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.

How To Best Treat CRPS On An Individual Basis

March 25, 2019 / Thomas Cohn, MD

crps Complex regional pain syndrome is one of the most vexing and difficult problems in the world of pain medicine. Traditionally it was thought to be a rare disorder that spontaneously affected some people especially after some sort of injury. Since it has been poorly understood, many pain practitioners have very limited experience and interest in trying to treat this condition. Many physicians actively try to avoid working with patients with the problem, others may try a few things but since they have limited knowledge and experience, they often end up giving up on trying to manage the problem. Luckily there are more than a few pain physicians who see the condition a lot and are becoming more successful with its management.

The thought leaders in pain medicine who treat CRPS seem to be some of the physicians who do a lot of work as interventional pain physicians who also take a very active role in diagnosis of their patients besides just providing treatments. The ability to fully evaluate a person is critical in understanding CRPS. The symptoms of CRPS always have a cause; it is not just a bunch of symptoms that lead to a painful extremity. It usually involves a structure in the body such as joint that is malfunctioning or a nerve in the area that is abnormally functioning. Treatment is needed to correct the structure that is not moving in the right way and to relieve the abnormal functioning of the nerves involved in the area.

The Challenges of CRPS

The first challenge is correcting the structural problems that often are orthopedic in nature that are wrong. The abnormal movement sends signals through the nervous system that something is wrong and often is interpreted by the brain as pain. These problems may start as simple degeneration like from a sprained ankle or a worn out knee. Most of the time, correcting the simple problems work, but if there are nerves malfunctioning in the area, possibly damaged by an injury or treatment, or more centrally also in the spine itself, then complex regional pain syndrome – CRPS may be manifested. The major challenge is finding the nerve problems correlated with the symptoms and finding a way to treat them.

Since CRPS often now is thought to involve peripheral nerve injury in the region of pain, then finding the nerve and extinguishing the signal from that location can sometimes effectively treat the problem. If the source of the pain is strictly peripheral, finding the right nerve and blocking that nerve proximal to the damage may stop the pain. In the last 1-2 years, technology has improved and techniques are now becoming available to electrically block isolated nerves in the extremities.

Spinal cord stimulation has been used to treat CRPS for years, and this is blocking signals more centrally at the spine. Now technology is allowing pain practitioners to more precisely block the nerves either as they exit the spine or superficially in the periphery with special implantable devices. Obtaining better pain control then involves the physician fully evaluating a person for all the places that may be contributing to sending painful sensory signals and then trying to find the simplest place to block the abnormal electrical signals such that they do not travel to the brain and signal pain and disaster to the brain. Further it means the physician who is going to be helpful in treating your pain must be fully evaluating the patient as well as working directly with the interventional techniques. A physician who is just providing injections or not fully involved in all aspects of pain management is unlikely to understand and be helpful in controlling symptoms in CRPS.

The understanding and treatment of CRPS is changing and with the right providers, pain control is often being significantly improved. This is not a mystery disease, but unfortunately not many physicians have seen enough of these types of problems to understand and manage the complex issues. Finding the right person is difficult, but the interventional pain physicians who see CRPS a lot, who actually evaluate their patients themselves and do the treatment may be the best source for a successful strategy toward treatment. The solutions sometimes are complex like the disease, but there are more and better treatments that are becoming available.

How To Talk To A Pain Specialist About Your Pain

August 16, 2018 / Thomas Cohn, MD

Pain can be fluid or come in waves, so it can be very difficult to explain what you’re going through to your family, friends or doctor. When it comes to explaining your pain to us, we don’t expect you to be able to perfectly describe it or be able to give us a clear idea of what’s going on. After all, if you knew what was causing the issue, you’d probably already have a strong treatment plan in place.

We want to do everything in our power to help you find a solution to your chronic pain issue, and that begins when you come in for your consultation and talk to us about your pain. Below, we share some tips for helping convey what you’re going through, and how to best open up about your experience.

Explaining Your Chronic Pain

Here are some tips for helping to convey to the pain specialist what you’re going through.

1. Document Your Pain When It Happens – Some people have a hard time describing their pain because they aren’t having a flareup when they are in the office. This is why it’s important to really focus on what’s going on when you’re dealing with a chronic pain flare up. Catalog in your head your symptoms and where pain is located when flare ups occur, or better yet, create a pain journal to write down your experiences. This will give you a clear and documented history of what you’re dealing with.

2. Don’t Hold Back – Another way in which patients inhibit their treatment is by holding back when it comes to explaining or bringing things up to the specialist. Whether it’s because you’re embarrassed or afraid, the only person you’re hurting by withholding information is yourself. We’re not here to judge you, we’re here to help you, so don’t hide anything pertaining to your condition from us.

3. Don’t Lie – Along a similar vein, don’t lie to your pain specialist. If you haven’t been the best about sticking with your physical therapy program or you’ve forgotten to take your medications at times, let your doctor know. You need to stick with your treatment plan in order to have the best chance of a full recovery, and if you’re not giving it your all, your doctor may move on to other treatments when a simpler solution was all that was needed. And this goes for things like your exercise and diet habits too, not just truths about your pain condition.

4. Specifics – Be as specific as possible when you’re describing your pain. Don’t just say that your back hurts, tell us that your back hurts when you’re standing for long periods or when you wake up in the morning. The more details we have, the easier it will be to pinpoint potential problems. Again, some people find it easier to be specific if they document their symptoms with a pain journal.

5. Ask Questions – Finally, both you and your pain specialist can benefit from asking and answering questions. Ask if certain symptoms are normal, or what types of treatment they’ve found to be most successful. Your conversation with your pain provider needs to be two-way in nature in order to have the most benefit.

Hopefully these tips can help you the next time you visit a pain specialist, and if you’d like to talk with Dr. Cohn about your pain, contact his office by clicking here.

How to Choose a Good Pain Doctor

June 17, 2013September 27, 2016 / Thomas Cohn, MD

Choosing a good doctor is always a challenge. There are many options to consider, including:

Insurance Requirements
Where you Live
The Degree of Specialization of the Physician you’re looking for

The best pain doctors will be those who have a broad range of experience, and a broad range of ability to evaluate and treat a variety of problems.

The Definition of Pain

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is how the body interprets certain sensory signals in the nervous system, which includes how the brain processes the signals and determines how to react to them. Pain sounds simple, but becomes extremely complex due to many causes and interactions.

Qualities of a Great Pain Doctor

A good pain doctor needs to have many qualities in order to successfully manage what can be an extremely complex problem. Pain often comes from multiple sensory sources, and finding each sensory source is a challenge. The start to finding the source is listening to the patient, the story, and where and what is happening. The story is often critical, and a good doctor will be able to recognize what story matches various internal problems. An experienced doctor can match a story very quickly to the pain problem.

In addition to listening to the patient’s story, a doctor may also need to perform other tests in order to grasp the full scope of your pain, such as:

Analysis of a patient’s movements
Checking motion in various body parts
Examining the neurologic and musculoskeletal system
Scans and X-rays

The best doctors have done this many times, and can put complex information together rapidly to determine a treatment plan.

Finally, all the good pain doctors should at least be fully licensed, and have subspecialty boards in Pain Medicine. Backgrounds in Physical Medicine and Rehabilitation are also a huge plus. Expect a good physician to be familiar with your history and examination, and have a comprehensive treatment plan, and be willing to address a number of complex issues contributing to your unique problem.