heroin Addiction

April 12, 2017 / Thomas Cohn, MD

In the 1960s, the drug culture was known for psychedelics, LSD and marijuana. Eventually, some of those users sought a stronger high, and that led them down the path to heroin. At least that was the message pushed by the government in its fight against drugs.

Heroin was actually not that common and it was often a drug of addiction found in Vietnam veterans due to its availability in that region. Intense drug programs and interventions to rid production significantly reduced heroin use in the U.S. from the 1970’s through about 2000. In the 1990’s, the era of everyone needing opioid pain management began and along came Oxycontin. The quick and easy option for most doctors to treat pain was to write a prescription for the magical opioid pill. For the last ten years, we now have discovered the rising tide of opioid addiction and now deaths from overdoses is catching up to the number from auto accidents.

Link Between Pills and Heroin

Oxycontin first came on the market in the 1990’s and was extensively marketed as a safe drug for management of pain. The manufacturer would fly physicians to resorts, wine and dine them, and then try to hire them to lecture other doctors on the wonder of their drug. By about 2005, some of the problems with addiction were becoming evident. The government convinced the manufacturer to develop a formulation that would deter abuse by making anti-crush pills, and these came on the market around 2010. It was still a potent drug, but it was not as fun to take and the pills became expensive on the black market. However, the damage had been done and now the main way to treat pain was with opioids, any many people had become addicted to the powerful medication.

A study recently done by the University of Pennsylvania and the Rand Corporation explains why heroin has now become a problem. The development of the new formulation of Oxycontin made this drug more expensive and harder to abuse. Heroin has become cheap, more pure, and once you’re hooked on opioids, it is now easier and less expensive to obtain. So once a person is addicted to pain pills, the cheaper route to get high and prevent drug withdrawal is to use heroin.

Now the latest trick for those with an opioid addiction to get high is to use heroin or oxycodone that is mixed with another synthetic opioid like fentanyl or cor-fentanyl which are a hundred to over a thousand times stronger. These drugs are often been manufactured in China or India, and they can be easily mailed anonymously without much suspicion into the U.S. If mixed wrong, these newer synthetic opioids are often deadly.

Takeaway Points

The message from the opioid crisis is that pain has many ways to be treated, and left unregulated the use of opioids is often more dangerous then helpful. Addiction is a disease; without treatment, some resort to the use of heroin since it is cheap, and many cut that drug with other potent drugs that are deadly.

Stopping the opioid crisis will take time and effort. Treating pain is not just about taking opioids – that has led to the addiction crisis. Money needs to be spent on pain research and the development of better pain management strategies. A third of the population has issues with pain, making it more prevalent than heart disease, cancer and diabetes combined. To solve the problem of pain and drug abuse, a concerted government investment into pain research and better medical management is needed.

Opioid Dependency and Prescription Length

April 10, 2017 / Thomas Cohn, MD

A new study conducted by the University of Arkansas on opioid use has been recently published by the Centers for Disease Control. It is somewhat of a curious study since it was based on record analysis of prescription records for opioids. The results will likely be twisted by the press soon to announce how bad these drugs are and how addictive they can be.

The question the study sought to answer was – “If a patient gets a certain amount of drug prescribed on a first visit, will they still be taking that drug a year later?” The numbers are somewhat surprising, but in reality it does not really say anything about opioids, addiction or pain. All it really says is that for some people there may be limited options to treat pain, and maybe it is very effective for some people.

Continued Opioid Use

The patients studied were all 18 and over, cancer free, studied June 2006 through September 2015 and did not have a history of opioid abuse. Here’s a look at the results:

A person who received 1-day supply of medication had a 6% chance of being on opioids for a year or longer.

With a 5-day supply, they had a 10% chance of being on opioids in a year.

With a 10-day supply the odds go to a 20% that they will be still using opioids in a year.

A 30-day supply had about 30% chance of being on the medications a year later.

So if you start on opioids, and have it for over 10 days, 1 in 5 of those people may still be on those medications. However, it also means that 80 percent will not still be on those drugs.

Interpreting The Results

Several messages can be inferred from this data. First, acute pain should be treated with the least amount of medication for the shortest length of time. If at all possible, avoid the use of opioids for acute pain and find other less addictive and dependency causing medications. Second, many people do not use these medications long-term and can use them responsibly. Lastly, pain is very complex, and since some medications are highly addictive, try to avoid them and use the multiple other ways to treat pain including everything from chiropractors, to physical therapy, to exercise, and to injections.

The study also may be an analysis of the treatments available for severe pain. Some of the most effective treatments sometimes are the least healthy and can cause dependency. Opioids have been around for hundreds of years. Our knowledge of pain is limited, as are the solutions. Since it is such a huge medical problem, we really need to spend more on research and solutions. We know there is an opioid crisis with addiction. We need research solutions and new treatments. Now is the time to spend on research, as it may provide better solutions for more people than some of the recent government spending recommendations.

Minnesota Medical Marijuana System Tough On Chronic Pain Patients

April 7, 2017 / Thomas Cohn, MD

One of the approved conditions for medical marijuana in the state of Minnesota is intractable pain. Intractable pain is pain that can’t easily be tracked to a specific source and treated successfully, and many patients with chronic pain are deemed to have intractable pain. So you’d think the medical marijuana program in Minnesota would be beneficial for chronic pain sufferers? Well, according to a recent article in the Star-Tribune, it’s anything but easy.

Jumping Through Hoops

Minnesota is at least moderately progressive in that it allows medical marijuana as a treatment option for some conditions, but there are still a number of issues with the current state of the program. For starters, the majority of doctors in Minnesota – including those who specialize in treating chronic pain – are not approved to certify patients for the medical marijuana program. The reason being is that the health care system employers prohibit these doctors from prescribing it. Some doctors who treat rare and severe illnesses can prescribe the treatment, but the vast majority cannot.

So, most doctors are unable to prescribe it. You’d think the state would compile a list of doctors that could prescribe medical marijuana to those who qualify, but no state-provided list exists. Instead, patients need to search the web, call clinics and try to track down a doctor who can prescribe the treatment on their own.

Footing The Bill

Once you’ve tracked down a doctor and had your medical records faxed over to the clinic, you finally get to meet with a specialist who can prescribe medical marijuana. But, according to the Star-Tribune columnist who sought medical marijuana for her pain, since the appointment was for medical marijuana certification, her insurance wouldn’t cover it. So the $844 bill for the 90-minute session would come out of her pocket.

If she would be approved by the state, she’d have to pay a certification fee. That runs $200, and it needs to be renewed each and every year. Moreover, after you pay your certification fee, your treatment needs to be approved by the state. If you are approved, you then have to fill out a Patient Self-Evaluation Form. Finally, after that is approved, you can visit a Cannabis Patient Center, where any purchases once again aren’t covered by insurance, so you’re paying out of pocket. Oh, and forget writing it off as a medical expense, as medical marijuana is not legal under federal law, so the expenses can’t be written off.

The author detailed how she would need to return to the clinic four weeks after receiving the medical marijuana for a follow-up appointment that again would not be covered by insurance (and again at six months). In all, she estimated that her start up costs would fall just short of $2,000 just to get into the program – and that’s without purchasing any medical marijuana.

There are good intentions behind the legalization of medical marijuana in Minnesota, but the program currently has many faults. These patients who are in incredible pain are repeatedly being asked to jump through hoops and open their wallets just with the hope that they can get in the program and find a solution for their pain. The current system is broken, and while we’d like to see more money being poured into medical marijuana research to ensure we increase treatment effectiveness, we can’t expect the solutions to happen on their own. We need to revamp the process for getting medical marijuana for patients with intractable pain.