Managing Chronic Pain During These Challenging Times

March 18, 2020 / Thomas Cohn, MD

Needless to say, we’re in unprecedented times in America and across the globe in terms of how we’re reacting to the COVID-19 outbreak. COVID-19, also termed the coronavirus, is a virus that spreading like wildfire and can have significant health impacts on anyone who comes down the the virus.

Specifically, older individuals and those with immunodeficiency disorders are at the highest risk of severe complications from the virus, and in our experience, individuals with chronic pain tend to be more likely to have an immunodeficiency disorder than the general population.

Now more than ever, we need to be diligent in how we manage our chronic pain. Even if you don’t have an immunodeficiency disorder and consider yourself young and healthy outside of your chronic pain, you need to make some conscious changes to how you manage your chronic pain in the coming days and weeks. We share some tips and situation updates below.

Managing Chronic Pain During The Coronavirus Outbreak

As we’ve stated on the blog in the past, exercise is one of the best things you can do to help manage your chronic pain condition. Exercise helps to strengthen key muscle groups and releases endorphins that can help mask some pain signals. However, gyms are closing because of the virus, so you may need to find a new way to work out. Going for a walk or a run is still fine so long as you avoid group running, and we encourage chronic pain patients to look for ways to stay active inside their home. Dust off that old exercise equipment, or do some home-based exercise routines like yoga or balance board training. Find ways to stay active without going to the gym.

If you need to have a consultation with a physician, whether it’s for a new sickness or because of your current chronic pain situation, you can take solace in knowing that the U.S. Department of Health and Human Services is making it easier for physicians to connect with patients through telemedicine. As long as the provider is acting in good faith, they can consult with patients over electronic means like Skype, Google Hangout and Facetime. Doctors can even do this across state borders, an action that was announced during a White House press briefing this morning. We’re still sifting through all these changes, but know that we’re working as diligently as we can to make it easier for patients to connect with physicians while still following smart social distancing guidelines.

Lastly, remember to take some time to focus on your mental health during these trying times. Your mental health plays a significant role in how your physical condition responds to treatment, so you need to take care of your physical and mental health. This may be easier said than done, but find ways to give yourself a mental break and to safely alleviate stress. Call friends and family members, organize a game night with your family, or dive into a book series you’ve been meaning to read. Taking your mind off other stressors can help with your physical condition, so keep that in mind over the next few weeks.

We’ll get through this together. If you need anything during this time, please don’t hesitate to reach out to Dr. Cohn’s office for answers or information.

How To Thrive If You Have Chronic Pain

March 10, 2020 / Thomas Cohn, MD

Chronic pain conditions can leave you feeling like you’re in a daily battle with your body, and that can make it hard for you to live life to the fullest. When it comes to not only surviving, but thriving if you have chronic pain, you really need to focus on certain aspects of your health and daily life. Below, we share five ways to help you thrive in your life even though you’re battling chronic pain.

Living Your Best Life With Chronic Pain

There’s no perfect solution for treating chronic pain because everyone’s pain is different and what works for one person may not work for another. However, if you really want to work to take back control of your life from your daily pain, consider these tips. Many patients have found that a combination of these changes and ideas can help them work towards living their best life in spite of their chronic pain.

1. Daily Exercise – We know that movement can be painful if you have chronic pain, and your pain condition can make it difficult to find the will to be active, but exercise is one of the best things you can do for your physical and mental health. Not only does it help to target painful structures and strengthen muscles, but it can also help release endorphins that mask pain and leave you in a happier mindset. If traditional exercise like running or gym work is too painful, consider less intense exercise like swimming or cycling.

2. One Thing Each Day – Find a way to take one tangible step towards reducing your pain each and every day. Maybe that’s in the form of exercise or doing your physical therapy routine, but try to do at least one thing each day that you can point to and say “this helped with some aspect of my chronic pain.” If you do this daily, odds are you’ll find yourself in more control over your pain.

3. Active Activities – Staying active is another great way to live your best life when you have chronic pain. Obviously this is easier said than done, and by activity, we don’t just mean exercise or physical exertion. Find an activity that helps to take your mind off your pain. You don’t need to break a sweat in order to find new ways to turn your attention to something other than your pain. Dive into a puzzle, go for a walk with a friend or try your hand at yoga. Anything that pulls your attention way from your pain will help you live life to the fullest. Find what works for you.

4. Connect With A Physician – You shouldn’t try to tackle your chronic pain on your own. Sync up with a pain management specialist in your area to get a comprehensive diagnosis and individualized treatment. Knowing that you have a professional in your corner who is working to help treat your pain can positively affect your mental health, and that can go a long way in helping you thrive in spite of chronic pain.

5. Don’t Ignore Your Mental Health – Chronic pain is often viewed as a physical problem, but it also impacts our mental health. If we solely focus on the physical aspect of chronic pain, we may be ignoring an even bigger mental health issue. Chronic pain can increase your risk of depression, anxiety and other cognitive issues, and failing to recognize and treat these conditions alongside your pain can inhibit treatment success. Make sure you trust your care to a specialist who is willing to treat all parts of your chronic pain issue.

For help with your pain journey, reach out to Dr. Cohn’s office today.

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.

How Effective Is Low Dose Naltrexone (LDN) for Pain?

January 19, 2020January 16, 2020 / Thomas Cohn, MD

Naltrexone is an old drug with many uses that was first developed in 1963. Its initial use was for treating opioid addiction. The drug is a derivative of the opioid oxymorphone but acts in the opposite way at regular doses to block the opioid receptors in the body. Naltrexone also has an effect to suppress the desire to consume alcohol, and won approval for this in 2006. The normal dose of naltrexone is 50 mg, while low dose Naltrexone ranges between 1.5 mg to 4.5 mg per day. The use of low dose Naltrexone began in the 1980’s and over the last several years some practitioners have been using this for pain care.

How Naltrexone Works

The use of a drug that blocks opioids to treat pain appears to be counter-intuitive. At low doses, many medications have different properties and effects than when given at higher doses. Medications like Naltrexone seem to decrease the inflammatory response of microglia in the central nervous system. Prolonged painful stimuli impairs the nervous system and the body’s ability to regulate endorphins. Resetting the central sensitivity to pain is what Naltrexone may do, but it tends to work in cases only when there is not ongoing tissue damage or stimulation of inflammatory factors. It would not work in degenerative arthritis or spinal issues causing acting nerve stimulation. The best use is in fibromyalgia, migraines and central sensitization of the nervous system.

The important factors related to low dose naltrexone and pain are that it affects the microglia in the central nervous system. The microglia are immune cells in the CNS and produce compounds that are excitatory and inflammatory. These can result in pain sensitivity, fatigue, cognitive disruption, mood disorders, and general malaise. Naltrexone can have a neuroprotective and analgesic effect in the nervous system by suppressing microglia activity. When pain is being produced by an overactive nervous system, then this medication may be helpful.

Low dose naltrexone is experimental. There is no FDA approval for such dosing but it has been approved for treatment of other medical conditions at doses ten times higher than what is recommended for pain. It is a generic compound, and can be made by a pharmacist into a capsule at some pharmacies. The cost is about $40 a month, it likely would not be covered by insurance and could be considered a reasonable option when other treatments have not been effective for chronic pain, fibromyalgia, central pain states and migraine headaches. The side effect profile is very low, the most common are vivid dreams and tiredness. There is limited hard research on Naltrexone at low dose, but the most common dosing is 4.5 mg once a day, lower doses down to 1.5 mg and higher or more frequent dosing have been used as well. Dosing is based on the drug’s activity in the body and its breakdown and metabolism.

At this time, if one has chronic pain with definite central pain sensitivity, the use of low dose Naltrexone is experimental. If conventional treatments are not effective, it may be worthwhile to consider trying this medication. If one of the main problems one suffers is fibromyalgia, migraines or a similar condition, it may be reasonable to trial this medication. It probably will not be approved by insurance, and you may have to travel to a pharmacy that can prepare the capsules. It has a low risk and it may be helpful.