Could This Be The Next Big Thing In Pain Management?

June 10, 2019June 10, 2019 / Thomas Cohn, MD

Last Sunday in the science section of the newspaper there was an article about research on a new pain drug. The scientists behind the drug are convinced they have the next great drug. The skeptic in me hopes but doubts it. The reason the news has not made the traditional rounds in in all the reputable medical sites that spread news of discoveries. Furthermore, the work to date is only in animals and there has not been definite evidence this will transfer to humans.

The article discusses the work of Dr. Bruce Hammock, an entomologist at University of California-Davis. In the 1970’s he was working on an enzyme that converted a corn ear-worm to an insect. Removing the enzyme essentially killed the insect before it converted to the moth and was able to breed. Overall this was not found to be a cost effective strategy for this insect to be controlled. Since that part of his work did not pan out, he started looking for how the enzyme or related enzymes might occur in other species. especially humans.

Eventually Dr. Hammock found these compounds in humans and they supposedly reduce pain. Of note, he does not specify what these compounds are, but only says they are chemically broken down rapidly in the body naturally. He then found a way to keep them from being broken down in the body as quickly. Dr. Hammock believes this compound can somehow help relieve pain.

Believe It When We See It

The reason to be skeptic is that naturally this compound that reduces the intensity of pain is very transient in the body by the description given. This makes me believe it is likely easily broken down by chemicals in the body and is in a very limited location. This type of compound is very hard to deliver conveniently (like a pill) into the body and be absorbed. It is also likely to be easily broken down no matter what one does. Lastly, the chemical sounds like it may be something that exists in the nervous system, and thus isolated by something like the blood-brain barrier.

The researchers behind this new novel compound are just looking at starting human trials. So far there has been little funding toward the research from what has been said in the regular press. Further, as noted earlier there is no information in the extensive research pain literature on the animal-level studies discussing this compound. If the research was really promising, more money would be involved without question since pain treatment is a billion dollar industry with huge potentials.

The bottom line is that there is research going on in the field of pain medicine trying to develop new treatments and medications. However, whether any of the current research will lead to new drugs is difficult to guess. A lot of treatments have been proposed but most die as they are tested. Human studies usually take between five and 10 years to complete. Only time will tell if this research will ever lead to a new drug that is useful to treat pain.

Get Your Vitamins and Minerals From Food, Not Supplements

April 23, 2019 / Thomas Cohn, MD

Many people ask about taking dietary supplements, vitamins, minerals, and various natural compounds to improve their pain and their life. These are not officially regulated as far as how well they work. They are regulated only to the level that they cannot be toxic when ingested and they have become a billion dollar business.

Are They Effective?

Recently, a large study was done with regards to multiple dietary supplements, with an extra emphasis on medications with claims of helping with heart disease and natural degeneration caused by aging. Simply put, nothing had any positive impact on health for any of the compounds being pushed. The study was published in JAMA in January 2019 and looked at many different compounds. Included were ginkgo balboa, coenzyme Q10, coral calcium, and many others. These are all found in the vitamin and supplement aisle of many stores. None of these promoted items had any impact on cardiac health, dementia, cognition or any general component of health. Basically, none of these vitamins, compounds or minerals made a difference.

The answer of what really works is eating healthy. All these various compound are found in our fresh foods. Eating fresh food provides nutrients in a way through the gut that the appropriate vitamins and minerals are absorbed correctly and can be used by the body. In pill form or other concentrate, the body often will not be able to utilize the compound successfully. Many times the form of the compound in a pill is not absorbed or is destroyed by the body’s digestive processes. When we eat our food, our digestive system can find the nutrients and make sure they travel to the correct areas of the body. All the studies show that nutrients that come from eating a good diet are helpful, and adding a variety of supplements shows no benefit.

The best suggestion based on all these medical studies is save the money spent on supplements and spend the money on eating a healthy diet with fresh fruit and vegetables and low fat protein. Highly processed foods with high carbohydrate loads often do not have a high nutritional value. Develop a diet that comes from the outer aisles of the grocery where the fresh foods are found. None of the claims for supplements have really be proven, so save your money for now.

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.

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.