Could Deep Brain Stimulation Help Treat Chronic Pain?

February 4, 2020 / Thomas Cohn, MD

Nearly one in three adults in the US suffers from some form of chronic pain, and despite everyone’s best efforts, it’s not always easy to treat. We’re always looking for new ways to best help our patients decrease and eliminate their chronic pain, and one new treatment that is being closely monitored and tested is deep brain stimulation.

Deep brain stimulation (DBS) may sound like some futuristic medical experiment, but it’s already being used to treat some cognitive impairments. It has been successful in helping limit symptoms in conditions like Parkinson’s disease, dystonia and tremors, and now doctors are wondering if it could be useful in managing some types of chronic pain.

DBS works by implanting electrodes deep into a person’s brain in the areas that help control movement. A stimulator is also implanted in the chest, and the stimulator can help drown out problematic brain signals. The only issue is that it’s not a perfect science, and you’d like it to be perfect when you’re implanting a device in a person’s head. The electrical current relayed through the stimulators is constant, meaning it can’t adjust to what’s going on in the brain, it simply operates as a way to drown out problematic signals.

Because of this, some patients have experienced changes in personality or problems speaking, and like many treatments, the brain can get used to the stimulation and find ways to drown out the signal that is supposed to be drowning out the problematic signals. So while it’s not a perfect system, medical experts are always trying to improve it, and now they are researching whether it could be a viable option for chronic pain patients.

Deep Brain Stimulation For Chronic Pain

Researchers at the UCSF Weill Institute for Neurosciences recently received a $7.56 million, five-year grant to see if DBS could be used as a treatment for some forms of chronic pain. However, their goal is to develop the technology so that the current can be harnessed and used based on signals from the brain in real-time, instead of as a constant current.

Researchers likened the system to a space heater and a thermostat. The space heater provides constant heat, whereas a thermostat can turn the heating system on and off based on the current temperature and a desired setting. Right now DBS is a space heater, but researchers say they hope to use the grant to help develop a more thermostat-style model.

“We are trying to build a model to serve as a thermostat to control electronic stimulation to provide pain relief,” said Dr. Prasad Shirvalker, assistant professor of Anesthesiology at UC San Francisco. “We’re at the front edge of trying to open up new indications for DBS.”

Hopefully researchers can figure out how to control DBS in the most complex system in our body so that chronic pain patients can have another avenue to pursue relief. We’ll keep tabs on this research as it progresses.

FDA Warns Against Pain Curing Claims Of CBD Industry

January 29, 2020 / Thomas Cohn, MD

cbd oil When it comes to selling healthcare products, companies often try to walk a fine line between marketing their product and making false claims about the true ability of their product. Oftentimes there are a lot of semantics at play and the Food and Drug Administration rarely intervenes over product claims unless they feel that the consumer is being grossly misled about a product. It appears they recently felt that way over claims made in the CBD industry.

We’ve talked about cannabidiol on the blog in the past, and like CBD, medical marijuana or other relatively new products on the healthcare market, our stance has been pretty similar. We want patients to find a solution that works for them, we want further scientific research to better understand these products, and we want patients to pair passive treatment options with active treatments like exercise and physical therapy. Until we can point to the science behind a product, we’re leery to suggest it as a solution other than to say, if it works for you and isn’t compromising your health, go for it.

CBD For Pain, Cancer and More

That’s not exactly the same sentiment felt by Rooted Apothecary LLC, a company based in Naples, Florida, that has been pushing CBD products on its customers. They are legally selling CBD products, but the FDA and the Federal Trade Commission believes the claims they are making about the effectiveness of the products are misleading and even illegal.

Some of the claims made by the company about their CBD products include such unsubstantiated claims as it can be effective for teething pain and earaches in infants, or that “CBD was effective in killing human breast cancer cells.” They also made claims that CBD has been effective in treating Parkinson’s disease, Alzheimer’s disease and can safely be used in conjunction with opioids. Not only are these claims unsubstantiated by science, but they can put the consumer’s health at risk.

“Cannabis and cannabis-derived compounds are subject to the same laws and
requirements as FDA-regulated products that contain any other substance,” said
Acting FDA Commissioner Ned Sharpless, MD, in a press release. “We’ve sent
numerous warning letters that focus on matters of significant public health
concern to CBD companies, and these actions should send a message to the
broader market about complying with FDA requirements. As we examine
potential regulatory pathways for the lawful marketing of cannabis products,
protecting and promoting public health through sound, science-based decision-
making remains our top priority.”

Whether it’s CBD or another health and wellness product, we recommend that you do your own research and consult with your physician if you have any questions, especially if you’re already trying certain treatments for your pain. If something sounds too good to be true, it probably is. CBD is far from snake oil, but it’s not a magic pill either. Do your research, trust your gut and consult a professional for any questions you have.

Can You Sleep Your Way To Less Chronic Pain?

January 15, 2020 / Thomas Cohn, MD

As we’ve talked about on the blog in the past, there is a clear link between sleep health and pain sensitivity, and we’re going to further explore the interconnections of these two things in today’s blog. A recent study published in the Journal of Science built on our knowledge of this connection, which leads to the question, can we sleep ourselves out of the cycle of chronic pain?

For their study, researchers took a closer look at a person’s brain and the pathways through which pain is perceived. This is the area that processes pain stimuli. In other words, it tells us where the pain sensation we’re feeling is coming from. This pain signal then moves to the insula, a part of the brain that integrates incoming signals and forms our perception of pain. Finally, that signal is sent to the nucleus accumbens, an area that plays a significant role in decision-making, reward and pain evaluation.

During their research, the team found that the activity of the nucleus accumbens in sleep deprived patients differed from those who regularly receive adequate amounts of sleep. The nucleus accumbens helps to dull incoming pain signals, but this process doesn’t occur as frequently or as greatly in patients who are sleep deprived.

Takeaways

The findings are in line with a previous study that found that burn victims increased their opioid consumption after just one night of interrupted sleep, which also reinforces the idea that sleep quality and our perception of pain is linked. But what does that mean for the average patient with chronic pain? It means you should focus on getting a healthy amount of quality sleep while also pairing that restful period with physical activity during the day. You’re not going to get rid of your chronic pain by laying in bed all day, but you’re also due for trouble if you get six hours of interrupted sleep each night.

Check out this old blog post on ways to improve your sleep quality, but we’ll provide some quick tips here. Get in the habit of going to bed at roughly the same time each night, make the room cool and as dark as possible, and avoid reading, watching Netflix or scrolling through your phone while in bed. Make the bedroom a place for sleeping and your body will begin to get in the habit of falling asleep and staying asleep. Also, avoid caffeine or alcohol late in the day as those beverages can make it harder to fall asleep and stay asleep.

Finally, you also need to pair this quality rest with activity. You need to put in some work to overcome your pain, whether that’s in the form of physical therapy, daily exercise or a regular stretching routine. These activites will help to increase our pain threshold and strengthen supportive muscle groups that can help prevent pain. Be active during the day and work on achieving quality sleep at night, and you may soon find your chronic pain under control! For help with any of this, reach out to Dr. Cohn’s office today.

Should You Eat Before Or After Exercise?

December 23, 2019 / Thomas Cohn, MD

Should you fuel up before hitting the gym, or is it best to burn calories on an empty stomach? That’s the question researchers at the University of Bath in England sought to answer with their latest study.

For their research, the team decided to look at the fat burning capabilities of exercise based on when the participant last ate. They were wondering if when a person ate influenced how much muscle fat was burned during activity, because muscle fat can be a key contributor to the eventual onset of insulin resistance and diabetes. For their study, the team divided 30 overweight men into three groups.

A control group that lived their normal lives.
A group that consumed a vanilla-flavored shake two hours before cycling exercise.
A group that consumed a placebo shake two hours before cycling exercise.

Participants wore monitors and masks that tracked a number of different factors, including their heart rate and the amount of fat and sugar they burned. After exercise, the participants drank the shake they had not yet consumed (placebo for the vanilla shake group, and a vanilla shake for those who consumed a placebo before exercise).

The study lasted for six weeks, and researchers drew some interesting conclusions after looking at the data. As expected, the control group’s insulin sensitivity remained unchanged, while the men in both exercise groups improved their fitness and narrowed their waistlines, although few actually lost weight. Notably, participants who pedaled on an empty stomach burned about twice as much fat during each ride as the men who consumed their shake prior to exercise. All riders burned about the same number of calories while pedaling, but more of those calories came from fat when the men did not eat first. Riders that consumed the shake afterwards also had greater improvements in insulin sensitivity and had developed higher levels of certain proteins in their muscles that influence how well muscle cells respond to insulin and use blood sugar than the other groups.

“You can probably get more out of your workout without increasing its intensity or duration by exercising before breakfast,” said Javier Gonzalez, a professor of physiology and nutrition at the University of Bath, who oversaw the study.

So if you’re wondering when the best time to exercise is, it might be first thing in the morning after you wake up. That being said, any exercise is better than no exercise, so just get it in when it works for you!

Don’t Give In To Arthritis

December 9, 2019 / Thomas Cohn, MD

Last week I read an article in the Washington Post that described how some patients, frustrated with their arthritic condition, seem to give into the disease and let it take hold of their life. Arthritis is a difficult condition to treat since there’s simply no way to turn back the clock and regrow lost cartilage, but with that said, we shouldn’t just give in to arthritis, because that’s only going to make things worse.

When it comes to managing your arthritis, you have to attack the condition head on. Simply taking a painkiller and sitting on your couch will do nothing to make the problem better, and it will contribute to the deconditioning of your joints, effectively advancing your arthritis. Instead, you need to pursue active treatments, because although your joints may never feel like you’re 21 again, it will keep the disease from getting worse, and that’s how you best manage arthritis.

Actively Managing Arthritis

Remaining active is key when it comes to combating arthritis. You may have to take it easier at times, and you may have to be smarter about the way you stay active, but you need to keep moving. If you need knee braces in order to help prevent pain when playing basketball or when going for a walk, invest in some quality braces so you can stay active. If it’s your back or spine that is bothering you, invest in some supportive shoe options to take some stress off your body so you can keep moving. If it’s the activity that’s bothering you, find some other ways to be active.

For example, many arthritis patients say that running is too difficult because it puts too much stress on their joints. If you’re finding this to be the case, look for activities that keep you moving that don’t put as much stress on your body. Swimming, for example, is a fantastic example of a low-impact exercise, and because water is naturally resistant, you only need to swim or walk around the inside of the pool to strengthen your joints and keep them healthy.

Other activities like cycling, yoga, tai chi and kayaking are all low-impact exercises that strengthen your joints and won’t overstress your body. These activities will help you strengthen the supportive muscles and soft tissues around your joints so that movements aren’t as painful.

If you need to take pain medication to manage your arthritis, that’s fine, but make sure they aren’t your only form of treatment. Don’t take painkillers just to lessen your pain, take them so that activities are more bearable and use them in combination with other active treatments. Paired correctly with other treatment strategies, opioids can play a crucial role in helping you best manage your arthritis.

If you have arthritis and want some individualized help getting your condition under control, reach out to Dr. Cohn’s office today.