back pain

Connecting The Medical Dots

/ Thomas Cohn, MD

Medicine today has become fractured. Primary care does basic analysis of a problem and basic care of that problem, while specialists have become such experts that they often can not see past their own rabbit hole. Few doctors are willing to look at the whole picture, analyze the patient as a person and all the problems presented. When someone takes the time and connects the dots, something special happens, and a path to the future can be found. For many patients, finding the doctor that has the experience to listen, to ask the right questions and to find the source of the problem can take years.

One Patient’s Dots Become Connected

Being a patient can be very frustrating. The other day I had a new patient with back pain, which is a pretty normal complaint for a referral. The patient was referred from an orthopedic spine surgeon who felt the patient was not a candidate for surgery. She was in her mid-30’s and had neck and upper back pain. She also has had longstanding scoliosis, a prominent curvature of the spine, and she had been to a number of previous providers for the problems and wants answers and a solution.

I usually work with a scribe. When I started my visit with the woman with scoliosis, she was fascinated. Within in a couple minutes and a few choice questions, my scribe saw a light in my brain go on and the discovery of the unifying diagnosis that no one in the past had a clue about. The patient had scoliosis, but had been double jointed, had shoulder and knee joint issues, had heartburn, and cardiac problems. She also had siblings that were double jointed. The unifying theme was a genetic-based connective tissue disorder, probably a form of Ehlers Danlos syndrome or Marfan’s disease. This will need to be confirmed by further testing and probably genetic testing.

Finding a diagnosis that connects the dots changes the whole picture of a problem. It no longer is a set of random of events causing pain. Now there is a reason and a pathway to follow to manage the problems. There is also knowledge about the course of the disease and a way to anticipate future medical issues.

Unfortunately, most patients never can connect the dots. Primary care physicians often do not have the time to address more than one problem at a visit. Specialists are only interested in their small corner of the world. My world often consists of looking at odd medical issues. Many times helping a patient means having to analyze the past, ask a few questions, closely listen to what a patient says, and bringing together the story to develop a pathway to the future.

The best patient care is provided by those providers who can see the big picture. Medicine has been fractured by the pressures to see as many patients as possible if providing primary care, or staying in your specialty only for others. Seeing the big picture and connecting the dots is a lost art. Changing lives for a patient means being able to go beyond the ordinary and really trying to answer the all their questions to uncover a long-term solution.

Chronic Pain In College Part 2 – Pain and Your Job

/ Thomas Cohn, MD

(Below is Part 2 of a four-part series on chronic pain in high school and college. It was penned by a college student who has dealt with chronic pain throughout her academic career. The four-part series will cover four important aspects of college life – Academics, Dating, Employment and Social Life. Here’s Part 2 on how holding a job while in school can be difficult if you deal with chronic pain. Part 1 on Chronic Pain and Academics can be seen here.

How Chronic Pain Affects Your Job

Working With PainIf you struggle with chronic pain, I’m sure the thought about getting and keeping full-time employment will have crossed your mind at some point or another. From my experiences I can offer suggestions and a few pieces of advice.

As you search for a job, search for a company that is employee-focused and cares about everyone in their company. Many companies will have similar positions for people of a certain major, but one of the biggest differences in the job you have comes from the company and culture at your workplace. Companies that stress work flexibility and employee support are the places to seriously consider because they will be more likely to offer flexible work hours (allow for doctor appointments, leave early on a bad pain day and work late another, etc), flexible working location (home or in-office), ergonomic work stations (sit-to-stand desks, supportive chair, etc), and other services for employees such as a gym, nurse, or physical therapists on-site.

During an interview, it is perfectly appropriate to ask questions that relate to company culture, how employees are treated and any other specific questions you have to help give you an idea of whether or not that company goes out of their way to make sure employees can comfortably and effectively get their work done. Once you have the job offer, you can ask HR more specific questions, including any concerns you might have or if they can make any accommodations before you accept the offer. When you start working (whether it’s a summer job, part-time position, internship, or full-time role) speak to your boss and project manager about your health and how it can sometimes affect how you need to work. If you don’t share this information, you won’t be able to ask for working accommodations and they won’t be able to understand what’s going on and how to help you to be successful at work.

Personally, I have found being up-front and honest really helped me because my project manager was able to look into ergonomic work stations and was very understanding if I had to leave in the middle of a day for a physical therapy appointment, go home early or even work from home on a day that my pain was bad. If you put in the effort to research the places you want to work at on sites like Glassdoor, Business Insider, and the company’s website, and you speak to your HR representative about work accommodations, I have no doubt you will be able to work in the field of your choice even while dealing with chronic pain.

Part 3 on Chronic Pain and Social Life in College will be published on Wednesday.

Chronic Pain In College Part 1 – Pain and Your Grades

/ Thomas Cohn, MD

Minneapolis Grades Pain School(Below is Part 1 of a four-part series on chronic pain in high school and college. It was penned by a college student who has dealt with chronic pain throughout her academic career. The four-part series will cover four important aspects of college life – Academics, Dating, Employment and Social Life. Here’s Part 1 on how Chronic Pain can make studying for exams and getting good grades even more of a challenge.)

What can I say, chronic pain sucks sometimes. That said you can still live an “almost normal” life as a young adult with chronic pain. Personally, I’ve been dealing with chronic pain in my neck and back since 2008 when I had my first of four back surgeries to correct my severe scoliosis. Over the last almost eight years, I’ve grown into a young adult, and I am attending college to obtain an engineering degree while dealing with a plenitude of medical appointments in addition to trying to enjoy college and life in general. I intend on addressing the following topics of concern among young adults with pain—getting through school (high school, college, technical training, etc.), working and keeping a job, having a significant other, and day-to-day life enjoyment.

Chronic Pain and College Grades

Having any medical condition that can affect class attendance and performance can be difficult and daunting for many as they think about pursuing higher education. Throughout grade school, middle school, and high school your parents can work with the health office to create a 504 plan in order to address your needs. I found it helpful to have a second set of textbooks so I could keep a set in my locker and a set at home so I wouldn’t have to carry a heavy backpack. If your pain causes problems during exams you may want to look into extra time or extended breaks for exams to be added to your 504 plan. While many teachers at the high school level will allow you the time needed to finish an exam, if this could affect standardized tests such as ACT/SAT and others, you will need 504 documentation in order to apply for these accommodations on standardized tests.

If you are in the process of touring colleges or looking up universities and know you have chronic pain, look into the resources the school offers for “students with disabilities.” At my university, we have a “Services for Students with Disabilities Office” that helps everyone with anything from a temporarily broken arm, to ADHD and chronic pain. Personally, I’ve found the office very helpful in providing documentation to professors and needed accommodations.

Some helpful things to consider as you begin college while dealing with chronic pain include:

  • Getting notes from the professor or using a scribe to take notes for you in class.
  • Talking with your teacher at the beginning of the semester about the possibility of getting extra time for assignments & excused class absences in the event you have a pain flair.
  • Extra time or stretch breaks during classes and exams.
  • Book scanning services (to have a digital version of textbooks to reduce backpack weight).
  • Look into scholarships to purchase an iPad (light-weight computer alternative).

After looking into a combination of the above-mentioned accommodations, I find myself much more easily able to meet the academic demands at a top university. Being proactive about your chronic pain from the moment you step foot on campus will help prepare you for an inevitable flare up, will help professors learn of potential issues before a problem arises (this is key), and help prevent symptoms from worsening. It’s not easy, and you’ve got enough on your plate as a new college student, but it’s crucial to be proactive.

Part 2 can be viewed here.

DARPA’s Role in Solving Chronic Pain

/ Thomas Cohn, MD

DARPA Pain SartellThe Defense Advanced Research Program Agency, known as DARPA, has a new project. DARPA is the agency that first fostered the development of the driverless car and a number of robots for both civilian and military purposes. It is the research wing of the military and it works on developing new technologies that may benefit the military as well as everyone else.

The latest project is the Electrical Prescriptions (ElectRx) program. It is designed to discover the science and technology that will stimulate the peripheral nervous system to detect and fight disease. The goal is to establish a better understanding of the nervous system and how it functions in health and disease.

The government has not spent significant money on pain in the past. Now DARPA is going to push major funding into the research area of understanding the nervous system, how it is injured, and what causes chronic disease. Then they plan to research how to use science and technology to modulate the nervous system. There are going to be seven research teams working over the course of four years to move the needle to improve our understanding of what goes wrong in injury and disease and to develop new technologies in treatment.

DARPA’s Plan

According to program manager Doug Weber, DARPA hopes to create fundamental changes in how we manage diseases and injuries.

“Through the combination of a growing understanding of how the nervous system regulates many aspects of our health and advancing technology to measure and stimulate nerve signals, I believe we’re poised to make fundamental changes to the way we diagnose and treat disease,” said Weber.

To that end, seven teams of researchers have been selected to research and demonstrate a way to modulate the nerves artificially so a healthy signal flow can be maintained for self-healing.

DARPA hopes to implement therapeutic stimuli when unhealthy activity in the nervous system occurs as an alternative to traditional treatments for chronic pain, inflammatory diseases, and PTSD among many possible conditions. The influx of a significant funding and research into the understanding of the nervous system in health and injury hopefully will lead to new and better treatments of pain. This appears to be a very positive step forward for the field of pain, however it will be several years before we know the results.

Desk Workers Have High Rates of Lower Back Pain

/ Thomas Cohn, MD

Desk Back Pain MinneapolisA three-month study that examined back problems of sedentary and active workers found that desk workers were more likely to end up in the doctor’s office with back pain.

The study examined employment data from 1,300 people who said they deal with spine-related pain. Researchers said that desk workers outnumbered field workers by a rate of 4 to 1. Additionally, one in four participants with a desk job had more than  one spine-related problem, like neck and back pain, or shoulder pain and finger numbness.

“Our data shows that half the patients with sedentary jobs had lower back pain,” said Dr. Garima Anandani of Qi Spine, the clinic that conducted the survey.

Growing Epidemic

According to the World Health Organization’s Global Burden of Diseases study, which was conducted in 2010, lower back pain caused by a person’s job is a growing problem. Lower back pain was the leading cause of absenteeism from work in 2010.

“People sit on chairs for 10 to 12 hours,” said Dr. Anandani. “Moreover, they tilt their heads to cradle a phone while typing. These factors affect the biomechanics of the body.”

Dr. Anandani said the best way to combat back pain during your time at the office is to focus on your posture. Some tips to keep in mind while working your desk job include:

  • Stand up for five minute every 30 minutes
  • Keep your back straight, don’t hunch over your computer
  • Consider a stand up desk
  • Keep your head positioned over your spine, not out in front of you
  • Consider a headset for phone calls, so your neck isn’t torqued to the side when you’re on a call
  • Exercise each day when you get home from the office.

If pain persists and exercise and anti-inflammatory medications aren’t working, consider visiting a back specialist. They’ll be able to diagnose the underlying problem and help chart a course of recovery.