back pain

The Importance Of A Support System When You Have Chronic Pain

/ Thomas Cohn, MD

support systemWhether you’re off pursuing your dreams of being a musician in New York City or trying out for the varsity basketball team, everybody wants to have a strong support system that they can turn to in a time of need. Another group of people who need a strong support system in their life are those individuals with chronic pain, but those with a chronic condition know that a good support system can be hard to find. Today, we share some tips for finding and building a strong support system if you have chronic pain.

Chronic Pain Support System

All of the following tips may not apply to your situation, but we’re confident at least some of them will. Here’s how you can build and learn to rely on a support system if you’re dealing with a chronic illness.

1. Find A Few Close Friends – You probably have one or two really close friends or family members that you can rely on when things get tough, and it’s important to lean on them when you need help. Just because you have a large family or a large network of friends doesn’t mean they are all going to be sympathetic to your cause and be reliable in your time of need. Recognize that not everyone is going to be part of your support system, so focus on the really reliable members of your support system instead of trying to involve a larger network of people.

2. Online Support – The rise of the internet has made it much easier for people to connect with other individuals who are going through the same thing. You can find highly specialized support groups that can allow you to talk to people who know what you’re dealing with. Try a simple google search and see what groups are out there. Find one or two that seem supportive and consider joining.

3. Share Your Experiences – A number of people find it helpful to share their stories with others. Whether you’re talking to your best friend on the phone or writing out your daily struggle on an online forum, it can be extremely helpful to talk about your experiences. Find a place where you can vent or be vulnerable, and let your story be heard.

4. Support Yourself – It’s also important to remember that you are the most important member of your support group, and you need to take care of yourself. You need to be getting regular exercise, eating a healthy diet and partaking in activities that contribute to a healthy physical and emotional well-being. If you have self-destructive tendencies, your support group may fall apart because others may think “Why should I care about them if they don’t seem to care about themselves?” Be your biggest supporter.

5. Professional Help – Finally, don’t be afraid to reach out to a professional for help. Whether you need a chronic pain specialist to help you get a grip on your condition, or you want to talk to a mental health counselor about your feelings and your concerns, please reach out for help. We want to be part of your support team, but we can’t get you help unless you connect with our office. Let us help you.

For more tips on building and maintaining a healthy support system if you have chronic pain, reach out to Dr. Cohn’s office today.

FDA Reexamining Opioids For Chronic Pain

/ Thomas Cohn, MD

FDA effectivenessThe Food and Drug Administration has announced that it will require drug companies to conduct studies to determine if prescription opioids are effective in treating chronic pain.

A number of studies have already suggested that pain controlling opioids are ineffective beyond 12 weeks, and many industry professionals say that continued opioid use after this period can increase a person’s likelihood of developing a dependence or addiction. The FDA wants to supervise the new studies to determine if certain changes, like the following, need to be made:

  • Changing the labeling on certain opioids
  • Imposing special rules for prescribing, dispensing and taking certain opioids
  • Prohibiting use of certain opioids in some cases

“We are going to impose a mandate on existing products . . . to answer the question that people have been posing for years: whether you have declining efficacy, and whether that declining efficacy can lead to addiction,” said FDA Commissioner Scott Gottlieb.

Some Don’t Agree

While it may seem like a good move that the FDA is appearing to take a step in the right direction of opioid abuse, others say the new measures are nothing more than a stall tactic for big pharma. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, said the FDA ordered a similar measure in 2013 and that they already have all the research they need to make changes that could help protect the public.

“Here we go again,” Kolodny said in an interview. “That’s exactly what the FDA said to us in 2013. . . . Five years later, we don’t have the studies and another FDA commissioner says, ‘We’re going to do the studies.’ ”

However, Gottlieb argued that the research would be aimed at immediate, extended-released and long-acting opioid tablets that are given for pain care outside the healthcare facility. The studies would also cover current medications on the market to examine if new applications of the pain reliever could be more effective. The FDA will also be conducting a second study that is out to determine if opioids can actually cause users to become more sensitive to pain.

A similar study was carried out back in 2013, but Gottlieb said those studies were difficult to carry out because the FDA could only ensure post-marketing studies on safety, not effectiveness. They now have the authority to demand effectiveness research as part of an act passed back in October.

The opioid crisis killed 47,600 people in 2017, but there’s hope that the new research can lead to effective changes. There’s still plenty of work to be done, but with more control over effectiveness research, there’s hope on the horizon.

How Regular Exercise Keeps Your Body Young

/ Thomas Cohn, MD

old fitnessNew research published in the Journal of Applied Physiology revealed that regular exercise can have your muscles acting as if you are decades younger than your actual age.

According to researchers, older men and women who exercised regularly for decades had muscles that were indistinguishable in many ways from the muscles of healthy 25-year-olds. These older men and women also had much higher aerobic capacities than most individuals their age, making them biologically about 30 years younger than their chronological age, the study’s authors conclude.

Previous studies have found that older athletes have healthier muscles, brains and immune systems than individuals of the same age who are sedentary. However, those studies have concentrated on competitive athletes, not recreational exercisers. This study suggests that you don’t need to be a professional athlete to see many of the same benefits of regular exercise.

Exercise Study

For the study, researchers looked at the health of individuals who took up regular exercise during the fitness boom of the 1970’s. They were most interested in individuals who maintained that hobby through the next 40-50 years, with activities like running, cycling, jogging or swimming, even if they never competed in these activities.

28 men and women fit the bill, and they were compared to a second group of age-matched older individuals who had not exercised during adulthood, as well as compared to a third group of active young people in their 20s.

Each group was tested in a lab setting to measure their aerobic capacities, and tissue samples were also taken to look for the number of capillaries and levels of enzymes in muscles. The higher the numbers, the better the muscle health.

After looking at the findings, researchers were surprised to find that the muscles of the older exercisers resembled the muscles of the young group, and their aerobic capacities were about 40 percent higher than inactive individuals their age. They also concluded that the active older group had cardiovascular health similar to that of people about 30 years younger.

These findings are amazing, and they help us understand why regular exercise is so important. Exercise can literally roll back the clock and slow down the aging process, which can help prevent problems like pain or degeneration-related issues. So take care of your health while you’re young, and continue exercising as you get older. If you do this regularly, you can prove that age really is nothing more than a number, and we are in control of our health!

What Does It Mean To Be Physically Fit?

/ Thomas Cohn, MD

fitnessEveryone is told to exercise and become physically fit. However, what does it mean to be “physically fit?” The definition that is commonly used is as follows; a set of attributes that people have or achieve that relates to the ability to perform physical activity. Fitness can help prevent some diseases, improves body composition, strengthen the heart and circulation and improve muscle fiber ability. Factors involved in fitness include cardiovascular fitness, muscular strength and endurance, body composition and flexibility.

The Components Of Fitness

The first factor often discussed with physical fitness is the cardiovascular and respiratory components of fitness. It includes the ability to perform aerobic activities like walking, to more intense exercise like sprinting. Aerobic activities increase the heart rate for a sustained period and improve the strength of the heart as a muscle and maintain the integrity of the vascular system. The lungs are a partner in this system moving air, extracting and delivering the needed oxygen. The recommended amount of aerobic conditioning is five times a week for 30 minutes total at 65% maximum heart rate for your age. Exercise can be done in small segments daily, 5-10 minutes at a time, while maximum heart rate is calculated from (210) – (your age) = (maximum heart rate).

Muscular strength is the ability of muscles to exert adequate force during activity. Any activity that works muscles against resistance and that causes muscle fatigue will increase strength. Muscle strengthening can be done by any number of activities such as weight training, using a rowing machine, performing Pilates, doing Tai Chi, or even just using gravity and your body for resistance. A physical therapist or an athletic trainer can often set one up with a program to build muscle strength. Along with exercise, protein from your diet is required for muscle development.

A third component of fitness is endurance, which is classified as the ability of muscles to continue to exert effort over a period of time without tiring. Two types of muscle fibers are used for endurance activities and they are slow twitch and fast twitch fibers. The slow twitch fibers are those used to perform endurance activities. They need lots of oxygen and can carry out prolonged tasks without fatigue. The fast twitch fibers contract quickly, can be used for sprint type activities and do not require significant blood and oxygen.

The most nebulous component of fitness is body composition. This is the relative amount of muscle, bone, water and fat in a person’s body. Your genetics, your fitness routine and your diet help to determine your body composition. The body type of a distance runner will be different from a weightlifter or a swimmer. The overall issue would be to have an appropriate body composition for the activities that one wants to perform and avoid having a high level of body fat.

The last component of physical fitness is having overall flexibility, the range movement across your joints. It is dependent on the tightness of muscles, tendons and ligaments across your joints. As one becomes older, deterioration of the joints from the natural aging process can sometimes limit flexibility. Surgical procedures such as fracture repairs, spinal fusions or joint replacements can also limit flexibility. Stretching exercises are often necessary to maintain flexibility. Again, some exercises like yoga and Tai Chi are excellent ways to maintain flexibility as part of a fitness program. If you have low back or neck issues, flexibility and stretching are helpful to reduce pain by preventing excessive muscle tightness. Muscles naturally try to tighten to prevent too much movement of a possibly painful area such as a joint. However, maintaining more normal motion in an area tends to improve structure health and decreases pain from abnormal stress on the region.

Physical fitness means maintaining regular exercise to benefit your health. It involves five aspects: cardiorespiratory performance, strength, endurance, flexibility and body composition. Optimizing each of the above components leads to becoming physically fit. It is a process and needs to be done on a daily basis.  

Drug Screening In Chronic Pain Clinics

/ Thomas Cohn, MD

drug testing Most pain practices have the occasional patient who they suspect are on controlled substances. Since drug abuse has always been a major problem in society, and because clinics prescribe medications, most practices also screen patients for appropriate drug use and abuse.

At the clinical level, drug screening is done in a number of ways, including testing blood, urine, or saliva samples for the presence of drugs. Some tests only show that a narcotic is present in the body, while others can tell how much of a drug is present. Depending on the circumstance, a provider may choose anyone of the different types of tests. Now a breathalyzer-type test is being developed to test for drugs of abuse.

Breath Tests For Drugs

A breath analyzer test has been done for decades for alcohol and now is being developed for marijuana, cocaine, fentanyl, PCP, and methamphetamine. These use a chemistry technique known as mass spectrometry so the test can identify the presence of certain chemicals and also help determine the level in the breath and possibly in the blood. Unfortunately for many of the compounds tested, there is not a standard for which these chemicals may cause impairment.

With marijuana, for example, we have no idea what level in the body correlates to any level of impairment compared to alcohol. The nice thing about this technique is that it is quick with the analysis being done in about 15 seconds. Currently the technology is very new and thus costly, but in the future it should be about $10,000 for a unit and be very portable.

For places looking to detect a very limited number of drugs of abuse, the breath analyzer will be good. For the pain practitioner, drug testing is more comprehensive. Usually a semi-quantitative screen of either urine or blood is used for drug screening. Most pain physicians want to know if the drugs a patient is supposed to be taking are in their systems and whether there are drugs that are present like street drugs that should not be in their system.

Most doctors also want to know if there are drugs not declared by the patient that may also be dangerous if taken with drugs they have prescribed. For the honest patient, drug screening should not be a worry. For those patients that are using street drugs or misusing their drugs, random testing often finds the problem. The patients who are misusing drugs often make mistakes and doctors discover them sooner or later.

In the midst of the opioid crisis and the high rate of misuse of prescription medicines, safe prescribing of any treatment for a pain patient always becomes a concern. There are many treatments for pain with medications being only a limited modality in the overall scheme of options. The use of addictive medications such as opioids is even less attractive since it often worsens pain and becomes ineffective over very short period of time for many people. Drug testing is one of the tools toward safe prescribing that needs to be implemented in pain clinics throughout the country.