New Chronic Pain Care Guidelines Recommend Ditching Medication

April 8, 2021 / Thomas Cohn, MD

The National Institute for Health and Care Excellence (NICE) recently released some updated guidelines for how pain practitioners should help their patients deal with their chronic pain condition. The most notable suggestion is that NICE is advising doctors to avoid prescribing pain medication for a pain condition and instead believes they should recommend exercise or psychological therapy for the most effective treatment. For chronic pain sufferers who rely on pain medication as part of this treatment process, the news may cause anxiety and fear over whether or not they’ll have their access to these medications restricted.

We’re here to let you know that while these recommendations certainly have merit, no physician worth his salt is going to take medications away from someone who is using them responsibly and progressing in their rehab. In today’s blog, we take a closer look at the recommendations and explain how they’ll likely be implemented going forward.

Exercise Over Medication

If we just look at the headline and start to draw conclusions from there, it’s easy to get worked up over the latest recommendations. We’re here to help calm your fears and explain that although the recommendations are rooted in sound science, applying them unilaterally to a condition so unique as chronic pain is a terrible idea. Pain is unique to the individual, which is why there is no one-size-fits-all treatment for chronic pain. Even when two people are suffering from the same diagnosis, their treatment regimens may be different. That’s why we can’t just say that medications should never be used for effective pain care.

Nobody is saying that all you need to do to rid yourself of your chronic pain condition is to lace up your running shoes and go for a jog, but as we’ve talked about on the blog in the past, there is extensive research behind the idea that exercise and movement can be a key factor in helping fight back against a chronic pain condition. Exercise is an active solution that improves muscles, helps to control inflammation and works to stabilize joints that could be contributing to your pain issue. Medications, on the other hand, are a passive treatment that work to mask pain instead of treating the underlying issue. Medications alone will not cure your pain condition, but exercise and strength training or psychological therapy could.

With that said, painkillers and active treatment modalities can absolutely compliment one another, and this is when we’re all for prescribing medication to patients. If medication can make it easier for you to follow through on a physical therapy routine or to stick to your exercise program, then we’ll gladly walk you through a responsible painkiller management plan. We want to give patients all the tools they need to take control of their pain condition, and pain medications can certainly be part of that equation, so long as the patient is educated on their purpose and continues to prove that they can use the medication responsibly.

So in spite of the new recommendations, know that your pain physician will only recommend tapering off your medications if they aren’t actually promoting your recovery. If they aren’t doing any good and are putting you at a heightened risk for dependency or overdose, any good physician will adjust treatment to find a more effective method.

If you have been unable to find an effective solution for your pain, or you just want to talk to a physician who will take the time to get to know you and your diagnosis to provide the best level of care, reach out to Dr. Cohn’s 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.

NIH Issues New Plan To Tackle Opioid Crisis

June 12, 2018 / Thomas Cohn, MD

Earlier today, the National Institutes of Health issued its new plan for taking on the opioid crisis in America. The plan is titled Helping to End Addiction Long-term, or HEAL. The plan has two main goals:

Fund projects that will help develop or facilitate treatments for opioid addiction and overdose.

Fund projects that are meant to improve the management of pain through research into how acute pain transitions to chronic pain, as well as research nonaddictive pain treatments.

“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit,” the authors wrote. “Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction.”

Treating Addiction and Overdose

For starters, researchers want to take a closer look at how we’re currently battling addiction and overdose. Through their research, they found that there are three main drugs prescribed to help wean people off of opioids. Researchers found that most people living with opioid addiction never get started on these treatments, and of those that do, half of them relapse within a year.

“Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have opioid use disorder,” the authors wrote.

The NIH also wants to fund efforts to create better drugs for reversing overdoses, especially among individuals who overdose on fentanyl. The current reversal drug is naloxone, and it isn’t as effective as experts want it to be when the overdoser has other drugs or alcohol in their system.

Treating Addiction Before It Starts

The second part of the initiative focuses on coming up with better pain treatment plans and stopping pain before it become chronic. This is what we’ve been championing for on the blog for years. We need to treat addiction at the source, and the underlying reason behind addiction is unaddressed pain. We need to find better ways to treat and manage pain conditions so they don’t progress to the point where opioids are needed.

Funding for both parts of the plan will come from a $500 million grant that Congress set aside for the NIH in the 2018 budget

Opioid Prescriptions Dropped Significantly in 2017

April 19, 2018April 19, 2018 / Thomas Cohn, MD

New data shows that the number of prescriptions for opioid painkillers filled in the United States last year fell drastically, representing the biggest drop in 25 years.

The decline comes amid prescription restrictions and public education campaigns to help spread awareness of how opioids, when used incorrectly, can have harmful side effects. The report on the findings, which was released Thursday, shows a nine percent average drop nationwide in the number of prescriptions for opioids filled by retail and mail-order pharmacies.

Each state and Washington D.C. had at least a five percent decrease in opioid prescriptions. Declines were higher than 10 percent in 18 states, including all of New England, West Virginia and Pennsylvania.

“We’re at a really critical moment in the country when everybody’s paying attention to this issue,” said Michael Kleinrock, research director at IQVIA Institute for Human Data Science, which released the report. “People really don’t want them if they can avoid them.”

Drop In Opioid Prescriptions

Opioid prescriptions have been rising steadily since the mid-1990’s, with use peaking in 2011. The US far outpaced levels of other wealthy countries where national health systems are more strict about narcotic control. Overdoses and deaths from prescription opioids have been soaring in recent years, but advocacy groups, physicians and patients have been fighting back with increased educational strategies.

With all this said, opioids still do play an essential role in pain management for patients with chronic conditions. We are not against opioids when they are part of an integrated pain management plan, the problem becomes when doctors don’t take the time to educate their patients about their risks or conduct follow up checks to ensure patients aren’t in over their heads with their medication.

The downturn in opioid prescriptions is both good and bad. It’s a good sign that pill-mill doctors are getting exposed for what they are, but there’s also a decent chance that some chronic pain patients are struggling to get access to the medications they dearly need. It’s a double-edged sword, and there’s no perfect solution, but we should continue to push patient education so every person who takes a painkiller for their issue knows exactly what to expect and how to avoid a potentially serious issue.

Concerning Behaviors Associated With Pain Pill Abuse

December 14, 2017 / Thomas Cohn, MD

Opioid management is probably the most charged topic that we talk about frequently on our blog. Many of our patients and readers take some type of opioid medication to help manage their pain, and they get nervous or angry when they hear big government talk about restricting opioid access due to an increase in overdoses. The majority of people take their pain pills responsibly, and they are concerned that the minority who are abusing pills will make it impossible for them to get the opioids they depend on.

Opioids certainly have value in a pain management program, but we also don’t believe they should be the only treatment option that is being tried. And if you are going to take opioids, you need to be sure you use them responsibly and they aren’t abused by others in your home. One way in which doctors and family members can help stop painkiller abuse is by looking for certain concerning behaviors that are often associated with opioid abuse. We take a closer look at some of those behaviors in today’s blog.

Behaviors Associated With Pain Pill Abuse

Here are some of the behaviors that doctors and family members can look for that may suggest a person is dealing with a substance abuse or pain management problem:

Missing appointments.
Taking their pills for something other than pain.
Using more medication than prescribed, or asking for a refill before the prescription end date.
Repeated inquiries to get an increased pill dosage.
Being aggressive or hostile to healthcare staff or family members.
Taking medication in combination with alcohol or other drugs.
Lack of participation in other treatment modalities.
Bouncing around from doctor to doctor or clinic to clinic.

If someone you now is demonstrating a few or all of these behaviors, reach out for support. Contact Dr. Cohn or reach out to your specialist to learn ways to talk to your loved one about painkiller abuse and how to get them the help and support they need. It’s never an easy conversation, but it’s one that needs to happen.

The consequences of painkiller abuse can be deadly, so don’t sit back and do nothing. Contact a healthcare provider or addiction services center to ask about the next steps in the process. We’ve also compiled a few links that you can check out if you suspect that a friend or family member is abusing pain pills. Please don’t hesitate to reach out if you have any questions.