Why Gabepentin Isn’t A Perfect Solution To Opioids

January 6, 2020 / Thomas Cohn, MD

Roughly one in five Americans suffers from chronic pain, and millions of opioid prescriptions were written just last year alone. However, it has become clear that opioids are far from a perfect solution for chronic pain. Overdoses and cases of addiction have skyrocketed as doctors have tried to help patients find a way to reduce their pain. As we’ve learned more about the dangers of opioids, doctors have begun to turn to different solutions to the chronic pain puzzle, one of which being gabapentin.

Gabapentin is an anticonvulsant drug that was originally designed to prevent seizures, but more recently it’s been used to help prevent neuropathic pain. It also won doctors over because it doesn’t present the same addiction threats as traditional opioids. From 2012-2016, presecriptions for gabapentin increased 64 percent, and now it’s the 10th-most-commonly prescribed medication in the US.

Baclofen, a muscle relaxant, has also become popular as an opioid replacement. Both drugs can produce a “boozelike” high in patients and help drown out some pain signals, and while they are safer in larger quantities than opioids, recent data on the drugs prove they also have their pitfalls. A researcher by the name of Kimberly Reynolds at the University of Pittsburgh and co-authors found that from between 2013-2017, people tried to commit suicide using gabapentin nearly 42,000 times, and countless more misused the drug.

Finding A Balance

When used correctly, these drugs can provide the type of assistance that some chronic pain sufferers need. However, their use needs to be carefully monitored and part of a larger care effort. A doctor can’t just write this prescription and send the patient on their way. There needs to be a coordinated care effort alongside the prescription. Patients need to try other forms of treatment in combination with their medications, because simply taking a passive drug isn’t going to solve the root problem.

Eventually, if you just rely on this drug, you’re going to need higher doses in order to achieve the same level of relief. Similarly, you may experience withdrawal symptoms if you stop taking the drug, which can have adverse effects on a person’s health. Even though these drugs are being championed as safer than traditional opioids, they aren’t a magic pill that will solve your pain. You need to be doing more alongside these medications to truly address the underlying problem. That type of care is something we try to provide to every patient because we truly want them to find a cure, not just short-term relief.

We’re not anti-medications, but they can’t be used as a stand alone option if you want to have the best results treating your chronic pain. And as recent studies about gabapentins show, they aren’t a perfect solution either. You need to develop a comprehensive treatment strategy with a pain specialist like Dr. Cohn if you want to have the best chance of putting your pain in the past. For more information, or for assistance with your pain condition, reach out to Dr. Cohn’s office today.

What Pain Patients Want From Their Doctors

November 11, 2019 / Thomas Cohn, MD

Last weekend in the StarTribune there was an editorial on opioids and pain from a neurologist and Chief Medical Officer Regions Hospital. It seemed a bit self-congratulatory about how great he is doing at reducing opioids and how unnecessary they are in most pain situations. It is great to talk about not using opioid medications especially for chronic pain, however if the main job one has is to be a pain medicine specialist, a better understanding of pain and its impact on an individual’s life is needed.

The article brags how many fewer opioid prescriptions have been written by HealthPartners clinics. By the sounds of it, no one was educated on treating pain and way too many scripts were being written. Physician education on management strategies for pain is woeful and minimal time in medical school and residency is spent on training physicians about pain. The best strategy to prevent chronic pain is to aggressively treat acute pain and prevent chronic symptoms from developing. Use a comprehensive strategy early and reduce the impact of pain. Opioids are just one of many tools to treat symptoms, and many better tools are available and should be employed.

Nobody enjoys having pain. Convincing someone that pain is normal is one of the worst strategies to reduce opioid use and abuse. Patients with pain do not want to be told pain is normal, they want their physicians to help determine what is wrong and find good ways to reduce symptoms to a manageable level. Telling a patient pain is normal just informs the patient as a physician you do not care what is wrong and whatever you tell the patient next, they already have the expectation that you have only your own agenda and not their interest first.

Reading the editorial as a pain physician, it was maddening to see the lack of knowledge with regards to how patients feel about their medical problems. Almost everyone knows about the opioid epidemic, but when one has pain, they want compassion, respect and help with understanding their problem finding solutions. They do not want to hear about opioid problems. They want a physician that will help lead them to answers, listen to what they are saying and give them a pathway to improvement. The expectation is that physicians have answers beyond opioids these days, and from a patient’s perspective, bragging about your reduction of the use of these medications is snobbery. Solve the patient’s problem and be empathetic. As a medical big wig, tell your insurance company to pay for proven alternative solutions and give the clinical doctor the ability to use all the tools necessary to help their patients without fighting your bureaucracy.

How Are Opioid Regulations Affecting Chronic Pain Patients?

October 21, 2019 / Thomas Cohn, MD

In the wake of increasing opioid overdoses across the country, lawmakers have called for much stricter regulations in how providers prescribe opioids to patients. The goal of the changes were to stop doctors from “taking the easy road” and prescribing opioids to patients because the doctor doesn’t want to take the time to dig into the problem and work towards a real solution. Lawmakers also undoubtedly thought that if fewer people have access to clinical opioids that overdoses would also decrease.

But how are these regulations actually affecting those individuals who are plagued with chronic pain? According to a new study, the changes aren’t exactly having the intended effect.

The Effects Of The Prescription Opioid Crackdown

According to a recent study published in the International Journal of Drug Policy, there have been a number of unintended and potentially harmful side effects associated with the recent prescription opioid crackdown. Researchers say that many patients on long-term opioid treatment for chronic pain reported experiencing the following in the wake of the crackdown:

Negative physical side effects
Emotional distress
Degraded relationships with their primary care provider

Although the study was relatively small in size (97 patients with chronic pain, mean age 61.3 years), the results were both interesting and alarming.

Negative physical side effects – According to the study, patients believed that their medications helped control their chronic pain, helped them sleep and provided them with the ability to think clearly without being bothered by daily pain. When they were tapered off their medications, they said their pain increased, and they had difficulty sleeping and concentrating.

Emotional distress – Many patients believed that stricter prescription opioid regulations would inhibit their access to vital pain medications and hinder their day-to-day well-being. Other patients responded that they went as far as to seek mental health counseling to deal with the stigma of being seen as an opioid user.

Degraded Relationship With Doctor – Finally, patients also reported that their relationship with their primary care physician worsened due to the new regulations. One patient felt angry with her physician for “enforcing a required opioid agreement” while another felt that he was being viewed by his doctor as a potential abuser as opposed to a patient.

“In addition to known side effects, patients also experience the burden of public discourse and associated institutional changes in opioid prescriptions as extremely stressful, placing a burden on their emotional health and relationships with their primary care providers,” noted the study authors. “ Chronic pain is a biopsychosocial phenomenon, requiring multi-faceted approaches and solutions.”

It takes a doctor who is willing to put in the time and effort with the patient, and a patient who is interested in active solutions to pain, in order to win the fight against chronic pain. Don’t get discouraged by recent regulations, just do what you can to find a specialist who takes your pain seriously and who won’t stop until you find relief. Dr. Cohn has done this for countless patients, and he can do it for you too. For more information, contact his office today.

Prescribing Opioids in 2019

September 23, 2019 / Thomas Cohn, MD

Every day in my practice I sit down with patients who strongly believe that opioids are the best course of action for their pain condition. While opioids certainly can play a crucial role as part of a comprehensive treatment plan, they definitely are not a stand alone option and are far from a perfect treatment as their problems are numerous and well known.

Pain is the physical and emotional response to certain sensory signals. In chronic pain, these signals are not necessarily any indication of danger or potential damage that may occur to the body. Opioids tend to modify the signals of pain, but often are not the most effective treatment and can have devastating secondary consequences. Due to the problems opioids may cause, most physicians are reluctant to prescribe these medications. A new study from the University of Minnesota is shining light on the inconsistencies in when opioids are prescribed.

Opioids In Today’s Society

Before I get into the crux of this blog, it’s worth reiterating that every patient who is interested in opioids is not simply trying to abuse their medications. Some are misinformed, and some truly believe they can help even if they won’t solve the true problem. However, there is a small subset who want medications for reasons other than to treat the underlying pain problem. Thirty years of practice has shown me all the tricks patients play to get medications prescribed. At times it is surprising the act some patients put on to get pain medications. Most physicians are aware of the issues, but still the charades occur.

The new study from the University of Minnesota shows that physicians tend to be vulnerable to over prescribing when they are tired, running late with their schedule, or at the end of the day. These are times when saying yes is easier than explaining no and finding an alternative strategy. This is especially important in acute pain situations when patients are especially prone to abuse and other solutions are appropriate. In some acute situations, short-term prescriptions are okay for several days, especially related to trauma or surgery when other medications for pain are not advisable. Awareness and prescription protocols by primary care providers and emergency rooms about opioids has led to a significant decrease in prescribing these medications. Other providers have been somewhat slower to adopt new habits for safe prescribing.

Opioids are only a small tool in the overall arsenal to treat pain. For many situations, opioids work poorly and are not very helpful. For some patients, opioids have so many problems that the risks of these medications are not even close to any benefit. The worst way to get these medications is to insist that they are the only thing that helps your pain. Usually that means that one does not want to work on other strategies that may be helpful. Unfortunately, some of the better treatments for pain are a struggle to implement because they take time, effort and money. Strategies like exercise, massage, relaxation and treating psychological issues are much more difficult then taking a pill. There’s no magic pill and it will take work, but you’ll be much better off for it.

Pain is difficult to manage, and pain specialists can help with a variety of options. Some problems are simple; most that end up with a pain specialist are very complex. There often is not a fix and most people will have to find a compromise and determine what they can manage and still function adequately. If you want help with your pain condition, reach out to Dr. Cohn’s office today.

The Benefits and Drawbacks Of Extended Release Opioids

July 29, 2019 / Thomas Cohn, MD

We are always looking for new ways to make painkillers safer for those individuals who suffer from acute or chronic pain conditions, and one such improvement was the shift to extended release opioids. These types of pills were promoted as safer than traditional opioids, and while they are in some aspects, they are far from a perfect solution. In today’s blog, we take a closer look at the benefits and drawbacks of extended release painkillers.

Extended Release Painkiller Benefits and Drawbacks

Here’s a look at some of the benefits of extended release painkillers, as well as some reasons why these benefits may not be a perfect solution to the problem.

Abuse Deterrent – Some painkillers were redesigned, making them harder to crush and snort. While this has been successful in preventing abuse of some opioids, it has led some abusers to try even more dangerous methods to get their quick fix, like in the form of injections with shared needles. Other types of abuse deterrent drugs actually were designed such that if they were crushed, the active ingredient would fail and the user would not be able to experience the drug’s effects, which helped prevent abuse.

Overdose Deterrent – Extended release formulas of some opioids mean that the individual taking the medication gets a mild amount of the drug over an extended period of time, as opposed to a quicker feeling of pain relief that patients might feel with normal formulas of the drug. This also means patients may need less of the drug because it provides longer and consistent relief instead of a stronger relief that fades over time. That being said, some people may be expecting quicker pain relief, and when they don’t achieve that soon after taking the pill, they could end up taking additional pills to quell their pain. This can lead to an increased likelihood of abuse, addiction or accidental overdose.

Easy To Find – Many companies were forced to invest in developing abuse-deterrent versions of their drugs, so there are a number of different ER opioid options. However, since companies needed to invest more time and money into developing these drugs, they are often more costly than the normal pills. Many patients don’t want to spend more on painkillers than they need to, meaning many opt against the extended release options.

Effective – The good news is that for many patients, ER opioids are effective at helping them manage pain. One thing many pain sufferers want is consistency, and a consistent, long-release drug can do all that. This can help them plan their day, including when they need to take the pills in order to participate in physical therapy or other active treatment options. The only issue is, like any drug taken over a long period of time, the body gets used to the drug and a higher dose is needed to achieve the same level of relief. ER opioids are great in the short-term when working towards a longer recovery goal, but like any opioid, should not be viewed as a long term solution if at all possible.