Opioids – Damned If You Do, Damned If You Don’t

February 2, 2023 / Thomas Cohn, MD

If you’re a regular reader of our blog, you know our views on opioids for pain management. Used correctly, opioids can be a wonderful compliment to a chronic pain management program, but their use can also cause some health issues even when carefully taken. According to a new study, not only can starting an opioid regimen be potentially hazardous to your health, so too can stopping opioid use. This doesn’t mean that you should plan to take opioids indefinitely, but it speaks to the importance of working with a pain management provider when starting and stopping an opioid regimen.

According to a recent study published in the journal PLOS Medicine, stopping a prescription opioid regimen can actually increase a person’s risk of overdose death. Opioid-related overdoses are a major concern here and in Canada where the study was conducted, and researchers wanted to learn more about the potential impact of discontinuing an opioid treatment plan. You might inherently believe that your risk of overdose falls to zero if you stop taking opioids, and in a perfect world, you’d be right. However, not everyone who stops taking opioids can do so easily, and therein lies the risk of eventual overdose.

Safely Stopping Opioid Use

For the study, researchers reviewed the medical records of more than 14,000 patients in British Columbia who had been on opioid therapy for at least 90 days. After reviewing the records, researchers found that discontinuing opioid therapy for chronic pain was associated with an increased overdose risk for people without an opioid use disorder (OUD). An inverse effect was seen in patients who tapered off of opioid use, as their overall risk of overdose decreased. Researchers concluded that abrupt opioid stoppage could be dangerous, and that patients should work with a provider to taper off of medications so as not to increase their risk of overdose as they seek to end an opioid regimen.

While there were some limitations in the study, including whether or not associated overdoses occurred with prescription medications or those obtained illegally, the general message holds true in that it is extremely important that you work with a physician when working to stop an opioid treatment plan. We understand that you are aware of some of the potential issues associated with opioid use, and we commend you on wanting to curb or eliminate your reliance on these medications. However, there is a right way to go about cutting prescription medications out of your system. Sometimes slow and steady wins the race, and cutting opioids cold turkey could have some unintended withdrawal effects.

If your current medication plan isn’t getting you where you want to be, talk to a doctor about safely adjusting your medication program. We want to help you find the right solution, but finding the right treatment is only part of the battle. You also need to approach the treatment in the right manner, otherwise you may face some unexpected obstacles.

For more information, or for help with a chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

More Patients Swapping Out Opioids For Medical Marijuana To Manage Pain

January 12, 2023 / Thomas Cohn, MD

New research has found that nearly one-third of patients with chronic pain report using medical cannabis to manage their pain, with more than half of them decreasing their reliance on other pain medications, like opioids, in the process.

“That patients report substituting cannabis for pain medicines so much really underscores the need for research on the benefits and risks of using cannabis for chronic pain,” said lead author Mark C. Bicket, MD, PhD, assistant professor, Department of Anesthesiology, and director, Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, in an interview with Medscape Medical News.

Medical Cannabis Use

For the study, researchers surveyed 1,724 Americans over the age of 18 with chronic noncancer pain living in areas where medical cannabis was available. Participants were asked about their use of three different types of pain management:

Medical marijuana
Pharmacologic treatments like opioids, non-opioid analgesics and over-the-counter medications
Non-pharmacologic treatments like physical therapy, cognitive behavioral therapy or mindfulness

After looking at the survey results, researchers found that 25.9 percent of respondents reported using medical cannabis within the last year, and 23.2 percent reported using it within the past 30 days. More than half of patients who said they used medical cannabis said this also led to a decrease in prescription opioid use, prescription non-opioids and over-the-counter medications. “Almost no one” said that medical cannabis led to a higher use of these medications, said Dr. Bicket.

Medical cannabis use also impacted other treatments as well, for the good and the bad. 38.7 percent of people said that cannabis use led to decreased physical therapy sessions, 19.1 percent said it led to lower use of meditation, and 26 percent said it led to less CBT. Conversely, 5.9 percent of patients said cannabis use led to more physical therapy, 23.7 percent said it led to more meditation therapy, and 17.1 percent said it led to more CBT, so cannabis use clearly had a more widespread variance on other therapies than it did on pharmacological treatments, which saw a very obvious decreased correlation.

While Bicket was pleased with the findings, he noted that the current environment – where cannabis use is medically approved on some state levels but illegal on the federal level – makes it harder to accurately study the best ways to implement cannabis use for a patient population.

“We really don’t have a good sense of the relative risks and benefits that could come from cannabis as a treatment for chronic pain,” said Bicket. “As a physician, it’s difficult to have discussions with patients because I’m not able to understand the products they’re using based on this regulatory environment we have.”

Bicket seems to have the same gripes about the current medical marijuana climate that we have about chronic pain care in general. For one reason or another, we’re not able to easily study the best ways to treat chronic pain or harness the power of certain treatments like medical marijuana. Hopefully the landscape changes in the near future so that patients can have better access to the right treatments for their individual needs.

Painkillers May Not Be Necessary After Some Knee And Shoulder Surgeries

October 14, 2022 / Thomas Cohn, MD

Medical researchers are always looking for more information about how they can help patients recover following a surgical procedure. The prevailing wisdom is that opioids and painkillers are needed to help patients manage discomfort following arthroscopic surgery, but new research found that these strong medications may not be necessary.

For the most recent study, researchers wanted to get a better understanding of how necessary opioid pain relievers were after arthroscopic knee or shoulder surgery compared to non-opioid pain relievers. To do this, they looked at 193 patients who underwent outpatient surgery on their shoulders or knees at three different participating hospitals. Roughly half of the patients received opioids for postoperative pain, while the other half received naproxen and acetaminophen for pain, as well as pantoprazole, a medication normally used to treat heartburn and acid reflux. Both groups had access to emergency opioids if needed to aid in pain relief.

Post-Op Pain Control

After six weeks, patients in the opioid group had used an average of 72.6 mg of opioids, compared to 8.4 mg in the opioid-sparing group. Two patients in the opioid-sparing group asked for opioid medication after their discharge. Researchers noted that there was no significant differences in patient satisfaction, pain levels or adverse events when comparing the two groups.

“This study clearly shows that many of these surgical patients can be treated safely without opioid medications in a select population,” said lead author Olufemi Ayeni, MD, a professor of surgery at McMaster and an orthopedic surgeon at Hamilton Health Sciences. “Furthermore, by reducing the number of opioids prescribed, we can collectively reduce the development of a reservoir of unused medications that can cause harm to many in society.”

More than one million arthroscopic surgeries are performed in the United States every year, and if it turns out that many of these patients can manage post-op discomfort without the need for potentially addictive and dangerous opioids, that’s a huge win. In fact, doctors have already started to make this shift. Data shows that since 2017, the number of opioid pills prescribed to patients undergoing minimally invasive surgeries has fallen by 50 percent, although that may be driven by a number of factors.

As we’ve always said on the blog, opioids can absolutely play a crucial role in a pain management program, but we have to be careful about becoming over-reliant on them. Opioids are never intended to be a long-term option, but they can certainly make it easier to participate in a rehab program after injury or surgery. Make sure that you take full advantage of the benefits of opioids when you need them most, and odds are you’ll find that you need them less and less.

For more information about appropriately managing pain after an injury or surgery, or for help overcoming a chronic condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

More Patients Seeking Chronic Pain Treatments Without Opioids

February 11, 2022 / Thomas Cohn, MD

A growing number of US adults with chronic pain are pursuing a combination of non-drug and non-opioid approaches to control and treat their condition, which is an encouraging sign.

As we’ve talked about on the blog in the past, pain medications can play an important role in a comprehensive chronic pain treatment program, but oftentimes other active treatments provide more benefits and do not pose the same risks as potentially-addictive pain opioids. A recent poll found that 55 percent of adults with chronic pain used pain management techniques that did not involve any opioids at all over the surveyed three-month period. 11 percent of respondents used both opioids and non-opioid techniques, and only four percent said they only used opioids for chronic pain management. However, 30 percent of patients with chronic pain said they did not pursue any pain management techniques over the three-month period.

Other Chronic Pain Findings

Here’s a closer look at some of the findings from the survey:

Complementary therapies were the most commonly used non-opioid pain management technique (35% of adults), followed by physical, occupational or rehabilitative therapies (19%).

5% of patients pursued self-management programs, 4% underwent cognitive behavioral therapy, and 2% sought out peer support groups.

39 percent of adults said they pursued non-opioid chronic pain treatments that weren’t expressly mentioned by the survey.

Participants using complementary and psychological or psychotherapeutic interventions were more likely to be younger women with more education.

Prescription opioid use for chronic pain management was more common among older adults between the ages of 45 and 64 years compared to those aged 18 to 44 years (19% vs 8%).

Prescription opioid use was also more common among women than men (17% vs. 13%), in adults with health insurance compared to those without (16% vs. 6%) and in those with a high school education than those with more than a high school education (17% vs. 14%)

Prescription opioid use was less common among people making more than $100,000 than those making less than $35,000 (9% vs. 20%)

Researchers concluded that the findings were a step in the right direction for curbing the national opioid crisis, and it shows that more patients are working to pursue alternative and active chronic pain treatments instead of over relying on opioids that oftentimes simply mask symptoms instead of treating the underlying issue.

It’s great that so many people are working to take a vested interest in their health and really pursue different treatments instead of just taking pain medications. Opioids can make movements less painful and make it easier for patients to pursue certain active treatments, but there are numerous studies that have found some risks associated with long-term opioid use. The results are encouraging, but nearly one in three people with chronic pain aren’t seeking any type of treatment for their pain, and that number is still far too large. If you know someone with chronic pain, encourage them to connect with a specialist, because oftentimes symptoms can be reduced or even eliminated!

For more information, or for help with your chronic pain issue, reach out to Dr. Cohn and his team today.

Five Alternatives To Opioids For Chronic Pain Management

June 10, 2021 / Thomas Cohn, MD

Opioids are a hot-button issue in the chronic pain community, and rightfully so. They can absolutely play a vital role in helping someone overcome a chronic pain condition, but they are also much riskier than other treatments that don’t carry a likelihood of overdose and dependency. We’ve seen firsthand how opioids can be a perfect compliment to a chronic pain management program, but we also want to give patients an opportunity to avoid painkillers if they so choose as part of their recovery plan. In today’s blog, we showcase five alternatives to opioids for chronic pain management.

Non-Opioid Treatments For Chronic Pain

Here’s a look at five non-opioid treatment options that may be recommended alongside or in lieu of a painkiller prescription.

1. Exercise – Exercise can work wonders for a chronic pain condition, but we understand how exercise can be hard to come by if you’re dealing with chronic pain. Find an exercise program that works for you, and know that any exercise is beneficial. You don’t need to run a marathon or spend two hours in the gym in order to do right by your body. Walking, swimming or cycling can all be beneficial forms of exercise that are not as hard on your body as some other forms.

2. Physical Therapy – Another way to condition and strengthen your body if you’re dealing with chronic pain is through a physical therapy program. Physical therapy involves targeted exercises and stretches developed by a professional who understands your unique situation and needs. This method can actually be more effective than general exercise because it focuses on weak points and specific body parts in need of attention.

3. Behavioral Health Intervention – Behavioral health intervention (BHI) helps to combat chronic pain by training the brain to change how it interprets sensory signals. The brain can become overwhelmed by sensory signals and misinterpret signals as pain sensations. A specialist can help to drown out these misfiring sensory signals or decrease their intensity through a variety of mindfulness-based techniques.

4. Sleep Improvements – While sleep alone won’t likely cure your chronic pain, regularly getting eight hours of uninterrupted sleep can do wonders for the expression of your chronic pain condition. Sleep is a restorative time period for the body where toxins are removed from key areas of our body and it can recover from the stresses of the day. Poor sleep can intensify pain signals and make it less likely that you’ll commit to the physical activities required to truly help fight your chronic pain condition. Improving your sleep quality is a key component to a comprehensive pain treatment plan.

5. TENs Unit – A TENs unit stands for transcutaneous electrical nerve stimulation, and it uses low doses of electricity to drown out and block sensory signals that are being interpreted as pain by the brain. Chronic back pain and muscle pain are two types of chronic injuries that tend to respond well to a TENs unit. A pain management specialist can take a look at your condition and determine if a TENs unit is something that could be appropriate for your situation.

So if you want to try to control and treat your chronic pain condition without the assistance of opioids, consider one of more of the treatments on this list. Better yet, connect with Dr. Cohn and his pain management team to develop a comprehensive solution suited to your individual needs. For more information, contact him today!