acute pain

Pain Catastrophizing and Chronic Pain Care

/ Thomas Cohn, MD

Pain CatastrophizingWhen it comes to managing chronic pain, it’s imperative to take as much care of your mental health as it is your physical health. Ignoring your mental health can lead to more negative attitudes towards your pain, which can lead to even more problems according to a new study.

A new report out of the Stanford University School of Medicine suggests that individuals who negatively fixate on their symptoms have been found to report greater pain intensity and are more likely to be prescribed opioids. Interestingly, the association was much higher in females than it was in men.

“When it comes to opioid prescriptions, pain catastrophizing has a greater effect on the likelihood for having a prescription in women than it does in men,” said medical student and lead researcher Yasamin Sharifzadeh.

Pain Catastrophizing

According to researchers, “pain catastrophizing” is defined as the cascade of negative thoughts and emotions in response to actual or anticipated pain. When you begin to let these negative thoughts continue to build and take hold over your pain, it can actually amplify the pain process and lead to greater pain and increased disability. Previous studies have shown that pain catastrophizing has been linked to increased pain sensations, but this is the first study to find a correlation between it and an increased likelihood of being prescribed opioids.

For their research, Sharifzadeh and her team analyzed clinical data from more than 1,800 patients with chronic pain. After analyzing the data and parsing out the results between genders, researchers came to an interesting conclusion.

“In men, it is pain intensity that dictates whether or not they are prescribed opioids,” Sharifzadeh said. “However, in women, there is a more nuanced issue where relatively low levels of both pain catastrophizing and pain intensity are associated with opioid prescription. Pain catastrophizing and pain intensity are working together in determining if a woman has an opioid prescription.”

This is especially problematic when you consider that women are more likely to suffer from chronic pain, be prescribed pain relievers and given higher doses for longer periods than men, according to the Centers for Disease Control and Prevention. However, by recognizing this correlation, doctors can help to mitigate this risk.

“If physicians are aware of these gender-specific differences, they can tailor their treatment,” Sharifzadeh said. “When treating chronic pain patients — especially women — they should analyze pain in its psychological aspect as well as its physical aspect.”

If you feel like your mental health is fighting a losing battle with chronic pain, reach out to your doctor. Contact Dr. Cohn today.

Spinal Cord Stimulation For Chronic Back Pain

/ Thomas Cohn, MD

Pain is something that can quickly take over our lives. Pain can lead us to be more emotional and less empathetic with family and friends. It can hinder our ability to do things that make us feel better, such as exercise. It can take away our earning potential if we are unable to work because of the pain. In other words, pain can upend what you do and who you are.

And chronic pain like back or leg pain can be particularly overwhelming. It’s different than pain in an extremity like a finger or toe; leg or back pain starts in one spot and can radiate elsewhere and be unrelenting.

Many people start with traditional medicine such as pills or doctor visits, but those may have limited impact. They may also try natural healing, but again—the person may determine how effective those are. One treatment that works for many is spinal cord stimulation; this graphic explains what it is and how it might help.

What Is Spinal Cord Stimulation?

Spinal cord stimulation is a safe and relatively effective treatment option for certain individuals suffering from chronic back or leg pain. Roughly 80 percent of individuals who undergo SCS experience some form of relief, whether it be in the form of decreased pain, a reduction in the need for opioids or better sleep quality.

Our friends at PainInjuryRelief.com recently reached out to us with an infographic about spinal cord stimulation and asked if we’d be interested in sharing it with our readers. We are always happy to discuss new technologies and potential treatment options, so we’ve included it below. Check it out if you believe spinal cord stimulation may be something that you could benefit from.

Block Pain and Get Back to Your Life with Spinal Cord Stimulation

Erythromelalgia and A Potential Chronic Pain Cure

/ Thomas Cohn, MD

gene painRecently, a colleague of mine sent me an in-depth piece from wired.com that explores a pain condition known as erythromelalgia. Erythromelalgia, also known as Mitchell’s disease or “man on fire” syndrome as the article calls it, is a pain disorder in which the blood vessels in the extremities are periodically blocked throughout the day. When they open, the area can become hypermic and inflamed, and it is usually accompanied by a burning sensation in the area.

Erythromelalgia episodes can be triggered by a number of different things. Some people are set off by heat, others by pressure, while others experience an episode due to mild activity, insomnia or stress. Patients who suffer from the condition have probably found their own personal way of achieving some minor relief when an episode comes, but a true treatment has yet to be found. However, we may be hot on the trail of a solution.

Causes of Erythromelalgia

Medical researchers have discovered that erythromelalgia is caused by a mutation of the voltage-gated sodium channel α-subunit gene known as SCN9A. This discovery led to the condition being recognized as the first human disorder that associated an ion channel mutation with chronic neuropathic pain.

This is all probably somewhat confusing, so we’ll try to simplify it a bit. Imagine your arm as a road and your hand as a bunch of cars where the cars represent pain sensations. In a normal functioning adult, the cars remain parked in the parking lot until you suffer an injury (say you touch a hot stove). When this happens, the cars get the green light to travel up to your brain and pass along pain signals to tell your body that it is in pain.

In a person with a gene mutation on SCN9A, stimuli other than pain causes the stoplight to go from red to green, which allows the pain signals to travel up to your brain and be interpreted as pain. Not only are non-painful stimuli causing this pain gateway to open, but researchers are finding that the pathway is often open longer for people with this condition, so their pain is more extreme or longer in duration. Interestingly, a different type of mutation on the same gene effectively causes the traffic light to permanently stay red, meaning the person feels the opposite effect – no pain. This may sound awesome, but remember, pain is a way of our brain telling our body to change what it’s doing. If you put your hand on a hot stove and don’t feel pain, you’re still going to do a lot of damage to your body, even if you can’t physically feel pain. However, the absence of pain may be better than chronic or extreme pain.

Treating The Condition

Now that researchers have a better understanding of the condition, they are hard at work at developing a solution. They can’t change the gene, and thus they can’t stop the cars from trying to drive down the road to the brain, but they believe they can try to fix the stop light. In individuals whose light goes green at random intervals or because of non-pain stimuli, researchers are hoping that they can find a way to stop that light from changing from red to green. If they can shut down or at least keep the light from going green at the wrong time, than pain will only occur when a real pain stimulus exists.

They are getting closer to an answer, as not long ago they found that spider venom can affect the problematic stoplight in patients with this condition. Synthetic formulas are being developed, and hope is on the horizon. The science behind pain management is fascinating, and hopefully it can be the catalyst for more research and effective treatment options. The more research we do into pain care, the better we can treat the most widespread condition in the world – pain.

Does Chronic Pain Increase Likelihood Of Cognitive Decline?

/ Thomas Cohn, MD

dementia pillsRecently, a new report published in the Journal of the American Medical Association suggests that there may be a link between chronic pain and the eventual onset of cognitive issues. But do these findings really suggest that chronic pain leads to an increased risk of cognitive decline, or is there something bigger going on? We take a closer look in today’s blog.

For their study, researchers at the University of California at San Francisco decided to look at how chronic pain impacted a person’s mental health. They began by examining data collected on more than 10,000 individuals over the age of 60 who were taking part in a different nationwide study. Patients in that study were surveyed about their pain scores and cognition in 1998 and 2000. Patients were then monitored over the next decade.

Chronic Pain and Brain Health

After looking at the data at the end of the study, researchers found that individuals who said they were persistently bothered by moderate or severe pain declined 9.2 percent faster in cognitive and memory tests over the next 10 years compared to those who said they were not in pain. Moreover, patients who complained about persistent pain exhibited a 7.7 percent greater chance of developing dementia than patients who did not experience regular pain.

“A persistent report of moderate to severe pain, which may reflect chronic pain, is associated with accelerated cognitive decline and increased dementia probability in a large population-representative data set of elders,” wrote first author Elizabeth Whitlock, MD, a postdoctoral fellow in the UCSF Department of Anesthesia and Perioperative Care. “Clinicians should be aware of this association, which persisted after extensive statistical adjustment for confounding health and demographic factors. Patients reporting ongoing pain may be at higher risk for current and incident cognitive impairment and physical debility.”

Pain Can Compound Mental Health Issues

The authors go on to make another key point about the problems associated with persistent pain and the onset of cognitive problems like dementia. Since individuals with pain oftentimes take opioids or other painkillers, cognitive decline can make it difficult for the patient to remember to take their pills or to get the correct dosage, which can be downright dangerous.

“Elderly people need to maintain their cognition to stay independent,” said Whitlock. “Up to one in three older people suffer from chronic pain, so understanding the relationship between pain and cognitive decline is an important first step toward finding ways to help this population.”

However, the study says the results don’t paint a perfect picture of the link between chronic pain and cognitive decline. Since a good deal of patients are on a variety of different pain medications to help control their pain, researchers said that the pills could be contributing to dementia and other cognitive problems, and pain may not play a role.

Hopefully future studies will look closer at the role opioids may play in cognitive decline. Regardless, this study is just more proof that we need to be investing more time and energy into seriously working to find solutions to the myriad of chronic pain problems in the US and throughout the world.

Opioids and a Healthy Mindset For Managing Pain

/ Thomas Cohn, MD

Pain MindsetThe most common treatment option in America for individuals suffering from chronic pain is opioids or pain medications. According to statistics, the US is home to 5% of the world’s population yet we consume 80% of the world’s opiates. Our pain isn’t any different than pain felt by someone in Africa or Asia, so why do we rely so heavily on opioids?

According to Dr. Aneesh Singla, it’s because we have the wrong mindset when it comes to setting expectations for opioid effectiveness.

The Myth of Zero Pain

The Centers for Disease Control and Prevention states that the number of prescription opioids sold in the US since 1999 has quadrupled, yet the number of Americans reporting pain hasn’t changed. That’s because opioids are viewed as a solution, not as an aid to simply decrease pain while other treatments are performed. Opioids will never cure a chronic pain condition on their own, yet we expect them to rid us of all our pain. In a recent article, Dr. Singla said this problem can sometimes be traced back to the physician, who fails to explain that a chronic pain situation is not a zero sum game.

“I believe that pain is protective to us and that opiates will never cure pain 100%; so we set expectations for perhaps 50% pain relief from opiates, so that opioids are not overused in search of 100% pain relief,” said Dr. Singla. “I tell my patients that a 50% reduction in pain is a reasonable goal when treating chronic pain, and we seek this with multiple treatment options, not simply through opiates.”

There are two key takeaways from that quote. First, that the main goal of pain care treatment needs to be a reduction in pain, not its elimination. If you’ve been dealing with chronic back pain for years, it’s unreasonable to think that treatment will completely cure the problem and leave you with zero pain or discomfort, so the focus needs to be on making every day or every week less painful than the previous. The second point is that opiates alone will never solve this problem.

Opioids and Pain Expectations

We talk about pain medications on this blog and on our social channels a lot, and it’s interesting because the topic often brings out a knee-jerk response from different people. When we write articles about painkiller abuse or that pain will never be solved by a pill alone, many people are quick to defend their responsible opiate use and feel that we are attacking individuals who truly need pain pills to help them get through their day. The problem is that knee-jerk reaction couldn’t be farther from the message we’re trying to convey when talking about addiction, abuse or painkillers in general.

Opioids can be a key component to effectively managing chronic pain. We aren’t against opioids at all. What we’re trying to show in these articles is that our current views on them are misguided and that they need to be re-evaluated. It starts with the pharmaceutical companies who only care about their bottom line; It trickles down to the doctors who over-prescribe or under-educate patients on what they should expect from the opioids and how they can be used in conjunction with other treatment modalities, and it ends with the patient who decides to take an extra pill because their back is more painful than normal because they’ve skipped their last three physical therapy sessions.

Managing pain is not easy, and opioids play a vital role, but we need to do a better job of setting expectations and pairing pills with active rehab options to ensure the best results for our patients.