Exercising Your Way To A Higher Pain Tolerance

April 25, 2024 / Thomas Cohn, MD

As we say time and time again on the blog, our bodies are designed to move. They crave movement. Movement helps to keep our muscles strong and functioning successfully, which is why movement and exercise are so often recommended for patients with chronic pain. However, new research suggests that regular movement could also help to improve a person’s pain tolerance.

For the study, researchers from UiT The Arctic University of Norway, the University Hospital of North Norway (UNN), and the Norwegian Institute of Public Health decided to see if there was a relationship between physical activity and pain tolerance. After reviewing data from more than 10,000 adults, they found that individuals who were physically active had a higher pain tolerance than those who were sedentary. Perhaps more interestingly, the higher the activity level, the higher the pain tolerance.

Can Exercise Prevent Pain?

Armed with this knowledge, researchers wanted to take it a step further and see if there was a connection between physical activity and the eventual onset of a chronic pain condition. They found that being active certainly appeared to help ward off chronic pain conditions.

“We found that people who were more active in their free time had a lower chance of having various types of chronic pain 7-8 years later,” said doctoral fellow Anders Årnes at UiT and UNN, who worked on the study. “For example, being just a little more active, such as going from light to moderate activity, was associated with a 5% lower risk of reporting some form of chronic pain later.”

Moreover, researchers found that higher activity was associated with a 16 percent reduced risk of developing a chronic pain condition in more than one location in the body. The believe that the ability to tolerate pain did in fact play a role in this apparent protective effective.

“This suggests that physical activity increases our ability to tolerate pain and may be one of the ways in which activity helps to reduce the risk of severe chronic pain,” said Årnes.

He added that although exercise may have a protective effect when it comes to chronic pain, it could also play a role in treatment as it helps people become less sensitive to pain signals.

“Physical activity is not dangerous in the first place, but people with chronic pain can benefit greatly from having an exercise program adapted to help them balance their effort so that it is not too much or too little. Health care professionals experienced in treating chronic pain conditions can often help with this.”

If you need help developing an exercise program tailored to your strengths and deficits, let us be your guide. Dr. Cohn has helped people of all activity levels find ways to move more and fight back against their chronic pain condition, and we can do the same for you. For more information, or for help with a different pain issue, reach out to Dr. Cohn and his office today at (952) 738-4580.

Why Posture Problems And Chronic Pain Are Often Linked

February 15, 2024 / Thomas Cohn, MD

Chronic pain conditions can be caused and exacerbated by a variety of factors, but one common culprit that is often overlooked is a person’s posture. If you have bad seated or standing posture, it changes how stress is dispersed on your whole body. It can put additional pressure on certain areas like your lower back or neck, speeding up natural degeneration and contributing to chronic pain in these areas.

And while the problem of poor posture is obvious from a provider side, it’s oftentimes overlooked by patients. A recent study by Orlando Health found that only 47 percent of survey respondents were concerned about poor posture and its impact on their health. This is especially concerning when you consider just how frequently the average person puts their spine in an less than ideal position.

Depending on which survey you’re looking at, you’ll find that the average American spends anywhere from 2-4 hours a day on their cell phone, and much of this time involves craning their head and neck forward to look at a smartphone in their lap. If they work a desk job, it only gets worse, as they likely aren’t in a perfect spinal alignment for the 8+ hours they spend at the office. That means that for some people, their spine is in a less than ideal position for more than half of the day.

How Poor Posture Triggers Chronic Pain

Poor posture can trigger chronic pain in a variety of ways. We already touched on one above, which is that poor posture changes how stress is dispersed in your body. When your neck and back have to handle additional stress because you are out of a healthy alignment, discs can wear down faster and irritate nearby nerves. Nerve pain is a common underlying cause for a number of chronic pain sufferers, and it can oftentimes be traced back to poor posture.

Bad posture habits can also contribute to chronic discomfort in the form of frequent headaches. When you’re out of alignment, the muscles and soft tissues in your neck have to work harder to support your head. These muscles are constantly tensed trying to support this additional stress, and this muscle tension can trigger migraines or the aptly named tension headache. Chronic headache sufferers may notice a major improvement in symptoms by improving their diet and their posture habits.

Poor posture also means that inflammation is more likely to develop in certain areas of your body. An inflammatory response is your body’s natural reaction to stress and trauma, so inflammation can develop if certain areas are constantly being overstressed because your spine is out of alignment. Inflamed tissues can irritate nearby nerves and structures, making movement painful and triggering a chronic pain flareup.

We live in a world where it is easy to fall into bad posture habits. Laptops, smartphones and other electronic devices have us constantly looking down or in a hunched seated position, and if we’re not careful, we can end up overloading different areas of our spine. Over time, this contributes to tissue degeneration, muscle tension and inflammation, all of which can serve to make chronic pain problems worse. We’re not saying that improving your posture will address all of your chronic pain issues overnight, but bad posture can oftentimes stifle your progress and cause chronic pain to linger. If you improve your posture, adjust your diet and get more regular exercise, we’re confident that you will be providing your body with the right environment to overcome your pain condition.

To learn more about the connection between your posture and chronic pain conditions, or to talk to a specialist about a pain issue you’re experiencing, reach out to Dr. Cohn and his team today at (952) 738-4580.

Medical Cannabis For Chronic Pain Could Increase Heart Arrhythmia Risk

January 11, 2024 / Thomas Cohn, MD

New research out of Denmark suggests that medical marijuana use for chronic pain issues may significantly increase a person’s risk for de novo arrhythmia compared to patients who pursue other treatments for their pain.

While the absolute risk of developing heart arrhythmia while taking medical cannabis for a chronic pain condition is still relatively low (0.4%), the fact that is raises your risk at all could be a cause for concern for many patients, especially those with a history of heart issues.

“Short-term risk of arrhythmia was significantly elevated in patients prescribed medical cannabis compared with matched control patients, but the absolute risk increase was modest at 0.4% in the first 180 days,” said Anders Holt, MD, cardiologist at Copenhagen University Hospital – Herlev and Gentofte in Denmark, in an interview with Healio.

Medical Cannabis And Heart Issues

For their research, Holt and colleagues used nationwide registers to identify 5,391 patients with chronic pain who began using medical cannabis between 2018 and 2021 as part of their treatment plan. This group was then age- and sex-matched 1:5 to 26,941 control patients with a chronic pain diagnosis that were pursuing another pain medication treatment other than medical cannabis.

For the patients that used medical cannabis:

24% used CBD
29% used combination CBD/THC
47% used THC alone

For patients pursuing other treatments, the most common medications were NSAIDs, anti-epileptic drugs and opioids.

Researchers reported that medical cannabis use was associated with a 180-day absolute risk for new-onset arrhythmia of 0.8%, whereas non-use was linked to a 180-day absolute risk for new-onset arrhythmia of 0.4%, meaning patients who pursued medical cannabis were twice as likely as their counterparts to develop a new heart arrhythmia. Researchers said the increased arrhythmia risk was similar regardless of the type of medical cannabis they pursued.

“Both CBD and THC have an effect on the CB1R receptor, which theoretically could lead to CV [cardiovascular] side effects,” said Holt. “Previously, side effects have been mostly suspected to be related to THC since the psychoactive properties of cannabis arise from this cannabinoid. Findings from this study suggest that both THC and CBD may play a role in the risk of CV side effects.”

The team did note that they observed no significant association between medical cannabis use for chronic pain and risk for acute coronary syndrome

“This study adds important and much-needed data on CV side effects related to medical cannabis; however, clinicians should consider the observational nature of these findings which limits their impact and applicability for clinical recommendations before changing any practice,” Holt concluded. “Considering all available data on medical cannabis treatment for chronic pain, I believe that it should probably be reserved for chronic pain conditions where the effect is supported by sufficient evidence, eg, neuropathic chronic pain. Considering data from this study, some improved monitoring of CV symptoms immediately following initiation could be beneficial, especially in patients with known cardiometabolic disease or history of cancer.”

Dr. Holt’s takeaway point here is key. Given the nature of the study results, physicians should thoroughly review a patient’s heart history before recommending medical cannabis as a treatment option, and heart monitoring could be beneficial for chronic pain patients who are beginning a medical cannabis regimen. Medical cannabis has been shown to be an effective tool in managing symptoms for many types of chronic pain patients, but it’s not without its own risks. Patients would benefit from an open and honest dialogue with their doctor about their heart health prior to beginning a medical cannabis regimen as part of treatment for their chronic pain condition.

For more information about medical cannabis or chronic pain treatment, reach out to Dr. Cohn and his team today at (952) 738-4580.

Tips For Starting An Exercise Program When Everything Hurts

December 28, 2023 / Thomas Cohn, MD

Exercising and chronic pain can be like oil and water. It can be hard to start exercising if you have chronic pain, but there’s a good chance that your chronic pain condition will improve by pursuing an exercise program. But how can you overcome a chronic pain condition and begin a beneficial exercise regimen? In today’s blog, we share some tips for starting an exercise program when your body hurts as a result of a chronic pain condition.

Starting An Exercise Program In Spite Of Chronic Pain

Starting and sticking to an exercise routine that will see you become a healthier version of yourself is never easy, and that’s especially true if you have a chronic pain condition. That said, there are some ways to make it a little easier to exercise despite your chronic pain condition. Here’s how:

Get Creative – When people think of traditional exercise, they oftentimes think of a running program. Running is a great way to build your muscles and challenge your body, but it certainly isn’t the only way to exercise. Get creative when it comes to exercise and pursue an activity that you find enjoyable (or at least bearable). Consider doing some yoga, riding your bike around the city or swimming laps at the local pool.

Develop A Routine – We know that developing a standard routine isn’t always easy when you have to adapt to the challenges of chronic pain, but begin to carve out some regular time for exercise. Perhaps that means waking up a half hour earlier on Mondays and Thursdays, or stopping at the gym on your way home from work a couple days a week. Your body and your brain will slowly start to get used to this routine, which will make it easier to regularly pursue exercise.

Pay Attention To Your Recovery Period – Even if you don’t have a chronic pain condition, odds are you’ll have some soreness and discomfort after exercising. It’s important that you help your body recover after exercise so that this discomfort doesn’t linger. Eat a healthy diet, get up and move, do some light stretching and stay hydrated to make it easier for your body to recover from the rigors of exercise.

Set Attainable Exercise Goals – We’re more likely to keep coming back for more exercise if we set realistic and attainable goals. Don’t plan to exercise 4-5 times a week if you are starting a new program. Slowly begin a new exercise program and gradually push yourself to take on bigger challenges. If you bite off more than you can chew or your goals are too lofty, you can end up sabotaging your own exercise routine. Set challenging but realistic goals.

Work With A Pain Management Specialist – Finally, know that you don’t have to develop and pursue an exercise program while dealing with chronic pain on your own. Dr. Cohn and his team can help you develop an exercise routine tailored to your strengths and current limitations so that it’s easier for you to reach your goals. Chronic pain can be isolating, but you have resources that you can lean on when your pain condition makes daily activities like exercise difficult. Let us help you make is easier to pursue regular exercise in spite of your pain condition.

Exercise has countless benefits for your body, and oftentimes it can really help to lessen symptoms of a chronic pain condition. It won’t be easy to start an exercise program when everything hurts, but we know it will be worth it. For more information, or for help with a different chronic pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

World Health Organization Releases Chronic Back Pain Care Guidelines

December 7, 2023December 7, 2023 / Thomas Cohn, MD

Earlier this week, the World Health Organization (WHO) released its first-ever guidelines for managing chronic low back pain in primary and community care settings. Not only do the guidelines focus on what healthcare workers should be doing to help patients treat their back pain, they also outlined what techniques should be avoided during routine care.

The WHO felt compelled to issue these new guidelines because low back pain is the leading cause of disability in the world. In 2020, roughly 1 in 13 people experienced low back pain, which equates to 619 million people globally. This number also reflects a 60 percent increase from 1990, and cases of low back pain are expected to surge to 843 million by 2050.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course. “Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care.”

WHO Chronic Low Back Pain Recommendations

The World Health Organization recommends non-surgical interventions to help patients experiencing chronic low back pain. They grouped their recommendations under different categories, which we’ll explore below:

Education – Patient education should be structured based on the individual needs of the patient and help the patient better understand their condition and some self-help strategies for treatment.

Physical Interventions – Physical intervention recommendations include structured exercise programs, physical therapy, spinal manipulation therapy, massage therapy, needling therapies and assistive devices.

Psychological Interventions – Operant therapy and cognitive behavioral therapy are recommended as treatments to address the psychological effects of chronic low back pain.

Medicines – WHO recommends non-steroidal anti-inflammatory drugs as part of a routine and comprehensive treatment plan for chronic low back pain.

Multi-Component Interventions – Finally, WHO recommends multi-component biopsychosocial care for patients battling chronic low back pain.

Interventions That Should Be Avoided

According to the World Health Organization, the following treatments should not be recommended as part of routine care for chronic low back pain. They may be recommended if specific conditions are met, but they are not currently recommended as part of routine chronic low back pain treatment:

Traction
Therapeutic ultrasound
TENS stimulation
Lumbar braces/Support belts
Opioid analgesics
SNRI antidepressants
Tricyclic antidepressants
Anticonvulsants
Skeletal muscle relaxants
Glucocorticoids
Injectable local anesthetics
Devil’s claw (Harpagophytum procumbens)
While willow (Salix spp.)
Pharmacological weight loss products

The recommendations by WHO mirror what we’ve been saying to patients for years. Chronic low back pain is best treated with active interventions like exercise and physical therapy, but it also needs to focus on patient education and the psychological effects of chronic pain. Treatment needs to be multi-faceted to be effective, so it’s nice to see that WHO is confirming the methods we’ve been using to help patients overcome their chronic low back pain for years.

If you need help treating low back pain or another chronic pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.