Could A Pinched Nerve Be Causing My Pain?

July 20, 2015 / Thomas Cohn, MD

A pinched nerve is one of the more common reasons people experience back pain. Because your back is such a complex structure, it doesn’t take much for it to get out of whack. When there’s too much pressure on the nerve – be it from bones, cartilage, muscles or tendons – it can get compressed and cause pain. Although your back is one of the more common places for a pinched nerve to occur, compressed nerves aren’t isolated in your back. You can also suffer pinched nerves in your neck, legs and arms.

Symptoms of Pinched Nerve Pain

Common symptoms of a pinched nerve include:

Numbness or decreased sensation in the affected area.

Sharp, tingling or burning pain in the area.

A tingling or a “pins and needles sensation” in the area.

Muscle weakness.

Shooting pain or sensation in the back, neck, arm or leg.

Worsening pain while sleeping.

Movement can exacerbate or alleviate symptoms, but exercise and activity is almost always recommended. Movement will usually help loosen the tissues that are pressing on the affected nerve. As we’ve mentioned before, exercise and physical activity is great for combating pain-related conditions.

Treating Pinched Nerves

Unless pain is severely debilitating, most people try to let the condition heal on its own. As you might have guessed based on the above paragraph, physical therapy is one way people try to correct their pinched nerve. A PT can teach you specific exercises to strengthen and stretch muscles to relieve pressure on the nerve.

In additional to physical therapy/activity, a common treatment option for those suffering from a pinched nerve is anti-inflammatory medications. If inflammation is the root cause of the pressure, NSAIDs can be the perfect remedy. More often than not, though, anti-inflammatory medications need to be paired with other treatment options to fully fix the issue.

One final non-surgical treatment option for pinched nerves is a corticosteroid injection. The injection can minimize pain and discomfort as well as reduce inflammation in the area. If you have a fear of needles, the steroid can be taken orally as well.

Pinched Nerve Surgery

If your pinched nerve doesn’t improve after several weeks of conservative treatment, surgery may be your best bet. Surgery will free the nerve from its compressed state, and your doctor can remove scar tissue or problematic bones spurs that might be causing the condition.

As you might have guessed, the type of operation depends on where the nerve is located and what’s causing the compression. For example, a pinched nerve in the arm could be relieved by removing bone spurs, a compressed nerve in the back could be alleviated by removing a herniated disc, while a nerve issue in the wrist could be treated by cutting ligaments to give nerves more room to “breathe.”

If you have pain in your back, or you are experiencing similar symptoms in another part of your body, swing into a physical medicine specialist right away!

Minnesota on the Eve of Medical Marijuana

June 29, 2015 / Thomas Cohn, MD

Recently there have been excellent reviews on the state of the science of medical marijuana. Minnesota is about to start its program, but only a handful of people have been approved for the program and there are not many providers interested in participating. So why is medical marijuana off to such a slow start in Minnesota?

Medical cannabis is a complex subject, after attending many lectures on the subject, and reviewing significant amounts of literature, the one main conclusion is that the science behind cannabinoids is only in its infancy. For the average reader, the Time Magazine May 14, 2015 and the National Geographic July, 2015 issues have good information. At a higher level for medical science, the June 23/30, 2015 issue of the Journal of the American Medical Association has more data.

US Lags Behind

The United States has not been a leader in the study of marijuana. Since marijuana has been labeled a Schedule 1 compound by the DEA, its scientific analysis in the U.S. has been extremely limited. Some of the best research initially has come out of Israel where many of the cannabinoid compounds have been isolated, and in Spain where some of the cancer research and other studies have been done. The most recent issue of JAMA has reviewed a large number of medical studies with regards to a variety of conditions. For the scientist, it is clear there is a significant shortage of information supporting claims of effectiveness of the compounds for most conditions. Most information is based on a very limited numbers of study participants. Comparing the information to almost all other drugs on the market, these studies would barely qualify for drug approval.

The quality of studies for marijuana and chronic pain has been especially limited. The studies researched include neuropathic pain and cancer pain. Most of the studies just looked at a numeric pain scale to measure success and did not quantify any other objective measure like functional ability. The outcome was a modest improvement in reported pain level, but deeper evaluation did not show any changes in quality of life measures when compared to placebo or standard treatments.

After reading multiple articles on cannabinoids and pain, one clear message is present. First, there are a number of different cannabinoid compounds, probably well over a hundred. Second, the chemistry is poorly understood and the effectiveness to treat a variety of medical conditions is limited. Medicine has become a very science driven field. Physicians are constantly under fire to provide care that is safe and effective. The current status for medical marijuana is truly still in the research phase. We won’t be able to fully embrace medical marijuana as a viable option until we know more about all of its compounds.

Talking Therapy May Help Ease Chronic Pain

June 19, 2015 / Thomas Cohn, MD

Talking therapy, where patients focus on easing psychological stress to make it easier to complete physiological activities, may be another avenue for chronic pain sufferers.

The therapy – also referred to as Contextual Cognitive Behavioral Therapy or CCBT – works by helping people overcome stress that can exacerbate chronic pain symptoms. For example, some people with chronic pain may become stress/fear avoidant, meaning they’ll avoid certain activities simply because they fear the potential outcome. Not only can limited activities make a chronic pain condition worse, but it can also make it harder for the patient to fully overcome the condition.

“We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments,” said Dr. Stephen Simpson, director of research and programs at Arthritis Research UK. “This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”

Talking Study

For their study, researchers recruited 89 patients with chronic back pain and split them into two groups. The first group received just physiotherapy, while the second group received CCBT and physiotherapy. After completing their assigned therapy, researchers noted that physiotherapy was more successful if patients also received CCBT. Additionally, patients who received both therapies said they believed CCBT helped them be successful in physiotherapy.

“Our study found that CCBT is acceptable to patients,” said Tamar Pincus, a professor at Royal Holloway University of London. “Interestingly many patients who took part, as well as several of the clinicians involved — both psychologists and physiotherapists — thought the best treatment was a combination of both physiotherapy and CCBT.”

Researchers concluded that physiological treatment is just as important as physical treatment when dealing with chronic pain, as mental therapy can improve patient conditions and reduce treatment costs.

Related source: UPI.com

Regular Exercise Isn’t Easy, But It’s Worth It

June 3, 2015June 3, 2015 / Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.

Addressing The Problem Of Physician Burnout

May 27, 2015May 28, 2015 / Thomas Cohn, MD

One of the front page articles this week in the StarTribune explored the subject of doctor burnout. Every job comes with stress; Medicine is not immune to stress and burnout is becoming a more recognized phenomenon. Many jobs have the pressure to perform, but many doctors try harder to push through the stress and daily duties. Recently, we began to realize we are no different than everyone else.

Medicine has for a long time been a very strenuous career. The academic requirements and training are very difficult. Most of us started our careers with residency training involving workweeks that exceeded 80 hours, and we continued working 50-60 hours each week after residency was complete. The time spent seeing patients is only a fraction of the time spent – many more hours involve paperwork, patient preparation, administrative tasks, and continuing education. Family and fun time become eclipsed by work requirements, and sleep is an afterthought.

Daily Doctor Stresses

Stress becomes a lifestyle. Seeing patients and being able to identify the correct diagnosis and treatment is always a challenge. Many physicians also perform complex procedures that could easily cause significant damage if something goes wrong, adding to the stress. Then, if patient is at all unhappy, we may have to deal with administrators questioning the encounter or the possibility of being sued.

Preventing stress and burnout in any profession is necessary. One may be busy, but to prevent burnout, one needs to take time out from work. Physicians need to do this just like everyone else. Some physicians take extended breaks from practice, taking months off at a time. They do charity work and get away from their normal practice. Others limit their work hours. Many try to find outside interests to focus on to reduce stress. No one goes to their graves saying that they wished they spent more time at work.

Work is only a small part of life. Maintaining outside interests is essential. Stress comes as part of the profession. Ways to handle the stress include maintaining good fitness and having outside interests that you enjoy. Often, the outside interests of a physician can be seen readily at their offices. A physician with no outside life besides medicine may be more likely to become burned out. Stress reduction for everyone is necessary. It is summer time and now is a time to be outside and enjoy the world.