What Patients Wish They Would Have Known Earlier About Their Chronic Pain

September 5, 2019 / Thomas Cohn, MD

Everybody can look back at some aspects of their life and say “I wish I knew then what I know now.” The same can be said for anyone who is dealing with chronic pain or who has progressed through a pain management plan. Oftentimes life would have been so much easier if we just would have known a few things back then. That sentiment is the focus of today’s blog. We’re going to share some things that many patients with chronic pain wish they would have known earlier in the process, and hopefully they can help you come to an understanding earlier than you may have on your own.

If Only I Would Have Known Sooner

Here’s a look at some sentiments a lot of patients wish they would have come to grips with sooner. We understand these may not apply to every single situation, but at least a few points should apply to your pain problem.

1. Pain is not just physical – One of the biggest misconceptions about your chronic pain is that it’s only a physical issue. Pain has a way of impacting us physically, mentally and emotionally, and it can exhaust all aspects of our life. You can’t just focus on the physical aspect of your health, because ignoring your emotional and mental health will wear you down and leave you feeling worse off. Treating pain needs to be a multi-faceted approach that focuses on your total wellness. If you’re feeling anxious, tired or mentally or emotionally fatigued, bring this up to your care physician because taking care of these areas of your life will help your physical pain as well.

2. Pain isn’t always curable, but it is treatable – What we mean by this is that although we do everything in our power to completely rid you of your pain, there’s no guarantee that you will be completely pain free when all is said and done. That being said, we are extremely confident that we will be able to help decrease your symptoms or help you get a better handle of your pain condition, no matter what you’re dealing with. We’ve never met a patient that we’ve felt that we couldn’t at least make life a little better for. But it’s important to manage your expectations. Assume that things will get better, but understand you might not be back to a completely pain-free way of living.

3. It’s going to take work – As we’ve said on the blog in the past, there is no magic bill to treat chronic pain. Painkillers can help mask pain, but they won’t treat the underlying problem. Most pain conditions best respond to physical therapy, controlled exercise, weight management and other healthy lifestyle choices. This takes concentrated effort, but it’s worth it. If you just hope time heals all wounds, you may be surprised at how little progress you see.

4. Control what you can control – A final aspect we want to share is that you need to focus only on what you can control. You can’t control how your pain responds to treatment, but you can control the effort you put in to treatment. You can’t control your good and bad days, but you can control your attitude and mindset, even if it’s not always easy. Know that some things are out of your control, and that’s ok. If you focus on what you can control, you’re going to be in a better mental space, and it often leads to better physical outcomes.

Could Scorpion Venom Help Solve Chronic Pain?

August 26, 2019 / Thomas Cohn, MD

Chronic pain is the most widespread health condition facing Americans today, so it’s no surprise that researchers and medical experts are looking for alternative methods to help patients find relief. A new study out of the University of California San Francisco is taking that thought to the extreme as they have been studying scorpion venom to see if it could be harnessed to help stop some types of nerve pain.

For their study, researchers took a closer look at how scorpion venom affected the human body on a cellular level. They found that scorpion venom can actually be used to target what’s known as the wasabi receptor, a chemical-sensing protein in the nerve cells (also called TRPA1). If you’ve ever take too large of a bite of wasabi, you’ve probably felt a sting in your sinuses, and that’s your wasabi receptor reacting to the properties of wasabi.

Wasabi Receptors and Pain

Some types of scorpion venom also trigger the wasabi receptor, and this was an area of focus because when the receptor is activated, sodium and calcium ions can move into cells and induce pain and inflammation. The venom is also of interest because of the way the venom triggers the wasabi receptor. The venom contains a unique and unusual sequence of amino acids that allows it to penetrate the cell’s membrane and pass straight through as opposed to the traditional mode of entry called endocytosis. If researchers can understand how this venom can pass through the cell membrane, they may be able to replicate the process and develop medications that can penetrate the cell’s barriers, which has caused problems in the past.

“The discovery of this toxin provides scientists with a new tool that can be used to probe the molecular mechanisms of pain, in particular, to selectively probe the processes that lead to pain hypersensitivity,” said UCSF doctoral student and lead author John Lin King “And for those interested in drug discovery, our findings underscore the promise of TRPA1 as a target for new classes of non-opioid analgesics to treat chronic pain.”

Developing new drugs that can be correctly absorbed by the body to target a wide variety of pain types has always been difficult, but studying scorpion venom could give us a better understanding of cellular membranes. So while you won’t be injecting scorpion venom to help with your chronic pain anytime soon, it wouldn’t be surprising if the substance led to a breakthrough in the field of chronic pain management in the not so distant future.

New Technologies For Pain Management

August 19, 2019 / Thomas Cohn, MD

Medicine is evolving as electronic technology invades all aspects of medical care, and pain management is no exception. The areas that have changed the most are imaging technology and implantable devices. What is interesting to patients is how imaging can improve care and implantable devices may help when nothing else is working. The improved imaging makes diagnostic and treatment decisions easier and also makes interventions more precise when tied to management by an astute clinician. No matter how good the technology is, without the skill of a good clinician to understand the medical problem, no solution would be helpful.

The new implantable technology available is peripheral nerve stimulation. This is designed for treatment of pain that is related to damage to a peripheral nerve, such as in the arm or leg. Pain can often be traced to an isolated nerve and preventing that nerve from propagating the pain signals helps to control the problem. These pain issues arise sometimes after amputations with phantom pains, and can be seen after trauma when nerves are damaged. These problems can also occur with surgeries like joint replacements, orthopedic interventions, spinal operations and some fractures. When the pain is not resolving and an isolated set of nerves can be found and successfully blocked with local anesthetic, then nerve stimulation may be appropriate. This is a treatment to consider when simpler interventions like medications, physical therapy, and injections have not been successful.

Nerve Stimulation For Pain Management

The idea of peripheral stimulation has been around for a long time. In the distant past, traditional spinal cord stimulators were used for peripheral nerve stimulation. Unfortunately, at some point this began being abused and since those systems were extremely expensive, this process stopped. In the last two years, new systems have been designed specifically for peripheral nerve stimulation that are very technologically advanced and effective.

One example is electrode stimulation. The electrode is a very thin wire coated in silicone that can be delivered to the right place along the specific nerve with a needle guided by ultrasound imaging. The wire contains a special signal receiver that can be used to help stimulate the nerve and drown out pain signals. Most importantly, the signal generator is now a very small rechargeable unit that is placed on the skin over the end of the electrode. In the near future the electrode may connect even further from the generator such that it may be able to be carried in a pocket or other safe place.

The new technology is FDA approved for peripheral nerve pain from any type of nerve injury. The easiest insurance approval is Medicare, but other providers are starting to approve of such treatments when proven simpler treatments have failed. There currently are at least two manufacturers of equipment, the difference appears to be mainly in the generator’s ability to deliver a variety of signals that may effectively block pain signals and not be uncomfortable to the patient. From experience developed in spinal cord stimulation, the electrical signals can be varied such that the nerve pain is blocked but the patient does not feel any other odd sensations. The net effect is that one can perform activities that were once painful without the ongoing sense of pain.

For pain patients, this new technology is nice since the only thing implanted into the body is a thin wire to the appropriate location. Testing prior to implant is first by a local nerve block with a long lasting anesthetic. If that is successful, than a trial implant can be done for a week or longer to determine if a final implant would be indicated. The permanent implant is a brief outpatient procedure and can be easily removed in the future if necessary.

Pain patients who may benefit from peripheral nerve stimulators include those where pain symptoms have a definite peripheral nerve origin and the pain can be extinguished by blocking just one or possibly two nerves that are nearby each other in the body. The first problems that have been treated have been pain related to shoulder injuries that do not resolve with surgery. Other common orthopedic problems include knee and foot pain after trauma or other surgery with nerve damage or nerve pain afterwards. Amputation phantom limb pain and complex regional pain syndrome are other pain problems that may benefit from this technology. An interventional pain specialist who does implants should be able to help determine if the pain problem may be helped with such treatment. Not all pain problems can be helped and if the pain is coming from multiple pain generators or is centrally generated in the brain, this treatment is less likely to be helpful.

Just How Effective Are PRP Injections For Pain Conditions?

June 24, 2019 / Thomas Cohn, MD

The field of regenerative medicine has been booming over the last several years. It includes the use of injections of stem cells and the use of platelet rich plasma (PRP) to hopefully cure many muscle, joint, ligament and tendon issues in the body. However, it is a fairly unregulated medical field. Most procedures have little scientific data to support their efficacy and therefore are rarely paid for by insurance. There is a lot of case report-type success but very little truly scientific studies to prove the success of these procedures. Many physicians recommend these procedures, knowing the research results would probably change many people’s mind.

Recently, research on PRP was presented at the American Academy of Orthopedic Surgeons by Dr. Herman Johal, MD. He performed a comprehensive review of the literature, especially of studies that were well designed control trials. The findings were surprising for the supporters of these procedures, and somewhat predictable. The procedures may be helpful for conditions like tennis elbow, lateral epicondylitis and knee pain. However, for tennis elbow it was no better than dry needling of the elbow tendons and it was significantly more expensive. For knee osteoarthritis, it did work, but again it was no better than hyaluronic acid treatments that are well researched, and are scientifically proven effective and covered by insurance.

PRP and Its Effectiveness

The use of PRP in all other areas of the body including the spines discs, muscles and other joints, especially the shoulders, was not effective. Traditional treatments such as physical therapy and exercise, anti-inflammatory medications as well as steroid injections were more successful. These new techniques pushed by many legitimate physicians are just not helpful. This is a stark reminder that placebos, otherwise known as sugar pills or sham treatments, will work in about 30 percent of people no matter what.

The message for many pain patients is that there often is a reason for a procedure not to be covered by insurance. If Medicare has approved a procedure and it has an approved specific billing code, then the procedure has scientific studies demonstrating its safety and effectiveness. Currently, the use of platelet rich plasma does not have the designation and it appears to be due to a lack of proven effectiveness. Unless one is independently wealthy, caution should be noted when a procedure is done strictly on a cash basis in our society, like PRP often is.

4 Ways You’re Incorrectly Treating Your Chronic Pain

June 20, 2019 / Thomas Cohn, MD

When you’re dealing with chronic pain, you’re willing to do almost anything to find respite. You’ve probably done some research online or talked to others with similar issues and come up with a plan. But what if you’re treating your chronic pain condition incorrectly? Not only can this prevent you from finding pain relief, in some cases, it can actually make pain worse. Below, we take a look at four ways you may be incorrectly treating your pain condition.

4 Wrong Ways To Treat Pain

It is in your best interest to talk to your doctor about how you can manage your specific condition, but in general, here are four ways that you may be mistreating your pain condition.

1. Not Exercising – You might think that rest is the best thing you can do for your body, and while it may be good in the short term, it may not be the best bet for your long term health. Exercise helps to increase healthy blood flow throughout your body and strengthen key structures that can help prevent pain. For example, if you’re dealing with back pain, although it may cause some discomfort to exercise because of your spine pain, strengthening your core and your back muscles can help to treat the underlying issue. Don’t just assume that rest is what you need to take care of your pain.

2. Over-Reliance on Opioids – Opioids certainly have a place in a pain care management plan, but they shouldn’t be your only source of treatment. Many people assume that because opioids help dull or eliminate their pain, that it is their best source of treatment. However, opioids do nothing to treat the underlying cause of pain. They may make it easier to exercise or fall asleep, but they need to be paired with active treatment options in order to be the most effective. Make sure you follow through on your other treatment options if you are given painkillers to help with your condition.

3. Isolation – There are times when it can feel great to have the house to yourself to do as you please or to shut out the world for a night, but if you’re constantly isolating yourself from others, it’s not going to help with your pain condition. Some people with pain problems avoid group settings or cancel plans because they don’t want to feel like a burden for others, but there have been studies on the importance of human and social interaction when it comes to pain management. We’re not saying you need to take up public speaking or be the office chatterbox, but social interaction, even if it’s just talking with a family member on the phone or having a friend over for dinner one night a week can really help your mental and emotional state. You’d be amazed at how much your mental and emotional health affects your physical health, so don’t shut out the world because of your pain.

4. Not Seeing A Specialist – The rise of the internet has made it much easier for people to research their symptoms and come up with a diagnosis and care plan of their own. The problem is that it’s easy to fall down a rabbit hole of misinformation or incorrectly diagnosis yourself based on inaccurate or surface level symptoms. If you truly want to get a grip on managing your pain, visit a Pain Management Specialist like Dr. Cohn. He’ll be able to provide a comprehensive diagnosis and set you up with an individualized care plan. Contact his office today to learn more about your options.