acute pain

Tiger Woods Is Past His Prime

/ Thomas Cohn, MD

Tiger WoodsTiger Woods is an excellent athlete who has strived to stay in the best of condition, but unfortunately he is no longer in his prime. To be a top-notch athlete, one needs to be able to perform without distraction and have a perfectly tuned body. Tiger is no longer 25 years old and in perfect health.  Today, there are many professional golfers who are younger and in better health. A 25-year-old Woods may be better than a 25-year-old Rory McIlroy, but Woods doesn’t have the luxury of a time machine.  The injuries that Tiger has had are not going to heal perfectly and his performance is clearly in decline.

Tiger Woods is now 38 years old and he is certainly past his prime. Woods has had significant knee surgeries and recently underwent a Microdiscectomy for a lumbar disc protrusion in his back. The body and all its parts age and show signs of wear in everybody. Typically by the age of 30, there are often subtle changes in the spine and joints as we stress them. The cartilage in the knee joints can show changes, and in the spine the discs bulge, tear, and show degeneration. By age 40, everyone has different signs of deterioration throughout the body. The design of the body is such that we can do most activities well until about age 40. 150 years ago, it was typical that people would die due to trauma, disease, infections, or even heart problems by age 40-50 years. Today, we are outliving the design of our body since we have better medical care.

The difference between amateur and professional athletes is the level of perfection they achieve in their sport. Physically, to achieve that level of perfection, everything in the body must be in perfect shape. A slight abnormality in the body sometimes can be compensated for, but often the level of ability is diminished. Today, the difference between the best athletes and an average athlete is the ability to do everything in a sport without compromise. Tiger’s back and knee injuries are forcing him to compromise. Tiger may be able to golf and occasionally win, but he will not be a future force and consistent top contender.

PGA Championship in Doubt

Woods was forced to withdraw from last week’s Bridgestone Invitational after suffering another setback with his surgically repaired back. The injury occurred as Woods took a step into a bunker on the 9th hole, and he withdrew from competition shortly thereafter. Some speculate that Tiger only withdrew because he was out of contention and didn’t want to jeopardize his chance to play in golf’s final major of the year this week at the PGA Championship, but his absence from the course Tuesday shows that something is clearly wrong with Woods.

Woods’ agent said the 38-year-old was at his home in Florida resting, but Tiger’s caddie went to the tournament to scout the course in case he decides to play, so there’s still a chance the 14-time major winner will chase another tour victory this week. We should know more about his status by the end of the day Wednesday. We’ll provide an update once more is known.

Pain Care: The Benefits of Pain Management

/ Thomas Cohn, MD

Pain Care BenefitsPain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition.  As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Dealing With Pain After A Car Accident

/ Thomas Cohn, MD

car accident injuriesTrauma from motor vehicle accidents can cause significant ongoing injuries. Typically, lingering injuries that require medical care resulting from a car accident include:

  • Lower back injuries
  • Spine injuries
  • Headaches and neck injuries
  • Broken bones and and large lacerations
  • Whiplash injuries to the head and neck

Treatments For Car Accident Injuries

Treating acute pain is done symptomatically. Ice and heat for muscle strains in both the neck and the low back region is recommended. Immobilizing the neck with a brace for several days to rest the muscles may also be helpful. That said, wearing a neck or back brace for more than a week or two is not a good idea as the muscles need to move in order to heal correctly. Restoring normal movements is one of the main objectives in early treatment. In most cases, the muscles are only strained and not torn and will heal within a short period of time. Restoring movement and strength may require assistance and physical therapy. Chiropractic or massage treatments may also be helpful in the short term, but continued passive treatments are usually not helpful for larger issues.

If pain is a significant issue, over-the-counter medications are often very helpful. Initially, acetaminophen and nonsteroidal anti-inflammatory medications like Advil or Aleve may provide significant pain relief. If the nonprescription medications aren’t providing sufficient relief, it is time to see a physician. The physician may opt for a short course of narcotics along with regular physical therapy. With aggressive early treatment, most people will resolve their injuries within a month or two.

Continued Pain

If your pain has not resolved in two months, at that time, asking your doctor to be referred to a pain specialist would be beneficial. A pain specialist can perform a comprehensive evaluation and determine further tests and treatment that would help resolve your ongoing medical problems. Sometimes injuries such as whiplash cause microscopic damage to the spine and joints, and the use of injections along with other medications and physical therapy will allow for almost complete resolution of symptoms. There are many options in managing pain related to a motor vehicle accident, and depending on the unique characteristics of each person, a program can be found that meets any individual’s needs. A pain specialist is an expert in the complex problems that cause ongoing symptoms and is extremely knowledgeable about all the possible treatment options that will allow you to return to a full life.

Joining the Pain Care Team at Center for Diagnostic Imaging

/ Thomas Cohn, MD

CDI SartellNow that it’s official, I wanted to make an announcement that I have accepted a position with the Pain Care team at the Center for Diagnostic Imaging in St. Cloud. I am very excited about my new opportunity at CDI.

I decided to join CDI to take on a new challenge as part of their expanding CDI Pain Care program. Some of the services the program will be offering include:

  • Diagnostic and therapeutic injections
  • Medication management
  • Physical therapy
  • Behavioral health or surgical consults

I am very grateful to have this wonderful opportunity at CDI, and I also want to say thanks to all my friends, colleagues, coworkers, and patients at MAPS Medical Pain Clinic. I learned a lot during my time at MAPS and met a bunch of wonderful people. I am blessed to have met all of you, and I wish you all the best going forward.

CDI has three offices in the greater St. Cloud area. I will be working out of the Sartell office. You can reach the office by calling 320-251-0609 or by visiting our website. We are open Mon-Fri 6:30am-10pm, and on Saturdays from 7am-3pm. Please call the office if you have any questions or would like to set up an appointment.

New Pain Treatment: Platelet Rich Plasma

/ Thomas Cohn, MD

Blood spinning PRPRecently, platelet rich plasma (PRP) has been making news as a treatment for hip bursitis after a presentation at the American Academy of Orthopedic Surgery annual meeting. PRP is blood that has been spun and has concentrated factors that stimulate tissue repair and growth. This concentrated solution can be injected back into the body in affected areas to improve healing in damaged tissue. New areas for use are being found regularly.

Initially, PRP was first used in trials for repair after a heart attack, but it has expanded into areas of tendon repair, nerve injury and bursitis. Most commonly it has been used in sports injuries, and for many of these patients it has been quite successful. Instead of just calming down inflammation like many medical treatments, PRP helps more intensely stimulate the body to repair the injury. The downside to this treatment is that it is still considered experimental and insurance rarely covers the cost which can be in the several thousand dollar range.

PRP for Tendonitis and Bursitis

The most common uses in pain management for platelet rich plasma is for shoulder, elbow, hip and knee pain especially related to tendinopathy, tenosynovitis and bursitis. Blood is taken from the patient and then spun in a centrifuge. The residual plasma is rich in a number of proteins and substances that promote healing in the body. The plasma then is injected with either ultrasound or X-ray guidance into the appropriate area, whether the shoulder, hip or by certain tendons to stimulate healing. A series of several injections may be necessary to fully promote healing.  Since it is an all natural product of the patient themselves, it is very safe, and may be very effective for the right conditions.

Tendonitis, bursitis, joint and ligament pain is always treated conservatively first. Rest, heat and ice, and physical therapy are the first lines of treatment. If the problems are not improving, medications like oral or topical anti-inflammatory drugs combined with exercises and therapy may also be effective. If those treatments do not help, corticosteroid injections may also be indicated and evaluation by a physical medicine pain specialist to guide treatment would be beneficial.

The medical literature at this time is showing that the use of platelet rich plasma may have many benefits in the treatment of some of these joint related conditions of pain and inflammation. PRP is not the first line of treatment; it is used when other courses have failed. Furthermore, insurance has not endorsed its use and the cost will most likely be the responsibility of the patient. As of now, the injections are mainly for athletes or people who can afford the treatment when other avenues have failed.