pain

Study Finds Antidepressants Oftentimes Ineffective For Chronic Pain Treatment

/ Thomas Cohn, MD

anti-depressantA large review of 176 trials involving nearly 30,000 patients found that there was “insufficient” evidence to suggest that antidepressants are an effective treatment for chronic pain.

The study, published in the Cochrane Database of Systematic Reviews, took a closer look at whether or not antidepressants like amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine could be effective in treating certain chronic pain conditions. Millions of people are prescribed anti-depressants to help treat their chronic pain issue, and while many chronic pain conditions involve physical, mental and emotional aspects, it doesn’t necessarily mean jumping on an anti-depressant regimen is helpful.

After conducting the meta-review, researchers were quick to question the efficacy of anti-depressants to treat chronic pain.

“Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point. Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence,” said lead author Professor Tamar Pincus from the University of Southampton.

The two-year study was the largest-ever assessment of anti-depressants currently recommended by the Food and Drug Administration and the UK’s National Institute for Health and Care Excellence (NICE).

Anti-Depressants And Chronic Pain Management

So while there is some clear doubt about the effectiveness of common anti-depressants for chronic pain management, you shouldn’t just stop your current medication regimen if you are on an anti-depressant. You should always consult with your physician before altering your medication schedule, because stark changes can actually lead to more issues.

Additionally, the review isn’t meant to suggest that you should never take an anti-depressant if you have chronic pain. As we mentioned above, chronic pain is rarely just physical, so it is important to care for your mental health as you work through a physical pain issue. That said, anti-depressants should not be your sole treatment plan. Anti-depressants may play a vital role in a comprehensive treatment plan, but they are unlikely to be a great stand-alone option.

Paired with treatments like physical therapy, dietary changes, sleep improvements and cognitive behavioral therapy, it’s certainly possible that anti-depressants may be helpful for your specific situation. Again, their use needs to be evaluated on an individual basis, and it should not be the treatment that you put the most energy towards. There are many other treatments that have been found to be much more effective at treating chronic pain conditions, and we’d be more than happy to help find the right treatment for you.

For more information, or to work with a pain management provider to find a treatment plan that’s right for you, reach out to Dr. Cohn and his team today at (952) 738-4580.

Drinking To Cope With Chronic Pain May Lead To Worse Pain

/ Thomas Cohn, MD

chronic pain alcoholAlcohol has a number of effects on our brain and body, and while it may be able to seemingly drown out some pain sensations in a very short-term manner, it’s obvious that turning to alcohol is not a smart or healthy way to cope with your chronic pain condition. That sentiment only becomes more true on the heels of a new study that found that turning to alcohol to cope with chronic pain can actually lead to worsening pain sensations.

Chronic Pain And Alcohol Use

To get a better understanding of the effects of alcohol and pain perception, researchers turned their attention to three groups of mice. One group was dependent on alcohol (excessive drinkers), another had limited access to alcohol (moderate drinkers), and the final group had never been given alcohol. The mice then had their access to alcohol restricted before having it reintroduced.

Researchers found that in mice that were dependent on alcohol, allodynia was a common symptom during alcohol withdrawal. Allodynia is a condition in which a normally harmless nerve stimulus is perceived as painful by the brain. In other words, the mice going through withdrawals were more likely to experience phantom pain.

Interestingly when these mice were reintroduced to alcohol, pain sensitivity decreased, which would likely only continue to worsen a dependency issue. However, that decrease in pain sensitivity was not the same across the board. About half of the mice in the moderate groups showed signs of increased pain sensitivity during alcohol withdrawal, but they did not see pain sensitivity decrease when reintroduced to alcohol.

Additionally, when researchers measured the level of inflammatory proteins in the animals, they discovered that specific inflammatory molecules were only increased in dependent mice. This suggests that different molecular mechanisms may be driving the two types of pain, but on a positive note, it may make it easier to create medications that targets these specific proteins.

“These two types of pain vary greatly, which is why it is important to be able to distinguish between them and develop different ways to treat each type,” said study first author Vittoria Borgonetti, PhD, a postdoctoral associate at Scripps Research.

The team hopes that their findings and their future research will be make it easier for medical experts to help treat chronic pain conditions that are being fueled or worsened by alcohol.

“Our goal is to unveil new potential molecular targets that can be used to distinguish these types of pain and potentially be used in the future for the development of therapies,” said co-senior author Nicoletta Galeotti, PhD, associate professor of preclinical pharmacology at the University of Florence.

So not only is alcohol unhelpful at treating the underlying cause of chronic pain, it can actually increase your risk of phantom pain signals. Instead of turning to alcohol, turn to a pain care provider like Dr. Cohn. We’re confident we can find the right treatment option for your unique pain condition. For more information, or to set up an appointment with Dr. Cohn, give his office a call today at (952) 738-4580.

5 Tips For Living Well In Spite Of Chronic Pain

/ Thomas Cohn, MD

painChronic pain can make everyday actions difficult and leave us not wanting to get out of bed in the morning. It’s perfectly fine to have some bad days when it comes to your chronic pain condition, but the key is to find ways to become healthier and string together more good days than bad. But what are some of the best ways to live healthier in spite of a chronic pain condition? We share five tips in today’s blog.

Living Healthier Despite Chronic Pain

Living healthier while dealing with a chronic pain condition won’t be easy, but it will be worth it. Regularly making smart choices will help you have more good days than bad, and that is incredibly important when dealing with a chronic pain condition. Here’s come advice we give all of our patients who are dealing with an uncomfortable chronic pain condition.

1. Prioritize Sleep – Sleep is a restorative process for your brain and body, but that doesn’t mean that we are always great about consistently getting enough sleep. We understand that a pain condition can make it harder to fall asleep and stay asleep, but we also need to be mindful to set ourselves up for success. Go to bed around the same time each night, keep electronics and other distractions out of the room, and make the room dark and cool so that it’s easier to fall asleep and stay asleep.

2. Regular Exercise – When you’re awake for the day, we want you to be active. Again, we know that this is easier said than done if you have a chronic pain condition, but exercise offers numerous benefits for a variety of pain conditions. Exercise will get your heart pumping, pushing oxygenated blood to structures that need it most, and it can help to strength areas that are unstable or contributing to your joint pain. Conversely, being inactive can lead to muscle and tissue atrophy, oftentimes worsening a pain condition. If standard workouts are too difficult because of your condition, pursue some low-impact exercises like swimming, cycling or moving on the elliptical.

3. Communicate With Your Pain Care Specialist – We want to do everything in our power to help you overcome your pain condition, and that’s a lot easier when the doctor and patient are effective communicators with one another. We’ll always be open and honest about your health and your pain condition, and we ask that you do the same. If you haven’t been doing your physical therapy sessions as recommended, or you’ve been stepping out of your physical restrictions, we need to know. We’re not here to judge you, but this information and effective communication can ensure that treatment remains on the right course.

4. Mind Your Diet And Weight – It’s also imperative that you make healthy food choices on a regular basis. We know that chronic pain can leave you feeling like you’ve lost control, and one thing you have full control over is your diet and food choices, which can be good or bad. Don’t retreat to unhealthy options because you had a bad day. You don’t need to eat perfectly, and be sure to reward yourself every once in a while, but string together more healthy meals. A poor diet can lead to weight gain, and this added stress typically only makes a chronic pain condition worse.

5. Be Willing To Pivot – Finally, it’s very rare for the first treatment strategy to completely resolve a complex pain issue, so you need to be willing to pivot if you’re not seeing the results you had hoped for. We’re always willing to pivot and find new methods for helping patients overcome pain, and we know that this process can be discouraging at times. Don’t give up! Keep following the other tips on this list and approach your pain care plan with an open mind, and we’re confident that you’ll eventually win out over your condition.

For more information, or for help with a different pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

6 Tips For Controlling Pain After Surgery

/ Thomas Cohn, MD

chronic painSurgery can be just what you need to overcome a painful and debilitating condition, but odds are you won’t experience that relief overnight. In fact, it’s common to experience pain and discomfort for a short period of time after the operation as your body works to adapt to the trauma of surgery. You can take solace in knowing that this post-surgical discomfort will fade, but life can be a little more comfortable if you work to control your post-op pain.

In today’s blog, we share six tips for controlling pain after surgery.

Managing Pain After An Operation

Here’s a look at six ways that you can work to control and decrease post-surgical discomfort.

1. Prehab – You don’t have to wait until after your surgery is complete to start working to become physically stronger. The stronger you are prior to surgery, the stronger you will be after your operation, and that can help to support joints and other structures that have been addressed during surgery. Ask your doctor for some exercises that you can perform before your operation.

2. Medication Management – Odds are you are going to be given some medications to help manage discomfort following your operation, but you need to take them in a specific manner in order for them to be most effective. Your care team will provide you with dosage instructions, but make sure that you understand how you are expected to handle your medications before you discharge or leave the pharmacy. Taking medications outside of your dosage instructions can lead to a number of issues, so if you have questions or are running into any issues, reach out to your care team.

3. Early Movement – You should always follow the specific recovery instructions of your treating physician, but don’t be surprised if they recommend early movement and activity. Odds are you won’t be told to stay in bed for weeks while your body recovers, because your body needs movement and controlled stress to improve circulation and become stronger. If allowed by your surgeon, make sure that you are up and moving as soon as it is allowed to help jump start the recovery process and limit pain or discomfort.

4. Physical Therapy –  In many instances, physical therapy will be the most effective treatment following an operation in terms of pain control and functional improvement. PT will help your structures become stronger, mobile and more stable, all of which help to control pain. Make sure that you are doing your PT exercises as directed and you never skip an appointment during your recovery.

5. Mind Your Mental Health – It’s easy to focus on your physical condition after surgery, but don’t overlook your mental and emotional health, because they are closely tied to your pain levels. Anxiety and depression can intensify pain sensations and our perception of pain, so make sure that you are caring for your mental health after an operation. Get outside, talk with friends or family and partake in activities that are energizing to your physical and mental health.

6. Connect With A Pain Specialist – If you are dealing with lingering pain or you just want to have some additional assistance managing a pain condition following your operation, connect with a specialist like Dr. Cohn. Pain is highly unique to the individual, but we will work hard to help find personalized ways to help you overcome your pain and improve your overall physical function. For more information, or for help with a different pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

Minnesota Considering Price Hikes On Chronic Pain Prescriptions

/ Thomas Cohn, MD

opioidsIf you’re dealing with a chronic pain condition, it’s entirely possible that it has impacted your financial earnings ability or led to increased expenses due to extra medical appointments. In other words, chronic pain can be a significant financial burden for many, and that burden may grow even stronger if Minnesota legislators end up passing HF 1728/SF 2142.

The proposal would add additional fees to opioid prescriptions, and these fees would be passed down to the patient. Legitimate medication has become much harder to get now that the US is really attempting to crack down on the rising opioid-related deaths, but for the patients with chronic pain or those with cancer who truly need their medication, not only are they having a harder time getting their prescription, but it may soon be more expensive. Passing these expenses onto the patients will only cause more strife for patients who are already financially burdened by their medical condition.

The Opioid Price Hike Problem

These price hikes would cause much more harm to legitimate chronic pain patients than it would help in curbing the opioid crisis. This is especially concerning because most chronic pain specialists advise their patients not to rely on pain medications as their main form of treatment. As we’ve preached on the blog in the past, opioids can absolutely be part of a comprehensive treatment plan, but they are not a great stand alone option. Doctors know that opioids alone will not address the underlying issue causing the chronic pain condition, so if they are going to prescribe them, they will be used in conjunction with other treatments like physical therapy, exercise or other active treatments. Making it harder for patients to have access to the medications that can make physical therapy more bearable or simply manage cancer-related pain isn’t the answer.

Lawmakers should seriously consider visiting a pain clinic or a cancer ward before they blindly vote to increase the price of opioids for those with a legitimate prescription in Minnesota. The overwhelming majority of patients use these medications responsibly and have a medically necessary reason for seeking them out. These price hikes will be deferred to them and may make it much harder for them to care for their pain condition. They may have to ration their pills outside of their doctor’s orders to cut down on other necessary expenses just to be able to afford their medications. This bill isn’t the answer, and it will put a bigger financial strain on many chronic pain sufferers across Minnesota.

We’ll keep an eye on the bill when it comes up for a vote, but hopefully Minnesotans aren’t further financially burdened by this potential price hike.