Women and Elderly With Pain At Elevated Risk For Opioid Abuse

July 25, 2016 / Thomas Cohn, MD

A nationwide survey of alcohol and substance abuse uncovered that chronic pain oftentimes plays a big role in why individuals begin to abuse opioids. The study revealed that individuals with chronic pain are 41 percent more likely to develop prescription opioid use disorders or to become addicted to opioids, according to the new report.

For their study, researchers looked at reported opioid use disorders and demographic factors, including age, gender, family history and other behavioral factors in more than 34,000 adults. The data was collected in two segments over a three-year period.

“These findings indicate that adults who report moderate or more severe pain are at increased risk of becoming addicted to prescription opioids,” explained Mark Olfson, Professor, Columbia University Medical Center in the US. “In evaluating patients with pain, physicians should also be attentive to addiction risk factors such as age, sex and personal or family history of drug abuse.”

Who’s At Risk?

After examining the results, researchers uncovered:

While men or younger adults remain the ones at higher risk for these disorders, women and older adults who became addicted to opioids are observably the ones who also reported chronic pain.

Participants who reported chronic pain with prescription opioid use disorders were also those concurrently suffering from mood and anxiety disorders.

Researchers concluded by saying that the results show physicians need to be more aware of the opioids they’re prescribing and to whom they are prescribing them to. They believe enhanced monitoring of some patients at greater risk for abuse can help prevent people from abusing opioids.

Prescription pain pills can certainly help provide relief for patients with chronic pain, but they should never be viewed as a solution. Exercises, physical therapy and even some surgeries can help provide temporary and permanent relief. Instead of managing pain, we need to keep treating it and solving the problems.

Short Takes on Electricity For Chronic Pain

July 18, 2016 / Thomas Cohn, MD

Electricity is used in many areas of medicine. Most of the time it is used to power medical equipment, but a newer trend is to use electrical currents to treat pain. From old techniques to new ones, electricity is being used more and more as an alternative to treat many pain conditions. Below is a look at how electricity is being used.

TENs

A TENs unit is transcutaneous electrical nerve stimulation. This technique uses a small battery powered pack to transmit an electrical signal between skin patches. Usually two or four patches are used and a variety of electrical signals can be programmed. The patches are placed around the painful area, often the neck, shoulders, or low back and the signals are used to block the transmission of pain sensation. Pain related to tight muscles and sometimes spine pain can be effectively managed with TENs unit. Computer chips and miniaturization has allowed a small battery pack to deliver a wide variety of electrical signals superficially to block pain.

Cefaly

This is a trade name device for cutaneous electrical nerve stimulation of the head for migraines. It is a headband type device that is battery powered and available by prescription only. It has been approved by the FDA. The device is supposed to generate a small current that will stimulate the trigeminal nerve peripherally. The unit runs for 20 minutes and stops automatically. Trials over in Europe indicated that the frequency and intensity of migraines were reduced by using this device.

Alpha-Stim Aid

This is another prescription cranial electrical stimulation device. This device has electrodes that attach to the earlobes and it passes a low level current between them. Apparently studies have shown the device to help decrease pain, improve moods and sleep quality. The device is used at night and the low level currents affect the brain’s normal electrical signals, and according to the manufacturer, studies have shown reduction in pain, anxiety and improved sleep after only five treatments.

Spring TMS

This is a transcutaneous magnetic stimulator used by prescription to treat migraine headaches. At the onset of a migraine headache, the magnet stimulator is placed on the back of the head, at the top of the neck. When turned on the unit delivers short magnet pulses to the back of the head, to the occiput region of the cortex. Within 2 hours, this affects the electrical activity in the brain and in about 38% of those treated, the migraine is gone.

Come Check Out The Minnesota RSD Coalition Potluck Picnic!

July 15, 2016 / Thomas Cohn, MD

If you’re looking for something fun to do next Sunday, considering checking out the Minnesota RSD Coalition Potluck Picnic! The event will take place from noon until 3 p.m. at Hidden Valley Park in Savage, located at 5000 W 132nd street.

You can see the flyer in the sidebar, but here’s what the text says:

Bring a dish to share and don’t forget a blanket and/or chair to sit on in addition to your sunscreen. It’s going to be an afternoon jam-packed with fun, food, laughter, socializing, games, balloons and more for all ages, with maybe even a few surprises tossed in!

Some of the planned events include:

Silent auction
Speaker event
An awards/recognition ceremony
One-on-one support
Balloons for the kids
Playground activities
Walking trails
Lawn Games: croquet, lawn Yahtzee, ball games (kickball, 500, etc).

Water will be provided by the RSD Coalition, but if you want other beverages, you’ll need to bring them yourself. Alcohol is not permitted at the event.

I’m still working on managing my schedule so I can stop by, but I hope some members of the chronic pain community will consider heading over to the potluck picnic next Sunday!

More About The RSD Coalition

The Minnesota RSD Coalition is an organization dedicated to providing support for those affected by Reflex Sympathetic Dystrophy Syndrome (RSD), more recently referred to as Complex Regional Pain Syndrome (CRPS) since 2002.

The MN RSD Coalition believes a positive outlook is a vital part of our care. Everyone has a right to be heard, believed, and treated with respect and dignity. By using a humanistic approach, they encourage each member to become more self-aware, find their inner strengths, learn positive ways of communication, and use various pain reduction techniques.

In my practice I see numerous patients with Reflex Sympathetic Dystrophy Syndrome and Complex Regional Pain Syndrome. It’s not easy to treat, and persistence and a positive attitude are key, two things that are easier done in word than in practice. I commend the RSD Coalition for their work and hope that I can make it out to the potluck next Sunday.

Medical Marijuana, Opioids and Pain Care As A Whole

July 7, 2016 / Thomas Cohn, MD

Late last month in the Star Tribune, there was a large article in the opinion section on pain relief titled “Medical Cannabis as a Valid Alternative to Deadly Opioids.” The second part of the lead says that in states where medical marijuana is available, opioid overdose deaths are down 25 percent. Now one might think that cannabis is a treatment that is good for pain, and that marijuana decreases opioid abuse and death, however, if is important to think about where this article was placed in the paper, in the opinion section.

Just because someone wrote an article on a subject does not mean it is fact. It may be even more important to find out who wrote the article. A medical doctor wrote this article. However, if you read the very last sentence of the article, this doctor just happens to be the co-founder of Leafline Labs, one of two companies producing medical cannabis for Minnesota. If enough people can be sold on his product, he will make significant money. The whole article is making a case for opioids being potentially deadly, and thus a bad treatment for pain. Then comes the pitch how some people have found cannabis helpful in treating pain. Lastly, it states that doctors should certify patients who have pain to be treated by medical cannabis.

It is very true that opioids have potential for addiction and death. It is also true that they can be used to treat pain, and very effectively. Long-term use of opioids is often not overly successful for chronic pain, but for many people it is the only medication currently available, often with other treatment that makes symptoms manageable.

The Cannabis Conundrum

Cannabis is a combination of over a hundred compounds. Scientifically we know very little about any of these compounds. We definitely do not know the long-term side effects to any significant degree. We do not know if there is any single compound in cannabis that helps with pain. We do not know if it is a combination of chemicals that may be helpful. There absolutely needs to be good scientific studies done on whether cannabis can help in certain forms of pain. If there is any benefit, then we need to know what are the risks and side effects of the compounds. Just like opioids, we once thought they were generally very safe, but now we better understand the range of dangers. Cannabis does have risks, as a variety of different compounds can cause problems.

Before everyone jumps on the bandwagon for medical cannabis, one should realize that very little is known about the compound. It may be reasonable for some people where all standard treatments for pain have failed. What is needed is that the United States needs to change its DEA schedule and good research needs to be done on the efficacy and safety of cannabis. Even better, we need research on what each compound in cannabis does do to the human body. Lastly, better understanding is needed on what causes pain and what will effectively treat and prevent pain.

Manipulating Statistics About Chronic Pain

June 27, 2016 / Thomas Cohn, MD

A newspaper headline read this week, “1 in 3 Medicare Patients took Opioids” in the last year. Is that as big a deal as the headline made it out to be? Probably not. If one starts to think about the article and read the whole story, it becomes ridiculous. The study being cited actually reports that 1 in 3 Medicare recipients overall received at least one prescription for an opioid medication in the last year. The article and the study indicated this was a major problem.

Some facts should be thought about when analyzing such a study. First, one in three people suffers from chronic pain. Further, chronic pain tends to be more common in the elderly and disabled, the very population that has Medicare. One prescription within a year’s time is probably not significant. Many people have significant medical procedures within one year, including dental procedures, numerous outpatient surgeries, or even painful diagnostic studies. Others have injuries that may be extremely painful for several days. The common thread is that all these things are appropriate for short-term opioid use to control pain. Obtaining one prescription within a year for a third of all Medicare patients would probably be very normal.

Interpreting The Stats

The focus of the study and the article is to emphasize how bad and problematic are opioids. If one stops and thinks for a second, making that conclusion on the basis of “1 in 3 Medicare patients have received a prescription for opioids in one year” is terrible. Acute pain is exactly what opioids are best used to treat, especially for just a few days. It would not be surprising to find out that 1 in 3 Medicare patients had a significant medical procedure for which an opioid was prescribed.

A more devastating fact should be that 1 in 3 people suffer from chronic pain. The causes of pain are extremely varied. The headlines of the paper are all about addiction. There are very few about how widespread pain is a problem. The big alarm is about death related to drug abuse. Addicts are obtaining billions of dollars for further treatment and research from the government. There are no headlines about how people struggle day to day with dealing with pain and still trying to continue with life.

Addiction to opioids and the increases in deaths is a problem. The solution in reality is probably to treat the true problem, which is the pain. Better pain medications that are not addictive definitely are needed. Research in the basic science of pain and how to prevent it is needed even more.