Minnesota Doctors Not Sold on Marijuana

January 18, 2016 / Thomas Cohn, MD

The Minnesota medical community is, according to January 12, 2016 article in the Star Tribune, not sold on medical marijuana. In reality, this is not very surprising. There are probably many reasons, but the most obvious reason is the idea that medical professionals like to base all their care on a scientific basis. From taking a history, to performing an exam and determining the tests and treatment, medicine is more of a science and depends on evidence for diagnosis and treatment of problems. If there is not evidence to support a treatment, medical professionals are trained to be skeptical of its use and purpose. Currently, medical marijuana definitely falls into this category.

Most important to the debate on medical marijuana is that there is very limited scientific research supporting many of the claims of usefulness. The research with regards to the management of most medical problems is related to a few small studies, and there are hardly any definitive studies that show significant positive value, and the study designs are often not blinded/controlled with any large number of participants. For pain management there is mostly incidental case report-type studies without mentioning which specific cannaboids are effective. Since cannabis plants contain over 100 different cannaboids and other compounds, using so many chemicals at once in a relative uncontrolled mixture is not a scientific approach to treatment. In a way it is like throwing a grenade at a problem and hoping everything does not blow up in your face.

Fixing The Marijuana Issues

The proponents of medical marijuana often bring to the table multiple examples of the wonderful help that various individuals have experienced with its use. However these are individual cases, and not necessarily what will occur with every individual. When a new drug is brought to market, we all want to have extensive testing performed to make sure it is safe, to ensure it performs correctly and that the same effect will occur each time it is taken. With medical marijuana we do not know most of these things. We have no idea what exactly is in the extracts, and we have no studies on how animals or humans will react to the compounds over time. Any other drug besides marijuana with this lack of scientific research would never even be considered to be used widely as an intervention. It is not surprising most medical professionals have a huge degree of skepticism about certifying patients to use medical marijuana and endorsing treatment.

In pain management there are many treatments available that have been shown to be reasonably effective. A pain management expert often can help a person through the maze of management options and help find an effective plan. There are a portion of patients with extremely complex problems without great solutions to control symptoms at this time. Failure of standard treatments may be a reason to want to try medical marijuana. Those who do go this route need to know at this time it should be considered truly an experimental treatment, and that the short and long term side effects and problems are not really known. There are a huge number cannaboids contained in medical marijuana, and while some may be helpful, others can be harmful. It may be a significant risk to use these compounds and until they are better studied and understood, and it is unlikely that the medical field will endorse such treatment without serious reservation.

MRIs Can Predict Chronic Pain After Whiplash Injury

January 15, 2016May 10, 2016 / Thomas Cohn, MD

Whiplash occurs when a person’s head is thrust forward or backward in a violent motion, over stressing the muscles and soft tissues in the area. The most common cause of whiplash is a car accident, especially accidents involving a rear-end collision. In this scenario the person who gets rear-ended will be thrust forward, but their head will usually snap backwards as their body is propelled forward.

Depending on the severity of the whiplash, most patients recover from their injury within 1-2 months, but others aren’t so lucky. For some, neck pain due to a whiplash injury becomes chronic, and symptoms remain for months or even years.

Luckily, we’re getting better at assessing whiplash symptoms and predicting who may suffer from long-term symptoms. With help from special MRI imaging, doctors are able to pinpoint with a fair degree of certainty which patients will develop chronic pain, disability and PTSD in the wake of a whiplash injury.

Chronic Pain Prediction

According to researchers at Northwestern Medicine, doctors can predict which patients will develop long-lasting symptoms within the first 14 days from the date of injury. By pinpointing which patients are likely to suffer long-term symptoms, doctors can better treat patients and help prevent potential setbacks down the road.

“This opens up a new door for research on whiplash,” said lead researcher James Elliott said. “For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

The special MRI technique measures the fat/water ratio in the muscles of a person’s neck, and scientists uncovered that patients who would go on to suffer long-lasting symptoms had larger ratios of fat in their neck muscles. They believe this fatty infiltration could lead to atrophy of the muscles, and their findings were consistent no matter the size or BMI or the patient.

Elliot believes the findings may be most significant for individuals who suffer from PTSD in the wake of a whiplash injury or a traumatic car crash. If a person is deemed at-risk for emotional instability after an accident, doctors can help them get the treatment they need earlier, which can lead to better outcomes.

“These patients have shown to not respond well to traditional rehabilitation such as physical therapy,” Elliott said. “It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist.” Emerging, yet preliminary evidence suggests this to be a reasonable strategy.

The Link Between Dry Eyes and Chronic Pain

January 11, 2016 / Thomas Cohn, MD

Dry eyes can be painful, but new research suggests that people who suffer from dry eyes may be more likely to suffer from other chronic pain conditions.

New findings out of the University of Miami Miller School of Medicine suggests that dry eyes could indicate an underlying neurological issue that could also cause pain in other parts of the body. For their study, researchers examined 154 patients with dry eye and measured their levels of reported pain and their dry eye symptoms using three different tools. Once the researchers had their measurements, they group patients into two groups – Dry eyes with high levels of chronic pain and dry eyes with low levels of chronic pain. When looking at these two groups it became apparent that individuals with high levels of chronic pain also expressed more neuropathic type dry eye symptoms. Those patients also exhibited some other concerning trends.

“Dry eye patients in our study reported higher levels of ocular and non-ocular pain associated with multiple chronic pain syndromes, and had lower scores on depression and quality-of-life indices consistent with a central sensitivity disorder,” said study co-author Dr. Roy C. Levitt.

Dry Eyes and Chronic Pain

Researchers believe the findings from the dry eye study can help doctors uncover root causes of ocular issues, and they can help doctors better manage all expressed symptoms.

“Traditionally, eye specialists have treated dry eye with artificial tears or topical medications for the surface of the cornea. However, even if these treatments improve some dry eye symptoms, many patients continue to report underlying ocular and non-ocular pain,” said lead author Dr. Anat Galor, MSPH, associate professor of clinical ophthalmology.

Building on that point, Dr. Galor concluded that doctors should consider dry eyes as a possible side effect of a chronic pain condition when diagnosing a patient.

“Our highest priority is educating physicians that dry eye represents an overlapping chronic pain condition,” said Dr. Galor. “Consequently, a multidisciplinary approach should be considered in the diagnosis and pain management of dry eye patients.”

Related source: HCPLive.com

Is Your Chronic Pain an Addiction?

January 8, 2016 / Thomas Cohn, MD

New research out of Northwestern University suggests that chronic pain can rewire your brain so a person actually becomes “addicted” to chronic pain.

The new research published in Nature Neuroscience examined how brain neurons in rats were affected by negative emotions and pain. When looking at the rodents, researchers noted that some rats experienced a hyper-excitable collection of neurons after an injury or pain. These neurons not only controlled some negative emotions, but their hyper-expression was also associated with a drop in the neurotransmitter dopamine, which plays a large role in our reward motivation. In essence, the brain was misconstruing why these neurons were firing, and it slowly became addicted to their hyper-expression. In essence, your body becomes addicted to pain.

“The study shows you can think of chronic pain as the brain getting addicted to pain. The brain circuit that has to do with addiction has gotten involved in the pain process itself,” explained corresponding author A. Vania Apkarian, PhD, adding that pain is both sensory and emotionally based.

New Understanding, New Solution?

With their new understanding of how some people’s body’s perceive pain, Dr. Apkarian began working on new ways to treat chronic pain. Using a combination of two different drugs, they were essentially able to rewire the brain so it stopped seeing pain as a rewarding behavior.

“It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad. By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models,” said the study’s lead author Dr. D. James Surmeier. “The question now is whether it will work in humans.”

The team hopes to take their study to the next stage and see if it produces a similar positive affect in humans whose brain’s have been affected by chronic pain.

More Than 90% of Patients Who Overdose Prescribed More Painkillers

January 5, 2016 / Thomas Cohn, MD

A new report suggests that more than 90 percent of patients who suffer a nonfatal overdose on prescription opioid painkillers are prescribed more pills following the overdose.

In certain situations, opioids can and do help prevent some of the pain caused by chronic conditions, but they are prescribed far too often by doctors who don’t take the time to get to the underlying cause of pain. The findings confirm this unfortunate trend.

The research, published in the Annals of Internal Medicine, suggest that not enough is being done to help treat pain patients, and the patients are the ones suffering. According to the findings, 91 percent of pain patients who suffered an opioid-related nonfatal overdose were later prescribed more opioids, and opioid overdose survivors who continued to take medications were twice as likely to have another overdose within two years.

It’s saddening but not surprising that these findings have been published, especially when you consider that the Centers for Disease Control and Prevention recently published an article saying opioid induced overdoses have reached epidemic levels. According to the CDC overdose deaths from prescription opioids and heorin have increased 200 percent since 2000.

Opioid Epidemic

Lead researcher Mark LaRochelle of the Boston Medical Center hopes the findings will be a wake up call for doctors who prescribe a lot of opioids.

“The intent of this study is not to point fingers but rather use the results to motivate physicians, policy makers and researchers to improve how we identify and treat patients at risk of opioid-related harms before they occur.”

For their study, researchers examined insurance claim data of more than 50 million people who filed a claim between 1999 and 2010. After narrowing their list down to 3,000 people who had suffered an opioid-induced nonfatal overdose on their prescription, researchers checked to see what care the patients received after their near death experience. Shockingly, nearly all of the survivors continued to receive opioid painkiller prescriptions, and, of the patients who remained on painkillers, 70 percent of them were prescribed medications from the same doctor who prescribed them the medications they eventually overdosed on. According to researchers, those doctors may have continued prescribing opioids after the overdose because they may not have known about the overdose, or they still felt the benefits outweighed the potential downfalls. They also believe some doctors may be ill-equipped to be making opioid judgments after an overdose.

The CDC issued guidelines suggesting that physicians should cut back on opioid prescriptions after a nonfatal overdose. Instead, they should pursue physical therapy or non-opioid painkillers.

Related source: ZME Science