When Pain Management Becomes A Pain

May 2, 2017 / Thomas Cohn, MD

Let’s be honest, taking part in a daily pain management routine is rarely fun, and at times it can become downright exhausting. Sometimes all the things you need to do to care for your pain become more burdensome than the pain itself, but that doesn’t mean you should give up and give into pain. Today, we share some tips for what to do when pain management becomes a pain.

Tips For Managing Pain

Whether you’re dealing with chronic regional pain syndrome, asymptomatic back pain or irregular headaches, here are some tips to keep in mind to help pain management become less burdensome.

1. Active Distractions – If you can distract your mind from your pain, all while working to rid yourself of chronic pain, you’re winning the battle. Things like Netflix or a bowl of chocolate ice cream can help take your mind off the pain, but they won’t actively help you strengthen your body and keep symptoms at bay. Try to find activities that are somewhat physical in nature that don’t feel like exercise or therapy. Activities like swimming, Tai Chi, cycling, walking, or yoga can all help strengthen key muscle groups and keep your mind off your pain without feeling like a regular exercise routine.

2. Vent – It can be healthy to vent about your pain once in a while, but don’t dwell on it. Most patients with chronic pain try to hide their pain from everyone because they don’t want to be seen as weak or “complainers,” but it’s perfectly healthy to express frustration with your pain. Whether it’s just yelling out loud for five seconds each day or blogging about your pain on a message board, these channels allow us to speak out about pain when so often we remain silent. Find what works for you.

3. Professional Help – Pain management physicians are trained in helping people who are battling complex pain problems, so reach out to one if you have questions or concerns about your pain. Odds are we’ve heard the question before, or we can think it over and give you some healthy advice. It doesn’t need to directly relate to your pain, either. You can ask about different therapy techniques or support groups in the area, and we’ll do our best to help give you some professional guidance.

4. Small Victories – Fighting the daily battle against chronic pain can feel like an uphill battle where for every two steps you take forward, you find yourself taking one or more steps backwards. This will be undoubtedly frustrating, but try not to dwell on the bad and instead focus on what you’ve accomplished and the progress you’ve made. Maybe your chronic back pain was so painful that you couldn’t go for a run like you planned, but instead you bucked up and did 20 minutes of therapy stretches. Don’t focus on the missed run – focus on the therapy you did to kick your pain’s butt! Enjoy the small victories as they come along.

The Importance Of Complementary Medicine

April 27, 2017 / Thomas Cohn, MD

As we talked about in our blog post on Tuesday, there’s no simple way to treat chronic pain. No magic pill is going to cure your pain. Instead, you need to have a comprehensive and multifaceted approach to controlling your chronic pain. Sometimes, that approach includes complementary medicine options.

We are a traditional pain clinic, but it would be wrong to simply ignore the benefits of some complementary options. We’ve talked about the benefits of acupuncture on our blog in the past, and our most viral post isn’t exactly a traditional medicine method.

Complementary Medicine Benefits

Mindfulness, acupuncture and other complementary medicine methods are key components to finding the best way to treat chronic pain, and that’s a sentiment shared by our friends at Burning Nights CRPS. In fact, they believe in the benefits of complementary approaches so much that they designed a wonderful infographic to help inform others. Take a look at the infographic below, and be sure to check out their site for more helpful information on how to best beat chronic pain!

Opioid Dependency and Prescription Length

April 10, 2017 / Thomas Cohn, MD

A new study conducted by the University of Arkansas on opioid use has been recently published by the Centers for Disease Control. It is somewhat of a curious study since it was based on record analysis of prescription records for opioids. The results will likely be twisted by the press soon to announce how bad these drugs are and how addictive they can be.

The question the study sought to answer was – “If a patient gets a certain amount of drug prescribed on a first visit, will they still be taking that drug a year later?” The numbers are somewhat surprising, but in reality it does not really say anything about opioids, addiction or pain. All it really says is that for some people there may be limited options to treat pain, and maybe it is very effective for some people.

Continued Opioid Use

The patients studied were all 18 and over, cancer free, studied June 2006 through September 2015 and did not have a history of opioid abuse. Here’s a look at the results:

A person who received 1-day supply of medication had a 6% chance of being on opioids for a year or longer.

With a 5-day supply, they had a 10% chance of being on opioids in a year.

With a 10-day supply the odds go to a 20% that they will be still using opioids in a year.

A 30-day supply had about 30% chance of being on the medications a year later.

So if you start on opioids, and have it for over 10 days, 1 in 5 of those people may still be on those medications. However, it also means that 80 percent will not still be on those drugs.

Interpreting The Results

Several messages can be inferred from this data. First, acute pain should be treated with the least amount of medication for the shortest length of time. If at all possible, avoid the use of opioids for acute pain and find other less addictive and dependency causing medications. Second, many people do not use these medications long-term and can use them responsibly. Lastly, pain is very complex, and since some medications are highly addictive, try to avoid them and use the multiple other ways to treat pain including everything from chiropractors, to physical therapy, to exercise, and to injections.

The study also may be an analysis of the treatments available for severe pain. Some of the most effective treatments sometimes are the least healthy and can cause dependency. Opioids have been around for hundreds of years. Our knowledge of pain is limited, as are the solutions. Since it is such a huge medical problem, we really need to spend more on research and solutions. We know there is an opioid crisis with addiction. We need research solutions and new treatments. Now is the time to spend on research, as it may provide better solutions for more people than some of the recent government spending recommendations.

Why Chronic Pain Patients Feel Targeted By Opioid Crackdowns

March 28, 2017 / Thomas Cohn, MD

As opioid overdoses continue to rise in the US, the government, lawmakers and medical personnel are all trying to figure out the best way to reduce these unnecessary deaths. Obviously restricting access to opioids would reduce the number of people who can get their hands on them, and in turn reduce overdose deaths, but it would also unfairly target people who need the pills. People like those suffering from chronic pain. So it’s understandable to see why when lawmakers propose strict rules for who can access these medications that chronic pain sufferers feel like they are being targeted and singled out.

It’s a tough balance to strike, and unfortunately it seems that as a nation we are more focused on what is easy and cheap instead of what will really address the root problem. Putting a band-aid over a large gash might stop some bleeding, but the wound won’t close correctly without stitches. Simply restricting access opioids and painkillers might stop some abusers from getting the pills, but it won’t solve the whole problem. We need to put some stitches in place.

Solving The Opioid Crisis

We’re not going to sit here and pretend we have all the answers for solving the problem of opioid addiction and overdose, but like we said above, simply restricting access is not going to solve the problem, and many innocent people who rely on those medications may no longer be able to access them. Instead, here are some steps that will help address the root problem.

1. Doctor Education – The vast majority of doctors understand that opioids do not address the root problem, but sometimes they are confused by a diagnosis or have seen other treatments fail and they fall back on them. Other doctors cut corners and prescribe pills freely and dangerously. We need to provide better understanding at the top level of how these drugs should be used, how to spot signs of abuse and how to ensure patients are safely taking their medications so that overdoses don’t occur.

2. Systemic Pressure – This problem will be harder to solve, but in many cases doctors are told to see as many patients as possible. If a doctor is feeling overwhelmed or rushed to see a number of patients, they can sometimes fall back on easy solutions like opioids. Doctors need to take their time with each and every patient and ensure they are giving them the best care possible. It’s possible the best care will involve opioids, but it should also involve therapy, exercise and regular abuse checks.

3. Patient Education – Patients also lack understanding of opioids and their abuse potential. Opioids are not a magic pill that will cure your pain, but they can provide temporary relief so other rehab techniques like exercise, swimming or physical therapy are more bearable. Opioids are a passive treatment, and they need to be paired with an active treatment option for best results. Patients also need to learn the warning signs of abuse for themselves and for loved ones who may have access to their pills.

4. Pill Technology – Medical researchers are looking into new abuse-deterrent opioids. They are creating pills that can’t be crushed or that become gooey if a user tries to extract the solution for injection. Other pills come in an extended release form and can’t be manipulated to give an elevated or intense high. More research into abuse deterrent options could prove useful.

Simply saying we need to restrict access to opioids will not solve the problem, and many chronic pain sufferers will be affected instead of those who are actually abusing the pills. That’s why so many patients feel targeted by these proposals. It won’t be easy to reverse this trend, but if we put in the time and money, it can be done.

Shared Reading Helpful For Chronic Pain Patients

March 9, 2017 / Thomas Cohn, MD

New research suggests that shared reading may help ease discomfort and provide cognitive benefits for individuals battling chronic pain.

Shared reading, as the researchers defined, was the act of of gathering with others and reading short stories, poetry or other literature out loud. Researchers said by reading literature that triggers memories of experiences throughout life, like happy childhood memories or relationships, patients can experience benefits similar to or that outweigh the effectiveness of cognitive behavioral therapy for chronic pain.

Shared Reading And Chronic Pain

There are hundreds of different treatment options for chronic pain, because chronic pain is unique to the individual. Some people experience pulsing pain in their lower back, others battle waves and waves of headaches, while others have nerve damage that sends pain signals to the brain when their is no painful stimulus present. What works for one person will not always work for another, and unfortunately that’s the problem that many pain sufferers are running in to. In turn, they are looking into alternative options, one of which is shared reading.

For their study, researchers compared the benefits of shared reading to cognitive behavioral therapy, which is a technique that aims to change the way people think and behave in order to better manage physical and mental issues related to chronic pain. To do this, patients with severe chronic pain were asked to participate in either five weeks of CBT or 22 weeks of shared reading. At the conclusion of the five weeks of CBT, individuals in that group joined the shared reading group for the remainder of the 22 weeks. The shared reading sessions incorporated literature that was designed to prompt memories of family, relationship, work experiences or other happy memories throughout their lifetime. Participants were required to report their pain severity and emotions before and after each session, and they were asked to record their pain and emotions twice a day in a personal journal.

Study Results

At the end of the study, researchers wrote:

While CBT helped to manage a person’s emotions, shared reading appeared to help patients address the painful emotions that might be contributing to chronic pain.

Pain severity and mood improved for up to two days after shared reading sessions.

“Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” researchers wrote. “The encouragement of greater confrontation and tolerance of emotional difficulty that sharing reading provides makes it valuable as a longer-term follow-up or adjunct to CBT’s concentration on short-term management of emotion.”

Researchers want to conduct future studies with larger sample sizes, but it’s an interesting approach to treating chronic pain. We’ll certainly keep tabs on shared reading as a potential treatment option.