How Much Sleep Is Chronic Pain Costing You?

June 19, 2018 / Thomas Cohn, MD

In order to fall asleep, we usually need to have a calm physical and mental presence, and that can be very difficult to achieve if you have chronic pain. Chronic pain conditions can make it difficult for patients to not only fall asleep, but stay asleep. In order to get a better understanding of how chronic pain affects the amount of sleep we receive, we turn to two recent studies on the matter.

Chronic Pain and Sleep Deprivation

For the first study, the National Sleep Foundation wanted to see how chronic pain impacted sleep duration and sleep quality. After looking at the data, researchers found that individuals with chronic pain had an average of a 42-minute sleep deficit between the amount of sleep they need and the amount they are getting.

“The relationship between pain and sleep is complex, as the consequences of sleep problems can affect perception to pain and, in turn, pain can interfere with sleep quality,” said Professor Robert Landewe, Chairperson of the Scientific Programme Committee, EULAR. “This is why these studies are important as they help elucidate the role of sleep in chronic pain and highlight it as a potentially important modifiable risk factor for alleviating the distress in these patients.”

Researchers also wanted to see if sleep problems could predict the eventual onset of chronic pain. The four sleep factors they analyzed were:

Initiating Sleep
Maintaining Sleep
Early Morning Waking
Non-Restorative Sleep

According to researchers, all factors except early morning waking predicted the onset of chronic widespread pain at 18 years.

“Our results demonstrate that sleep problems are an important predictor for chronic pain prognosis and highlight the importance of the assessment of sleep quality in the clinics,” said Katarina Aili, PhD, of the Spenshult Research and Development Center in Sweden.

Anxiety and Chronic Pain

In the second study, researchers explored the link between chronic pain, anxiety and the inability to achieve restful sleep. When compared with a normal population, individuals with chronic pain were much more likely to report both anxiety and severe sleep problems.

“Although the relationship between sleep and pain is complex, our results clearly indicate a strong association which needs to be explored further,” said Julia S. Malmborg, PhD student at Halmstad University. “As both problems affect the physiological and psychological well-being of sufferers we hope that these results will be used by school health professionals to promote student health.”

Getting good sleep is hard enough before chronic pain gets in the way, but if you want to give yourself the best chance to fall asleep and stay asleep, consider the following tips:

Avoid caffeine within three hours of going to bed.
Avoid working out right before bed.
Make the bedroom as dark as possible.
Turn off distractions like the television or your phone.
Invest in a supportive mattress and pillow.
Keep the bedroom temperature cool.

For more tips on maintaining healthy sleep if you have chronic pain, reach out to Dr. Cohn today.

NIH Issues New Plan To Tackle Opioid Crisis

June 12, 2018 / Thomas Cohn, MD

Earlier today, the National Institutes of Health issued its new plan for taking on the opioid crisis in America. The plan is titled Helping to End Addiction Long-term, or HEAL. The plan has two main goals:

Fund projects that will help develop or facilitate treatments for opioid addiction and overdose.

Fund projects that are meant to improve the management of pain through research into how acute pain transitions to chronic pain, as well as research nonaddictive pain treatments.

“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit,” the authors wrote. “Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction.”

Treating Addiction and Overdose

For starters, researchers want to take a closer look at how we’re currently battling addiction and overdose. Through their research, they found that there are three main drugs prescribed to help wean people off of opioids. Researchers found that most people living with opioid addiction never get started on these treatments, and of those that do, half of them relapse within a year.

“Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have opioid use disorder,” the authors wrote.

The NIH also wants to fund efforts to create better drugs for reversing overdoses, especially among individuals who overdose on fentanyl. The current reversal drug is naloxone, and it isn’t as effective as experts want it to be when the overdoser has other drugs or alcohol in their system.

Treating Addiction Before It Starts

The second part of the initiative focuses on coming up with better pain treatment plans and stopping pain before it become chronic. This is what we’ve been championing for on the blog for years. We need to treat addiction at the source, and the underlying reason behind addiction is unaddressed pain. We need to find better ways to treat and manage pain conditions so they don’t progress to the point where opioids are needed.

Funding for both parts of the plan will come from a $500 million grant that Congress set aside for the NIH in the 2018 budget

The Only Advice You Need For Treating Chronic Pain

April 3, 2018 / Thomas Cohn, MD

Chronic pain comes in so many unique forms, and everyone experiences pain differently. Consequently, there is no one-size-fits-all solution to chronic pain. So as the title of this blog implies, how are we going to provide you with the only advice you need for treating chronic pain? Read on to find out.

Managing Chronic Pain

When it comes to managing carpal tunnel, lumbar spine pain or chronic migraines, there’s really only one piece of advice you should abide by when caring for your condition, and that’s this – Find what works for you, and stick to it.

As a medical professional, I always want to do my reading and examine the science behind pain management techniques. That’s why I’m hesitant to unconditionally provide support for things like medical marijuana and Kratom. There’s simply so much that we don’t know about individualizes strains and how they react to each person individually for most doctors to 100 percent support their use to treat pain.

That being said, we can 100 percent support a person who has found a relief through these methods. At the end of the day, our goal as pain specialists is to help you manage, reduce and ultimately eliminate your pain. If one of these solutions works for you, we’re going to be your biggest supporter, but that doesn’t mean we’ll blindly prescribe the same treatment for someone else dealing with a different pain problem. What works for one may cause a rash of problems in someone else. If there was a magic pill to treat pain, our job would be easy, but there’s not, so pain care requires a highly individualized approach.

Finding What Works

As I’ve mentioned on the blog before, I have struggled with my own pain problems throughout my life. I deal with regular occurrences of back pain, and it took me a while to find out what works to reduce flare ups and keep pain from controlling my life. It’s rarely easy, but that’s the challenge of pain care. I have to make time to get regular exercise, to eat healthy foods and to stretch before a partake in activity. It would be easier to stay on the couch or sleep in a little longer, but I know that doing so means a day with more pain. By finding what works and sticking to the plan, I’ve been able to take control of my back pain.

You can do the same. Whether that involves exercising in the evening, avoiding caffeinated beverages, a daily Kratom pill or acupuncture, when you find something that works, stick with it, but also build on it. If morning exercise helps, see how you body responds to morning exercise and another therapy technique. Keep trying new things until you’ve optimized a treatment plan that greatly reduces or eliminates your pain. Remember that it’s not going to be easy, but if you’re truly committed to finding a solution, you’ll make these treatments a priority.

If you need help developing a care plan or figuring out new treatment techniques to try, don’t hesitate to reach out to our clinic. Because at the end of the day, we want to find a solution that works for you.

Apitherapy – Why All Alternative Treatment Options Aren’t The Same

March 29, 2018 / Thomas Cohn, MD

If you’ve been following our blog for some time, you know that our goal is to help everyone find a solution to their pain problem. If you find something that works for you, then stick with it. That being said, not all alternative methods are created the same, and some can be downright dangerous.

That’s the lesson we learned when a 55-year-old woman recently died due to complications from apitherapy. For those of you who know your word origins, you might be able to figure out what apitherapy is – bee therapy. More specifically, apitherapy is known as live bee acupuncture.

Apitherapy Gone Wrong

We’re not saying the therapeutic technique is bonkers, because some people swear by it, and as is our motto, we want everyone to find a solution to their individual pain problem, so if it’s working for you, more power to you. That being said, even if it seems safe, it’s clear that we don’t know as much as we thought we did about the therapy technique.

According to the news reports, the 55-year-old woman had been undergoing apitherapy for more than two years without problems. However, during her most recent session, she developed a severe reaction and began wheezing, coughing, and suffering from shortness of breath. She eventually lost consciousness and was taken to an emergency facility. She died a couple weeks later of multiple organ failure. Medical researchers are saying it’s the first documented apitherapy death where the individual had previously been tolerant of the bee stings. Medical researchers who studied the woman’s case concluded that apitherapy is an “unsafe and unadvisable” treatment option.

Like a lot of things in this world, apitherapy has become more popular after being championed by an uninformed celebrity. In 2016, Gwyneth Paltrow touted the “thousands-of-years-old treatment” as something she tried for an old injury. Gerard Butler also said he received a bee sting injection in an attempt to calm inflammation from stunt work, but he ended up hospitalized after having a poor reaction to the injection. He said he felt like his heart might explode and it was as if he had ants crawling under his skin.

What Doctors Are Saying

The theory behind apitherapy is that bee stings cause inflammation, which in turns leads to an inflammatory response from your body. The hope is that the inflammatory response will address both the inflammation from the bee sting along with other local inflammation in the joints.

Doctors say patients considering the therapy should be fully informed of the dangers of apitherapy prior to treatment. They also recommend that measures be taken to identify if someone could have a bad reaction before receiving a full injection, and that practitioners should be trained in how to manage severe reactions and that they should have specific reaction medications on hand. There should also be a system where the patient can receive emergency response care in a quick manor if needed.

“The public need to be very aware of the unorthodox use of allergens such as bee venom,” said Amena Warner, Head of Clinical Services for Allergy UK. “This will come with risk and, in susceptible individuals, can lead to serious life threatening reactions.”

Want To Improve Your Core and Spine? Try This One Exercise

March 26, 2018 / Thomas Cohn, MD

plank Plank exercises are a simple way to work on core strength. They can also be used as part of an overall program to build strength and can even be used as part of an aerobic conditioning program. The nice part of this exercise is that they do not require any extra equipment. As one makes them more challenging, weights and balance balls can be added. The most common planking position is holding the position of the body straight while balancing on bent arms at the elbows, and the with the legs stretched out on your toes.

Muscles Used In Planks

Planks look easy but it takes a lot of muscle strength to keep the body in a good position for even 30 seconds. The muscles used include abdominal, back, arm and shoulder. Specific primary muscles are the erector spinae and abdomimal wall muscles. Secondary muscles, or stabiliziers, include the trapezius, rhomboids, rotator cuff, deltoids, pectoralis and serratus anterior, and in the lower body the gluteus maximus, gastrocnemius, and quadriceps. Regular planks use muscles all along the spine, shoulders, abdomen, pelvis and legs.

Once the regular basic plank is routine, it can be made much more difficult to keep things challenging. The next level is doing side planks. This is holding a plank type position on either side of the body. Side planks activate abdominal muscles, some of the spine and shoulder muscles, and a lot of the pelvic, gluteal, hip and upper leg muscles. The nice thing is this a whole different set of muscles that can be strengthened, and again one needs no special equipment.

Planks can still be made even harder with a variety of techniques. In a standard plank, a person has four points of supports using the arms and legs. Move to three points of support and the exercise becomes significantly harder. Balancing on the feet and one arm at time stresses more upper body strength. Lifting off one leg requires more abdominal, back and arm stabilization. Maintaining good form for even 30 seconds is extremely difficult. With side planks, one has two points of support in general, so increasing the workload can be achieved with raising and lowering the upper leg, strengthening the hip muscles even more.

For true punishment, planks can be made even more difficult in two ways, decreasing the stability of the platform for the feet or arms, and adding weights to use with the arms or legs. Doing planks with the use of a wobble board, movement ball, half sphere – Bosu, or balance platform adds the challenge of maintaining position without tipping over or falling. Adding light weights of a few pounds to the arms or the legs can add more to the strengthening.

Controlling neck, back, shoulder, and pelvic pain all involve improving your core muscle strength. Working on strengthening does not take a fancy gym with expensive equipment, it can be done simply at home. Start a program with planks and see how difficult working on the core muscles can be.