The Link Between Chronic Pain And Borderline Personality Disorder

March 3, 2020 / Thomas Cohn, MD

bpd New research presented at the American Academy of Pain Medicine 2020 Annual Meeting found a significant connection between patients with chronic pain and borderline personality disorder (BPD).

Results of a systemic review found that nearly 1 in 4 patients with chronic noncancer pain had some features of borderline personality disorder, including mood instability and difficultly maintaining relationships.

“The fact that one fourth of individuals with CNCP could have co-occurring BPD underscores the need for improved access to good psychological care,” lead investigator Fei Cao, MD, PhD, University of Missouri at Kansas City, told Medscape Medical News in an interview.

Chronic Pain and BPD

For the study, Cao and colleagues reviewed 11 studies published between 1994 and 2019. During their investigation, they found that 23.3 percent of patients with chronic pain expressed traits of BPD. Some of the conditions that expressed BPD traits included:

Chronic headaches (11.3%)
Arthritis (27.5%)
Chronic spinal cord pain (24.3%)

The biggest takeaway for Cao and his team was that doctors can’t just focus on chronic pain, there needs to be a comprehensive approach to total body wellness.

“The point of this research is that you cannot help these patients in the long-run if you only treat their pain. We also have to treat their BPD. This can then make pain easier to control,” said Cao. “If we treat the borderline personality disorder and address the psychiatric needs as well as the pain needs of the patient, then we will be able to treat their pain more successfully.”

Not everyone with chronic pain suffers from BPD, but this study speaks to how underlying conditions can oftentimes make chronic pain more difficult to treat. If we’re not treating the whole patient, treatment success can be undermined, especially when it’s a psychological component at play. Having healthy mental and emotional health can help to improve functional physical outcomes, and the opposite is also true. If we ignore our mental and emotional health, some of the treatments were’ trying for physical ailments may not be as successful because we’re not treating the totality of our issues.

Cao concluded by saying that physicians should consider screening patients with unresponsive chronic pain that may or may not be showing signs of BPD. Not only can it help the patient improve their mental health, but it may also help increase the success of current treatments for chronic pain.

So if you’ve been dealing with chronic pain and it’s affecting your mood or your mental state, reach out to a physical medicine specialist to get a comprehensive diagnosis and a treatment plan suited to your individual needs.

How To Battle Back Against Nagging Spine Pain

February 25, 2020 / Thomas Cohn, MD

Back pain is one of the most common health conditions in the world, and tens of millions Americans deal with one form of the condition every single day. Spine pain can make even the most mundane activities painful, and it can really impact our quality of life, so it’s not something you should try to ignore and push through. Only treating the problem head-on will help put an end to your nagging back pain. We explore some ways to fight back against nagging back pain in today’s blog.

Treating Chronic Back Pain

This is far from a one-size-fits-all solution to chronic back pain, but odds are you’ll find some form of relief by pursuing one or more of the following techniques. So if you want to take back control over your nagging back pain, consider:

Getting A True Diagnosis – The spine is a complex structure, so if we’re researching our symptoms online, it can seem like we’re dealing with one thing when we’re actually dealing with something else. If you treat the wrong underlying condition, odds are you aren’t going to find relief. Head to a pain management specialist to get a comprehensive diagnosis and a treatment plan catered to your individual needs.

Pursue Active Treatment – For the majority of spinal conditions, rest alone isn’t going to solve the problem. We need to actively work to strengthen injured or nearby structures so that our body is up to the physical tasks we demand of it. Exercise, targeted stretching and physical therapy are all great ways to strengthen your spine and help achieve symptom relief.

Proper Medication Management – We’re not here to tell you to ditch the opioids and pain medications because we know from first hand experience just how integral they are to some patient’s pain care plan. However, you need to make sure that you are maximizing the benefits of these opioids, because eventually you’re going to build up a tolerance. If painkillers help make movements less painful, use that time to go to the gym or perform your PT exercises. Pain medications play a key part in pain management, but for full benefit they need to be paired with active treatment options.

Treat Your Mind – It’s also important to care for your mental health while you’re trying to tackle back pain. Your mindset plays a key role in the success of treatment as well as your willingness to partake in helpful activities like rehab or PT. Talk to your doctor about any negative thoughts or anxious feelings you’re having, and find healthy ways to help take your mind off back pain. Psychological and physical well-being are often connected, so don’t ignore one while trying to treat the other.

Stick With It – Finally, really dive into a care plan routine and see it through. You’re not going to lose weight and make your New Year’s resolutions if you stop going to the gym after a week, and you’re not going to see much progress if you skip physical therapy sessions or make poor dietary choices. Really commit to a back pain treatment plan, and we’re confident you’ll see positive results soon enough.

For help with any aspect of your back pain management, reach out to Dr. Cohn’s office today.

Daily Exercise The Key To Combating Chronic Pain

October 16, 2019 / Thomas Cohn, MD

As someone who has suffered from chronic back pain for more than a decade, I know just how hard it can be to manage a chronic condition on a daily basis. You have good days where you feel like you can conquer the world, and you have bad days where you don’t even want to get out of bed. No matter what kind of day you’re having, it’s important that you push through any discomfort and find time to exercise, because that’s likely your best bet at stringing together more good days than bad.

Daily exercise isn’t something that comes easy. Most of us can find some spare time throughout the week, but we can’t always carve out time every single day, and when we do get spare time, oftentimes we’d rather use it on anything other than exercise. However, it’s this consistency that might be just what you need to put your chronic pain in the past.

The Benefits Of Daily Exercise

A recent study decided to take a closer look at the benefits of moderate versus daily exercise when it comes to helping control problems associated with chronic pain. For the study, researchers conducted a small, weeklong study of 40 healthy women on their sensitivity to pain before and after exercise. The individuals were asked to walk briskly on a treadmill for their exercise, and patients were separated into three different groups. One group walked three times per week, another group walked five times a week, and the final group walked 10 times a week.

After reviewing the data, researchers found no differences in pain perception following exercise for those who exercised three times a week, but the findings were significantly different for those who exercised at least five times a week.

“We asked them to rate that pain,” said neuroscientist Benedict Kolber, lead researcher on the study. “And at the end of the study, they rated the same pressure — the exact same pressure — as 60% less painful than they rated it at the beginning of the study.”

In other words, a small dose of exercise did nothing for helping manage chronic pain, but a bigger dose worked wonders. A good motto to live by is to “Strive For Five” in terms of striving to exercise at least five times a week. However, it’s also worth remembering that you need to start slow. If you haven’t been a frequent exerciser, don’t go straight to exercising for an hour each day. Ramping up your activity too quickly can lead to overstress injuries and exacerbate inflammation. Start slow, be it 5-10 minutes a day, and work your way up from there. Focus on doing small amounts daily instead of a longer session 1-2 times a week, and work your way to longer durations.

There have been days where the last thing that I wanted to do was get up before work and work out, but I knew I needed to do it if I wanted to function at my best throughout the day. I try my best to work out every day, and my back pain has been much more controlled than in years past, even though I’m years older. Controlled exercise can be your best friend when it comes to caring for your pain condition. If you need help developing a safe exercise routine, or you want some tips on what types of activity might be best considering your condition, reach out to Dr. Cohn’s office today.

Prescribing Opioids in 2019

September 23, 2019 / Thomas Cohn, MD

Every day in my practice I sit down with patients who strongly believe that opioids are the best course of action for their pain condition. While opioids certainly can play a crucial role as part of a comprehensive treatment plan, they definitely are not a stand alone option and are far from a perfect treatment as their problems are numerous and well known.

Pain is the physical and emotional response to certain sensory signals. In chronic pain, these signals are not necessarily any indication of danger or potential damage that may occur to the body. Opioids tend to modify the signals of pain, but often are not the most effective treatment and can have devastating secondary consequences. Due to the problems opioids may cause, most physicians are reluctant to prescribe these medications. A new study from the University of Minnesota is shining light on the inconsistencies in when opioids are prescribed.

Opioids In Today’s Society

Before I get into the crux of this blog, it’s worth reiterating that every patient who is interested in opioids is not simply trying to abuse their medications. Some are misinformed, and some truly believe they can help even if they won’t solve the true problem. However, there is a small subset who want medications for reasons other than to treat the underlying pain problem. Thirty years of practice has shown me all the tricks patients play to get medications prescribed. At times it is surprising the act some patients put on to get pain medications. Most physicians are aware of the issues, but still the charades occur.

The new study from the University of Minnesota shows that physicians tend to be vulnerable to over prescribing when they are tired, running late with their schedule, or at the end of the day. These are times when saying yes is easier than explaining no and finding an alternative strategy. This is especially important in acute pain situations when patients are especially prone to abuse and other solutions are appropriate. In some acute situations, short-term prescriptions are okay for several days, especially related to trauma or surgery when other medications for pain are not advisable. Awareness and prescription protocols by primary care providers and emergency rooms about opioids has led to a significant decrease in prescribing these medications. Other providers have been somewhat slower to adopt new habits for safe prescribing.

Opioids are only a small tool in the overall arsenal to treat pain. For many situations, opioids work poorly and are not very helpful. For some patients, opioids have so many problems that the risks of these medications are not even close to any benefit. The worst way to get these medications is to insist that they are the only thing that helps your pain. Usually that means that one does not want to work on other strategies that may be helpful. Unfortunately, some of the better treatments for pain are a struggle to implement because they take time, effort and money. Strategies like exercise, massage, relaxation and treating psychological issues are much more difficult then taking a pill. There’s no magic pill and it will take work, but you’ll be much better off for it.

Pain is difficult to manage, and pain specialists can help with a variety of options. Some problems are simple; most that end up with a pain specialist are very complex. There often is not a fix and most people will have to find a compromise and determine what they can manage and still function adequately. If you want help with your pain condition, reach out to Dr. Cohn’s office today.

Five Non-Opioid Options For Chronic Pain Relief

September 19, 2019 / Thomas Cohn, MD

Chronic pain is one of the most complex health conditions to treat because it is so unique to the individual. What works for one person isn’t guaranteed to work for another, and sometimes many different treatment options are required in combination with one another in order to provide relief.

In our experience, painkillers and opioids can be effective for the right patient when used in combination with other treatment options, but they aren’t a good primary source of treatment. What we mean by that is we’ve never seen a patient get better solely by taking an opioid. They may be helpful in conjunction with dietary changes and other interventions, but they aren’t a great stand-alone option because they don’t address the root problem. Because of this, we want to share five chronic pain treatment options that can treat the root cause of pain and help you find relief. Below, we share five non-opioid treatment options that may be effective for your chronic pain condition.

Treating Chronic Pain Without Meds

This is a general guide of some treatment options we’ve found effective for some common types of chronic pain. For individualized care and a treatment plan tailored to your specific condition, please reach out to our office.

1. Exercise – Exercise is one of the most basic treatment options for some types of chronic pain. Exercise pushes healthy blood through your body, which can help structures function properly, and it works to strengthen supportive muscle groups. If back pain is causing discomfort, some low-stress exercises like swimming, walking or yoga may be just what you need to calm spinal nerve compression or strengthen key muscle groups that can contribute to pain.

2. Physical Therapy – A close cousin of exercise is physical therapy. PT is great for a number of different patients, but it’s especially helpful for those chronic pain patients who are battling arthritis or joint issues. Physical therapy helps you reestablish mobility and range of motion in the joint, and it can help prevent the further progression of arthritis, keeping you more mobile. Physical therapy works by targeting specific areas with certain exercises, stretches and movements.

3. Tens Unit – We’ve talked about TENS units on the blog in the past, but they can be just what the doctor ordered for the right patient. TENS stands for transcutaneous electrical nerve stimulation, and it is a small device that transmits electrical signals to drown out pain signals. Many of them are widely used among patients who suffer chronic headaches or migraines. You can learn more about different units and their uses in the above link.

4. Spinal Cord Stimulation – Spinal cord stimulation is another topic we’ve talked about in the past. They work similar to a TENS unit in that they provide electrical stimulation to drown out painful nerve signals, but these can be implanted inside the patient and controlled by a device to provide different types of stimulation as pain develops. New technology means these devices can even be recharged while still in the body. Again, you can learn more about this option in our expanded post in the above link.

5. Nerve Blocks – Finally, Dr. Cohn’s offers nerve blocks and corticosteroid injections for patients who are dealing with certain chronic pain conditions. For chronic muscles spasms or irritated spinal nerves, a calming injection can provide relief and allow patients the ability to pursue other active treatments, like PT or exercise. They aren’t always a very good stand-alone long-term solution, but they can be paired with other techniques to provide symptom relief.