Law Change Helps Patients Fighting Chronic Pain In Minnesota

August 8, 2022 / Thomas Cohn, MD

A number of new laws went into effect on August 1, but one law in particular could be a godsend for certain chronic pain patients in Minnesota. The law clarifies and updates how doctors can prescribe medications to patients battling chronic pain, which will make it easier for some patients battling complex pain problems to receive the medications they so desperately need.

The new law came after some concerns developed in the wake of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Those guidelines really attempted to reduce opioid addiction and overdose deaths by placing limits and restrictions on the types of medication that patients with chronic pain could receive. However, as we’ve talked about on the blog in the past, chronic pain is highly individualized, so attempting to paint all pain patients with a broad brush stroke and subject them all to the same restrictions was bound to cause problems for some patients.

The 2016 guidelines featured specific numeric thresholds for opioid prescribing, which were later adopted widely and used in regulations and state laws to police opioid prescribing. But these restrictions also had an unintended effect – patients who could no longer get the crucial medication they needed to help with their pain would sometimes turn to the streets for painkillers.

“Many have turned to the streets out of desperation,” said Laura Johnson, a chronic pain patient who spoke to the Minnesota Senate during a spring hearing. “Many more have ended their lives.”

Both the American Medical Association and the Minnesota Medical Association backed up Johnson’s testimony, sending letters in support of a proposed change.

The New Guidelines

The updated guidelines essentially allow doctors more freedom to continue prescribing opioids past the previous threshold so long as they are doing so with a clear purpose and accurate documentation. The revised statute provides new or updated definitions for treating problems like intractable pain, palliative care and other rare conditions. Here’s what they say:

No physician, advanced practice registered nurse, or physician assistant shall be subject to disciplinary action by the Board of Medical Practice or Board of Nursing for appropriately prescribing or administering a controlled substance in Schedules II to V of section 152.02 in the course of treatment of a patient for intractable pain, provided the physician, advanced practice registered nurse, or physician assistant keeps accurate records of the purpose, use, prescription, and disposal of controlled substances, writes accurate prescriptions, and prescribes medications in conformance with chapter 147 or 148 or in accordance with the current standard of care.

No physician, advanced practice registered nurse, or physician assistant, acting in good faith and based on the needs of the patient, shall be subject to disenrollment or termination by the commissioner of health solely for prescribing a dosage that equates to an upward deviation from morphine milligram equivalent dosage recommendations or thresholds specified in state or federal opioid prescribing guidelines or policies, including but not limited to the Guideline for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and Prevention and Minnesota Opioid Prescribing Guidelines.

Prescribers are prohibited from tapering a patient’s medication dosage solely to meet a predetermined dosage recommendation or threshold if the patient is stable; is experiencing no serious harm from the level of medication prescribed, and is in compliance with treatment plan and patient-provider agreement.

No pharmacist, health plan company or pharmacy benefit manager shall refuse to fill a prescription for an opiate issued by a licensed practitioner authorized to prescribe opiates solely based on the prescription exceeding a predetermined morphine milligram equivalent dosage recommendation or threshold.

Prescribers and patients are required to enter into an agreement that includes the patient’s and prescriber’s expectations, responsibilities, and rights according to the best practices and current standard of care with agreement to be signed by the patient and the prescriber, and a copy of the agreement included with the patient’s medical record and a copy to the patient, to be reviewed at least annually and when there are any changes to treatment plan.

Absent clear evidence of drug diversion, nonadherence with the agreement must not be used as the sole reason to stop a patient’s treatment with scheduled drugs.

These updated guidelines should ensure that patients and providers who are doing everything in their power to correctly address a chronic pain issue won’t run into problems with access to medications that they need. Hopefully we see these intended results in the near future. And if you need help with a pain issue in the greater Twin Cities area, reach out to Dr. Cohn and his team today at (953) 738-4580.

In Pain, Stigmatized and Unsupported – What It’s Like To Have Chronic Pain in 2022

August 4, 2022 / Thomas Cohn, MD

As technology advances and we get a better understanding of the underlying causes of chronic pain, you’d think we’d be able to put up a better fight against the debilitating condition. However, a recent survey from the U.S. Pain Foundation uncovered the true landscape of what it’s like to have chronic pain in 2022. Needless to say, we have a lot of work to do in addressing the problem.

The Current Chronic Pain Landscape

For their survey, the U.S. Pain Foundation interviewed 2,275 patients with chronic pain, 72 caregivers and 31 health care professionals to better understand the health care crisis that is chronic pain. The results revealed that for many people, pain is significant, and they don’t know where to turn for support. Here’s a look at a number of the findings from the survey.

On a scale of 1-10, more than half of respondents (52%) rated their average pain level a 7 or higher.
99% said that their chronic pain condition restricted their ability to engage in routine activities.
Only 18% were employed full-time.
79% said they felt stigmatized because of their pain, and 63% said they felt stigmatized by their provider.
1 in 4 patients said they rarely or never had their feelings validated or listened to by their provider.
79% of respondents currently take prescription medications, and 77% felt that it was the most helpful treatment for their pain.
49% of respondents said cost of services was their leading barrier to treatment.
41% of people with pain said they felt their insurance coverage decisions were driven by cost, not what was in their best interest medically.

There’s a lot to sift through in this report, but it provides a pretty rough outlook on chronic pain in 2022. A couple of the biggest takeaways that we want to touch on are in regards to:

Pain – Chronic pain is a condition that affects millions of Americans, but it seems unlikely that people realize just how painful these conditions can be. With more than half of people rating their pain at a 7 or higher, it’s clear that pain isn’t just bothersome or uncomfortable, it’s downright painful. We need to work on lessening pain scores.

Stigma – Fighting the stigma of chronic pain has been one of our top priorities. We pride ourselves in giving each patient the full time and attention they deserve to really understand their pain and how it’s affecting them. By doing this, we believe we’re better able to match patients to active treatments like physical therapy, exercise, breathing techniques or mindfulness training to help overcome their individual issue.

Treatment – As we’e said countless times on the blog in the past, medications can absolutely play a pivotal role in helping you overcome a chronic pain condition, but they shouldn’t be a standalone option. While the report did mention that multidisciplinary approaches were common, it’s a bit concerning to see that 77% felt that it was the best treatment for their pain. It’s possibly the best treatment for their symptoms, but it’s unlikely to be the best treatment for their underlying issue. Hopefully patients are taking advantage of the symptom relief provided by medications to pursue other endeavors like exercise or physical therapy to also attack the root issue of their pain disorder.

If you want someone who won’t make you feel stigmatized and will be a resource for you on your road to recovery from chronic pain, reach out to Dr. Cohn and his team today at (952) 738-4580.

What Is Chronic Pain Spoon Theory?

July 28, 2022 / Thomas Cohn, MD

If you’re a chronic pain sufferer or you know someone battling a chronic pain condition, you may have heard about spoon theory or the phrase “counting your spoons.” Spoon theory is widely accepted in the chronic pain community as a way to help others understand and empathize with how a chronic condition can affect a person. In today’s blog, we take a closer look at spoon theory and how it applies to the chronic pain community.

Counting Your Spoons

Spoon theory is the idea that a person with chronic pain has a certain number of spoons that they start out with every morning. Each spoon represents the energy required to complete a certain task, and some tasks require more spoons than others. For example, because of your chronic pain condition, you may only start the day with a few spoons. One spoon may represent the energy it takes to get ready in the morning, a trip to the doctor may take a couple of spoons, and by the time a person gets home at the end of the day, they may have no more spoons left for other pursuits.

Oftentimes someone explaining spoon theory has physical spoons in their hands that they dole out based on the activities that each day presents. This way, you can actually see where your energy is being applied, and it makes sense to others how you may not have the energy or ability to follow through on certain activities, because you’re simply out of spoons.

But spoon theory isn’t just helpful in explaining to others how a chronic pain condition can drain your energy, it can also make it easier for a chronic pain sufferer to plan their day accordingly. Of course, you may not know how many “spoons” you will start the day with, but if you start to get in the habit of understanding the toll certain activities have on your body and your mind, you cans find ways to get more done each day. You can avoid wasting spoons on non-critical pursuits, or better yet, you can look to find ways to increase your spoon count. For example, while daily exercise may require some spoons each day, if this type of beneficial physical activity can keep symptoms at bay, help you destress and increase your energy levels, you may find that you have more spoons to start with every day.

Spoon theory is really about prioritization, and that can be extremely beneficial when it comes to chronic pain treatment. You need to prioritize the activities and choices that will help you overcome your chronic pain condition. Conversely, if you spend your spoons on things that help treat your chronic pain condition, or worse, actively sabotage your long-term prospects, you can find yourself with fewer spoons each day.

If you’re interested in taking small steps to find more spoons each day and work to overcome your chronic pain condition, reach out to Dr. Cohn and his team today. We understand that chronic pain is different for every person and that unique solutions are often required, but we’re confident we can find ways for you to fight back against your pain. Give our team a call today at (952) 738-4580 and soon your spoon count may be on the rise!

Tips For Managing Chronic Back Pain If You Have A Desk Job

July 20, 2022 / Thomas Cohn, MD

Millions of Americans work desk jobs or in a position where they are very sedentary for an extended part of their day. If you sit for eight hours a day, five days a week, it’s not uncommon to develop back discomfort or even chronic back pain. However, if you are a little proactive in how you approach your job and life outside the office, you can work to reduce or completely alleviate your back pain. In today’s blog, we share some tips for reducing lower back discomfort if you work a desk job.

Combating Back Pain If You Work A Desk Job

You don’t need to completely overhaul your life to combat back pain if you work a sedentary job, you just have to make a few tweaks to your daily routine, and odds are you’ll notice a big improvement in your symptoms. Here’s a look at some of the ways to help reduce back pain if you’re stuck at a desk for an extended period each day.

1. Break Up Long Seated Periods – When you’re seated for a long time, your spine is holding static stress, oftentimes in the lumbar spine. This may not feel all that strenuous in the moment, but over time it will break down structures and contribute to continued pain. Try to get up and move for a couple minutes at least once an hour. Even if that’s just walking to the end of the hall and back or to refill your water bottle in the break room.

2. Stand – Standing will help to take pressure off your lumbar spine and better disperse the stress of gravity and your body weight. See if you company will invest in a sit-to-stand workstation, or find ways to incorporate more standing in your day. Take that conference call on your feet!

3. Exercise – When you’re not in the office, commit some time to an exercise routine. Make sure that these exercises don’t overlook your core, because core stability helps to support your spine. Don’t just focus on your arms and your legs, do some core strengthening exercises, and you back will become stronger and better able to handle stress.

4. Mind Your Diet – A poor diet can be pro-inflammatory, whereas a healthy diet can help to calm inflammation that could be compressing areas in your spine. Plan ahead so that you have healthy meals at the office and you don’t fall in the habit of grabbing fast food because you’re ill-prepared.

5. Posture Checks – Poor posture can also put additional stress on your lumbar or cervical spine, so if you are going to be seated for an extended period, make sure that you have ideal posture. Regularly check your posture to make sure that you’re sitting up straight, with your head directly above your shoulders. Make corrections any time you notice that you’re out of alignment.

6. Connect With A Specialist – If you’re still dealing with chronic back pain even after pursuing some of these techniques, connect with a specialist like Dr. Cohn. He can get to the bottom of your spine pain and suggest additional conservative techniques to help manage discomfort. If more hands-on care is needed, he can provide pain-relieving injections or perform a minimally invasive procedure to put an end to your pain.

For more information, or to talk to a specialist about your back discomfort, reach out to Dr. Cohn’s office today at (952) 738-4580.

When You Don’t Have Time For Chronic Pain

July 14, 2022 / Thomas Cohn, MD

Nobody has time for a chronic pain condition, but for busy individuals who try to push through the pain to get on with their day, taking the time to appropriately treat their condition may be the first item that they skip when they are trying to plan their hectic schedule.

You may even convince yourself that you don’t have time to receive treatment for your chronic pain because between getting the kids to school, working, planning dinner and doing chores around the house, there simply aren’t enough hours in the day.

If this sounds like your life, this blog is for you. Below, we explain how you can work to improve your chronic pain condition when you’re struggling to find the time to treat it.

Treating Chronic Pain On A Bust Schedule

Here are some tips for how you can work towards a healthier version of yourself and treat your chronic pain condition when you don’t have a lot of extra time to spare.

1. Incorporate More Movement In Your Life – Movement is wonderful for your body and your chronic pain condition. Activity helps to strengthen muscles, boost your circulation and avoid weight gain that can further stress your body. Find little ways to become more active throughout the day if you find it hard to get to the gym for a full workout. Take the stairs over the elevator, park further away from the entrance to work or the grocery store, or walk around while you’re on a phone call or waiting for your kids to finish soccer practice. Strive to take more steps every day.

2. Make The Time – This is obviously easier said than done, because you can’t physically create more hours in the day, so any time you carve out for physical therapy or exercise will come by sacrificing something else. Our best advice here is to make 15-20 minutes each day where you turn off all the distractions and focus on yourself and your health. That may mean waking up 15 minutes earlier, staying up a little later, or simply having a conversation with your family about how you need a few quiet minutes after dinner to focus on yourself and your health. Finding just a few minutes each day where it’s only about you will do wonders for your physical and mental health.

3. Improve Your Diet – Your diet can help or hurt your chronic pain treatment, so make some simple adjustments to ensure it’s working to solve your chronic pain. Busy people can sometimes over-rely on unhealthy options like fast food or flash frozen options. Meal plan for the week or take a few minutes each night to prep your meals for tomorrow so that you know where your meals are coming from and you can make healthier choices. Also, consider investing in a water bottle so that you can always stay hydrated when you’re on the go, as dehydration can lead to blood pressure issues and muscle pain.

4. Reevaluate Your Priorities – We understand that exercise and physical therapy may not be the most fun thing in the world, but few things are more important than your health, so you’ll want to keep that in mind when you’re planning your day. Really start to get in the habit of making time each day for your health, and soon it will become easier to follow through with your exercises as you develop a routine. Make sure your priorities are in the right order.

5. Connect With A Professional – Finally, if you’re too busy to fight your chronic pain condition on your own, enlist a professional. A pain specialist can figure out what’s going on, develop an individualized care routine and may even be able to see you through a virtual visit so that you don’t have to take time driving to and from the clinic. Let a professional make sure that you get the most out of the limited time you have to commit to a pain management program. In the greater Twin Cities area, connect with Dr. Thomas Cohn for help with your chronic pain problem. Give his clinic a call today at (952) 738-4580.