painkillers

Painkillers May Not Be Necessary After Some Knee And Shoulder Surgeries

/ Thomas Cohn, MD

painkillersMedical researchers are always looking for more information about how they can help patients recover following a surgical procedure. The prevailing wisdom is that opioids and painkillers are needed to help patients manage discomfort following arthroscopic surgery, but new research found that these strong medications may not be necessary.

For the most recent study, researchers wanted to get a better understanding of how necessary opioid pain relievers were after arthroscopic knee or shoulder surgery compared to non-opioid pain relievers. To do this, they looked at 193 patients who underwent outpatient surgery on their shoulders or knees at three different participating hospitals. Roughly half of the patients received opioids for postoperative pain, while the other half received naproxen and acetaminophen for pain, as well as pantoprazole, a medication normally used to treat heartburn and acid reflux. Both groups had access to emergency opioids if needed to aid in pain relief.

Post-Op Pain Control

After six weeks, patients in the opioid group had used an average of 72.6 mg of opioids, compared to 8.4 mg in the opioid-sparing group. Two patients in the opioid-sparing group asked for opioid medication after their discharge. Researchers noted that there was no significant differences in patient satisfaction, pain levels or adverse events when comparing the two groups.

“This study clearly shows that many of these surgical patients can be treated safely without opioid medications in a select population,” said lead author Olufemi Ayeni, MD, a professor of surgery at McMaster and an orthopedic surgeon at Hamilton Health Sciences. “Furthermore, by reducing the number of opioids prescribed, we can collectively reduce the development of a reservoir of unused medications that can cause harm to many in society.”

More than one million arthroscopic surgeries are performed in the United States every year, and if it turns out that many of these patients can manage post-op discomfort without the need for potentially addictive and dangerous opioids, that’s a huge win. In fact, doctors have already started to make this shift. Data shows that since 2017, the number of opioid pills prescribed to patients undergoing minimally invasive surgeries has fallen by 50 percent, although that may be driven by a number of factors.

As we’ve always said on the blog, opioids can absolutely play a crucial role in a pain management program, but we have to be careful about becoming over-reliant on them. Opioids are never intended to be a long-term option, but they can certainly make it easier to participate in a rehab program after injury or surgery. Make sure that you take full advantage of the benefits of opioids when you need them most, and odds are you’ll find that you need them less and less.

For more information about appropriately managing pain after an injury or surgery, or for help overcoming a chronic condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

New Chronic Pain Care Guidelines Recommend Ditching Medication

/ Thomas Cohn, MD

painkillersThe 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.

To Prescribe Or Not To Prescribe

/ Thomas Cohn, MD

prescribe“To be or not to be, that is the question,” is the famous line from the play Hamlet. For many doctors, especially pain management physicians, they battle with a similar question with every patient they encounter – “To prescribe or not to prescribe.”

Medication prescription and the written and unwritten rules that govern the practice have been a hot button issue of late, especially during the pandemic. In an effort to stay up to date on the latest news regarding chronic pain care, we often find stories blasting doctors for over-prescribing or doctors who find it necessary to validate their very real and very appropriate treatment plan that involves the prescription of opioids. Patients are also caught in the mix. Heck, I’ve had a colleague killed by a former patient because they would not prescribe opioids, which only makes it harder for patients with legitimate ailments and conditions that can effectively be managed by opioids to get their hands on the medications they so desperately need.

The debate over opioids has in some ways mirrored the most recent presidential election. Any reasonable person realizes that neither party is right 100 percent of the time, but many of the loudest Republicans and loudest Democrats only seek to champion their beliefs and refuse to listen to what the other side has to offer. We’ve seen the same situation play out with opioids, as it seems like we’re either hearing about opioid hysteria and mass over-prescribing or that no doctor should ever stand in the way of a patient who wants painkillers for their pain condition. And just like with politics, the answer tends to lie somewhere in the middle.

Prescribing Or Not Prescribing

There is no one-size-fits-all answer to whether or not a physician should always or never prescribe opioids, because every individual and every pain condition is unique. Even in patients who have similar characteristics and similar pain conditions, it’s irresponsible to say that they should always or never receive opioids as part of their care plan. An assessment needs to be made on an individual basis and it needs to be made on the totality of the situation.

There are so many different factors that need to be understood before a doctor makes a determination as to whether or not painkillers would be in the patient’s best interest. There are the obvious factors like age and diagnosis, but there are also the less-than-obvious factors like whether or not underlying anxiety or a mental health condition could be exacerbated by beginning a new opioid regimen. A physician will also dive into a patient’s medical and family history to look for signs of abuse or potential abuse. It’s not that the doctor doesn’t trust the patient with opioids, it’s that we want to make sure we’ve uncovered all potential hurdles to successful treatment. Navigating known potential obstacles is so much easier than trying to blindly push forward with a care plan.

And of course, a good pain physician will listen to the patient. We want to learn about your goals, your wishes and your concerns and factor those into our decision to prescribe opioids. During our decades of practicing medicine, we’ve certainly encountered the patient that clearly has ulterior motives for wanting a quick and fast prescription. But far more often than not, patients want opioids to play a role in a comprehensive treatment plan. They want painkillers so that their physical therapy exercises can be performed a little easier, or they believe opioids will help them live a more active lifestyle and combat their pain condition in other ways.

Painkillers can absolutely play an essential role in a pain care plan, but that doesn’t mean they should absolutely be prescribed for every patient. A totality of factors need to be analyzed in order to provide the best care for the patient, which is what all physicians should strive for. Doing right by the patient means taking the time to really understand their condition, their frustrations, their goals, their concerns and their opportunities. Sometimes that involves painkillers, sometimes it doesn’t. The sooner we realize that we need to come together to help find solutions for pain patients instead of condemning chronic pain sufferers and physicians, the better we all will be for it.

Prescribing Opioids in 2019

/ Thomas Cohn, MD

painkillersEvery 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.

The Benefits and Drawbacks Of Extended Release Opioids

/ Thomas Cohn, MD

extended releaseWe are always looking for new ways to make painkillers safer for those individuals who suffer from acute or chronic pain conditions, and one such improvement was the shift to extended release opioids. These types of pills were promoted as safer than traditional opioids, and while they are in some aspects, they are far from a perfect solution. In today’s blog, we take a closer look at the benefits and drawbacks of extended release painkillers.

Extended Release Painkiller Benefits and Drawbacks

Here’s a look at some of the benefits of extended release painkillers, as well as some reasons why these benefits may not be a perfect solution to the problem.

Abuse Deterrent – Some painkillers were redesigned, making them harder to crush and snort. While this has been successful in preventing abuse of some opioids, it has led some abusers to try even more dangerous methods to get their quick fix, like in the form of injections with shared needles. Other types of abuse deterrent drugs actually were designed such that if they were crushed, the active ingredient would fail and the user would not be able to experience the drug’s effects, which helped prevent abuse.

Overdose Deterrent – Extended release formulas of some opioids mean that the individual taking the medication gets a mild amount of the drug over an extended period of time, as opposed to a quicker feeling of pain relief that patients might feel with normal formulas of the drug. This also means patients may need less of the drug because it provides longer and consistent relief instead of a stronger relief that fades over time. That being said, some people may be expecting quicker pain relief, and when they don’t achieve that soon after taking the pill, they could end up taking additional pills to quell their pain. This can lead to an increased likelihood of abuse, addiction or accidental overdose.

Easy To Find – Many companies were forced to invest in developing abuse-deterrent versions of their drugs, so there are a number of different ER opioid options. However, since companies needed to invest more time and money into developing these drugs, they are often more costly than the normal pills. Many patients don’t want to spend more on painkillers than they need to, meaning many opt against the extended release options.

Effective – The good news is that for many patients, ER opioids are effective at helping them manage pain. One thing many pain sufferers want is consistency, and a consistent, long-release drug can do all that. This can help them plan their day, including when they need to take the pills in order to participate in physical therapy or other active treatment options. The only issue is, like any drug taken over a long period of time, the body gets used to the drug and a higher dose is needed to achieve the same level of relief. ER opioids are great in the short-term when working towards a longer recovery goal, but like any opioid, should not be viewed as a long term solution if at all possible.