6 Tips To Avoid Pain While Driving

March 9, 2015March 18, 2016 / Thomas Cohn, MD

Now that the weather is warming up people are getting outside and planning roads trips. Cross country or day trips can be a lot of fun, but not if you’re plagued by chronic or acute pain. Today, we share six tips to help you control and alleviate pain during a long road trip.

1. Break Up The Trip – This point is probably the most obvious tip. If it’s painful to sit for hours on end, do yourself a favor and break up the trip with some stretching. Find a rest stop every hour or so and move around for a couple minutes. Doing this will keep your joints from getting stiff.

2. Plan Ahead – Banking off point number one, plan ahead so you have time to get out and stretch during a particularly long road trip. Leave a little earlier so you have time to get out and stretch your legs.

3. Medication Management – Once again playing off the above tip, use some foresight when it comes to managing your pain medications. Make sure you pack enough of your prescription to get you through the trip, and if you’re running short on supply contact your physician to ensure you don’t run out mid trip. As always, when traveling with medication, keep them away from children in child-safe containers.

4. Take Turns – If you’re traveling with friends or family, take turns driving. Consider switching every time you get out to stretch, eat or go to the bathroom. Although you’re still stuck in a car, having a little more room and being able to take your eyes off the road can help keep pain from setting in during the trip.

5. Eat Right – If you’re planning on eating on the road, pack a healthy lunch or opt for a healthier fast food option. Certain foods can trigger flare ups, so don’t just load up on junk food.

6. Pack a Mix-Tape – As my colleague Dr. Lance Silverman recently shared on his blog, audio therapy is helping children control pain after surgery. Audio therapy can help take your mind off the pain and put you in a better state of mind. So cue up your CD player or iPod and jam out on your cross country trip!

How Friends With Pain Affects Your Pain

February 2, 2015 / Thomas Cohn, MD

A recent article in the journal Current Biology found that humans and mice exhibit more pain when with friends with pain than with strangers without pain issues. Those who are with friends with pain will report more severe symptoms than when they are with strangers. Furthermore, people exhibited more pain related behavior in these situations. The researchers hypothesized that when friends had pain, we make a bigger deal about it than when our companions are pain free. As a pain practitioner, it should be a shame on the researchers for jumping to such conclusions.

All pain patients find living with chronic pain is extremely difficult. Pain is mentally fatiguing and depressing. It is a constant battle to control symptoms. Most of the time the battle to control pain is fought alone. People who do not have the problem usually do not want to hear about other people’s medical issues. Others also do not want to be brought down emotionally by the struggles of someone else since they have their own problems.

When one meets another who shares the same problems you have, one may tend to be more honest in the portrayal of your own issues. It is not that you are making your pain sound worse than it is, you just are actually reporting how bad are the symptoms. A person with the same problem is likely to better understand what the other is saying. The communication is more honest and more clear cut. There is also no fear of shame that pain is a significant problem.

Pain Support Groups

The concept of a support group hinges on the fact of a common understanding of a problem. Chronic pain severely affects many people, impacting all aspects of their lives. In normal relationships, one often tries to hide medical problems. We all figure few people understand the problem and we do not need to be shamed by disbelief. Meeting someone who understands the problem of pain and the impact allows the person with pain to be honest about their concerns. To the outsider, this is likely to be seen as embellishment of the pain.

The researchers who wrote this study about pain patients being more open and “feeling worse” when with others who have pain may not be looking at the responses correctly. It is likely that those with pain were just being on honest with how they were feeling when they were with friends who had similar problems. When with strangers, people with pain will often just bite the bullet and act as if everything is okay. No one wants to be known as a complainer. The bottom line in this story is that 40% of the population suffers pain, so maybe we need to show a little more compassion for those with this problem.

Safety First: Surgical Centers vs. Pain Specialists

January 19, 2015January 16, 2015 / Thomas Cohn, MD

Recently there was an article on whether having a procedure done in a surgery center is safe. In the world of pain management, some practitioners only do procedures in these facilities (or hospitals) while others do most of their procedures in the office. Surgery centers can handle more complex procedures, and can typically handle a deeper level of sedation. In pain management, surgery centers can be beneficial for complex procedures such as implants, but often they rarely are necessary. Sedation for a pain management procedure usually does not need to be very deep, and should be able to be done without a surgery center.

The safety of a surgery center and a procedure in reality is no better than the quality, skill, and experience of the practitioner. After spending more than 20 years performing complex spinal procedures, as well as teaching courses to other physicians, it is the ability of the physician that really matters. Surgery centers are often profit centers for the physicians working in them. Furthermore, a physician who sedates most patients for procedures is often using the sedation to cover for a technique that may cause pain. A skilled interventionist should be able to do most procedures with a local anesthetic and ensure they are practically painless. The use of sedation for many practitioners is a crutch to reduce the need to talk to the patient and to perform the procedure with the least painful technique.

Pain Medicine Safety

In pain medicine, the most common injections – spinal and joint related procedures – should be able to be done quickly and comfortably. The main issue that most practitioners should be treating is the anxiety of the patient. Light medication to treat the anxiety can often be given orally. For longer procedures, IV medication is sometimes easier to use. Universally, procedures that are painful are most often due to the technique and experience of the provider. Experience often allows the practitioner the knowledge of how to perform a procedure when a patient presents a more complex situation.

In the end, safety of a center is dependent on the practitioners. If the provider does not fully know what they are doing or the best techniques, the patient is more likely to have issues with the procedure. Further, if the patient is significantly sedated, the patient will not react when the practitioner does something wrong, making it more likely that significant damage may occur. The best physicians will always care most about the patient and the problem, not the payment they might receive from doing an intervention. The best physicians have years of experience, are board certified, and have an intense, loyal patient following. Skill and experience help keep a patient safe and make a procedure safe and effective. Errors in pain management procedures are generally rare. Surgical centers and sedation are not important in patient safety; the quality of the practitioner is the most important variable.

Doctor Ratings and the Importance of Communication

November 24, 2014 / Thomas Cohn, MD

Everyone wishes to have the best doctor available. In Minnesota there are multiple rating services available that score doctors, however, which rating systems are the best? Some services rate doctors on their compliance to medical guidelines such as those established for asthma and diabetes. Other services monitor the cost of a physician’s per patient billing to the insurance company, while others are patient reviews. The real question is, what will make you happy with your choice of physician?

Important qualities in a doctor includes their knowledge, skill, understanding of a patient’s condition and their communication skills. Almost every physician will have a good basic set of knowledge about any medical condition that they treat. In any profession, from car mechanics to teachers, 90 percent of the practitioners are good and 10 percent are exceptional and have a special talent in that field. Skill level is similar; most physicians have good techniques, but some just know the small things that make all the difference when doing any procedure, and are just better than others.

Understanding a patient’s condition is somewhat complex. First, a doctor must be prepared. This includes reviewing a patient’s medical record and knowing their history. This is ongoing, and the doc should know this information at each visit. Medical records are helpful, but personal notes may be needed in addition to fill gaps. Experience is also important, as is continuing to grow in their skill by attending conferences and seminars on a regular basis.

Doctor-Patient Communication

Communication between the doctor and patient is critical in quality of care. Most important is that communication is not one directional. To treat a patient, a doctor needs to know what is wrong, what are the symptoms, and what is actually working correctly. Since doctors often have limited time with each patient, they will need to guide the conversation to obtain the relevant information. Being honest is also extremely important. There are often multiple sources to confirm data, and if the information provided is not truthful, a doctor will likely be guarded in their care. Patients also need to ask questions about their condition and be open about their recovery.

Ratings of doctors are of limited value. The final rating that matters is how well you communicate with your doctor and whether or not you trust his ability and knowledge. Sometimes, you can find the right physician without any trouble. Other times, word of mouth and information from friends who know the practitioner is critical. Ratings on the web may be inaccurate or forums for the unhappy patient. No physician will be perfect, but finding the right physician may be a matter of how well both you and the physician communicate with each other.

Pain Prevalence in America

October 29, 2014 / Thomas Cohn, MD

A recent report from the Institute of Medicine described in an article in the Journal of the American Medical Association has discussed the magnitude of the prevalence of pain in the US. The article states that about 100 million Americans suffer from chronic pain. This is pain that lasts weeks or months; Not bumps and bruises that resolve quickly.

The data used to determine this number is based on a number of techniques to review medical information and was assembled at least in part by the National Center for Health Statistics. If you have chronic pain, you are not alone. These numbers are also consistent with research from the World Health Organization that estimates that 37% of the population in developed countries has chronic pain.

The prevalence estimates of adults for selected pain conditions were also listed in the report. Moderate pain affected 10% of the population, or 21.3 million people. Another 11% had severe pain, effecting about 22.5 million. Joint pain affects about 33% of the population. Arthritis of all types affects 25% of the population. Functional disability affects 12% of the population. The authors also noted that the study did not include children, military personnel, people in prison, and those in long-term care facilities.

The report mainly concentrates on the fact that there is a huge number of people who deal with chronic pain on a daily basis. However, we do not have good information of the impact of pain on employment, disability, functional abilities and the direct and indirect costs. In general, there is minimal information available on the cost of pain, in terms of medical expenditures and secondary costs to society.

The report makes a strong recommendation for a national, population-level prevention and management strategy. A public health approach to pain management is necessary, including prevention, care, education and research. It also recognized the serious problems associated with opioid use and diversion, and the need to develop a better approach to pain care that is beyond the use of such addictive medication.

As noted in this article, reducing the effects of pain and its associated morbidities with regards to the quality of life will require a cultural transformation. Chronic pain itself may need to be considered as disease. The extent of this disease affects about 4 out of every 10 adults in developed nations worldwide. Patients and healthcare providers need to recognize the problem and develop improved treatment and management solutions for the complex condition.