chronic pain

Minnesota Getting $16.6 Million To Fight Opioid Epidemic

/ Thomas Cohn, MD

opioids chronic pain minnesotaMinnesota is set to receive $16.6 million in federal grants that will be given to foundations and organizations committed to fighting the opioid epidemic.

More than 30 different agencies will receive grants from the federal fund, and the goal is to reach and help more than 110,000 Minnesotans who are seeking treatment for opioid dependency. Most of the money will go to existing programs to launch new efforts or expand current efforts in combating the opioid crisis.

“These grants are designed to build on what we are doing,” said Minnesota Human Services Commissioner Emily Piper.

The Opioid Problem In Minnesota

According to health data, there were nearly 2,500 opioid-related overdoses last year, and 376 of those overdoses were fatal. There were more than 3.5 million prescriptions written for opioid painkillers in Minnesota in 2016.

The federal grant will go to a number of specific places and programs, including:

  • More widespread availability of naloxone, a key substance in helping save people who have overdosed on painkillers.
  • Expanding medication-assisted treatment.
  • Increasing aid and resources on American Indian reservations.
  • Adding opioid-specific care providers throughout the state.
  • Establishing a program to help unborn and newborn babies of mothers with opioid dependencies.

There has also been a push for more regulation at the national level from Minnesota lawmakers. A presidential opioid crisis commission recommended that President Trump support two bills proposal by Minnesota Senator Amy Klobuchar. The first would require more monitoring of drug prescriptions and the second would attempt to reduce the number of opioids that are being illegally distributed through the US mail system.

Electricity’s Role In Chronic Pain Management

/ Thomas Cohn, MD

electrical neurostimulationElectricity and its role in treating chronic pain oftentimes gets a bad rap because some people automatically associate neurostimulation with shock therapy. Yes, electrical current is used in order to help quell your pain, but we’re not sending painful volts into your body like you sometimes see in Hollywood films. With opioids becoming a growing concern in many circles, more professionals and medical researchers are looking to see if electricity could be the next big thing in chronic pain management.

Nueromodulators and Chronic Pain

Neuromodulation or neurostimulation is not exactly a new approach to chronic pain management, as versions of these devices have been around for decades. Like any medical device, the first prototypes are a step in the right direction, but it takes a while for researchers to work out the kinks and really perfect the technology. Dr. Mark Malone, founder of Advanced Pain Care in Texas, believes we’re getting much closer to perfecting these neuromodulators.

“In the last 18 months or so, a new generation has come out including (Abbott’s) Burst and Dorsal Root Ganglion,” said Malone. “These two techniques are far more effective and it’s really an amazing revolution. For the first time ever, we’ve been able to say things like ‘cure chronic pain.'”

So how exactly does neuromodulation work? Essentially, it uses electrical impulses to trick the brain into believing the area is no longer sending pain signals.

“This is the application of electrical energy in the nervous system to quiet down pain impulses,” said Malone. “It’s more of a language. You’re speaking to the nervous system in the language of the nervous system and telling the brain the pain is no longer important.”

Neuromodulation is similar to the process that happens if you were to accidentally hit your thumb with a hammer. When you do this, you probably grab your thumb and rub it to help dull the pain. By rubbing your thumb, you’re providing the area with a new sensory signal and helping to block the pain signal. This process is known as tonic stimulation, and it’s an underlying principal of the electrical stimulation process. The small implantable device can drown out pain signals by stimulating other areas.

No Addictive Side Effects

Dr. Malone has been using a neuromodulator of his own for a little over six months. He had been on disability for more than a year and only working at his clinic on a part-time basis, but after seeing how successful it was for his patients, he decided to give it a shot for his pain. He’s been thrilled by the results, and electrical stimulation does not have the same potential drawbacks as opioids.

“It’s really an amazing gift that we suddenly have this treatment that’s so effective for even the worst pain patients and it’s completely drug free,” said Malone, noting that electricity isn’t addictive and that it produces no euphoric side effects.

The neuromodulator isn’t a perfect device, but it’s a big step in the right direction. It can’t stop certain types of pain, like widespread fibromyalgia, but it has been successful in patients with certain types of complex regional pain syndrome and failed back surgery syndrome. So if you’re still looking for answers to your chronic pain problem, ask a pain management specialist about your options with neuromodulators and electrical stimulation.

Opioids and the Pain Recovery Process

/ Thomas Cohn, MD

Pain stagesPatients who deal with pain can be stratified into a three general categories: acute, sub-acute and chronic in terms of the length of symptoms. This is not an absolute, but a general system. Acute pain is the time immediately associated with an injury or surgery and during the first three months of treatment. Sub-acute is the period of time roughly three to six months after the initial injury. The most difficult time is the chronic period after six months when injuries may be permanent and long-term strategies will need to be determined. Determining treatment options during each period is challenging.

Acute Pain

The acute pain phase is hopefully the only time a person will have problems. It is the period right after injury or surgery, and for most people this is a very short period of time, lasting several days to a week. Many people are able to pass through this period with minimal problems and are on to healing and recovery without the use of any significant medications. With more major problems, symptoms are more prolonged, and more extensive use of treatments are necessary from therapy or long-term medications. Furthermore, everybody has a different need for management and finding the correct strategy may be quite complex.

This also is a period where a person with a tendency toward addiction psychologically or physically can develop a problem. Up to 15-20 percent of the population may be at risk for addiction to opioids. For those people, even within a few doses, the brain starts abnormally seeking the dopamine release stimulated by these drugs. The injury may heal, but the brain continues to desire opioids. This is one of the main times when people develop addiction and start a downward spiral. It is extremely difficult to predict who will develop an addiction and that is the reason for medical practitioners to try to limit exposure. The crisis in drug abuse has pushed the need to reduce the exposure and risk for everyone.

Sub-Acute Pain

The sub-acute phase of pain management is the period of time between three and six months after a medical problem. A management strategy needs to be developed at this point to determine what the diagnosis and prognosis is for the condition. At this point, a specialist is often appropriate so that the best strategy can be determined. Finding the correct person to treat a problem that is not resolving is often the most difficult issue. Physicians are often lacking knowledge and experience to solve the more difficult medical problems.

Fortunately, 90 percent of physicians can guide you through the medical maze. If you are one of those with a particularly difficult problem, you will need one of the best physicians in that field. These physicians are often not in prestigious places like universities or major medical centers, but are the hardworking private practitioners. They often have been in practice for a number of years and they have enough experience to determine what is the best path forward for the complex issues and are not constrained by a single strategy. During this time, hopefully a patient can be transitioned away from opioid-type medications and toward a comprehensive strategy.

Chronic Pain

The last phase is when a problem turns chronic. That time period is after six months. Sometimes, if the initial treatment has not been successful, this is the period when a skilled physician needs to be found to fully diagnose the issues and develop a new strategy. These skilled experts can clarify and define issues others have not seen. They are also the ones who will act as a guide through the maze of medical issues and not give up. If you listen and work with them, it is likely that a positive outcome will be achieved.

Chronic pain problems may or may not be well served with opioid medications. There are far more down sides to these medications than positives. They may seem helpful, but often are treating the anxiety associated with pain more than the pain itself. Opioids increase the sensitivity in the nervous system to painful stimuli and suppress the body’s own pain fighting ability. Everyone will become tolerant to opioids and up to 20 percent of the population will develop an addiction. With over 140 deaths/day and over 60,000 deaths/year associated with opioid addiction, it is a very limited treatment option. Most pain physicians therefore are reluctant to use these medications and push every other option. If they are used, then strict compliance rules are mandated for safety. Break any of the established rules and the option disappears, possibly permanently. If these medications are maintaining high levels of function such as full-time gainful employment, then they may be reasonable.

If you use opioids either short-term or for a long span of time, expect strict rules. These drugs are notoriously dangerous, and they often have a narrow range of safe dosage. Any improper usage can lead a provider to stop prescribing. Addiction, death and damage to the patient or others are always a concern. Further, if there is a better treatment available, then prescribing opioids may be a poor choice for both the patient and prescriber.

If you are told this is not the best treatment for you, there is probably a good reason and you should try every other option offered. Often a person in pain has poor insight into their own behavior and listening to others is necessary. Pain can be extremely complex, and often there is no solution but only management options.  For chronic pain, sometimes one needs to look at your own situation and determine a different path to follow in life such that life can be more enjoyable.

5 Tips For Exercising With Chronic Pain

/ Thomas Cohn, MD

exercise painExercise can help prevent and manage chronic pain, but chronic pain can also make it difficult to exercise on a regular basis. However, if you keep some tips in mind, you may find it easier to get through your exercise routine even if you are plagued by chronic pain.

Today, we share five tips that can make exercise easier even if you are battling a chronic pain condition.

Chronic Pain and Exercise

Here are five tips for making your exercise routine a little more bearable when you’re dealing with chronic pain.

1. Avoid The Wrong Activities – Try to get your exercise in by being mindful of where pain exists and which activities overstress these areas. You want to strengthen certain areas while avoiding overstressing painful areas. For example, if you have chronic low back pain, exercise activities like cycling or canoeing may put excess stress on your lumbar spine. Don’t partake in activities that will make the problem worse.

2. Find Your Pace – Yoga classes or group exercise routines can help make exercising more fun, but not if you’re struggling to keep up. Go at your own pace and do not worry what other people are doing. If you’re dead set on working out with a group or another person, find someone who closely matches your ability and who will be willing to scale things back or stop altogether if pain makes exercise too difficult.

3. Aqua Therapy – We’ve pushed the benefits of aqua therapy in the past, and we think it’s a great option for chronic pain sufferers because the water’s natural buoyancy helps to take stress and pressure off our joints. Also, the water provides natural resistance, which makes it easier to strengthen different structures that you might not be able to as easily on land.

4. Balanced Routine – While we want you to find what works for you, it’s also important that you find some balance in your workout routine. You need to focus on your cardiovascular health, aerobic conditioning and strength training in order to best keep chronic pain at bay.

5. Accept That Not Every Day Is Going To Be Great – This happens with everybody, so don’t get discouraged if you just don’t seem to “have it” on any given day. As long as you are up and trying to improve your physical health, that day is a win. It’s not going to be easy, and it’s not always going to go smoothly, but if you’re making a conscious effort to exercise 4-5 times a week, your body will thank you for it.

For more tips on how to exercise with chronic pain, or to talk to a doctor about your chronic pain condition, reach out to Dr. Cohn today.

Let’s Talk About Chronic Pain and Suicide

/ Thomas Cohn, MD

chronic pain suicideNew research presented at PAINWeek 2017 in Las Vegas suggested that individuals with chronic pain are twice as likely to attempt suicide than those without chronic pain.

For their study, researchers asked more than 1,500 chronic pain sufferers to fill out a questionnaire on their pain and their mental mindset. What they found was that individuals with chronic pain were twice as likely to attempt suicide than individuals without chronic pain, and that 32 percent of chronic pain sufferers reported “suicide ideation in some degree.”

According to researchers, chronic pain (as opposed to acute pain) may share some neural networks with mental health disorders like depression, which can contribute to self-harm tendencies.

“This shared neurobiology may explain why cognitive behavioral interventions can be effective in chronic pain patients,” said Dr. Joseph Pergolizzi, who suggested that patients with chronic pain should be evaluated for other helpful treatments, like cognitive behavioral therapy or mental health counseling. They recommended that mental health assessments during the diagnosis and treatment of chronic pain could be clinically important for reducing the risk of suicide or self-harm in this patient population.

Getting The Help You Need

As someone who is prone to chronic back pain from an injury I suffered back in college, I know how frustrating chronic pain management can be. It can take forever to find a solution that works, and there’s no guarantee that it will work the next day. You’re fighting an uphill battle, but it’s important that you try to stay positive. Remember that you can only control what you can control. You can’t always control your pain, but you can:

  • Get regular exercise
  • Eat a healthy diet
  • Partake in physical therapy
  • Seek a second opinion
  • Get involved a chronic pain group
  • Try new treatment alternatives
  • Share your experiences with others online
  • Take time to focus on your mental and physical health

Pain may play a role in your life, but you should never feel like it is controlling your life. If you’ve found that it’s harder to get out of bed or you just haven’t been the same lately, reach out to a Pain Management specialist. We can take another look at your pain and figure out the best way to help you manage it. We can also set you up with wonderful programs to ensure that your mental health remains positive while you’re tackling your chronic pain issue.

Nobody knows exactly what you’re going through, but that doesn’t mean we’re not willing to learn or to help. Please, if you’re struggling with chronic pain or depression, make a call to our office or to a pain specialist in your area. We’ll do everything in our power to help reduce you pain levels and find something that works for you. We can’t promise solutions, but we can promise that we will try our hardest to find a treatment option that makes your day a little brighter. Contact us today.