Some Opioids May Actually Hinder Healing

June 6, 2016 / Thomas Cohn, MD

A recent study on rats has brought to light another problem with using opioids for pain treatment. In the study, rats had an experimental trauma to the sciatic nerve causing leg and foot pain.

One group was given opioids to control pain while recovering from the injury, while the control group was not given any medicine and allowed to heal on their own. The opioid treatment group took at least 16 weeks to heal, while the other group healed in eight weeks, and the control group actually reported more complete healing. The opioid group showed signs of prolonged inflammation throughout the treatment period. The untreated group did not have signs of ongoing inflammation. Now as a reminder, this study was in rats, not in humans.

The significance of the above study is that the use of opioids in humans does have many negative effects. We know that these medications cause problems from cognition to constipation, depression, and many other medical issues. The current leading concern is addiction. Now if the above research holds true in humans, or has even a partial effect in humans, using opioids for pain may be inhibiting recovery from injury and prolonging pain and inflammation.

Having The Reverse Effect

The goal of most physicians when treating pain is to promote recovery from difficulties that may be causing damage to the body. Pain physicians promote multiple strategies to treat painful conditions. Medications are one strategy. More effective treatments often involve physical therapy in order to promote healing and more natural restoration of function. It takes strength and endurance to function normally. Return to normal function after injury takes a lot of work, there is not a magical pill to reverse pain.

As time goes on, the more we learn about medications, the more we realize that every substance that we put in our bodies has the potential to create more problems. Most medications prescribed by physicians are relatively safe, but they can all cause problems. If we want to do the best thing for our bodies, we need to often go back to the basics. The body needs the right exercise, food, nutrition, and rest. Treat the body right and it will not be angry and painful. Doctors can only help a person so much, the rest is up to the patient to take care of themselves.

Pain Supplements and Their Processes, Part 2

August 12, 2015 / Thomas Cohn, MD

For part 1 of “Pain Supplements and Their Processes,” click here. Below, we continue exploring some pain supplements, their dosages and their uses.

Turmeric is a plant and the main spice in curry. It is used for arthritis, headaches and fibromyalgia. The chemicals in it are thought to decrease inflammation. Caution is recommended if you are on a blood clotting medication, have diabetes, or have stomach irritability and heartburn problems. The recommended dosage to treat arthritis-related problems is 500 mg twice a day.

Boswellia, or Indian frankincense, is a tree native to India and Arabia. The sap or resin from the bark is extracted into this compound. It is used for osteoarthritis, rheumatoid arthritis, joint pain, tendonitis and bursitis. Boswellia is thought to decrease inflammation, and no significant side affects are known. The usual dose for joint pain is 100 to 250 mg a day.

Lastly, green tea is thought to be helpful for headaches and joint pain. This is tea or an extract made from the Camellia sinensis plant. Benefits are obtained from the polyphenols in the steamed fresh leaves. These compounds are thought to prevent inflammation and swelling, and protect and lessen joint cartilage degeneration. It also contains antioxidants that art protective to the heart. It should be noted that green tea does have small amounts of caffeine that could affect heart disease, blood pressure, diabetes, bleeding disorders and osteoporosis. The recommended dosing is about one to three cups of tea per day.

Taking natural supplements for pain may or may not be helpful. Above is a list of some of the compounds that have been recommended for treatment of painful joint conditions. Most have some sort of properties that affect inflammation, but the studies that prove their effectiveness have been somewhat limited. If you wish to try these remedies, and do not have other medical issues, they are likely to be mostly safe, but consult with your physician prior to starting any supplement regimen.

Pain Supplements and Their Processes, Part 1

August 10, 2015 / Thomas Cohn, MD

Joint pain affects millions in the United States. The CDC estimates that over 50 million people in the US have arthritis, or about 25% of the population. The vitamin and supplement business in the United States is a multi-billion dollar enterprise.

The proof for the effectiveness of any of the compounds is very limited. In general, the best that can be said is that they may be helpful, and the only harm that is likely is possibly a hole in your pocket book. Today, we take a look at some supplements, their common dosages and what they treat. Be sure to check back in later in the week for more information on other pain supplements.

Supplement Guide

Glucosamine is one of the top supplements recommended for joint health. This is a chemical that can be found naturally in the human body. As we age, the levels tend to decrease. It is used by the body in helping build tendons, ligaments, cartilage and the synovial fluid in and around joints. Most commonly it is recommended for those with osteoarthritis. Knee pain is the most common location. In rare cases, side affects have included increases in blood pressure, cholesterol and blood sugars. The dose that has been studied is 500 mg three times a day.

Mixed with glucosamine is chondroitin, and this is also normally found in the cartilage of joints. It is manufactured from animal sources, commonly cow cartilage or shark cartilage. Chondroitin is supposed to help with arthritis pain and may help with osteoporosis. It is supposed to work by slowing down breakdown of joint cartilage. A caution is recommended if you have asthma or are on a medicine to prevent blood clots since this may interfere with both conditions. The typical dose is 200 to 400 mg two to three times a day, but it may be all taken at once.

Omega 3 fatty acid supplements are used for a variety of conditions. It has been recommended for blood pressure control, cholesterol, depression, ADHD, diabetes, osteoporosis and inflammatory conditions causing pain including arthritis. Omega 3 fatty acids in fish oil are not made by the body, so ingesting them is necessary, and they reduce pain and swelling. For any condition, this supplement is said to help, but literature also indicates there is a possibility it may also worsen that condition. The dosing for arthritic conditions is about 4 grams a day.

Ginger root is commonly used for muscle and joint pain along with stomach pain. The chemicals in ginger root are thought to work in the stomach and intestines as well as the nervous system to affect inflammation. There is a definite interaction with blood clotting medications, like Coumadin, increasing bleeding problems, so if you are on those, do not take ginger root. There are various ginger extracts on the market and suggested dosing is 170 mg three times a day to 250 mg four times a day.

That’s all we’re going to cover today. Swing back on Wednesday for more information on supplements.

Supplements For Joint Pain

July 31, 2015 / Thomas Cohn, MD

Chronic joint pain plagues many of my patients, and oftentimes this condition is caused by arthritis. Because so many people suffer from joint pain and arthritis, a lot of pharmaceutical companies are trying to cash in on the demand for vitamins and supplements. But which supplements are the best, and what else should you do to combat arthritis pain?

The first thing you’ll want to do is understand that there is no magic pill to fix arthritis. Some supplements may alleviate some symptoms in the short term, but they won’t provide a full on cure. You need to take proactive steps and focus on all aspects of your health if you really want to see results. That means you need to get off the couch and start exercising. We already know that 30 minutes to an hour of moderate to intense activity is great for your body, but it can also help alleviate symptoms associated with arthritis.

Diet is another area of focus. Foods with Omega-3 fatty acids are natural anti-inflammatories, so ditch the pizza and soda for fish and leafy greens. Combined with exercise, a balanced diet can help you lose weight, which means your body won’t need to bear as much weight. Losing weight is a natural way to take some stress off your joints.

Paired With Pills

If you are going to take a supplement to combat your osteo or rheumatoid arthritis, be smart about what you put in your body. First and foremost, you should follow your doctor’s instructions. Ask them what supplements they’d recommend, especially if you are taking other medications to manage pain. Stick to your doctor’s instructions, and never take more than the recommended amount, even if you’re in more pain than normal.

Again, discuss these options with your doctor, but some good vitamins and supplements to consider include:

Calcium

Vitamin D3

Ginger

Turmeric

Omega-3

Vitamin E

Green Tea

Paired with diet and exercise, supplements can be a key component in keeping your arthritis under control.

1 in 4 Misuses Chronic Pain Meds

April 15, 2015 / Thomas Cohn, MD

New research published in the journal PAIN suggests that approximately 20 to 30 percent of opioids prescribed for chronic pain are misused. Additionally, the current rate of opioids addiction hovers around 10 percent.

“On average, misuse was documented in approximately one out of four or five patients and addiction in approximately one out of ten or eleven patients,” who were prescribed pain pills as part of their treatment for chronic pain, said Dr. Kevin E. Vowles and colleagues. They added that the new findings provide “updated and expanded” estimates of the opioid problem in America.

Increased Prescriptions, Increased Addictions

To see how increased opioid prescriptions have fueled pain pill addictions, researchers analyzed 38 reports to measure three separate opioid-related problems:

Misuse
Abuse
Addiction

Researchers examined documented cases of dependence, withdrawal and overdose to come to their conclusion. Opioid misuse was classified as “using opioids contrary to instructions, regardless of harmful or adverse effects.” After adjusting for variables, researchers concluded that between 21 and 29 percent of people who are prescribed opioids misuse them.

“If it is accurate that approximately one in four patients on opioids display patterns of opioid misuse, but not addiction, then perhaps more efficient targeting of treatment resources would be of benefit,” said Dr. Vowles.

As for opioid abuse, which is classified as continued opioid use with actual or potential harmful effects, researchers suggested that about 8 to 12 percent of patients abuse their medications.

Dr. Vowles and colleagues concluded by saying that physicians should seriously evaluate if a patient is a good candidate for an opioid prescription, as the dangers seem to be outweighing the benefits.

“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”

Related source: Medical News Today