NSAIDs For Inflammation And Pain Relief

/ Thomas Cohn, MD

NSAIDS pain pillsNonsteroidal anti-inflammatory drugs (NSAID) are the most commonly prescribed drugs in the world. Generally they are safe medications and they are often available as over-the-counter (OTC) items. The risks and benefits of these drugs are often misunderstood. Taking too much is common; not taking enough to be effective may also be an issue. The directions on how to take the drugs do vary depending on the exact compound. Furthermore, every drug has different strength, so a small amount of one drug could be stronger than a big pill of another one. Lastly, some drugs have unique delivery systems, such as they are available in creams to put on the skin.

Understanding NSAIDs

Medications like aspirin, ibuprofen, naproxen and diclofenac are the most common NSAIDs that are used and available OTC. Acetaminophen (Tylenol) is not a NSAID since it does not have any anti-inflammatory activity. NSAIDs inhibit cyclooxygenase (COX) enzymes, and these affect the making of certain prostaglandins and thromboxanes, leading to their anti-inflammatory abilities.

Inflammation is a cause of pain in many ailments, like osteoarthritis, rheumatoid arthritis, headaches, low back pain, and many causes of muscle and joint pain. Using a medication that blocks inflammation therefore often diminishes pain. If one has ongoing muscle or joint pain, these medications may be helpful. If your pain is due to nerve damage or irritation, like a disc bumping a nerve, or nerve trauma and damage, NSAIDs often do not help. Some of these NSAIDs come in crèmes, especially aspirin, and diclofenac, and using them on painful muscles and joints every four hours as needed can be extremely helpful with little or no risk overall to your health.

NSAID Risks

These medications have been thought to increase the risk of heart disease, especially the risk of a heart attack or stroke. Vioxx was an anti-inflammatory that was pulled from the market because it did increase the risk of heart attacks. Celebrex is very similar to Vioxx in how it works and there was concern it had some of the same risks related to heart attacks. Ibuprofen, aspirin, and naproxen are not as selective for just inflammation as Celebrex and have been found not to increase heart attack risk. In November 2016, a huge study reported that looked at the risk of Celebrex compared to the other NSAIDs and found the risk to be fractionally less. The overall risk for taking an NSAID is 0.7% for having a cardiovascular event. What this means is the risk for heart attacks while taking any of these medications is very low.  

The most important risks of this class of drugs are the affects on the stomach, kidney, and on hypertension. Nonsteroidal anti-inflammatory drugs as noted above affect prostaglandins and thromboxane, and these compounds in the body can affect bleeding and blood clots. Taking NSAIDs can irritate the stomach causing pain and bleeding, if this happens, the medications should be stopped and your doctor told about the symptoms. If one is taking a medication to thin blood to prevent a blood clot, an NSAID or aspirin can make one prone to bleeding problems and should also not be taken. The changes in prostaglandins caused by the NSAIDs can affect how well the kidneys work, as one gets older, the kidney function may naturally be diminished and these drugs can cause the kidneys to fail. The affect on the prostaglandins also impacts blood pressure in some people. If you have hypertension, these can make the problem worse and may need to be stopped or changed to a different NSAID. In general, these medications do not affect the liver and do not cause liver damage. There are other reactions to NSAIDs but these are less common, if they seem to be causing some sort of medical problem, talk to your doctor.

CRPS – The Pain Is Real

/ Thomas Cohn, MD

Complex Regional Pain SyndromeRecent findings suggest that individuals with complex regional pain syndrome deal with a great amount of pain during every day activities. According to some pain scale rankings, CRPS ranks higher on the pain scale than childbirth, cancer and even amputation.

For those of you unaware of what complex regional pain syndrome is, CRPS is categorized as a chronic condition that typically affects one limb, usually arising out of a trauma. CRPS involves a disruption in the way sensory signals are processed and deciphered along the central nervous system, leading to extreme pain even when no traumatic experience is happening. Actions like putting on your socks or brushing against a door frame can trigger inflammation and painful sensory signals.

Treating CRPS

According to the National Institutes of Health, CRPS typically affects women, and the average age of a CRPS sufferer is 40 years old. The issue with CRPS is that since it involves a communication breakdown in the central nervous system, it can be extremely hard to diagnose correctly. One report suggests that the average CRPS sufferer searched for answers for four years before receiving the appropriate diagnosis. Part of the problem is medical oversight, but this is due in large part to it being such a rare condition, and the fact that research dollars are being spent elsewhere.

So how do we work to treat and prevent this problematic condition? For starters, education is key. That’s the main reason we shared a large infographic about CRPS on the blog earlier this week. Both patients and healthcare providers need to be aware of the problem of CRPS. It can be treated and managed, but only with an accurate diagnosis. People should not have to wait four years to get to the bottom of their health problem.

Funding For CRPS

We also need to be spending more research dollars on understanding chronic conditions. Chronic pain affects roughly 30 percent of Americans, and the toll it takes on the healthcare system as a whole is billions of dollars, yet funding to better understand the condition and help those who suffer day in and day out continues to be lacking.

St. Paul CRPS Pain Doctor

If you’re dealing with chronic pain, and you’re struggling to get answers about your condition, set up a consultation with a Minnesota Pain Specialist. We won’t stop until we get to the bottom of your condition, because our goal is to help you live a pain-free life. Contact us today for more information.

What Is Complex Regional Pain Syndrome?

/ Thomas Cohn, MD

Complex Regional Pain Syndrome (CRPS) is a complicated condition in which nerves incorrectly send pain signals to the brain, even though there is no painful sensory action taking place. For people with CRPS, actions like a gust of wind on their neck or toweling off after a shower can trigger a painful flareup. CRPS can be difficult to treat because it can be difficult to pinpoint exactly where the problem is along the nerve path to the brain. However, with careful evaluation and coordinated treatment with a pain management specialist, symptoms can be kept under control.

Today, we want to take a closer look at CRPS by partnering up with our friends at Burning Nights CRPS. They’ve created a wonderful infographic that examines the problems caused by CRPS and what actions you can take if you’re suffering from the condition. Check out the infographic below, and be sure to swing over over to BurningNightsCRPS.org to learn more about CRPS and other chronic conditions.

CRPS Infographic

New Report Examines Benefits and Drawbacks Of Medicinal Marijuana

/ Thomas Cohn, MD

Medical Marijuana statsWe’re still in the early stages of managing how medicinal marijuana is used to treat certain health conditions. However, since the door has been opened, millions of dollars in funding has been given to explore the benefits and drawbacks of medical marijuana for treating specific health ailments. A new report from the National Academic of Sciences, Engineering and Medicine reveals some areas of potential and some points of concern when it comes to medicinal marijuana. We explore what the report found in today’s blog.

Medical Marijuana For Ailments

One of the major points the review found was that medicinal marijuana has beneficial effects for the treatment of chronic pain. The review committee found evidence that patients who were treated with marijuana for their chronic pain were more likely to experience a significant reduction in pain symptoms. A similar finding was made for individuals suffering from muscle spasms, and for patients suffering from chemotherapy-induced nausea and vomiting.

Furthermore, researchers found no evidence that smoking marijuana was related in an increased risk of cancer development, but they stated that more research was needed to see if there was a correlation between marijuana use and an increased risk of heart attack, stroke or diabetes.

Drawbacks of Medicinal Marijuana

So while medicinal marijuana can be helpful for some patients with chronic pain, it is not without its drawbacks. According to the review, there was evidence that cannabis slightly increased a person’s risk of developing schizophrenia, social anxiety disorders, and to a lesser extent, depression. Heavy marijuana users are also more likely to report thoughts of suicide compared to non-users, and cannabis use increased a person’s risk of being involved in a motor vehicle accident. There were also increases in the number of marijuana overdoses among children who accidentally ingested the drug compared to states where recreational marijuana use was not legal.

Marijuana could also make certain ailments worse. Researchers stated that regular cannabis use was related to an increase in episodes of chronic bronchitis and other respiratory ailments, like chronic coughing and phlegm production. They did note that is unclear if marijuana use worsens symptoms from respiratory conditions like COPD or asthma.

Potential Abuse & Other Drug Problems

Finally, researchers suggested that marijuana could lead to abuse or other drug problems. Evidence suggests that with greater frequency of use, there is an increased likelihood of developing problem cannabis use, and there was moderate evidence to suggest that there was a link between marijuana use and the development of substance dependence of marijuana or other substances like alcohol, tobacco or illicit drugs.

So while medical marijuana is certainly an interesting avenue for controlling pain, it is not without its drawbacks. Identifying these potential pitfalls is the first step. Now we need to learn how to mitigate these risks so chronic pain sufferers aren’t exposed to danger when pursuing medicinal marijuana for their pain.

Opioid-Related Deaths Increase in Minnesota

/ Thomas Cohn, MD

minnesota opioid overdoseAlthough we’re still waiting on the numbers from 2016, it’s clear that there is a growing problem with opioid overdoses in Minnesota.

According to new data from the U.S. Centers for Disease Control and Prevention, deaths from opioid overdoses rose in Minnesota in 2015, especially among young adults. The data suggests that 338 people died from opioid overdoses in Minnesota in 2015, up from 319 in 2014. A closer look at the data suggests that the highest number of deaths occurred in individuals in their late 20s and early 30s rather than older individuals for the first time since the 1990s. The problem isn’t contained to the big cities, either.

“It’s hitting rural areas harder than it is cities,” said Rural Aids Action Network program manage Maggie Kazel. “I think that’s a hard concept for a lot of people to grasp because we have a historic setup in our brains of drugs equal big cities. What we see in Duluth is horrible, what they see in Iron Range is pure tragic.

Synthetic Drugs On The Rise

Pain pill abuse has been a problem for a while now, as the number of people killed by opioid overdoses in Minnesota has risen steadily since 1999. The CDC recently awarded Minnesota more than a half million dollars to develop more opioid overdose prevention plans, but it’s not just normal opioids that health officials need to be aware of. According to Dana Farley, the Minnesota Department of Health’s alcohol and drug prevention policy director, synthetic drugs are popping up in Minnesota more frequently. He said synthetic drugs have become more accessible recently, which tend to be more popular in younger crowds. He believes synthetic drugs played a big part in why younger people were dying at such a higher rate in 2015.

Pain Management in Minnesota

We need to develop better opioid management programs here in Minnesota. Doctors and medical professionals can’t keep handing these pills out like candy. Opioids certainly have numerous benefits and they truly help some people, but we need to have better management of how these drugs are administered to ensure they aren’t abused. Too many people are dying, and there’s little sign for optimism based on the trends of the last decade. We need to make preventing opioid abuse a priority in Minnesota.