Withdrawal Symptoms Common In Chronic Pain Patients Using Medical Marijuana

January 13, 2021 / Thomas Cohn, MD

As we’ve said on the blog in the past, we’re a proponent of helping patients find a treatment plan that works to help prevent or control their unique chronic pain condition. For many individuals, medical marijuana plays a key role in their treatment, but it’s far from a perfect solution. As we’ve also said on the blog in the past, we want more studies to be conducted on medical cannabis so that we can begin to unwrap this complex component. A recent study did just that, and they found a potentially concerning side effect associated with its use for chronic pain patients.

According to a new study, more than half of all patients who used medical marijuana to help treat a chronic pain condition experienced withdrawal symptoms during even short consumption breaks. There have been documented studies that suggest among recreational users, with about 40 percent experiencing some sort of withdrawal symptoms when not using, but this study took a closer look at these effects on medical marijuana users. Withdrawal symptoms aren’t expressly projected as a user’s yearning for their next dosage, rather, these symptoms can manifest in a number of different ways that affect a person’s health. For example, withdrawal symptoms can affect a person’s sleep, mood, mental state, energy and appetite, and these issues are manifesting in roughly half of medical marijuana users.

Withdrawal Symptoms And Chronic Pain

For this study, researchers polled more than 520 individuals using medical marijuana to treat non-cancer-related chronic pain issues. They were asked if they experienced any of the symptoms after not using for a significant time: Craving for cannabis, anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.

At baseline, 41 percent of people were classified in the mild withdrawal symptom group, 34 percent were in the moderate group, and 25 percent were in the severe group. Additionally, 13 percent of participants saw their withdrawal symptoms rise to the next level by the end of the first year of treatment, and eight percent transitioned upwards by the end of two years.

Interestingly, regardless of the group they were in, sleep problems were the most common symptom. And as we’ve said on the blog, inadequate sleep can have significant effects on your chronic pain condition. Poor sleep quality can worsen pain symptoms, so while some of these withdrawal symptoms may not seem all that bad, they can actually be making your pain condition worse.

At the end of the day, while they are two different treatment paths, a medical marijuana program needs to be implemented much like an opioid regimen for pain. A comprehensive patient profile needs to be developed, the patient needs access to educational material to ensure they understand the potential risks associated with the treatment, and regular checks need to be conducted along the way to ensure everything stays on track. If withdrawal symptoms or other issues are present, specific interventions need to be developed, because it’s unlikely that the problems will go away on their own. In fact, they oftentimes get worse.

So while medical marijuana can be a great addition to a chronic pain treatment plan, we doctors and patients need to be aware of the potential pitfalls to successful treatment so that they can be avoided and managed. If you’re dealing with a chronic pain condition and want help with treatment, reach out to Dr. Cohn and his experienced medical team for more information.

5 Non-Physical Factors That Influence Chronic Pain Perception

December 28, 2020 / Thomas Cohn, MD

Chronic pain is oftentimes treated as a physical problem, but there’s much more to it than that. There are a number of other factors that play a role in the onset or alleviation of chronic pain symptoms, so being aware of these factors and doing your best to control the modifiable aspects can really help you in your quest to manage your chronic pain condition. In today’s blog, we take a closer look at those factors and explain how to use them to help control your pain symptoms.

Non-Physical Factors That Affect Chronic Pain

Here’s a look at some non-physical factors that influence how you interpret or perceive chronic pain:

1. Psychological – We tell all of our patients that chronic pain is oftentimes just as much of a mental battle as it is physical. Learning about your chronic condition and working to improve your mental health can be just as important in helping control symptoms as treatments like physical therapy. Make sure you don’t ignore your mental health when it comes to dealing with the fallout of a physical condition.

2. Emotional – Physical pain can also throw our emotions out of whack, and that can hinder our ability to successfully treat our physical ailment. A physical ailment can leave a person feeling annoyed, angry or short-tempered, none of which will help with getting control over your pain condition. It’s easier said than done, but find healthy ways to control your emotions and reach out to your doctor if you’re feeling depressed or angry about your physical condition.

3. Stress – Stress is also a huge component of how chronic pain develops and is perceived. Stress from daily life or your work environment has been shown to trigger tension headaches or inflammatory responses from the body, both of which can serve to make your pain condition worse. Don’t let stress bottle up inside of you, find healthy outlets like exercise or yoga to help you relieve stress.

4. Educational – The fear of the unknown can leave patients overstressing about certain aspects of their health, which can serve to make pain worse. Conversely, many patients who take the time to learn more about their specific chronic pain condition end up in a better position to make healthy choices to help manage symptoms. Turn to your doctor or trusted medical resources online for more information about your condition and treatment strategies for alleviating symptoms.

5. Our Bad Habits – Finally, there are vices in life that can make your chronic pain condition worse. Smoking, for example, can restrict healthy blood flow and contribute to degenerative spinal disc disease. Similarly, heavy alcohol use can lead to nerve damage, which can affect how pain signals are sent or interpreted by the brain. Getting control of your chronic pain condition includes making positive changes on your daily habits that could be having a negative affect on your health. Do some self-reflection and assess whether certain lifestyle choices are making your pain condition worse.

If you keep these tips in mind and do what you can to help control them, we’re confident that you’ll be putting yourself in a good position to beat your chronic pain condition. For more information or for help with any aspect of your pain care, reach out to Dr. Cohn’s office today.

What To Look For In A Pain Care Specialist

December 21, 2020 / Thomas Cohn, MD

Pain isn’t created equal, and either is pain care. As a patient with such a highly individualized issue like chronic pain, you should be treated by someone who is going to do all they can to help you find a solution to your specific issue. Not all pain care providers are built the same, so it’s important that you take the time to find someone who is right for your situation.

But how do you know what you should be looking for in a pain management physician? We explain some traits and abilities you should look for when trying to find the right physician for your chronic pain issue.

Finding The Right Chronic Pain Specialist

When trying to find a specialist to help with your chronic pain issue, it’s important that you don’t just pick the closest physician to your house or the first one you come across in-network. You need to look at some other relevant factors if you want to give yourself the best chance at finding a physician who can treat your pain issue. Here’s what you’ll want to look for.

1. Depth Of Knowledge – Most general practitioners have a wide breadth of knowledge, and that allows them to provide professional care for a number of different issues. However, for a specific condition like chronic pain, you want to find someone with a deep knowledge and years of experience on the subject. Although we’ve noted that pain is highly specific to the individual, drawing on the experiences with past patients can make all the difference in finding a solution to the problem presented by the current patient. Find someone with years of experience in the specialized field of pain management.

2. A Listener – Does your current physician really take the time to listen to your story and apply those facts to your treatment, or do your words seem to be going in one ear and out the other? They say that “doctor knows best,” but that doesn’t mean the patient can’t provide crucial and relevant facts to assist in the treatment process. A great doctor really listens to the patient and uses this information to provide the best level of care. If you feel like you’re being treated as just another patient and the doctor seems to have their mind made up before you even get a chance to talk, consider looking for a different specialist to help with your pain.

3. Willing To Adjust – Another thing that both patient and provider need to be willing to do is adjust to roadblocks that develop, because they always do. If they didn’t, chronic pain would be easy to treat. Your provider needs to be able to look at the changing landscape of your pain condition and make adjustments to account for these potential obstacles to successful treatment. This may involve finding new forms of physical therapy, adjusting if pain injections are no longer as effective as they used to be, or consulting another professional when a problem proves mystifying. If you feel like you’re just trying the same old techniques that haven’t been working, why should you expect anything to ever change?

4. Seeks Long Term Solutions Over Short Term Relief – Any pain physician can write a prescription for painkillers and provide their patient with short term relief. It’s a passive solution that is like putting a band-aid on a bullet hole. Painkillers absolutely can be part of a comprehensive treatment plan, but they shouldn’t be the focal point of your care. You want a pain care provider that pursues active treatment options that will help you find long term relief. If your doctor isn’t working towards long term relief, switch physicians.

If you can find all four of these things in your care provider, odds are you’ll have an increased likelihood of regaining control over your pain condition. Dr. Cohn has done this for countless patients in the past, and he can do the same for you. For more information, or to set up an appointment, reach out to his clinic today.

Surviving The Holidays If You Have Chronic Pain

December 14, 2020 / Thomas Cohn, MD

The holiday season is upon us, and while it’s often marketed as the happiest time of the year, for individuals with chronic pain, the holiday season is often filled with stress and pain. Those two things – stress and pain – often go hand in hand with one another because stress can be a chronic pain trigger, and the holidays can be one of the most stressful times of the year, in turn making it a painful time of the year for chronic pain sufferers.

And while we don’t have all the answers to make your holiday season perfect, there is a playbook you should follow if you want to help prevent against painful flareups. Below, we share some tips for surviving the holiday season if you have chronic pain.

Pain, Stress and the Holidays

This blog is going to focus on some of the major stressors of the holiday season and tips for alleviating this stress so that they don’t become a source of a chronic pain flareup.

Finances – Money can easily become tight during the holiday season if we’re not careful, and money is one of the most common sources of stress during everyday life. Develop a budget, limit your spending and make sure that you don’t go into a financial hole trying to buy things during the holiday, because this can lead to stress and pain flareups.

Diet – A poor diet can also trigger inflammation and a pain flareup, so try to eat somewhat healthy over the holidays. It can be easy to indulge in Christmas candy and stocking stuffers, but if you eat too much sugar, your pain condition may be more present throughout the holidays. Strive to make more healthy food choices during the holidays.

Limited Exercise – Exercise is a great way for us to manage stress, but oftentimes it can be tough to perform your regular exercise during the holidays. You may be crunched for time because of the holidays or find it difficult to perform a workout when it’s cold and dark most of the day, but don’t avoid physical activity. If you find yourself getting stressed, carve out time for some simple exercise, because it will be beneficial for both your mind and body.

COVID Stress – Obviously the coronavirus is still a major problem in Minnesota and throughout the United States, and fear of contracting the virus during family gatherings or church can lead to a lot of internal stress. Put your health first and avoid unsafe gatherings. You’re not a Grinch or a Scrooge if you skip out on certain events this year because of rightful concerns over the coronavirus. Don’t add stress to your plate because you felt obligated to go to an unsafe gathering.

Take Time For Yourself – If you’re one of those people who wants to please everyone else during the holidays, you need to make sure you’re taking some time for yourself. Because if you don’t, stress will catch up with you. Practice some yoga or meditation, or just wake up 30 minutes before everyone else and take some time to enjoy your morning coffee in peace. If you take time for yourself, you’ll be better able to care for others during the holiday.

Sleep – Finally, make sure you are getting enough quality sleep each and every day. Lack of sleep can lead to inflammation and chronic pain flareups. We know that this is easier said than done, but force yourself to head to bed at a reasonable time and make your bedroom an ideal sleep environment. Improving your sleep quality is one of the easiest ways to limit stress and chronic pain flareups.

If you need help with any of the above aspects, or you want professional assistance with your pain condition, reach out to Dr. Cohn’s office today.

To Prescribe Or Not To Prescribe

December 2, 2020 / Thomas Cohn, MD

“To be or not to be, that is the question,” is the famous line from the play Hamlet. For many doctors, especially pain management physicians, they battle with a similar question with every patient they encounter – “To prescribe or not to prescribe.”

Medication prescription and the written and unwritten rules that govern the practice have been a hot button issue of late, especially during the pandemic. In an effort to stay up to date on the latest news regarding chronic pain care, we often find stories blasting doctors for over-prescribing or doctors who find it necessary to validate their very real and very appropriate treatment plan that involves the prescription of opioids. Patients are also caught in the mix. Heck, I’ve had a colleague killed by a former patient because they would not prescribe opioids, which only makes it harder for patients with legitimate ailments and conditions that can effectively be managed by opioids to get their hands on the medications they so desperately need.

The debate over opioids has in some ways mirrored the most recent presidential election. Any reasonable person realizes that neither party is right 100 percent of the time, but many of the loudest Republicans and loudest Democrats only seek to champion their beliefs and refuse to listen to what the other side has to offer. We’ve seen the same situation play out with opioids, as it seems like we’re either hearing about opioid hysteria and mass over-prescribing or that no doctor should ever stand in the way of a patient who wants painkillers for their pain condition. And just like with politics, the answer tends to lie somewhere in the middle.

Prescribing Or Not Prescribing

There is no one-size-fits-all answer to whether or not a physician should always or never prescribe opioids, because every individual and every pain condition is unique. Even in patients who have similar characteristics and similar pain conditions, it’s irresponsible to say that they should always or never receive opioids as part of their care plan. An assessment needs to be made on an individual basis and it needs to be made on the totality of the situation.

There are so many different factors that need to be understood before a doctor makes a determination as to whether or not painkillers would be in the patient’s best interest. There are the obvious factors like age and diagnosis, but there are also the less-than-obvious factors like whether or not underlying anxiety or a mental health condition could be exacerbated by beginning a new opioid regimen. A physician will also dive into a patient’s medical and family history to look for signs of abuse or potential abuse. It’s not that the doctor doesn’t trust the patient with opioids, it’s that we want to make sure we’ve uncovered all potential hurdles to successful treatment. Navigating known potential obstacles is so much easier than trying to blindly push forward with a care plan.

And of course, a good pain physician will listen to the patient. We want to learn about your goals, your wishes and your concerns and factor those into our decision to prescribe opioids. During our decades of practicing medicine, we’ve certainly encountered the patient that clearly has ulterior motives for wanting a quick and fast prescription. But far more often than not, patients want opioids to play a role in a comprehensive treatment plan. They want painkillers so that their physical therapy exercises can be performed a little easier, or they believe opioids will help them live a more active lifestyle and combat their pain condition in other ways.

Painkillers can absolutely play an essential role in a pain care plan, but that doesn’t mean they should absolutely be prescribed for every patient. A totality of factors need to be analyzed in order to provide the best care for the patient, which is what all physicians should strive for. Doing right by the patient means taking the time to really understand their condition, their frustrations, their goals, their concerns and their opportunities. Sometimes that involves painkillers, sometimes it doesn’t. The sooner we realize that we need to come together to help find solutions for pain patients instead of condemning chronic pain sufferers and physicians, the better we all will be for it.