How To Keep Chronic Pain From Ruining Your Thanksgiving

November 27, 2019 / Thomas Cohn, MD

Thanksgiving is tomorrow, and if you’re like a lot of people, you’re either preparing to travel to or host a Thanksgiving meal. This can be stressful in and of itself, but that only becomes amplified if you regularly deal with chronic pain. We’re not saying that we can make sure your Thanksgiving holiday goes perfectly, but if you follow these tips, we can help give you a better chance of avoiding a chronic pain flareup when you’re with family and friends.

Thanksgiving and Chronic Pain

Here are a number of tips to keep in mind if you want to help give yourself the best chance of avoiding a chronic pain flareup on Thanksgiving.

1. Get Plenty of Sleep – No, we don’t mean gorge on turkey and let the tryptophan do what it does best, we mean get plenty of sleep the night before. You’re going to have a busy Thursday, so let your body prepare for what’s ahead with a good night’s sleep. Head to bed early, get rid of the distractions like your phone or TV, and strive to get some quality sleep before the big day.

2. Travel Well – A long ride in the car can lead to chronic pain flareups, so be smart about how you travel. Check out this expanded post for more tips, but some tips to remember include stretching before you hit the road and when you make pit stops, staying on top of your medications and having good posture when you’re in the car!

3. Eat Right – This is easier said than done, but try to put some healthy options on your plate when it’s time for the meal, and avoid overeating, as this can lead to problems like acid reflux and GERD. We’re not saying you need to pass on they turkey and ham, but maybe skip that second helping of pecan pie. Fatty and sugary foods can lead to the onset of localized inflammation, which can compress nerves and trigger chronic pain.

4. Move – After the meal, you may feel inclined to sit on the couch and take a nap, but fight those urges and move around a bit. Whether that means helping with the dishes, helping hang Christmas lights or taking part in the annual family football game, movement will help push healthy blood around your body. Movement can also prevent muscles from being overstressed by being held in the same position for a long period of time.

5. Stay Ahead Of Your Pain – If you have reason to believe a flareup may be around the corner, be proactive with your over-the-counter or prescription medications. Take as directed, but you know the warning signs of a flareup, so consider taking an anti-inflammatory if you want to stay ahead of your pain.

6. Put You First – Finally, at the end of the day, it’s important to put yourself and your health first. Don’t overdo it, and don’t try to hide your pain, because it will rear its head. If you need to lay down for a few minutes, excuse yourself and prioritize your health. If you need a minute away form the chaos that is Thanksgiving, throw on your coat and go for a short walk. Put your health first today, because it can get hectic quick.

For help with all your pain needs, reach out to Dr. Cohn’s office today.

Nanoparticles Could Make Opioids Obsolete For Chronic Pain

November 20, 2019 / Thomas Cohn, MD

Painkillers are currently used to treat a number of different pain conditions, but everyone knows they are far from a perfect solution. Traditional opioids carry a high risk of addiction and overdose, which is why researchers are so keen on finding another way to calm irritated nerves and help block nerve signals. With the help of nanoparticles, they may do just that.

According to an international team of researchers, we may soon be able to use nanoparticles to deliver drugs into specific compartments of nerve cells, allowing us to better treat pain while also reducing the risk of dependency that comes with traditional opioids. Researchers said the nanoparticle delivery method has proven successful in rats and mice, and they hope to improve the science so the results are replicable in humans.

“We have taken a drug—an FDA-approved anti-vomiting medication—and using a novel delivery method, improved its efficacy and duration of action in animal models of inflammatory pain and neuropathic pain,” said Nigel Bunnett, PhD, chair of the Department of Basic Science and Craniofacial Biology at New York University (NYU) College of Dentistry and the study’s senior author. “The discovery that nanoparticle encapsulation enhances and prolongs pain relief in laboratory animals provides opportunities for developing much-needed non-opioid therapies for pain.”

Nanoparticle Delivery

The team of researchers began by studying a family of proteins called G protein-coupled receptors, which are an area that are targeted by roughly one-third of clinically used drugs. The standard line of thinking was that these receptors function at the surface of nerve cells, but the team discovered that when activated, the cells moved within a compartment called the endosome. Inside the endosome, the receptors continue to function for prolonged periods, and this activity is what drives pain perception.

In their study, researchers narrowed their focus on a G protein couple receptor called the neurokinin 1 receptor.

“Major pharmaceutical companies had programs to develop neurokinin receptor antagonists for chronic diseases, including pain and depression. However, in human trials, things fell apart,” said Bunnett. “The neurokinin receptor is the poster child for failures in drug discovery to treat pain.”

Researchers believed that those drugs failed to provide relief because they were designed to block pain receptors at the surface level of the cells, not in the endosomes. But by turning to nanoparticles, researchers can deliver a neurokinin receptor blocker called aprepitant, which is an FDA-approved drug that is used to prevent nausea and vomiting. Essentially, these nanoparticles enter the nerves that transmit pain signals and release the neurokinin receptor blocker, halting pain. In clinical trials involving mice and rats, pain completely resolved or resolved for longer periods compared to opioids and other traditional treatments. By using this technology, it also minimizes the dosage needed, which can help to prevent traditional side effects.

Researchers hope that these results can be mimicked in clinical trials involving humans, and they hope to further their understanding by eventually only targeting the nerve cells that sense pain, as this would lead to even smaller doses. Hopefully they are successful, because we can always use more effective and less dangerous ways of controlling chronic pain.

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.