Chronic Pain in the Military

December 10, 2014January 18, 2016 / Thomas Cohn, MD

A recent study published in JAMA Internal Medicine suggests that chronic pain in active and former military members is a significant problem.

The study surveyed 2,597 soldiers who served in either Iraq or Afghanistan in 2011 in order to understand how chronic pain affects their everyday lives. According to the survey results:

45.4 percent reported suffering combat injuries.

44 percent reported experiencing chronic pain.

48.3 percent reported pain lasting at least a year.

55.6 percent said they suffer from “constant” pain.

51.2 percent said their pain was moderate to severe.

Those tasked with helping military members reintegrate back into society after a deployment know the management of physical and emotional pain is crucial. The study also attempted to uncover how military members use opioids to aid in pain management.

“I had conducted a similar study at [the] CDC because we felt that it was important to understand [the] use of opioids to get a greater context for misuse and abuse,” said lead author Dr. Robin L. Toblin, a clinical research psychologist at the Walter Reed Army Institute. “When I began my current position, we sought to look at the same constructs within a military population, who seemed to be that much more likely to be in pain due to the combat deployments over the last decade.”

Dr. Toblin noted that providing opioid therapy and management to combat veterans is key. Opioids can certainly ease pain after a combat injury, but problems can arise if veterans try to self-medicate or are uninformed about proper dosages. According to Dr. Toblin, 15.1 percent of soldiers say they have received opioid-based therapy to control their chronic pain.

“[Based on these findings], we hope that the military services will be more aware of the unmet needs for the assessment, management and treatment of pain and will broaden the services and availability of those services for servicemembers,” Dr. Toblin said.

The findings have touched off some debate over whether military members should be taking opioids. Obviously we want returning service members to be pain free, while others claim the drugs could affect their physical and mental performance. In the end, I think it really comes down to taking a strong, hands-on approach to ensure our veterans and returning servicemembers get the care they deserve and a treatment strategy that suits their individual situation.

Is The Web A Useful Resource for Medical Information?

December 8, 2014 / Thomas Cohn, MD

The web can be a very good place for information, but one has to be careful at which places they look for info. There are many commercial based sites that try to sell products based on your search criteria. Other sites are the equivalent of an infomercial for a medical practice or institution, while some may simply be a personal blog. Various organizations also sponsor sites, and some are very good, while others are pushing their philosophy toward a certain problem as the only true solution. The best sites seem to try to explain the science behind a problem and explain the variety of solutions available.

The sites that I have found the best are sponsored by the government or large medical organizations. For instance, the Mayo Clinic has a huge amount of information on a variety of topics. They write informational pages on various topics, like medical problems, the typical history, diagnostic studies that may be needed and treatment options. Other good places to look for factual information include insurance companies, health organizations, medical groups, and large universities. Many of these places have fact sheets available on topics of interest that are good reference material. The U.S. government also sponsors information, often from the National Institutes of Health, on a variety of issues.

Then there’s the gray area source of Wikipedia. Generally this source can is an excellent place for information and entries are written by top notch experts on a disease, however, it can be also written by someone who actually has no medical background and just decided to write an article for the site. The information found on this site should be verified with other sites and not be taken as a sole source of data.

The Internet and Chronic Pain

The internet can provide an excellent resource of information for the self motivated person. I have found it useful for baseline information about various pain conditions. I also use it as a resource for patients who want more information on certain topics, like exercises for low back pain. Youtube also has videos that demonstrate a variety of things from exercises to surgical procedures.

Cellphones have brought the internet to the palm of the hand. For a quick definition or piece of information it can be wonderful. Medical providers can find a variety of references for free that help make diagnoses, identify medications and there uses, and for dosing information. That said, reliable and free information in app form is hard to find. iPhone apps are a huge business, but I’ve found no beneficial free exercise apps for patients with chronic pain. There are some inexpensive apps for exercise, but read the reviews first to see if they are going to be helpful for your situation.

The internet is like the Wild West from long ago. There are many very good sites and areas to find educational information about a variety of conditions. The better sites are free and often sponsored by large medical institutions, such as the Mayo Clinic, Johns Hopkins University, other not-for-profit organizations or the U.S. government. Some doctors are also prolific writers and work at trying to educate their patients through the web. Unfortunately, in the pain world, there are also some terrible sites that are forums to gripe about a condition, and the doctors who “know nothing.” The internet can often be a very good starting place for information. It is also a good place to develop questions such that you can have a good discussion with your doctor about what to do next in your management.

Texting May Be Causing Your Neck Pain

December 5, 2014 / Thomas Cohn, MD

As more and more people are becoming glued to their smartphones, medical professionals are warning people about a new condition called “text neck.”

If you’re at school or the breakroom at work it probably doesn’t take long to see more than a few individuals hunched over their cellphone. Responding to texts and sending that work email are important tasks, but you may be jeopardizing your neck health if you hunch your head down while typing away.

“It isn’t the best for our posture,” said Linda Scholl, a University of Utah physical therapist. “It’s not correct posture, but kind of leaning forward.”

Dr. Kenneth Hansraj, a spine surgeon in New York, coined the condition “text neck.” He says the condition is caused by tilting a your head down while staring at your smartphone. According to Dr. Hansraj, teens are especially at risk, as some teens have spent an additional 5,000 hours on their phone compared to older adults.

Scholl agrees, saying teens and colleges students are spending more time than ever buried in their smartphones.

“People are spending more time leaning forward, paying attention to what’s in front of them, instead of having their posture upright and looking at the world around them,” Scholl said.

Scholl noted that people have hunched their heads in the past – be it by reading books or working at their desks – but these activities rarely cause a person’s neck to be in a poor position for such a long duration.

Text Neck Pain

Scholl went on to discuss just how much pressure you can put on your neck by tilting it forward. According to her, the human head weights about 12 pounds, and the farther forward you lean, the more weight is placed on the cervical spine. Once your tilt reaches 60 degrees, “you have about 60 pounds worth of pressure going through your spine. So that soft tissue has to hold the weight of the head in this forward position.”

In addition to neck issues, poor head position can lead to other side effects like reduced lung capacity, neurological problems and heart disease.

Preventing Text Neck

Text neck is a serious problem, but it can be prevented pretty easily. Follow these tips to avoid neck problems while texting.

Mentally note where your neck location is every time you use your phone. When using your phone, try to keep it out in front of you. If it’s in your lap, you’re going to need to lean forward to use it.

Regularly stretch and exercise your neck. Rotate your shoulders and neck at regular intervals.

Don’t be glued to your cell phone. Sure, sometimes it’s very necessary to be on your phone, but the more you’re on it, the more likely you are to subconsciously slip into a poor posture.

If you suffer from neck pain, take a close look at your cell phone use. You may be doing harm without even realizing it!

Related source: Deseret News

Smoking Increases Risk of Chronic Back Pain

December 2, 2014 / Thomas Cohn, MD

A new study conducted at Northwestern University found further evidence that smokers are at an increased risk for developing chronic back pain.

While medical experts have known for a while that smoking increases a person’s risk of chronic back pain, this study examines why that’s the case. Researchers were keen to learn more about the link between back pain and smoking as back pain affects more than 80 percent of the population at some point in their life. According to the folks at the American Chiropractic Association, back pain is the number one reason for missed work and the second most common reason for doctor’s visits.

Smoking Study

For their study, researchers examined 160 individuals who had developed subacute back pain, which is defined as back pain lasting between 1-3 months. In addition, researchers analyzed 32 participants with chronic back pain – back pain for more than five years – and 35 people with no symptoms of back pain. Patients were asked to complete a health and wellness questionnaire once a year for a period of five years, and they also underwent MRI brain scans to analyze brain activity in the nucleus accumbens and the medial prefrontal cortex. These areas play a role in a person’s addictive behavior and motivated learning.

Without getting too technical, researchers say there is a crucial connection between these two areas of the brain. The stronger the connection between the too, the less resilient a person is to chronic pain. According to researchers, smokers had a stronger connection between these two areas of the brain compared to non-smokers, meaning smokers were more likely to develop chronic pain. In fact, researchers suggest that a smoker is three times more likely to develop chronic back pain than a non-smoker.

But there is good news. Dr. Bogdan Petre said the connection between the nucleus accumbens and the medial prefrontal cortex can be decreased by kicking the habit.

“We saw a dramatic drop in this circuit’s activity in smokers who – of their own will – quit smoking during the study,” said Petre. “So when they stopped smoking, their vulnerability to chronic pain also decreased.”

Petre concluded that his team’s findings are only further evidence that smokers are putting themselves at risk for chronic back pain.

“We conclude that smoking increases risk of transitioning to chronic back pain, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning.”