acute pain

Thoughts On Attending The Latest Pain Conference

/ Thomas Cohn, MD

conference meetingEvery physician is required to obtain continuing education credits. Depending on a when one was board certified, the types of boards one has, and what state you live in, the number of credits needed each year varies.

At least once a year, I try to attend some sort of conference in order to to add to my knowledge about how to treat pain. This year I have ventured into the new realm of the American Society of Regional Anesthesia (ASRA). Since pain care crosses the line into a number of different disciplines, one of the best ways to improve is to pick up knowledge outside your normal specialty.

Thoughts From The ASRA Meeting

For the last several days I have been at the annual pain meeting of the ASRA. It is a group of about 5,000 practitioners, which is actually one of the smaller major groups involved in pain management. Each group has a different focus, and finding a good balance is hard. So far I have enjoyed the meetings; it’s like being back in an intense school all day long. Best yet, most of the information has been very relevant to my regular practice. It also has included a lot of practical knowledge, and there hasn’t been too much esoteric academic information or stuff aimed at an someone just beginning to practice pain medicine. Many of the pain conferences are aimed at physicians who do not do any advanced procedures or only at physicians doing injections, and both extremes can be lacking balance for patient treatment.

One of the most important things a conference does is challenge your thinking. Hopefully questions are entering your mind about what can you improve upon and how to do better patient care. A conference like this is great. It is not focused on a single topic and there are many areas of my practice it could impact. General topics have ranged from very specific aspects of implantable pain technologies to the best ways to evaluate and treat very specific medical problems. One odd topic that has caught my interest is how to deal with changing government regulations to prevent burnout of physicians.

The hot topic at any of these conferences is now opioid use and abuse. However, at a pain conference it is not about a crisis of addiction, but a crisis of lack of treatments available to treat complex pain. The money is being spent on addiction management and not finding treatments that would manage the root cause of pain, and thus markedly reduce addiction.

The hardest thing at a conference (besides sometimes staying awake) is trying to sift through what is truly good information. After going to enough of these conferences, one begins to recognize those who are in it for self promotion. Every conference seems to have several people who promote the latest fad. If there is no money to be made with regards to a topic, the information is probably more science and less sales.

Learning new information is good. Missing seeing patients is tough, but the time gone is for the good of all patients in order to provide the best care. Benefits will be made on everything from what to do for patients to learning new things that may help tough patients. New treatments now will be tried for everything from CRPS to knee or elbow problems. The only sad part of going to these conferences is that often I see no other pain physicians from my location, but I’m certainly glad I went to this conference.

Electricity’s Role In Chronic Pain Management

/ Thomas Cohn, MD

electrical neurostimulationElectricity and its role in treating chronic pain oftentimes gets a bad rap because some people automatically associate neurostimulation with shock therapy. Yes, electrical current is used in order to help quell your pain, but we’re not sending painful volts into your body like you sometimes see in Hollywood films. With opioids becoming a growing concern in many circles, more professionals and medical researchers are looking to see if electricity could be the next big thing in chronic pain management.

Nueromodulators and Chronic Pain

Neuromodulation or neurostimulation is not exactly a new approach to chronic pain management, as versions of these devices have been around for decades. Like any medical device, the first prototypes are a step in the right direction, but it takes a while for researchers to work out the kinks and really perfect the technology. Dr. Mark Malone, founder of Advanced Pain Care in Texas, believes we’re getting much closer to perfecting these neuromodulators.

“In the last 18 months or so, a new generation has come out including (Abbott’s) Burst and Dorsal Root Ganglion,” said Malone. “These two techniques are far more effective and it’s really an amazing revolution. For the first time ever, we’ve been able to say things like ‘cure chronic pain.'”

So how exactly does neuromodulation work? Essentially, it uses electrical impulses to trick the brain into believing the area is no longer sending pain signals.

“This is the application of electrical energy in the nervous system to quiet down pain impulses,” said Malone. “It’s more of a language. You’re speaking to the nervous system in the language of the nervous system and telling the brain the pain is no longer important.”

Neuromodulation is similar to the process that happens if you were to accidentally hit your thumb with a hammer. When you do this, you probably grab your thumb and rub it to help dull the pain. By rubbing your thumb, you’re providing the area with a new sensory signal and helping to block the pain signal. This process is known as tonic stimulation, and it’s an underlying principal of the electrical stimulation process. The small implantable device can drown out pain signals by stimulating other areas.

No Addictive Side Effects

Dr. Malone has been using a neuromodulator of his own for a little over six months. He had been on disability for more than a year and only working at his clinic on a part-time basis, but after seeing how successful it was for his patients, he decided to give it a shot for his pain. He’s been thrilled by the results, and electrical stimulation does not have the same potential drawbacks as opioids.

“It’s really an amazing gift that we suddenly have this treatment that’s so effective for even the worst pain patients and it’s completely drug free,” said Malone, noting that electricity isn’t addictive and that it produces no euphoric side effects.

The neuromodulator isn’t a perfect device, but it’s a big step in the right direction. It can’t stop certain types of pain, like widespread fibromyalgia, but it has been successful in patients with certain types of complex regional pain syndrome and failed back surgery syndrome. So if you’re still looking for answers to your chronic pain problem, ask a pain management specialist about your options with neuromodulators and electrical stimulation.

Fibromyalgia – Not Just In Your Head

/ Thomas Cohn, MD

The problem with invisible illnesses like fibromyalgia or CRPS is that people who don’t understand the condition often think someone is faking the condition or making it up for attention. The fact of the matter is that these are real conditions that plague hundreds of thousands of individuals in the United States each and every day. Because symptoms come in waves and patients can have good days and bad days, outsiders think that symptom prevalence can arise or decrease at “convenient times.”

Let me tell you this – there is nothing “convenient” about these illnesses. Some of the strongest people I’ve seen carry around the weight of these invisible diseases every day. Nobody wants to be bothered by painful flare ups or joint discomfort. They want to be pain free, and oftentimes they’ve undergone countless different treatment options to no avail.

Understanding Fibromyalgia

In an effort to help more people understand these invisible illnesses, we’ve decided to share an infographic that helps to shine a light on one of the more common chronic conditions – Fibromyalgia. So take a couple of minutes and give the infographic a closer look, so the next time someone opens up about their pain, you’ll have a better understanding of what they might be going through.

The following infographic is from MBA-Healthcare-Management.com

fibromyalgia

Let’s Talk About Chronic Pain and Suicide

/ Thomas Cohn, MD

chronic pain suicideNew research presented at PAINWeek 2017 in Las Vegas suggested that individuals with chronic pain are twice as likely to attempt suicide than those without chronic pain.

For their study, researchers asked more than 1,500 chronic pain sufferers to fill out a questionnaire on their pain and their mental mindset. What they found was that individuals with chronic pain were twice as likely to attempt suicide than individuals without chronic pain, and that 32 percent of chronic pain sufferers reported “suicide ideation in some degree.”

According to researchers, chronic pain (as opposed to acute pain) may share some neural networks with mental health disorders like depression, which can contribute to self-harm tendencies.

“This shared neurobiology may explain why cognitive behavioral interventions can be effective in chronic pain patients,” said Dr. Joseph Pergolizzi, who suggested that patients with chronic pain should be evaluated for other helpful treatments, like cognitive behavioral therapy or mental health counseling. They recommended that mental health assessments during the diagnosis and treatment of chronic pain could be clinically important for reducing the risk of suicide or self-harm in this patient population.

Getting The Help You Need

As someone who is prone to chronic back pain from an injury I suffered back in college, I know how frustrating chronic pain management can be. It can take forever to find a solution that works, and there’s no guarantee that it will work the next day. You’re fighting an uphill battle, but it’s important that you try to stay positive. Remember that you can only control what you can control. You can’t always control your pain, but you can:

  • Get regular exercise
  • Eat a healthy diet
  • Partake in physical therapy
  • Seek a second opinion
  • Get involved a chronic pain group
  • Try new treatment alternatives
  • Share your experiences with others online
  • Take time to focus on your mental and physical health

Pain may play a role in your life, but you should never feel like it is controlling your life. If you’ve found that it’s harder to get out of bed or you just haven’t been the same lately, reach out to a Pain Management specialist. We can take another look at your pain and figure out the best way to help you manage it. We can also set you up with wonderful programs to ensure that your mental health remains positive while you’re tackling your chronic pain issue.

Nobody knows exactly what you’re going through, but that doesn’t mean we’re not willing to learn or to help. Please, if you’re struggling with chronic pain or depression, make a call to our office or to a pain specialist in your area. We’ll do everything in our power to help reduce you pain levels and find something that works for you. We can’t promise solutions, but we can promise that we will try our hardest to find a treatment option that makes your day a little brighter. Contact us today.

Understanding Chronic Pain in Children

/ Thomas Cohn, MD

chronic pain childrenPreventing chronic pain is a daily battle for many adults, and the symptoms can be even tougher to control in children and teens. Interestingly, new research published in Health Psychology suggests that adolescent pain may be linked to previous experiences with pain, and if we can improve these initial experiences, children may be less likely to experience future pain.

It may sound complicated, but the research wanted to see if there was a link between a previous pain experience and how pain is felt and managed in the future. To do this, researchers examined children who had undergone a major surgery, as these experiences, even if they go as expected, may be traumatic to the child and are likely accompanied with some pain or discomfort.

“This is not to say that every child who has chronic pain had a surgery that led to it,” said study author Melanie Noel. “Rather, it’s that surgery is the only context where we can catch these kids before they develop chronic pain. We know that 15 to 20 per cent of children who undergo these major surgeries will develop chronic pain. So, if we can catch them early and begin to understand the factors leading to their chronic pain, maybe we can prevent it from happening in the first place.”

At the conclusion of the study, researchers found that a child’s memories of pain following major surgery actually influenced their recovery and was associated with an increased risk of the development of chronic pain down the road.

“We’ve discovered that the way children are remembering their pain is an underlying factor in the development of chronic pain,” Noel explained. “It’s not the pain they actually experience so much as the way they process those memories of the pain which is driving whether or not they’re improving, right around the time that pain can transition into chronic pain. At a certain point, these children should be feeling better but those who develop chronic pain are not.”

Managing Adolescent Chronic Pain

The study, which was conducted in Canada, suggests that anywhere from 15-40 percent of Canadian children experience chronic pain at some point during their childhood. Moreover, 60 percent of these children eventually develop chronic pain in adulthood, so it’s important to control chronic pain while kids are young to prevent it from becoming a problem when they’re older.

Researchers believe the findings can help point doctors and parents towards solutions. They believe that psychological and language-based interventions may be able to help kids better cope with post-surgical pain, which will help re-frame their memories of the pain and in turn decrease their likelihood of developing chronic pain in adulthood.

“We can teach kids how to reminisce and talk about their pain experiences in a way that emphasizes anything positive about it,” said Noel. “Maybe the child coped with something well, maybe there was a really friendly nurse. It’s getting them to talk about things that aren’t just focused on the awful after effects of the surgery. It’s a way of catching it, a talk-based intervention that can possibly re-frame the memories. This may actually alter the pain trajectory. It’s one thing we can do to make the recovery and future experiences of pain better.”

This is fascinating research, and I hope the findings are considered by pain professionals when helping children get to the bottom of their chronic pain.