Obama Weighs In On Opioid Crisis in America

February 23, 2016 / Thomas Cohn, MD

President Barack Obama shot down a proposal on Monday from the nation’s governors designed to curb America’s opioid and heroin crisis. The proposal called for limiting the number of high-powered painkillers a doctor could prescribe at a time, but Obama said the move could block access to drugs that people truly need.

“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said. “In some cases, addiction is already there.”

The recommendation had received bipartisan support at the National Governors Association’s winter meeting, but President Obama rejected the sweeping proposal. The president thanked the governors for crossing party allegiances to come to a solution, but he didn’t think it adequately addressed the full scope of the problem.

“This is an area where I can get agreement from Bernie Sanders and Mitch McConnell. That doesn’t happen that often,” Obama said.

Opioids in America

According to the Centers for Disease Control and Prevention, heroin and prescription painkillers play a roll in the deaths of 78 Americans every day. Certain prescription opioids are seen as gateway drugs to heroin, which is cheaper and often much easier to obtain.

Vermont Govermor Peter Shumlin criticized Obama for rejecting the proposal, saying, “You can’t convince me that we’ve got 250 million Americans in chronic pain.”

The fact of the matter is that opioids are likely over-prescribed in this country, and while some doctors certainly hand them out too easily, for some patients, it is truly the only option that keeps their pain at bay. For others, surgery or costly therapy sessions are out of the question, so they rely on those painkillers to manage their pain. Dr. Steven Stack, president of the American Medical Association, praised Obama for shutting down the blanket rule which would have undoubtedly hurt a large portion of actual chronic pain sufferers.

“The complexity of the problem makes it difficult to create a successful one-size-fits-all approach,” Stack said.

Stack is right. There is no perfect one-size-fits-all approach to chronic pain care, just like there is no magic pill to solve one’s pain. In the end, we need comprehensive exams to understand to underlying cause of pain, and we need to work with patients to understand their treatment options and the potential implications of each. It’s much harder than simply prescribing a painkiller, and it also takes work on the patient’s end to work to get better and not just rely on their pain pills, but this duel-responsibility approach is what it’s going to take to start reversing the opioid crisis.

Cyrotherapy for Chronic Pain

February 17, 2016October 25, 2017 / Thomas Cohn, MD

Cyrotherapy is a relatively new approach to treating some types of chronic pain. The therapy involves short-term exposure to very cold temperatures. It works because the skin reacts to the cold temperatures and sends messages to the brain that work as a stimulant to normal bodily functions. This exposure also helps trigger the release of anti-inflammatory molecules and endorphins.

In fact, the therapy is already being used by a particular subset of people who deal with pain on a frequent basis – professional athletes. These athletes use cyrotherapy for a number of reasons, including to:

Reduce pain
Improve recovery time
Improve therapy results

Researchers hope that through more study, we can expand this therapy to chronic pain sufferers.

Cyrotherapy Risks

In any treatment where you’re working with elevated or decreased temperatures, there will be risks involved. Some potential risks of cyrotherapy include:

Nerve damage
Tissue damage
Burning sensation on skin

Medical data shows that roughly 1,500-2,000 injuries happen each year due to cyrotherapy, but the majority of the injuries are due to inexperience or overexposure. It’s also worth noting that a woman died last year after using a cyrotherapy chamber without supervision, adding to the idea that it should only be pursued with the assistance of a well-trained specialist.

Recently, the University of Texas was awarded a 4-year grant to study and improve cyrotherapy techniques. Their goal is to learn exactly how blood flow is affected by cyrotherapy, and they want to introduce antioxidants and substances into the bloodstream to block certain nerve responses. In essence, they want to better learn how to manipulate pain responses during cyrotherapy, which could be a breakthrough for chronic pain sufferers.

We plan on keeping an eye on the University of Texas as well other research facilities who are attempting to build on this therapeutic program. People have been icing injuries and using cold packs for hundreds of years, hopefully we can continue to build on that premise.

What is the Best Treatment For Low Back Pain?

February 10, 2016October 25, 2017 / Thomas Cohn, MD

A recent study in the New England Journal of Medicine reported that the best treatment for low back pain was exercise. It would be great if the answer was that simple, just to exercise and everything will be better. However we all know life is not that easy, if it was no one would be going to the doctor and no one would have ongoing problems with pain.

Anyone who has had low back pain that did not go away quickly has struggled with finding the answer of what is wrong and what should be done about it. Every patient that comes and sees a specialist for back pain is asking the same questions. Most have tried to exercise, but for many it just doesn’t work. The main reason is because pain extremely complex, and when it does not go away easily, there are usually complex interactions occurring between multiple structures perpetuating pain signals. Studies that show simple solutions to back pain often concern only a small segment of those people who have problems. These are people with muscle strains and no other structural, psychological or nervous system changes affecting the lumbar region.

Best Bet For Back Pain

Simple problems like muscle strains, no matter where they are in the body, tend to heal. The best solution is often exercise to promote structural repair and to strengthen the muscle so that it is not re-injured. Sometimes one can do this on their own and at other times working with a trainer or other healthcare professional is necessary. The key here is that the damage is not permanent and can be reversed with the proper care.

Those who have complex pain often need a more comprehensive treatment plan. The first step is finding a good expert who can determine what is causing problems and devise an overall management strategy. Complex problems often have components that are not reversible, such as general age-related joint or disc degeneration. The goal then becomes how does one manage the symptoms and keep them from interfering with other functions. It often takes multiple different things from drugs, injections, exercise and possibly surgery to control the problem. Essential to treatment in most cases is of some type of exercise. Movement keeps the body healthy and often improves healing of most structures in the body including the back. Exercise is definitely one of the most important elements toward healing a sore back, but doing the right type and intensity along with other interventions from medical providers is often necessary. If a sore back does not get better with simple exercise, seek out expert medical advice.

How To Properly Dispose of Pain Pills and Opioids

February 8, 2016October 25, 2017 / Thomas Cohn, MD

Opioid abuse has become a huge problem in the United States. After many minor procedures and trauma people are prescribed pain medication. Oftentimes people have leftover pills that end up sitting around the home. This is one source of pills that may be misused or abused by others, or the patient themselves and can lead to addiction. No one usually wants to waste their medicine, but with the abuse potential and danger of these opioids, disposal then becomes an issue.

Leftover pain medications that are opioids need to be handled properly. When storing them at home, due to the street value and abusive potential, they should be kept hidden and locked away securely. One does not want these medications to ever be lost or stolen. Furthermore, easy access may allow another household member or friend the ability to take the opioids and use or abuse them. Your safety and others is dependent on keeping all your medications secure and used only according to the directions of the prescriber.

Proper Disposal

Disposal of medications has become a major problem. Most drugs, no matter the category, are considered hazardous substances. Drugs can be toxic to other people, animals and the environment. Studies of wastewater have often showed traces of a wide variety of substances from birth control hormones, to antidepressants and narcotics. The most common recommendation for drug disposal has been to flush them down the toilet. Unfortunately this has led to the spread of many compounds into the water system and the environment. A better solution for personal disposal is to crush and mix the pills with dirt or cat litter making the drug unusable and disposing with the trash.

Currently, the best option for disposal is burning the medication in a commercial incinerator. This actually destroys and fairly safely vaporizes most medications. Minnesota does have a program coordinated by local law enforcement offices to take unused prescription medications, and these are sent for hazardous waste incineration. Unfortunately this is not the most convenient system for a lot of people. Physician offices usually do not have the ability to do this but often they can add prescription medications to other drugs and materials that are sent out as hazardous waste on a very limited basis. Pharmacies and drugstores do not generally have the ability to accept returned medications.

Hopefully in the near future, Minnesota will develop a system to encourage medication return to pharmacies for disposal in a secure and proper way. A wide spread system of pharmacy return and transfer for incineration would be ideal. For this to occur, Minnesota would need to change its law and assist with the coordination of collection and proper disposal. This would be a major step forward in reducing medication available for abuse and it would lessen the toxic effects on the environment.

The Importance of An Anti-Inflammatory Diet, Part 2

February 4, 2016 / Thomas Cohn, MD

Earlier this week, we posted a blog titled “The Importance of An Anti-Inflammatory Diet, Part 1.” In the post, we discuss five tips for keeping chronic pain at bay through a healthy diet. Here’s Part 2, which includes five more tips.

Tip 6: Try adding onions to more dishes – Onions are packed with beneficial antioxidants. These may help reduce inflammation, lower bad cholesterol and reduce heart risks. Use more onions in your food preparation from sauces to salads and on things like sandwiches.

Tip 7: Watch out for some plants that may have the reverse effect of increasing inflammation – The most notable would be potatoes and corn since they are high in starches. Others are more controversial in effects, but are most likely beneficial. These include tomatoes, peppers and eggplant. All the latter are found significantly in the Mediterranean diet and are likely to have benefits from a number of compounds they contain that are antioxidants.

Tip 8: Fiber is your friend – Fiber lowers C-reactive protein levels and is a marker of inflammation that can be detected in the bloodstream. Fiber also fills up a person, and makes one feel full during a meal. This also helps in the overall digestive process and improves gastric motility, decreasing constipation. Fresh vegetables, some fruit, and unprocessed grains are good sources. Eat popcorn without extra salt and butter for snacks as an additional bonus.

Tip 9: Avoid processed foods, like white bread or rice, chips, cookies, and many prepackaged foods – These often are high in sugar, preservatives and salt and all are linked to being unhealthy. Many of these things tend to promote inflammation. Salt also promotes unnecessary fluid retention and high blood pressure and is found in large amounts in processed food.

Tip 10: Do everything with a degree of moderation – When you eat a meal, use a smaller plate, this will encourage one to eat less. There is no need to stuff oneself and constantly be eating. The brain needs time to receive the signals that you are full, so eat less and slow down. Eat more fresh food and prepare it yourself. Adding in a small amount of wine is a good treat and many wines contain resveratrol, another anti-inflammatory compound. Coffee has also been shown to be healthy with a number of anti-inflammatory and antioxidant compounds, so you can still enjoy your morning.

Changing your diet, eating less, eating more fresh fruit and vegetables, cooking your own food and improving your lifestyle can improve pain levels. Unfortunately, it does take a fair amount of dedication to change. However, if you keep doing things the same way all the time, the same results are going to occur. Consider the benefits of change to decrease pain and inflammation. For many chronic pain conditions there is no magical solution and changing your lifestyle is necessary to obtain the desired results.