How Is Chronic Pain Diagnosed?

March 18, 2021 / Thomas Cohn, MD

If you head to the doctor with the suspicion that you broke your arm, it’s pretty easy to test your hypothesis with an imaging test. An X-ray will tell you all you need to know about your arm, and it will pave the way for a treatment plan. However, not all medical conditions can be so easily diagnosed with the assistance of an imaging test. Others, like chronic pain, often require a variety of different diagnostic efforts to come up with an accurate conclusion. In today’s blog, we take a closer look at the different methods used to diagnose chronic pain.

Diagnosing Chronic Pain

Every chronic pain situation is different, so there is no one-size-fits-all method for diagnosing the problem. Instead, a combination of methods are used and studied in connection with one another to form a diagnosis. Here’s a look at some of those diagnostic methods:

Imaging Tests – Imaging tests may not be as effective for chronic pain as they are for broken bones, but we can still learn a lot from them. They may not be able to always tell us what’s wrong, but they can help doctors rule out potential problems. A physician can use an imaging test to rule out fractures or disc herniation, and sometimes more detailed images can help determine if an inflammatory chronic pain condition is the likely culprit.

Patient Discussion – Talking with the patient is also a very helpful form of developing a diagnosis. We’ll want to know where pain resides, what makes it worse, what makes it better and what types of symptoms you’re experiencing. Be as detailed as possible, because all of this helps a physician make a comprehensive diagnosis.

Functional Testing – Sometimes your doctor will ask you to perform a few movement exercises to see if it triggers a flare up or brings relief. Seeing your body in motion and how it responds to action can tell a physician a great deal about the muscles and soft tissues in your body. Trust that they know what they’re doing when they ask you to perform a few stretches or exercises.

Psychological Exams – As we’ve discussed on the blog in the past, oftentimes there is a significant psychological component to physical pain. Your doctor isn’t trying to determine if you’re crazy by diving into your mental health, they are trying to understand the full scope of the condition and how psychological-based interventions could provide physical pain relief. Questionnaires or neurological exams are common for complex chronic pain conditions.

Bloodwork – Testing a blood sample is another way to determine what’s going on in your body. A blood test can look for the presence of an infection, overproduction of certain blood cells or other biomarkers tat could help pinpoint what’s causing discomfort in your body.

Used together with one another, a good pain management specialist can connect the findings collected through the above techniques and come up with an accurate diagnosis for your individual condition. To see this plan put into action, reach out to Dr. Cohn’s office today.

The Updated Guidelines For Treating Children With Chronic Pain

February 18, 2021 / Thomas Cohn, MD

We often visualize chronic pain as a condition that only affects older individuals who have suffered a traumatic injury or whose bodies have been exposed to decades of stress and degeneration. While those groups do make up the majority of the people we treat for chronic pain, they are far from the only groups we help.

Another group that accounts for millions of cases of chronic pain throughout the United States is children. These cases can be much more complex, because oftentimes it’s not normal wear and tear that has caused their chronic condition. It can be caused by a number of other factors, like significant injury, genetic and growth plate defects, or a combination of psycho-social issues.

To continue to help provide the best care to children with chronic pain, the World Health Organization recently updated their 10 best practices for treating children with chronic pain. We take a look at the new recommendations and offer our insights in today’s blog.

10 Best Practices For Treating Chronic Pain In Children

According to the World Health Organization, here are the 10 best ways that chronic pain physicians can manage and treat the condition in children:

Children with chronic pain and their families and caregivers must be cared for from a biopsychosocial perspective; pain should not be treated simply as a biomedical problem.
The biopsychosocial model of pain recognizes pain as a complex multidimensional experience that is the result of interaction among biological, psychological and social factors. Pain management thus requires a multimodal, interdisciplinary and integrated approach.
A comprehensive biopsychosocial assessment is essential to inform pain management and planning. As a component of this assessment, healthcare providers should use age-, context- and culturally appropriate tools to screen for, and monitor, pain intensity and its impact on the quality of life of the child and family.
Children with chronic pain must have a thorough evaluation of any underlying conditions and access to appropriate treatment for those conditions, in addition to appropriate interventions for the management of pain.
Children presenting with chronic pain should be assessed by healthcare providers who are skilled and experienced in the evaluation, diagnosis and management of chronic pain.
Management, whether with physical therapies, psychological or pharmacological interventions, or combinations thereof, should be tailored to the child’s health; underlying condition; developmental age; physical, language and cognitive abilities; and social and emotional needs.
Care of children with chronic pain should be child- and family-centered. That is, the child’s care should focus on family values, cultural preferences and resources available.8. Families and caregivers must receive timely and accurate information. Shared decision-making and clear communication are essential to good clinical care. Communication with patients should correspond to their cognitive, development, and language abilities.
The child and their family and caregivers should be treated in a comprehensive and integrated manner: all aspects of the child’s development and well-being must be attended to, including their cognitive, emotional and physical health. Moreover, the child’s educational, cultural and social needs and goals must be addressed as part of the care management plan.
In children with chronic pain, an interdisciplinary, multi-modal approach should be adopted which is tailored to the needs and desires of the child, family and caregivers, and to available resources. The biopsychosocial model of pain supports the use of multiple modalities to address the management of chronic pain.

To sum up these recommendations, a pain management specialist who is familiar with chronic pain in children needs to be able to assess the physical and social constructs that go into the expression of a pain condition. From there, the specialist needs to be able to effectively communicate with both the child and their families and provide solutions and ideas tailored to each, taking into account their age, education level, values, cultural needs and access to certain types of care. Pain management needs to be an ever-changing collaboration between the patient, the physician, their family and their care team.

Needless to say, treating chronic pain conditions in children is a tall task, and one that you need to trust to just the right physician. You need a physician who is going to put in the time and the effort needed to help treat the underlying cause, not just alleviate the symptoms. It’s hard work, but it’s arguably the most rewarding work in our field when you can help put an end to a child’s pain. Dr. Cohn has extensive experience doing this for children with a range of chronic pain conditions, and he’d like to help your child find a solution to their pain.

For more information, or for assistance in treating your child’s pain condition, reach out to Dr. Cohn’s office today.

How Artificial Intelligence Could Replace The Pain Scale

February 4, 2021 / Thomas Cohn, MD

For anyone who has suffered from chronic pain or has been treated for a pain-related condition, you may remember being asked to rank your pain on a scale of 1-10. While this 10-point pain scale has become the standard for many pain management specialists across the US, it’s far from a perfect model.

Because unlike a blood pressure cuff that can give an objective result like 120 over 80, the 10-point pain scale is subjective in nature. What may feel like a 4 to one patient may be a 7 for another. For this reason, it’s often tough for pain specialists to gauge a person’s pain level and how to best help treat them.

However, artificial intelligence may soon be able to assist in how we quantify the subjective measure of pain. According to scientists at IBM and Boston Scientific, artificial intelligence may be able to capture pain sensation readings and allow them to be interpreted with a more objective model.

Artificial Intelligence And Chronic Pain

For their experiment, researchers used activity monitoring devices in order to capture and analyze biometric data that can correspond to the perception of pain. Researchers used biomarkers collected in clinical studies involving patients undergoing spinal cord stimulation. This included things like movement data, sleep data, heart rate levels and even voice recordings. Then artificial intelligence was employed to sift through all the results in hopes of identifying patterns that may allow a doctor to “read” a patient’s pain levels through data instead of using the 1-10 pain scale.

“We want to use all the tools of predictive analytics and get to the point where we can predict where people’s pain is going to be in the future, with enough time to give doctors the chance to intervene,” said Jeff Rogers, senior manager for digital health at IBM Research.

The research is still in its infancy, but scientists are encouraged by early results. However, it’s going to take tens of millions of data points in order to come up with anything close to resembling the readable pain scale they hope for. If all continues to go as hoped, researchers believe it could lead to the development of medical devices that can not only accurately forecast a person’s pain, but also spot the early signs of a flare up so patients can take steps to stay ahead of their pain. It’s a lofty goal, but it could be a gamechanger for millions of Americans who battle chronic pain on a daily basis. We’ll keep tabs on its progress over the coming months and years and provide any updates as they are released.

5 Non-Physical Factors That Influence Chronic Pain Perception

December 28, 2020 / Thomas Cohn, MD

Chronic pain is oftentimes treated as a physical problem, but there’s much more to it than that. There are a number of other factors that play a role in the onset or alleviation of chronic pain symptoms, so being aware of these factors and doing your best to control the modifiable aspects can really help you in your quest to manage your chronic pain condition. In today’s blog, we take a closer look at those factors and explain how to use them to help control your pain symptoms.

Non-Physical Factors That Affect Chronic Pain

Here’s a look at some non-physical factors that influence how you interpret or perceive chronic pain:

1. Psychological – We tell all of our patients that chronic pain is oftentimes just as much of a mental battle as it is physical. Learning about your chronic condition and working to improve your mental health can be just as important in helping control symptoms as treatments like physical therapy. Make sure you don’t ignore your mental health when it comes to dealing with the fallout of a physical condition.

2. Emotional – Physical pain can also throw our emotions out of whack, and that can hinder our ability to successfully treat our physical ailment. A physical ailment can leave a person feeling annoyed, angry or short-tempered, none of which will help with getting control over your pain condition. It’s easier said than done, but find healthy ways to control your emotions and reach out to your doctor if you’re feeling depressed or angry about your physical condition.

3. Stress – Stress is also a huge component of how chronic pain develops and is perceived. Stress from daily life or your work environment has been shown to trigger tension headaches or inflammatory responses from the body, both of which can serve to make your pain condition worse. Don’t let stress bottle up inside of you, find healthy outlets like exercise or yoga to help you relieve stress.

4. Educational – The fear of the unknown can leave patients overstressing about certain aspects of their health, which can serve to make pain worse. Conversely, many patients who take the time to learn more about their specific chronic pain condition end up in a better position to make healthy choices to help manage symptoms. Turn to your doctor or trusted medical resources online for more information about your condition and treatment strategies for alleviating symptoms.

5. Our Bad Habits – Finally, there are vices in life that can make your chronic pain condition worse. Smoking, for example, can restrict healthy blood flow and contribute to degenerative spinal disc disease. Similarly, heavy alcohol use can lead to nerve damage, which can affect how pain signals are sent or interpreted by the brain. Getting control of your chronic pain condition includes making positive changes on your daily habits that could be having a negative affect on your health. Do some self-reflection and assess whether certain lifestyle choices are making your pain condition worse.

If you keep these tips in mind and do what you can to help control them, we’re confident that you’ll be putting yourself in a good position to beat your chronic pain condition. For more information or for help with any aspect of your pain care, reach out to Dr. Cohn’s office today.

What To Look For In A Pain Care Specialist

December 21, 2020 / Thomas Cohn, MD

Pain isn’t created equal, and either is pain care. As a patient with such a highly individualized issue like chronic pain, you should be treated by someone who is going to do all they can to help you find a solution to your specific issue. Not all pain care providers are built the same, so it’s important that you take the time to find someone who is right for your situation.

But how do you know what you should be looking for in a pain management physician? We explain some traits and abilities you should look for when trying to find the right physician for your chronic pain issue.

Finding The Right Chronic Pain Specialist

When trying to find a specialist to help with your chronic pain issue, it’s important that you don’t just pick the closest physician to your house or the first one you come across in-network. You need to look at some other relevant factors if you want to give yourself the best chance at finding a physician who can treat your pain issue. Here’s what you’ll want to look for.

1. Depth Of Knowledge – Most general practitioners have a wide breadth of knowledge, and that allows them to provide professional care for a number of different issues. However, for a specific condition like chronic pain, you want to find someone with a deep knowledge and years of experience on the subject. Although we’ve noted that pain is highly specific to the individual, drawing on the experiences with past patients can make all the difference in finding a solution to the problem presented by the current patient. Find someone with years of experience in the specialized field of pain management.

2. A Listener – Does your current physician really take the time to listen to your story and apply those facts to your treatment, or do your words seem to be going in one ear and out the other? They say that “doctor knows best,” but that doesn’t mean the patient can’t provide crucial and relevant facts to assist in the treatment process. A great doctor really listens to the patient and uses this information to provide the best level of care. If you feel like you’re being treated as just another patient and the doctor seems to have their mind made up before you even get a chance to talk, consider looking for a different specialist to help with your pain.

3. Willing To Adjust – Another thing that both patient and provider need to be willing to do is adjust to roadblocks that develop, because they always do. If they didn’t, chronic pain would be easy to treat. Your provider needs to be able to look at the changing landscape of your pain condition and make adjustments to account for these potential obstacles to successful treatment. This may involve finding new forms of physical therapy, adjusting if pain injections are no longer as effective as they used to be, or consulting another professional when a problem proves mystifying. If you feel like you’re just trying the same old techniques that haven’t been working, why should you expect anything to ever change?

4. Seeks Long Term Solutions Over Short Term Relief – Any pain physician can write a prescription for painkillers and provide their patient with short term relief. It’s a passive solution that is like putting a band-aid on a bullet hole. Painkillers absolutely can be part of a comprehensive treatment plan, but they shouldn’t be the focal point of your care. You want a pain care provider that pursues active treatment options that will help you find long term relief. If your doctor isn’t working towards long term relief, switch physicians.

If you can find all four of these things in your care provider, odds are you’ll have an increased likelihood of regaining control over your pain condition. Dr. Cohn has done this for countless patients in the past, and he can do the same for you. For more information, or to set up an appointment, reach out to his clinic today.