The Benefits and Drawbacks Of Extended Release Opioids

July 29, 2019 / Thomas Cohn, MD

We are always looking for new ways to make painkillers safer for those individuals who suffer from acute or chronic pain conditions, and one such improvement was the shift to extended release opioids. These types of pills were promoted as safer than traditional opioids, and while they are in some aspects, they are far from a perfect solution. In today’s blog, we take a closer look at the benefits and drawbacks of extended release painkillers.

Extended Release Painkiller Benefits and Drawbacks

Here’s a look at some of the benefits of extended release painkillers, as well as some reasons why these benefits may not be a perfect solution to the problem.

Abuse Deterrent – Some painkillers were redesigned, making them harder to crush and snort. While this has been successful in preventing abuse of some opioids, it has led some abusers to try even more dangerous methods to get their quick fix, like in the form of injections with shared needles. Other types of abuse deterrent drugs actually were designed such that if they were crushed, the active ingredient would fail and the user would not be able to experience the drug’s effects, which helped prevent abuse.

Overdose Deterrent – Extended release formulas of some opioids mean that the individual taking the medication gets a mild amount of the drug over an extended period of time, as opposed to a quicker feeling of pain relief that patients might feel with normal formulas of the drug. This also means patients may need less of the drug because it provides longer and consistent relief instead of a stronger relief that fades over time. That being said, some people may be expecting quicker pain relief, and when they don’t achieve that soon after taking the pill, they could end up taking additional pills to quell their pain. This can lead to an increased likelihood of abuse, addiction or accidental overdose.

Easy To Find – Many companies were forced to invest in developing abuse-deterrent versions of their drugs, so there are a number of different ER opioid options. However, since companies needed to invest more time and money into developing these drugs, they are often more costly than the normal pills. Many patients don’t want to spend more on painkillers than they need to, meaning many opt against the extended release options.

Effective – The good news is that for many patients, ER opioids are effective at helping them manage pain. One thing many pain sufferers want is consistency, and a consistent, long-release drug can do all that. This can help them plan their day, including when they need to take the pills in order to participate in physical therapy or other active treatment options. The only issue is, like any drug taken over a long period of time, the body gets used to the drug and a higher dose is needed to achieve the same level of relief. ER opioids are great in the short-term when working towards a longer recovery goal, but like any opioid, should not be viewed as a long term solution if at all possible.

Relearning How To Sleep With Chronic Pain

July 22, 2019 / Thomas Cohn, MD

Chronic pain can make daily tasks seem impossible, and one of the most common areas of your life affected by chronic pain is your ability to fall asleep and stay asleep. For many people, they need to relearn how to achieve quality sleep because it no longer comes naturally thanks to their pain condition. In today’s blog, we share some tips for relearning how to get restful sleep, because quality sleep plays an important role in controlling chronic pain.

Getting A Good Night’s Sleep With Chronic Pain

Here are some tips for falling asleep and staying asleep if you deal with a chronic pain condition.

1. Regular Bed Time – Get in the habit of going to bed around the same time every night. You body has what’s known as a circadian rhythm that helps regulate awake and tired periods for your body, and if you get up and go to bed around the same time, this will help you body find a good circadian rhythm. Even if you struggle to fall asleep right away, going to bed and laying down around the same time at night will help your internal body clock.

2. Lose The Distractions – The bedroom needs to be a place for sleeping, not for reading on your iPad or clicking around on Netflix. Research has shown that the bright lights of screens in dark rooms can stimulate our brain at a time when we want to be winding down. Read or watch TV out in the living room so that the bedroom becomes a place where you focus on achieving quality sleep.

3. Avoid Caffeine and Alcohol – In the hours before bed, avoid certain liquids that can inhibit restful sleep, like caffeine and alcohol. Even though alcohol may help you fall asleep, it disrupts your ability to achieve REM sleep, the deep and quality type of sleep you need to receive. Avoid these liquids as the sun begins to set.

4. Water Intake – If you’re looking for something to drink, go with water, but make sure you’re cognizant about your water intake. If you’re even slightly dehydrated when you go to bed, it can cause your mouth and nasal passages to become dry and lead to disruptive snoring. However, drinking too much water can lead to the need to get up and go to the bathroom in the middle of the night. Play around with your water intake in the hours leading up to bed so you are hydrated when you crawl into bed.

5. Temperature and Noise – Finally, the key to quality sleep is to stay asleep once you’re out. You don’t have a lot of control over this, but you can help by ensuring your bedroom has the right temperature and noise level. Keep the room cool and use blankets to get comfortable, and find out if noise helps or hinders your ability to fall asleep. Some people like white noise machines, others like the drum of a fan, while others need complete silence. See what helps you fall asleep and stay asleep, and then recreate those conditions each night.

For more tips on falling asleep if you have chronic pain, or for help with your specific pain condition, reach out to Dr. Cohn’s office today.

Chronic Pain Patients Struggling To Find Primary Care Services

July 15, 2019 / Thomas Cohn, MD

A new study published in JAMA Network Open found that chronic pain sufferers have a harder time finding primary health care because they have an active prescription for opioids.

According to the study, 40 percent of the nearly 200 primary care clinics contacted as part of study said they would not accept a new patient who takes Percocet daily for chronic pain as a result of a past injury, no matter what type of health insurance they had. An additional 17 percent of clinics said they would want more information about the patient before deciding if they would take them on, with two-thirds of this subset saying the patient would be required to come into a preliminary appointment before a decision could be made. Despite these findings, all of the clinics said they were currently accepting new patients.

The findings suggest patients with a history of chronic pain could face health care access problems.

“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees’, being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” said study lead researcher Pooja Lagisetty, M.D., M.Sc. “However, there have been no studies to quantify the extent of the problem. These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician.”

Slippery Slope

Dr. Lagisetty said for patients with chronic pain conditions, getting access to primary care goes beyond just checkups and preventative care. Having a regular physician could allow them to receive other pain-relieving treatments, and in some cases, work with the new provider to gradually and safely taper off their use of opioids. Primary care providers can also help recognize the signs of opioid use disorders or addictions, so not accepting patients simply because they are trying to manage their pain only works to further the crisis.

“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” said Dr. Lagisetty. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”

It’s easy to accept the healthy young adult at your clinic, and it can be harder to take on the patient managing multiple health conditions, but both should be guaranteed access to primary care providers. We need more doctors who are willing to take on the harder patient.

Could Man’s Best Friend Help With Your Chronic Pain?

July 9, 2019 / Thomas Cohn, MD

A recent article posted in Physician’s Weekly posited if dogs should be prescribed for chronic pain patients. The piece went on the say that roughly 1 in 5 U.S. adults deals with a chronic pain condition, and that dogs may be able to help them with their pain condition. Although many of the claims are not linked to scientifically backed studies, it’s not hard to see how a dog could help with some aspects of your pain condition.

How A Dog Can Help With Your Pain

For starters, there’s the idea that a dog can help you maintain an active lifestyle. Staying active is certainly something that we preach as physicians, because exercise helps to strengthen crucial structures and ward off potentially problematic inflammation. Dogs require daily exercise, so if getting a dog will get you outside and keep you active, there’s reason to believe it could end up being helpful for your pain condition. That being said, you don’t need to get a dog in order to go for a daily walk.

Next, there’s the idea of caring for your mental health. Many physical ailments are connected to your mental well-being. According to the article, the presence of a dog and petting the dog can help distract chronic pain sufferers from their pain and combat feelings of loneliness. Dogs can do wonders for our mental health, but at the same time, if you’re struggling to care for yourself, adding a pet to the equation may only add to your burden and leave you feeling even more stressed. There are mental health benefits, but there can also be drawbacks, so don’t just head out and buy a puppy without doing some research.

Another area that was discussed in the article was sleep health. Sleep is imperative for chronic pain patients, as its a restorative process for our body to heal from the stresses of the day. The article mentions the “overwhelmingly positive” health effects of chronic pain patients who co-sleep with their dog. While a dog may help you feel less anxious or lonely and in turn help you fall asleep, it’s not all positive. Adding a dog to the bed can cause disruptions as you or the dog move throughout the night. Even if you don’t let them sleep in your bed, odds are a puppy isn’t going to be able to make it through the night without going to the bathroom. If you find it hard to fall asleep or stay asleep because of your pain condition, adding regular nighttime potty sessions to your schedule may only make the pain condition worse.

At the end of the day, there certainly may be some benefits to adding a four-legged companion to your home if you have a chronic pain condition, but there are also plenty of drawbacks that you’ll want to acknowledge before picking out a dog. A new dog or puppy can add financial or physical stress to your daily life, which may make chronic pain flareups even worse, so make sure you’ve addressed all potential pitfalls before considering your own therapy dog.

Tips For Managing Chronic Pain During The Summer

July 2, 2019 / Thomas Cohn, MD

The summer should be one of the most enjoyable times of the year in Minnesota, but for many people who deal with chronic pain, the summer heat can make their condition worse. So how can you not only survive, but thrive, during the summer months if you have chronic pain? Consider this blog your playbook to managing your pain condition this summer.

Handling Chronic Pain in the Heat

Here are a number of ways to fight back against your chronic pain condition during the summer:

Exercise During Non-Peak Hours – As we talk about on this blog all the time, exercise is very important to help strengthen key structures and treat chronic pain conditions. However, if you’re exercising when it’s hottest out, it can trigger a flareup or lead to a less than successful exercise session. Wake up early or exercise when the sun goes down to avoid the heat.

Dress For What’s Ahead – Becoming overheated can trigger a pain flareup or make your CRPS worse, so look ahead at the weather and plan accordingly. Wear appropriate clothes for the day and try to be inside when it’s supposed to be the hottest to avoid problems with your pain condition.

Swim – Swimming is one of our favorite exercises during the summer, because not only does it get the heart pumping and strengthen supportive muscle groups, but it also helps to keep you cool. On days when you don’t want to do a traditional workout outdoors, head to the community pool or a nearby lake to do some swimming. If you want help developing a water-based exercise routine to treat your pain condition, reach out to our office today.

Stay Hydrated – Pain conditions can also trigger if you’re dehydrated, as can other problems like an increased risk of muscle strains and sprains. Make sure you bring water if you’re going to be outside for long periods or if you’re going to be sweating.

Stay Inside – Finally, if you don’t have to go outside and take on the heat, stay inside where it’s cool. Do your workout inside where it’s cool, or go for a run indoors on your treadmill. It’s important to stay active even when indoors to help keep healthy blood pumping throughout your body, but don’t go out in the heat if you know it’s going to cause problems for your pain condition.

If you follow these tips, we’re confident that you’ll be able to take control of your pain condition even in these hot months. And if you need additional assistance with any aspect of your pain condition, reach out to Dr. Cohn’s office today.