back pain

Spinal Cord Stimulation For Chronic Back Pain

/ Thomas Cohn, MD

Pain is something that can quickly take over our lives. Pain can lead us to be more emotional and less empathetic with family and friends. It can hinder our ability to do things that make us feel better, such as exercise. It can take away our earning potential if we are unable to work because of the pain. In other words, pain can upend what you do and who you are.

And chronic pain like back or leg pain can be particularly overwhelming. It’s different than pain in an extremity like a finger or toe; leg or back pain starts in one spot and can radiate elsewhere and be unrelenting.

Many people start with traditional medicine such as pills or doctor visits, but those may have limited impact. They may also try natural healing, but again—the person may determine how effective those are. One treatment that works for many is spinal cord stimulation; this graphic explains what it is and how it might help.

What Is Spinal Cord Stimulation?

Spinal cord stimulation is a safe and relatively effective treatment option for certain individuals suffering from chronic back or leg pain. Roughly 80 percent of individuals who undergo SCS experience some form of relief, whether it be in the form of decreased pain, a reduction in the need for opioids or better sleep quality.

Our friends at PainInjuryRelief.com recently reached out to us with an infographic about spinal cord stimulation and asked if we’d be interested in sharing it with our readers. We are always happy to discuss new technologies and potential treatment options, so we’ve included it below. Check it out if you believe spinal cord stimulation may be something that you could benefit from.

Block Pain and Get Back to Your Life with Spinal Cord Stimulation

The Science Behind Brain Development

/ Thomas Cohn, MD

Your brain is the most complex organ in your entire body, and we are always striving to learn more about how it develops and the way it interacts with our body. Many people suffering from chronic pain are battling this condition due to a misfiring synapse in the brain or an issue in how the organ interprets signals it receives from other areas of our body.

Recently, a colleague from overseas at Sofia Medical University reached out after coming across the blog. He was interested in what we had written about the brain and its role in chronic pain interpretation. He asked if we would be interested in sharing an infographic that he developed that dives deeper into how our brain develops as we age. I believe it is a thought-provoking and informative visual guide, so I was more than happy to share it on the blog.

So please, check out the infographic below to learn more about the science behind our brain’s development.

Human Brain Development

Does Chronic Pain Increase Likelihood Of Cognitive Decline?

/ Thomas Cohn, MD

dementia pillsRecently, a new report published in the Journal of the American Medical Association suggests that there may be a link between chronic pain and the eventual onset of cognitive issues. But do these findings really suggest that chronic pain leads to an increased risk of cognitive decline, or is there something bigger going on? We take a closer look in today’s blog.

For their study, researchers at the University of California at San Francisco decided to look at how chronic pain impacted a person’s mental health. They began by examining data collected on more than 10,000 individuals over the age of 60 who were taking part in a different nationwide study. Patients in that study were surveyed about their pain scores and cognition in 1998 and 2000. Patients were then monitored over the next decade.

Chronic Pain and Brain Health

After looking at the data at the end of the study, researchers found that individuals who said they were persistently bothered by moderate or severe pain declined 9.2 percent faster in cognitive and memory tests over the next 10 years compared to those who said they were not in pain. Moreover, patients who complained about persistent pain exhibited a 7.7 percent greater chance of developing dementia than patients who did not experience regular pain.

“A persistent report of moderate to severe pain, which may reflect chronic pain, is associated with accelerated cognitive decline and increased dementia probability in a large population-representative data set of elders,” wrote first author Elizabeth Whitlock, MD, a postdoctoral fellow in the UCSF Department of Anesthesia and Perioperative Care. “Clinicians should be aware of this association, which persisted after extensive statistical adjustment for confounding health and demographic factors. Patients reporting ongoing pain may be at higher risk for current and incident cognitive impairment and physical debility.”

Pain Can Compound Mental Health Issues

The authors go on to make another key point about the problems associated with persistent pain and the onset of cognitive problems like dementia. Since individuals with pain oftentimes take opioids or other painkillers, cognitive decline can make it difficult for the patient to remember to take their pills or to get the correct dosage, which can be downright dangerous.

“Elderly people need to maintain their cognition to stay independent,” said Whitlock. “Up to one in three older people suffer from chronic pain, so understanding the relationship between pain and cognitive decline is an important first step toward finding ways to help this population.”

However, the study says the results don’t paint a perfect picture of the link between chronic pain and cognitive decline. Since a good deal of patients are on a variety of different pain medications to help control their pain, researchers said that the pills could be contributing to dementia and other cognitive problems, and pain may not play a role.

Hopefully future studies will look closer at the role opioids may play in cognitive decline. Regardless, this study is just more proof that we need to be investing more time and energy into seriously working to find solutions to the myriad of chronic pain problems in the US and throughout the world.

What’s New In Spinal Cord Stimulation?

/ Thomas Cohn, MD

spinal stimulationTreatment of chronic pain is often complicated and requires multiple strategies to solve the problem. Spinal cord stimulation is an advanced strategy in the United States, but in other parts of the world, it is often employed even prior to spine surgery. Over the last several years, there have been several new developments in the field, but whether they will help more than a few it remains to be seen.

Spinal Cord Stimulation For Pain

The science behind spinal cord stimulation goes back to 1984 when Medtronic designed the first unit. The original technology was adapted from heart pacemakers, and this concept remains about the same, except that we are pacing the nervous system instead of the heart. Over the last 30 years, research has improved in several areas including shrinking of electronic circuits as well as improved battery technology.

Besides these obvious areas, medical science has greatly advanced in understanding different components of the nervous system and diseases that may be contributing to pain. As technology has improved, the ability to electrically stimulate the nervous system has also changed. We know how to better find and block or modulate the abnormal signals causing pain. We can use multiple programs to change the pain signals and often find a variety of different things that all dampen pain, making it more manageable. Now that the batteries for these units are remotely rechargeable through the skin, the units are no longer limited by how long the battery would last.

Increased Effectiveness

Basic science has also contributed to increased effectiveness of spinal cord stimulation. We have a better understanding about how pain signals travel from the periphery of the body to the brain through the spinal cord. We now can direct signals to very specific regions of the cord to be more effective in controlling pain. For some very isolated pain situations, we can stimulate a specific nerve in the periphery of the body (known as peripheral nerve stimulation), or just as the nerve enters the spine (dorsal root ganglion stimulation). For some people, stimulating the spine at the thoracic T9 level at a high rate can not be felt, but it is effective to block pain signals. The last new pattern is known as burst stimulation, and that is using a special pattern of high frequency pulses to the spinal cord to block transmission of pain signals.

The new forms of spinal cord stimulation use a variety of electrical techniques to modify the ability of painful electrical signals to travel from the periphery to the brain. At this time, pain specialists cannot tell whether a certain type of electrical stimulation will be helpful unless a reversible trial is performed. If conservative treatment has failed to control pain, an interventional pain expert who has experience with spinal cord stimulation may be able to help determine whether this type of therapy is a reasonable option.

With the new types of stimulation available, if you are a candidate for implantable management options, this type of intervention is often an extremely successful treatment. In the right person, the success for pain control is about 70 percent, and failure is due to a variety of factors but especially due to patients disliking the electrical stimulation sensation.  As technology improves, hopefully this will be used earlier in the treatment of pain.

Vitamin D’s Role In Controlling Chronic Pain

/ Thomas Cohn, MD

vitamin d painWhen it comes to controlling chronic pain, we all know how important it is to get a restful night’s sleep, but that’s easier said than done when you’re in regular pain. However, new research suggests that adding something to the mix may help control pain and provide you with a better night’s sleep.

According to research published in the Journal of Endocrinology increasing the levels of Vitamin D in the body can help manage chronic pain conditions, including arthritis. The correlation between the sun vitamin and pain control is no secret, as previous research has suggested that the vitamin can help inhibit the body’s inflammatory response, which sometimes triggers pain sensations. Other research has shown that Vitamin D deficiency has been linked to sleep disorders, so correcting the problem may lead to a better night’s sleep, and in turn, less pain.

New Findings on Vitamin D

The newest findings regarding Vitamin D are that when used in conjunction with a good night’s sleep, it can actually make other treatment methods more effective. This means that patients who increase their levels of Vitamin D and who partake in physical therapy for their chronic pain condition may notice more pain relief than individuals who only partake in physical therapy.

“We can hypothesize that suitable vitamin D supplementation combined with sleep hygiene may optimize the therapeutic management of pain-related diseases, such as fibromyalgia,” said Dr. Monica Levy Andersen, who led the review.

They concluded that pain management specialists and primary care physicians should consider asking patients about their Vitamin D intake or begin monitoring it in order to see if increasing intake on a daily basis helps to mitigate symptoms from certain pain conditions. Now, it’s important to remember that simply taking a Vitamin D supplement isn’t going to take your pain from a level 8 to a level 2, but there’s a chance that when paired with other treatment options that it could help take your symptoms down a level or two. It’s certainly something worth exploring.