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.

Medical Marijuana Approved For Chronic Pain Patients In Minnesota

December 4, 2019 / Thomas Cohn, MD

Earlier this week, Minnesota regulators announced an expansion to the state’s medical marijuana program, as they added chronic pain and age-related macular degeneration to the list of conditions that can make a person eligible for treatment. The state’s Health Department also said they planned to expand to more sites so patients can have easier access to medical marijuana.

This is a large expansion for the relatively young medical cannabis program here in Minnesota, which began back in 2014. Back then, only nine conditions made the original list of approved conditions. Now, the program has expanded to include conditions like:

PTSD
Cancer
Sleep Apnea
Chronic Pain
Macular Degeneration

Health Commissioner Jan Malcolm said the new conditions were added to give individuals more ways to deal with debilitating illnesses.

“Minnesota’s medical cannabis program tracks patient experiences so we can learn about the real-world benefits and downsides of using medical cannabis for various conditions,” she said in a statement. “The bottom line is that people suffering from these serious conditions may be helped by participating in the program, and we felt it was important to give them the opportunity to seek that relief.”

How To Get Medical Marijuana For Chronic Pain

The changes don’t go into effect until August, so you’ll still need to wait until the second half of next year in order to get medical marijuana for chronic pain. Under the program’s regulations, you’ll also need to get a doctor’s diagnosis in order to be eligible for the medical cannabis program. The state believes it will be easier for patients to get medical approval for chronic pain than for intractable pain, which was already on the approved list, because intractable pain is defined as pain that cannot be removed, only managed, and many doctors are hesitant to slap the label of incurable on a patient.

The state’s acting medical cannabis program director believes there will be a sizable boost in the amount of patients in the program once August rolls around.

“We do know that 20 percent of the U.S. adult population suffers from chronic pain, and so we could apply those numbers to Minnesota’s population, and of course it would be a smaller subset of folks that would be even interested in trying our program,” said program director Chris Tholkes.

It’s interesting to note that while chronic pain and age-related macular degeneration made the list of approved conditions, four other conditions were rejected. Those conditions that didn’t make the cut were anxiety, insomnia, psoriasis and traumatic brain injury.

We’ll continue to share news related to this change as August approaches as we get ready for what we expect to be a sizable shift in how certain patients with chronic pain try to manage their condition.

How To Keep Chronic Pain From Ruining Your Thanksgiving

November 27, 2019 / Thomas Cohn, MD

Thanksgiving is tomorrow, and if you’re like a lot of people, you’re either preparing to travel to or host a Thanksgiving meal. This can be stressful in and of itself, but that only becomes amplified if you regularly deal with chronic pain. We’re not saying that we can make sure your Thanksgiving holiday goes perfectly, but if you follow these tips, we can help give you a better chance of avoiding a chronic pain flareup when you’re with family and friends.

Thanksgiving and Chronic Pain

Here are a number of tips to keep in mind if you want to help give yourself the best chance of avoiding a chronic pain flareup on Thanksgiving.

1. Get Plenty of Sleep – No, we don’t mean gorge on turkey and let the tryptophan do what it does best, we mean get plenty of sleep the night before. You’re going to have a busy Thursday, so let your body prepare for what’s ahead with a good night’s sleep. Head to bed early, get rid of the distractions like your phone or TV, and strive to get some quality sleep before the big day.

2. Travel Well – A long ride in the car can lead to chronic pain flareups, so be smart about how you travel. Check out this expanded post for more tips, but some tips to remember include stretching before you hit the road and when you make pit stops, staying on top of your medications and having good posture when you’re in the car!

3. Eat Right – This is easier said than done, but try to put some healthy options on your plate when it’s time for the meal, and avoid overeating, as this can lead to problems like acid reflux and GERD. We’re not saying you need to pass on they turkey and ham, but maybe skip that second helping of pecan pie. Fatty and sugary foods can lead to the onset of localized inflammation, which can compress nerves and trigger chronic pain.

4. Move – After the meal, you may feel inclined to sit on the couch and take a nap, but fight those urges and move around a bit. Whether that means helping with the dishes, helping hang Christmas lights or taking part in the annual family football game, movement will help push healthy blood around your body. Movement can also prevent muscles from being overstressed by being held in the same position for a long period of time.

5. Stay Ahead Of Your Pain – If you have reason to believe a flareup may be around the corner, be proactive with your over-the-counter or prescription medications. Take as directed, but you know the warning signs of a flareup, so consider taking an anti-inflammatory if you want to stay ahead of your pain.

6. Put You First – Finally, at the end of the day, it’s important to put yourself and your health first. Don’t overdo it, and don’t try to hide your pain, because it will rear its head. If you need to lay down for a few minutes, excuse yourself and prioritize your health. If you need a minute away form the chaos that is Thanksgiving, throw on your coat and go for a short walk. Put your health first today, because it can get hectic quick.

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