The Link Between Chronic Pain and Insomnia

chronic pain insomniaThe following guest article was written by Katrina Rice.

Anyone who suffers from chronic pain from health issues like rheumatoid arthritis or osteoarthritis knows the drastic effects it has on their way of living – whether it be restricted mobility, increased medical expenses or reduced social life, accomplishing tasks seem to become quite unbearable every single day. And at night, sleep is disrupted due to the aching hips, back, knees and legs.

According to medical experts, arthritis sufferers are highly likely to suffer from insomnia as well. But recent studies show that restless nights and arthritis symptoms are a “two-way street” problem. Chronic pain can lead to a lack of sleep, and sleep deprivation can make chronic pain worse.

Doctors have recently become more focused on treating insomnia to improve the health conditions of patients suffering from chronic pain. One important note to remember is pain and insomnia work in a cycle. According to Professor Alan Silman, a medical director of Arthritis Research UK, “Pain induces insomnia and insomnia induces pain”.

Arthritis and Insomnia

Osteoarthritis is the wear and tear or degradation of bone tissues whereas rheumatoid arthritis is when the immune system attacks the joints. Much of the pain patients feel is due to the inflammatory responses of their body whenever it travels to their joints. It is fully understood by experts that disrupted sleep does increase the number of inflammatory markers and further aggravates the joints.

Inflammatory compounds in the body play a vital role in sleep disturbance. This disturbance will then alter the natural cycle of hormones in the body and affect the underlying levels of inflammation. Other cytokines (pro-inflammatory messengers) may also be involved in this activity. While insomnia releases more damaging inflammatory chemicals in the body, it also means the body misses out on the opportunity to heal when sleeping. After all, sleep is the longest time when the body is at rest and has low inflammation levels. So it is really the best time for the damaged cells to heal.

Effects Of Sleep Deprivation On Chronic Pain

The most notable effect of sleep loss in chronic pain is the low production of growth hormones. The growth hormone is vital in many body processes including cell development, weight regulation of the body and tissue repair, as well as replacement of collagen and bone cells. Though the growth hormone is released in the body at any time of the day, the biggest bursts come from the moment our bodies fall into deep sleep. But if deep sleep is not achieved, the body may not produce enough growth hormones. Furthermore, lack of sleep makes patient irritable and weary – this makes them even more sensitive to pain.

There are a number of treatments and alternative remedies that can be used to help ease the pain, but NSAIDs are usually prescribed for those who experience severe pain. Other forms of treatment come in natural supplements like glucosamine, chondroitin and curcumin supplements.  Patients with osteoarthritis usually choose glucosamine, but curcumin pills are also becoming more popular among arthritis patients. As for side effects, you can easily search reviews and testimonials in Google.

The bottomline is that chronic pain sufferers are stuck in a vicious cycle and they need to get out of it. In order to help them increase their pain threshold and reduce chronic inflammation, getting enough rest is a must. Here are six tips to use to help achieve a good night’s sleep.

  • Avoid taking afternoon naps. No matter how much you want to rest, it only gives you more energy in the evening. Keep yourself occupied when you start feeling sleepy in the afternoon.
  • Use lamps with warm light instead of ceiling lights. Warm lights have a soothing effect and can help you feel calmer and sleepier.
  • Avoid coffee, tea or any caffeinated products after 3:00 p.m., and never drink alcohol after 9:00 p.m.
  • Keep your waking and bed time consistent every day. This helps your biological clock get used to the routine and will eventually follow that pattern on its own.
  • Eliminate midnight snacking.
  • Do not gain weight, and instead, try to lose more pounds. Excess body fat can put more pressure on your joints. Gaining more weight means your fat cells will expand and your body will eventually start producing more cytokines – a fuel for inflammation.

Katrina Rice is a mom and a freelance writer. She strongly believes in the concept of holistic wellness through healthy and natural living, traveling and immersing one’s self in new activities. A self-proclaimed health enthusiast, she hopes to inspire more people to turn to natural treatments in addressing health issues.

Understanding Opioids, Addiction and Naloxone

opioids safety drugsChronic pain patients have a multitude of possible treatments available for the management of symptoms. Strategies often include exercise, physical therapy, chiropractic care, massage, injections and medications. One of the more frowned upon treatments is opioids, but sometimes they are used successfully. With the current opioid crisis, many pain patients fear using them and want to be safe if they have them in their possession.

Opioid Safety

The most important rule with regards to use of any medication, especially opioids, is to never take more than what has been prescribed. Opioids can build up in the body and suddenly become deadly if too much is taken. Running out early can cause opioid withdrawal syndrome and while it is uncomfortable, it is not dangerous to your health. If you are taking opioids, expect your doctor to closely monitor your medication and behavior while taking these drugs. Since they are highly addictive and abused, most doctors will tightly control prescriptions and refills. Drug testing, opioid contracts, behavior screenings, depression screenings and monitoring of other medications are standard. Mixing of medications like sedatives, anti-anxiety treatments like benzodiazepines, and using any street drugs often will lead to ending a prescriptions for opioids, and often there is zero tolerance of any safety rules due to the extreme danger inherent with opioid misuse.

Mixing Street Drugs and Opioids

The latest step in opioid safety is the prescribing of naloxone in addition to the opioid. Naloxone is a drug that can block the opioid receptors for most opioid-type drugs, and it can prevent an accidental or purposeful overdose. In Minnesota it can be obtained at most pharmacies even without a prescription, and can be given effectively as either an injection or as an intranasal spray. Anyone who is routinely taking an opioid or has opioid medications in the home should likely have naloxone too, in case they accidentally or purposefully take too much, or someone else takes their medications. If you are on these medications, ask your doctor about having a safety prescription for naloxone.

Using street drugs for an addiction to opioids or for pain is high-risk behavior. The singer Prince was using Percocet obtained from street sources to control his hip joint pain. The Percocet he obtained had allegedly been mixed with fentanyl, which is an extremely potent opioid and caused his overdose death. If you are addicted to opioids, are using them to get high, use heroin, or have family or friends that is misusing opioids, you can obtain naloxone and this may save someone from an overdose death.

Successful Opioid Treatment

Opioids can be helpful in treating pain, but they are extremely difficult to use due their limited safety. More physicians are very reluctant to prescribe these medications and their long-term efficacy and safety is limited. More information has become available on how opioids actually tend to increase pain over time versus being helpful. Pain management specialists will work with patients to find alternative strategies to these dangerous medications.  

One last issue with regards to all medications, especially opioids, is how to dispose of unused or outdated prescriptions. In the past, medications were often flushed down the toilet or thrown out in the trash. The environment does not do well with those methods, and it tends to lead to contamination of our waterways and ground water. Freshwater fish are starting to show significant levels of some commonly disposed medications. The best way to get rid of unwanted medications is to bring them to your local police or sheriff’s department where they have disposal lock boxes. These medications then are handled as hazardous waste and usually incinerated at high temperatures to completely destroy them and turn it to relatively safe ash.

If you’re struggling with an opioid addiction or want a doctor to help get to the bottom of your pain, contact Dr. Cohn today.

How Unregulated Opioid Use Can Lead To Heroin Addiction

Opioids pills heroinIn 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.

Minnesota Medical Marijuana System Tough On Chronic Pain Patients

medical marijuana programOne 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.

Why Chronic Pain Patients Feel Targeted By Opioid Crackdowns

pain pill overdoseAs opioid overdoses continue to rise in the US, the government, lawmakers and medical personnel are all trying to figure out the best way to reduce these unnecessary deaths. Obviously restricting access to opioids would reduce the number of people who can get their hands on them, and in turn reduce overdose deaths, but it would also unfairly target people who need the pills. People like those suffering from chronic pain. So it’s understandable to see why when lawmakers propose strict rules for who can access these medications that chronic pain sufferers feel like they are being targeted and singled out.

It’s a tough balance to strike, and unfortunately it seems that as a nation we are more focused on what is easy and cheap instead of what will really address the root problem. Putting a band-aid over a large gash might stop some bleeding, but the wound won’t close correctly without stitches. Simply restricting access opioids and painkillers might stop some abusers from getting the pills, but it won’t solve the whole problem. We need to put some stitches in place.

Solving The Opioid Crisis

We’re not going to sit here and pretend we have all the answers for solving the problem of opioid addiction and overdose, but like we said above, simply restricting access is not going to solve the problem, and many innocent people who rely on those medications may no longer be able to access them. Instead, here are some steps that will help address the root problem.

1. Doctor Education – The vast majority of doctors understand that opioids do not address the root problem, but sometimes they are confused by a diagnosis or have seen other treatments fail and they fall back on them. Other doctors cut corners and prescribe pills freely and dangerously. We need to provide better understanding at the top level of how these drugs should be used, how to spot signs of abuse and how to ensure patients are safely taking their medications so that overdoses don’t occur.

2. Systemic Pressure – This problem will be harder to solve, but in many cases doctors are told to see as many patients as possible. If a doctor is feeling overwhelmed or rushed to see a number of patients, they can sometimes fall back on easy solutions like opioids. Doctors need to take their time with each and every patient and ensure they are giving them the best care possible. It’s possible the best care will involve opioids, but it should also involve therapy, exercise and regular abuse checks.

3. Patient Education – Patients also lack understanding of opioids and their abuse potential. Opioids are not a magic pill that will cure your pain, but they can provide temporary relief so other rehab techniques like exercise, swimming or physical therapy are more bearable. Opioids are a passive treatment, and they need to be paired with an active treatment option for best results. Patients also need to learn the warning signs of abuse for themselves and for loved ones who may have access to their pills.

4. Pill Technology – Medical researchers are looking into new abuse-deterrent opioids. They are creating pills that can’t be crushed or that become gooey if a user tries to extract the solution for injection. Other pills come in an extended release form and can’t be manipulated to give an elevated or intense high. More research into abuse deterrent options could prove useful.

Simply saying we need to restrict access to opioids will not solve the problem, and many chronic pain sufferers will be affected instead of those who are actually abusing the pills. That’s why so many patients feel targeted by these proposals. It won’t be easy to reverse this trend, but if we put in the time and money, it can be done.