Chronic Pain Incredibly Common Among TBI Survivors

brain painNew research shows that upwards of 60 percent of people living with a traumatic brain injury are affected by a chronic pain condition.

The study found that chronic pain affects a large portion of TBI survivors, even up to 30 years after their initial head injury. The research was published in The Journal of Head Trauma Rehabilitation, and it involved over 3,800 respondents who had previously been hospitalized with a moderate to severe TBI. Most respondents were white (77%) and male (75%), with an average recovery time since injury of five years (between 1-30 years).

For the study, researchers surveyed participants about their head injury and other current health issues they are facing, like chronic pain, which was defined as “persistent or recurring pain that lasts longer than three months, including headaches or pain anywhere in the body, which occurs more than half of the days over a three-month period.”

Study Results

After looking at the data, researchers uncovered some concerning statistics about the connection between TBIs and chronic pain onset. They found:

  • 46 percent said they were currently living with a chronic pain condition.
  • 14 percent said they previously dealt with a chronic pain condition.
  • 40 percent reported no chronic pain symptoms now or since their TBI.
  • 32.5 percent of participants with a current chronic pain condition reported constant pain.
  • Compared to those with no chronic pain, patients with a current chronic pain condition had severely worse scores on three outcomes measured in the survey – the Functional Independence Measure, the Disability Rating Scale and the Glasgow Outscore Scale.

Another concerning finding from the survey was that medications were the most common form of chronic pain treatment. Medications were used by more than 91 percent of patients with a current chronic pain condition and by 90 percent of patients with a past chronic pain condition. As we’ve always said, it’s not that medications aren’t an effective part of a comprehensive treatment plan, but they cannot be your main or only form of treatment. You need to pursue active interventions, like exercise, diet, weight loss, cognitive behavioral therapy or relaxation/deep breathing techniques in order to get the most out of any medication regimen.

The study stopped short of explaining the specific connection between head trauma and chronic pain onset, but it stands to reason that damage in the brain can affect nerve relays throughout our body. Nerve damage can cause our pain signals to be fired when no painful stimuli is felt, or it can cause your brain to interpret a normal sensation as a painful one. It should come as no surprise that patients with a moderate to severe head injury ended up having some neural connection issues even long after the trauma. It speaks to the importance of working to overcome the totality of the TBI so that symptoms don’t manifest later down the road.

If you’re struggling with chronic pain and believe it may be tied to a previous head injury, reach out to a pain specialist in your area like Dr. Cohn. We can work to pinpoint the source of your chronic pain issue and get you set up on the road to recovery. It’s never too late to take the first step towards less chronic pain. For more information, or for help with a different pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Millions Battling Chronic Pain And Concurrent Mental Health Condition

mental healthNew research from the University of Arizona Health Sciences and published in the journal PAIN found that nearly five million Americans experienced the co-occurrence of chronic pain and a mental health condition like anxiety or depression, leading to functional limitations in their daily life.

As we’ve mentioned on the blog in the past, it’s not uncommon for chronic pain and a mental health condition to develop alongside one another because chronic pain can have a significant effect on your physical, mental and emotional health. If you are forced to miss social events, your career aspirations are limited or you simply find it hard to pull yourself out of bed in the morning because of physical pain, your mental health will also take a hit. For some, that manifests in the form of anxiety or depression.

In a review of data from 31,997 people who participated in the National Health Interview Survey, researchers found that that roughly 38.1 million Americans are dealing with a chronic pain condition, 9.6 million are dealing with a diagnosed mental health condition, and 4.9 million are dealing with co-occurring chronic pain and a mental health condition. Additionally, adults with chronic pain were roughly five times more likely to report anxiety or depression compared to adults without chronic pain.

“The study’s findings highlight an underappreciated population and health care need – the interdependency between mental health and chronic pain,” said the paper’s lead author Jennifer S. De La Rosa, PhD, director of strategy for the University of Arizona Health Sciences Comprehensive Pain and Addiction Center, which funded the study. ”This work is so exciting because it offers the opportunity to use team-based interdisciplinary approaches to medicine, leveraging what is known across disciplines to meet the needs of these individuals.”

Chronic Pain And Mental Health Conditions

Other important findings from the study include:

  • Nearly 70 percent of people with co-occurring symptoms reported limitations at work.
  • More than 55 percent of people with co-occurring symptoms reported difficulty taking part in social events
  • Nearly 44 percent of people with co-occurring symptoms said they had difficulty running errands alone
  • Among all U.S. adults living with unremitted anxiety or depression, the majority (55.6%) are people who also have chronic pain.

This study only further emphasizes the idea that you can’t simply focus on treating the physical aspects of a chronic pain condition. Pain weighs heavy on your mind, and if you’re only focused on the physical pain, you may find that your mental health is suffering.

Even if you don’t believe your mental health has been affected by a chronic pain, you need to be aware that you’re at a higher risk of certain mental health disorders. You need to trust your care to a provider who will give you the comprehensive care you need to tackle all aspects of your chronic pain condition. Dr. Cohn and his team have done that for years for other patients, and we’d be more than happy to put our experience to work for you. For more information, or for help with a different chronic issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Empathy Can Help Reduce Chronic Pain Sensations

empathyWe always recommend that you surround yourself with a support system that is empathetic to your chronic pain condition, but new research shows that empathy can actually help to decrease pain sensations.

According to research published in the Proceedings of the National Academy of Sciences, researchers found that patients exposed to empathetic remarks from a physician experienced decreased levels of pain compared to a control group when exposed to the same stimuli.

For the study, researchers used a functional MRI to scan the brains of 20 patients living with chronic pain. During the scans, patients were exposed to stimuli on their legs that ranged from painless to moderately painful, and patients recorded their perceived pain intensity using a standard pain scale. 10 of the patients were subjected to the painful stimuli while alone, while the other 10 were exposed to the stimuli while in the presence of a physician. Of the 10 that were exposed while with a physician, half of those patients had spoke to the physician before the evaluation, while the other five had not had any prior interaction with the physician in the room.

Empathy And Chronic Pain Intensity

After looking at the responses, researchers found some interesting data points. According to the study:

  • Patients who were alone during the testing reported greater pain sensations than those who were in the presence of a physician.
  • Patients who had already spoken with the physician in the room felt that the physician was empathetic and understood their pain, and physicians were better able to estimate the pain their patients experienced.

During the functional MRI, researchers noted that there was greater activity in certain areas of the brain that react to pain in the patients who had previous spoken to a physician. They believe this brain activity shows the real-world impact of having an empathetic doctor in your corner when dealing with chronic pain.

While there will certainly be more studies on how empathy and other traits can impact the chronic pain experience, this study highlights how chronic pain can be harder to overcome if you believe you are battling the issue by yourself. Chronic pain is certainly an individualized and oftentimes isolating experience, but you need to surround yourself with friends, family and physicians who believe you and want to help your condition improve.

Now more than ever, it is important to empathize with our patients and show them that we care, and that can be difficult when physicians are tasked with seeing as many patients as possible each day. In order to empathize with the patient and show them that you really care, you need to give them the time of day they deserve, and many hospitals would be smart to remember that the quality of care is much more important than the quantity of care. We always strive to empathize with out patients because we know first hand just how debilitating and frustrating a chronic pain condition can be.

So if you feel like just another patient to your care provider, look elsewhere for care. Dr. Cohn will give you the time and attention you deserve, and you may notice that this attention has positive implications for your chronic pain condition. For more information, or to set up an appointment with Dr. Cohn, give his office a call today at (952) 738-4580.

Study Finds Antidepressants Oftentimes Ineffective For Chronic Pain Treatment

anti-depressantA large review of 176 trials involving nearly 30,000 patients found that there was “insufficient” evidence to suggest that antidepressants are an effective treatment for chronic pain.

The study, published in the Cochrane Database of Systematic Reviews, took a closer look at whether or not antidepressants like amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine could be effective in treating certain chronic pain conditions. Millions of people are prescribed anti-depressants to help treat their chronic pain issue, and while many chronic pain conditions involve physical, mental and emotional aspects, it doesn’t necessarily mean jumping on an anti-depressant regimen is helpful.

After conducting the meta-review, researchers were quick to question the efficacy of anti-depressants to treat chronic pain.

“Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point. Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence,” said lead author Professor Tamar Pincus from the University of Southampton.

The two-year study was the largest-ever assessment of anti-depressants currently recommended by the Food and Drug Administration and the UK’s National Institute for Health and Care Excellence (NICE).

Anti-Depressants And Chronic Pain Management

So while there is some clear doubt about the effectiveness of common anti-depressants for chronic pain management, you shouldn’t just stop your current medication regimen if you are on an anti-depressant. You should always consult with your physician before altering your medication schedule, because stark changes can actually lead to more issues.

Additionally, the review isn’t meant to suggest that you should never take an anti-depressant if you have chronic pain. As we mentioned above, chronic pain is rarely just physical, so it is important to care for your mental health as you work through a physical pain issue. That said, anti-depressants should not be your sole treatment plan. Anti-depressants may play a vital role in a comprehensive treatment plan, but they are unlikely to be a great stand-alone option.

Paired with treatments like physical therapy, dietary changes, sleep improvements and cognitive behavioral therapy, it’s certainly possible that anti-depressants may be helpful for your specific situation. Again, their use needs to be evaluated on an individual basis, and it should not be the treatment that you put the most energy towards. There are many other treatments that have been found to be much more effective at treating chronic pain conditions, and we’d be more than happy to help find the right treatment for you.

For more information, or to work with a pain management provider to find a treatment plan that’s right for you, reach out to Dr. Cohn and his team today at (952) 738-4580.

COVID-19 Vaccine Science Could Help Tackle Chronic Pain

monoclanal antibodiesThe COVID-19 pandemic forced medical experts to explore different ways to help slow the spread and create vaccines, and one of those techniques involved the infusion on monoclonal antibodies to help patients fight infections. Monoclonal antibodies are lab-made antibodies that help the patient overcome infections and illnesses, but the hope is that the same technology may eventually be able to replace opioids and help calm chronic pain conditions.

Research is currently being led by Vladimir Yarov-Yarovoy and James Trimmer, two professors in the Department of Physiology and Membrane Biology at the University of California Davis School of Medicine. They’ve also employed several experts to work on their team, including members who have worked to turn tarantula venom into pain medication. The team was awarded a $1.5 million grant earlier this year by the National Institutes of Health’s HEAL Initiative, which hopes to develop solutions for the nation’s opioid crisis.

Hoping To Curb Opioid Use

Addictive opioids are a problem here in the US and worldwide. According to the CDC National Center for Health Statistics, there were 107,622 drug overdose deaths in 2021, up from 93,655 in 2020. Researchers hope that alternative therapies can help to quell chronic pain without turning to potentially dangerous medications.

“Recent breakthroughs in structural and computational biology — using computers to understand and model biological systems — have set the stage for applying new approaches to create antibodies as superior therapeutic candidates to treat chronic pain,” said Yarov-Yarovoy. “Monoclonal antibodies are the fastest growing sector of the pharmaceutical industry and have many advantages over classical small molecule drugs,” added Trimmer.

Trimmer and his lab team have created thousands of different mononclonal antibodies for various purposes over the years, but this will be the first time he turns his attention towards creating antibodies designed for pain relief. And while the prospect of treating chronic pain with the help of monoclonal antibodies may be new, the technology is already being used to treat other ailments. The Food and Drug Administration has already approved monoclonal antibodies to help prevent and treat certain types of migraines.

“Nerve cells are responsible for transmitting pain signals in the body. Voltage-gated sodium ion channels in nerve cells are the key transmitters of pain,” explained Yarov-Yarovoy. “We aim to create antibodies that will bind to these specific transmission sites at the molecular level, inhibiting their activity and stopping the transmission of pain signals.”

If successful, researchers say the antibodies will fit into these sodium ion channels like a lock into a key. These antibodies will then stop the channels from sending pain signals but not interfere with other signals sent through the nerve cells.

So while there is optimism that these antibodies could be harnessed to help treat chronic pain, researchers say that viable human antibodies are still years away. First they’ll need to create antibodies to be tested on lab-created neutral tissue, so hope for a “pain vaccine” is still years away.

One of the most exciting aspects of monoclanal antibodies is that they can circulate in the bloodstream for an extended period before they are broken down by the body. While non-steroidial anti-inflammatory medications are broken down quickly by the body, researchers believe monoclanal antibodies will remain in a person’s system for a month or longer before they are broken down by the body. The team hopes that this means that patients would only need to self-inject with the monoclanal antibodies once a month.

“For patients with chronic pain, that’s exactly what you need,” Yarov-Yarovoy said. “They experience pain, not for days, but weeks and months. The expectation is that the circulating antibodies will be able to provide sustained pain relief for weeks.”