Drug Screening In Chronic Pain Clinics

October 8, 2018 / Thomas Cohn, MD

Most pain practices have the occasional patient who they suspect are on controlled substances. Since drug abuse has always been a major problem in society, and because clinics prescribe medications, most practices also screen patients for appropriate drug use and abuse.

At the clinical level, drug screening is done in a number of ways, including testing blood, urine, or saliva samples for the presence of drugs. Some tests only show that a narcotic is present in the body, while others can tell how much of a drug is present. Depending on the circumstance, a provider may choose anyone of the different types of tests. Now a breathalyzer-type test is being developed to test for drugs of abuse.

Breath Tests For Drugs

A breath analyzer test has been done for decades for alcohol and now is being developed for marijuana, cocaine, fentanyl, PCP, and methamphetamine. These use a chemistry technique known as mass spectrometry so the test can identify the presence of certain chemicals and also help determine the level in the breath and possibly in the blood. Unfortunately for many of the compounds tested, there is not a standard for which these chemicals may cause impairment.

With marijuana, for example, we have no idea what level in the body correlates to any level of impairment compared to alcohol. The nice thing about this technique is that it is quick with the analysis being done in about 15 seconds. Currently the technology is very new and thus costly, but in the future it should be about $10,000 for a unit and be very portable.

For places looking to detect a very limited number of drugs of abuse, the breath analyzer will be good. For the pain practitioner, drug testing is more comprehensive. Usually a semi-quantitative screen of either urine or blood is used for drug screening. Most pain physicians want to know if the drugs a patient is supposed to be taking are in their systems and whether there are drugs that are present like street drugs that should not be in their system.

Most doctors also want to know if there are drugs not declared by the patient that may also be dangerous if taken with drugs they have prescribed. For the honest patient, drug screening should not be a worry. For those patients that are using street drugs or misusing their drugs, random testing often finds the problem. The patients who are misusing drugs often make mistakes and doctors discover them sooner or later.

In the midst of the opioid crisis and the high rate of misuse of prescription medicines, safe prescribing of any treatment for a pain patient always becomes a concern. There are many treatments for pain with medications being only a limited modality in the overall scheme of options. The use of addictive medications such as opioids is even less attractive since it often worsens pain and becomes ineffective over very short period of time for many people. Drug testing is one of the tools toward safe prescribing that needs to be implemented in pain clinics throughout the country.

Dr. Cohn Featured In Minnesota MD News!

July 31, 2018 / Thomas Cohn, MD

Chronic pain is a huge problem in Minnesota and throughout the United States, and more people are becoming aware of the issue and trying to help spread awareness. One group that is attempting to help keep people informed and find solutions to chronic pain is Minnesota MD News!

Recently, Sheri Levisay sat down with Dr. Cohn and other members of the CDI Pain Care team to get a better understanding of how we’re working to treat chronic pain and find permanent solutions for every patient.

We’ve pasted a snippet of the feature story below, but for the full story, head on over to Minnesota.MDNews.com. Thank you to Sheri and her team for helping to put a spotlight on pain conditions that affect millions of Americans each and every day!

Few conditions affect more Americans than chronic pain. The American Academy of Pain Medicine estimates 100 million adults suffer from chronic pain, at an annual direct and indirect cost of up to $635 billion. A 2015 National Institutes of Health analysis found 25.3 million people with chronic pain suffered daily for at least three months, and 40 million described their pain as severe.

Compounding the problem is overreliance on opioids. Annual opioid prescriptions in the United States exceed 200 million, according to the CDC, and 165,000 Americans died from overdoses related to opioid pain medication from 1999 to 2014.

As leaders in health care and government search for solutions, patients with pain are left wondering whether their only alternatives are painkillers and surgery.

At CDI Pain Care, Thomas G. Cohn, MD, board-certified in physical medicine and rehabilitation as well as pain medicine, has an answer to that dilemma which reflects his 25 years of experience in the field: conservative pain management.

CDI Pain Care’s comprehensive approach starts with…continued here.

Chronic Pain Can Be A Mother

May 14, 2018 / Thomas Cohn, MD

Mother’s Day has come and gone, and hopefully you were able to celebrate the day with your family. However, for countless Americans, just getting out of bed each day is a struggle due to their chronic pain condition.

There is no one size fits all way to handle chronic pain, but that doesn’t mean you should just sit back and hope it gets better on its own. Instead, take an active role in managing your condition. Today, we share five things you can do to help take back control over your pain condition.

Taking Back Your Life From A Pain Condition

Here are five things you can do to take an active role in managing your pain condition.

1. Eat Well – Eating a healthy diet is probably the easiest thing to control thing on this list. Even if pain makes it difficult to move around, you can still make some good dietary choices. Make it a habit of getting plenty of fruits and vegetables each day, and rely on lean proteins instead of fats and oils. On your good days, do some healthy meal prep so you can have some easy to reheat options later in the week when cooking may feel like a chore. Eating healthy helps you maintain a healthy weight, which can help take stress off painful structures.

2. Exercise – Find time to work in some daily exercise, even if that just involves walking around the block. Exercise has physical and psychological benefits, and it can also work to calm inflammation that may be contributing to your pain condition. Ask your pain care provider about exercise routines that you can perform that will help calm your pain. Try to find time to get out and exercise for 30 minutes at least 4-5 times a week. Your mind and body will thank you for it.

3. Progress Journal – It can be difficult to see just how far we’ve come after an injury or with a pain condition, so some patients find it helpful to keep a progress journal. This allows you to see how your therapy is progressing over time, and it also allows you to keep track of your diet and exercise. Being able to tangibly look back and see the progress you’ve made is a great psychological way to keep your recovery on track.

4. Be Open About Your Condition – By this, we don’t mean that you need to share the gory details or tell everyone you meet how much pain you’re in. Instead, we mean that you should be open and honest with your friends and family about your condition and the limitations it presents. If you’ve been living with a chronic pain condition for some time, odds are you’ve had to miss some events or cancel plans at the last minute due to pain. From an outsider’s perspective, it can be tough to comprehend why you can’t just “buck up” or why your ideal night is at home in comfortable clothes watching a cheesy movie with friends.

Let those close to you know that you want to be involved with their lives, but pain makes that hard, and it’s nothing personal if you have to cancel last minute. Also, reach out to them on your good days. If they’re always asking you to do things and you’re turning them down because of pain, they may stop asking. But, if you’re open about your condition and make an effort to be a good friend and family member, they’ll understand and your relationship will thrive.

5. Talk To A Pain Specialist – Finally, make it a point to see a pain specialist for your condition. A primary care doctor is unlikely to have all the tools needed to give you the best course of treatment. Instead, seek out a pain management specialist who has a deep knowledge of the intricacies of pain. We’ve been helping people find treatment techniques that are tailored to their individual needs, and we can do the same for you. Contact our office today for more information.

The Only Advice You Need For Treating Chronic Pain

April 3, 2018 / Thomas Cohn, MD

Chronic pain comes in so many unique forms, and everyone experiences pain differently. Consequently, there is no one-size-fits-all solution to chronic pain. So as the title of this blog implies, how are we going to provide you with the only advice you need for treating chronic pain? Read on to find out.

Managing Chronic Pain

When it comes to managing carpal tunnel, lumbar spine pain or chronic migraines, there’s really only one piece of advice you should abide by when caring for your condition, and that’s this – Find what works for you, and stick to it.

As a medical professional, I always want to do my reading and examine the science behind pain management techniques. That’s why I’m hesitant to unconditionally provide support for things like medical marijuana and Kratom. There’s simply so much that we don’t know about individualizes strains and how they react to each person individually for most doctors to 100 percent support their use to treat pain.

That being said, we can 100 percent support a person who has found a relief through these methods. At the end of the day, our goal as pain specialists is to help you manage, reduce and ultimately eliminate your pain. If one of these solutions works for you, we’re going to be your biggest supporter, but that doesn’t mean we’ll blindly prescribe the same treatment for someone else dealing with a different pain problem. What works for one may cause a rash of problems in someone else. If there was a magic pill to treat pain, our job would be easy, but there’s not, so pain care requires a highly individualized approach.

Finding What Works

As I’ve mentioned on the blog before, I have struggled with my own pain problems throughout my life. I deal with regular occurrences of back pain, and it took me a while to find out what works to reduce flare ups and keep pain from controlling my life. It’s rarely easy, but that’s the challenge of pain care. I have to make time to get regular exercise, to eat healthy foods and to stretch before a partake in activity. It would be easier to stay on the couch or sleep in a little longer, but I know that doing so means a day with more pain. By finding what works and sticking to the plan, I’ve been able to take control of my back pain.

You can do the same. Whether that involves exercising in the evening, avoiding caffeinated beverages, a daily Kratom pill or acupuncture, when you find something that works, stick with it, but also build on it. If morning exercise helps, see how you body responds to morning exercise and another therapy technique. Keep trying new things until you’ve optimized a treatment plan that greatly reduces or eliminates your pain. Remember that it’s not going to be easy, but if you’re truly committed to finding a solution, you’ll make these treatments a priority.

If you need help developing a care plan or figuring out new treatment techniques to try, don’t hesitate to reach out to our clinic. Because at the end of the day, we want to find a solution that works for you.

Balancing Best Practices and Patient Satisfaction

January 24, 2018 / Thomas Cohn, MD

You would think that in all cases, giving the patient the optimal treatment plan will result in a satisfied patient. Surprisingly, this is not always the case. In an ideal world, a doctor would have a healthy and satisfied patient, but if they have to sacrifice one for the other, your doctor is going to put your health over your satisfaction.

Balancing the best treatment plan and patient satisfaction is especially tough in the world of chronic pain care. For example, in a recent study of nearly 20,000 people with musculoskeletal pain conditions, individuals who were prescribed opioids to manage their pain were much more satisfied with their care. Individuals who used opioids moderately were 55 percent more likely than non-users to report high levels of care satisfaction, and heavy opioid use was associated with a 43 percent higher likelihood of reporting high satisfaction. The more doctors prescribe, the better the chance patients are satisfied with their care.

The problem with prescribing opioids because it will satisfy patients is that overdose and abuse can set in at any time. Taking opioids for chronic pain is a primary risk factor for dying of an opioid overdose, and an overdose leaves many unsatisfied people in its wake.

Prioritizing Health

As we’ve said on the blog many times in the past and will continue to preach on here, we’re not anti-opioid. Pain medications can play a pivotal role in a pain management plan when closely monitored and administered. Instead, we’re anti doctors who prioritize gaining favor or satisfying patients by prescribing pills when it is not in the patient’s best interest or it is not coupled with active treatment modalities, like exercise, physical therapy or diet changes.

The study that analyzed patient satisfaction also pointed out a major flaw in the healthcare system – doctors are often compensated based on patient satisfaction, either directly on the paycheck, or indirectly in terms of online reviews and word of mouth. So we have a system that rewards doctors for doing what the patient wants, instead of what’s best for the patient. Providing the best care and satisfying the patient don’t always go hand-in-hand in pain management, and when doctors see more benefits in appeasing the patient than doing what’s best for them, it’s the patient who suffers.

Doctors are a lot like personal trainers at the gym. You aren’t going to grow muscles by wearing an ab band and sitting on your couch, you have to pick up some weights and put in the work. The same goes for treating your chronic pain condition. There is no magic pill that will allow you to heal without putting in the work on your end. You might not like your doctor at the end of the day, but if you find a good doctor, you’ll know that they truly do have your best interests in mind. Down the road, you’ll thank them.