World Health Organization Releases Chronic Back Pain Care Guidelines

December 7, 2023December 7, 2023 / Thomas Cohn, MD

Earlier this week, the World Health Organization (WHO) released its first-ever guidelines for managing chronic low back pain in primary and community care settings. Not only do the guidelines focus on what healthcare workers should be doing to help patients treat their back pain, they also outlined what techniques should be avoided during routine care.

The WHO felt compelled to issue these new guidelines because low back pain is the leading cause of disability in the world. In 2020, roughly 1 in 13 people experienced low back pain, which equates to 619 million people globally. This number also reflects a 60 percent increase from 1990, and cases of low back pain are expected to surge to 843 million by 2050.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course. “Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care.”

WHO Chronic Low Back Pain Recommendations

The World Health Organization recommends non-surgical interventions to help patients experiencing chronic low back pain. They grouped their recommendations under different categories, which we’ll explore below:

Education – Patient education should be structured based on the individual needs of the patient and help the patient better understand their condition and some self-help strategies for treatment.

Physical Interventions – Physical intervention recommendations include structured exercise programs, physical therapy, spinal manipulation therapy, massage therapy, needling therapies and assistive devices.

Psychological Interventions – Operant therapy and cognitive behavioral therapy are recommended as treatments to address the psychological effects of chronic low back pain.

Medicines – WHO recommends non-steroidal anti-inflammatory drugs as part of a routine and comprehensive treatment plan for chronic low back pain.

Multi-Component Interventions – Finally, WHO recommends multi-component biopsychosocial care for patients battling chronic low back pain.

Interventions That Should Be Avoided

According to the World Health Organization, the following treatments should not be recommended as part of routine care for chronic low back pain. They may be recommended if specific conditions are met, but they are not currently recommended as part of routine chronic low back pain treatment:

Traction
Therapeutic ultrasound
TENS stimulation
Lumbar braces/Support belts
Opioid analgesics
SNRI antidepressants
Tricyclic antidepressants
Anticonvulsants
Skeletal muscle relaxants
Glucocorticoids
Injectable local anesthetics
Devil’s claw (Harpagophytum procumbens)
While willow (Salix spp.)
Pharmacological weight loss products

The recommendations by WHO mirror what we’ve been saying to patients for years. Chronic low back pain is best treated with active interventions like exercise and physical therapy, but it also needs to focus on patient education and the psychological effects of chronic pain. Treatment needs to be multi-faceted to be effective, so it’s nice to see that WHO is confirming the methods we’ve been using to help patients overcome their chronic low back pain for years.

If you need help treating low back pain or another chronic pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Tips For Overcoming High Impact Chronic Pain

November 30, 2023 / Thomas Cohn, MD

More than 50 million Americans battle a chronic pain condition on a regular basis, but for a portion of these individuals, their pain is even more debilitating. According to research published in the Journal of Pain, roughly 11 million U.S. adults are dealing with what’s known as “High Impact Chronic Pain.” High Impact Chronic Pain, also referred to as HICP, is similar in nature to standard chronic pain in that it is categorized as pain that has lasted three months or longer. However, in patients with HICP, their pain is so significant that is also causes at least one major active restriction, like:

Being unable to work
Being unable to go to school
Being able to perform household chores

Because of the significant physical burden caused by HIPC, it’s also not uncommon for individuals to also be plagued by mental health issues like anxiety and depression. It can be a vicious cycle, with pain limiting physical and mental stimulation, which only makes it harder for a person to overcome their chronic pain issue. We don’t pretend like we have all the answers, but we do want to use today’s blog to give some advice on how you can work to overcome your high impact chronic pain condition.

Overcoming High Impact Chronic Pain

There is no step-by-step guide for overcoming high impact chronic pain, especially because pain conditions are so unique to the individual. With that said, there are a few things you can do that you may find helpful in providing mild, moderate or major relief for your pain condition. We recommend a combination of the following:

Professional Assistance – You shouldn’t try to manage your high impact pain condition by yourself. It’s already burdensome enough without also trying to figure out the best way to treat your unique pain condition. Instead, lean on a pain specialist with decades of experience treating all sorts of pain problems. Let us work alongside you to find solutions and make it easier for you to gradually work to overcome your pain issue so that you can get back to doing all the activities you love.

Be Active – We know that this is easier said than done, but activity is really important for your body if you’re dealing with a pain condition. Obviously you’ll want to tailor the activity to your current strengths and limitations, but physical activity will do wonders for your physical and mental health. Being active strengthens key areas inside your body, and it can be mentally rewarding to know that you are doing your part to help control your pain condition, which is key for your mental health.

Physical Therapy – If you want to pursue some physical activities and exercise under the guidance of a professional, consider syncing up with a physical therapist. Your physical therapist will develop a PT routine suited to your diagnosis and your goals, and they’ll gradually have you take on greater challenges as you work towards becoming the most functionally capable version of yourself. Many people like working with a PT because it allows them to get real-time feedback from a professional who will adjust their workout to their ever-changing needs.

Improve Your Diet And Sleep – You can’t eat and sleep your way back to full health, but your diet and your sleep quality can certainly prove beneficial or detrimental in your quest to overcome your pain condition. A poor diet can be pro-inflammatory, while a lack of quality sleep has been shown to increase pain sensitivity, which is not something you want if you’re dealing with high impact chronic pain. Conversely, a healthy diet ensures that your body gets the nutrients it needs for numerous essential functions, and quality sleep makes it easier for you to wake up feeling refreshed and ready to attack the day with activity.

Overcoming a chronic pain condition is never easy, and that’s especially true for patients with high impact chronic pain. With that said, if you strive to make a few small changes and you connect with a provider like Dr. Cohn, we’re confident that we can help you get your HIPC under control. For more information, or for help with a different pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

1 in 4 Chronic Pain Patients Treating Their Condition With Medications Only

November 22, 2023 / Thomas Cohn, MD

New data from the National Institutes of Health found that more than 1 in 4 patients with a chronic pain condition were pursuing pharmacologic treatments as their only form of care. As we’ve said on this blog time and time again, chronic pain is a complex issue that needs to be treated with a combination of active and passive treatments.

Pharmacologic treatments are considered a passive treatment and involve things like over-the-counter medications, prescription nonopioids and opioids. Non-pharmacologic treatments tend to be more active in nature, like exercise, physical therapy and cognitive behavioral therapy. Dr. Cohn and his team follow the current recommendations of the Centers for Disease Control and Prevention, which suggest that chronic pain treatment oftentimes works best with a mix of nonpharacologic and pharmacologic therapies.

However, a recent NIH survey found that a fair amount of chronic pain patients are pursuing passive care as their only treatment option for their chronic pain condition. A survey of 7,422 patients with chronic pain uncovered that 26.6 percent of adults said pharmacologic therapy was their only form of chronic pain treatment.

Chronic Pain Treatment Findings

Additional findings from the survey include:

60.2 percent of adults were pursuing both pharmacologic and nonpharmacologic therapies for their pain condition.

The most common pharmacologic treatments used were over-the-counter pain relievers (75.5%), prescription nonopioids (31.1%) and prescription opioids (13.5%).

The most common nonpharmacologic therapies used were exercise (55%), complementary therapies (36.7%), physical or occupation therapy (17.2%) and cognitive behavioral therapy (2.2%).

Older adults with more severe pain and those on public insurance were more likely to treat their pain with prescription opioids

The most concerning finding from the survey was that more than 1 in 4 patients are taking medications as their only form of chronic pain management. These medications treat the symptoms, and while they can calm inflammation or make movement more comfortable, they won’t serve to address the underlying issue that is causing inflammation or similar joint issues. You absolutely need to pair passive techniques like rest and medications with active techniques like exercise and physical therapy. These active treatments help you become stronger so that you can better handle stress, and they also work to stabilize structures that could be suffering from instability or mobility issues. Medications won’t solve your root problem, and while they can be a great compliment to a comprehensive treatment program, they are never a good stand alone option!

To connect with a provider who can develop a treatment plan suited to your specific needs, or to help create a treatment plan that incorporates the right balance of active and passive treatments, reach out to Dr. Cohn and his team today at (952) 738-4580.

How To Tackle The Physical, Mental And Emotional Sides Of Chronic Pain

November 17, 2023 / Thomas Cohn, MD

The physical pain of a chronic pain condition gets most of the attention, but a pain issue affects you in more than just a physical manner. There is also a significant mental and emotional side of chronic pain, and if you aren’t careful in how you treat the problem, you may find that the issue never fully resolves. In today’s blog, we take a look at some ways to tackle these three sides of a chronic pain problem.

Managing The Physical Side Of Chronic Pain

Let’s start by looking at the physical ways you can fight back against your chronic pain condition. These are some of the most common treatments that will be recommended from your pain management specialist. Odds are they suggest a combination of some of the following techniques:

Daily exercise
Controlled stretching
Physical therapy
Posture improvements
Weight loss

All of these techniques serve to make you physically stronger or make it easier for your body to handle the stress that you are putting on it. Because chronic pain is oftentimes tied to a stability issue or problematic inflammation, working to improving your body’s functional performance through physical activity and exertion and be extremely beneficial.

Managing The Mental Side Of Chronic Pain

A chronic pain condition can also put a significant burden on your mental health, so it’s important that you don’t ignore your mental health while you’re pursuing some of the physical treatments listed above. Chronic pain can leave you feeling worried and anxious, so you’ll want to make sure that you are stimulating your brain and working to appropriately frame your chronic pain condition in your mind. For example, don’t just lay in bed all day and hope that pain goes away. Find ways to stimulate your brain and take your mind off chronic pain. Pursuing mentally stimulating activities can lead to the production of hormones that can help drown out pain signals.

It’s also important that you have the right mindset when it comes to your chronic pain condition. It can be easy to catastrophize your pain condition or always view things with a “glass half empty” perspective. You can’t always control your pain, but there are certain aspects you can control, and if you put your time and effort into the aspects of your condition that you can control (like diet, exercise, mental stimulation), you can take solace in knowing you are doing what you need to do to fight back against chronic pain. Try not to focus on the uncontrollable and reframe how you approach your care, and you’ll find that you have more peace over your condition, which can actually help you overcome your pain!

Managing The Emotional Side Of Chronic Pain

Finally, chronic pain can also be very emotionally draining. If you’ve had your pain condition for a while, odds are you’ve had to cancel plans to stop pursuing certain activities you love because of your pain, and that can really wear on a person’s emotions. Similar to the above point on how you need to pursue activities that are mentally stimulating and rewarding, you need to also throw yourself into activities that are emotionally rewarding. Have a friend over for dinner, go for a walk with your sister, call your friend who moved across the country, etc.

You can also find emotionally rewarding activities that don’t depend on other people. Force yourself to go see that new movie, volunteer to walk a dog at the adoption shelter every Friday, or simply curl up with a new book. Chronic pain can be isolating and emotionally draining, so you also want to make sure that you are finding ways to add a little joy to your life. When you’re happier and emotionally balanced, it will be much easier to manage the ups and downs of a pain condition.

If you need help with any of these aspects, or your want to create an individualized care plan for your pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Vitamin Treatment May Be The Key To Unlocking Chronic Pain

November 9, 2023 / Thomas Cohn, MD

A type of Vitamin B3, called nicotinamide riboside, could hold the key to unlocking the problem of chronic pain in millions of Americans.

The vitamin works by targeting inflammation, which is oftentimes the source of pain in patients with chronic pain. Inflammation is your body’s natural response to injury, but in many patients with chronic pain, inflammation develops too easily or fails to resolve in an adequate manner, leading to frequent bouts of chronic pain. Inflammation onset and its ability to resolve is believed to be tied to mitochondria function. Your mitochondria help to power your cells and ensure the cell has the ability to perform a number of essential functions, like tissue repair and inflammation control.

To see if they could improve mitochondria function and in turn inflammation control, researchers triggered an inflammatory response in the hind paws of 15 mice. They then measured the amount of oxygen consumed by mitochondria in the sensory neurons of the mice, which is a helpful indicator of mitochondria function. A week after inflammation had resolved, researchers noticed that these mitochondria were consuming significantly more oxygen, suggesting that inflammation was inhibiting their normal function.

When comparing metabolites between mice in the test group and mice who had not experienced an inflammatory reaction in their hind paws, they found that mice in the test group had lower than expected levels of nicotinamide riboside in the mitochondria of their sensory neurons. Nicotinamide riboside helps mitochondria function properly.

Vitamin B3 And Chronic Pain

With all that new information, researchers conducted another test. This time, researchers gave half the mice a high dose of nicotinamide riboside. Next, they assessed the animals’ sensitivity to pain by measuring how quickly they moved their paws away from a heat source. They found that mice who did not receive the dose of vitamin B3 pulled their foot away from the heat source twice as quickly as those who had received the dosage, suggesting that nicotinamide riboside can help combat pain sensitivity, a common denominator in patients with chronic pain.

Researchers concluded by saying that they believe that nicotinamide riboside can help to calm pain sensitivity and restore crucial mitochondria function in mice dealing with an inflammatory response. Should these results translate to humans, it could be a major breakthrough in how inflammation-driven chronic pain is treated.

But before you rush out to grab some vitamin B3 supplements, know that this was early stage research conducted on mice, and we’re a long way away from proving its viability in humans. Still, it’s research like this that gives us hope that we may soon be able to find new and effective ways to treat the complex problem of chronic pain. In the meantime, if you’d like to work with a pain management specialist who will pursue some more clinically-proven techniques for treating your chronic pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.