Working Through Chronic Pain

May 18, 2015 / Thomas Cohn, MD

Living with chronic pain isn’t easy. Some people are awarded full or partial disability, but for many people, those benefits eventually run out or their claim is denied altogether. Because of this, many people are forced to work, even with debilitating chronic pain. Today, we share some tips for getting through the work day with chronic pain.

1. Move Around

You might think you’re making your pain problem worse by moving around, but staying sedentary for long periods can actually trigger chronic pain. For example, if you’re dealing with chronic back pain, staying seated in one position can actually put more strain on your back. Moving around helps build muscle and helps regulate blood flow to affected areas. Try to get up and walk around for five minutes every hour. This doesn’t necessarily mean you need to take a break every 60 minutes – just find an excuse to walk around. Deliver those memos to accounting by hand or walk around while you’re talking on the phone.

2. Don’t Overdo It

While you want to move around, you don’t want to overdo it at work. It may sound obvious, but a lot of workers want to prove to themselves and their coworkers that their pain condition won’t hold them back at work. Lifting heavy boxes or equipment can exacerbate a previous pain condition. Talk to your boss about your condition so there are no surprises when you return to work. If you can’t preform all the typical duties, talk with your boss or your coworkers about other ways you can contribute. For example, instead of loading boxes onto the truck every Friday, maybe you can compile the weekly productivity reports. Being open and honest about your limitations means there will be no confusion about your job duties.

3. Tell Your Boss

As we mentioned above, it’s important to talk to your work superiors about any limitations you might have because of your chronic pain. Lying or trying to hide your pain can be extremely problematic. First, it can affect your disability benefits. If you tell your insurance company that your injury is preventing you from completing all your tasks, but you attempt to push through the pain and complete them anyway, your insurance can deny your claim. On the other hand, if you don’t open up about your condition to your boss, he or she might not be as open to hearing why you didn’t finish a certain task.

4. Adjust Your Schedule

This one again goes hand in hand with the above point. If possible, try to adjust your schedule to accommodate your pain. For example, if you are supposed to take water therapy classes to alleviate your back pain, and the classes are only offered at 8am on weekdays, but you normally work 8am-5pm, ask your boss if you can work from 9am-6pm on Tuesdays and Thursdays so you can get to your treatment. If you can’t adjust your work schedule, do your best to adjust your personal schedule so you can best manage your pain condition.

Another NASCAR Driver Dealing With Problematic Pain

April 22, 2015 / Thomas Cohn, MD

Denny Hamlin is the latest NASCAR driver to have his season impacted by debilitating pain, as he needed to withdraw from Sunday’s race at Bristol Motor Speedway with neck pain.

Hamlin told reporters that he pulled something in his neck during the 12th lap, and he didn’t feel want to compete if he thought he was a danger to others.

“I can’t move my head or neck like I need to, and I’m not doing this team any justice if I go out there like this,” Hamlin said after withdrawing from the race. “I have no idea what happened. I think it’s just a pull, something where you jerk your head around and you feel a pain. Almost like you slept on it wrong.”

It’s surprising that the injury occurred so early in the race. We’ve shared ideas for avoiding pain and injuries while driving in the past, but NASCAR drivers don’t typically have the luxury of getting out of their car and stretching to break up the drive.

Despite pulling out of Sunday’s race, Hamlin said he plans to compete in three races this week, which seems a little aggressive for a driver who only completed 22 of 500 laps last week. He added that he’s received treatment early this week, and he’s excited to compete this week at a track 20 miles from where he grew up.

“After treatment this week, I feel close to 100 percent, and I’m confident that I’ll be good to go this weekend in Richmond,” Hamlin said. “It’s a great track for our team, and one that means a lot to me personally. Hopefully we can go out there and compete for the win.”

Another NASCAR Injury

Hamlin’s neck pain is the one of the first NASCAR injuries we’ve heard about this year, but last season the injury news centered around Jeff Gordon, who claimed that chronic back pain could force him into retirement. Over the course of his career, Gordon has undergone professional treatment, strengthening exercises and received anti-inflammatory medications and cortisone injections to manage his back pain.

Although he hasn’t publicly stated that it’s due in part to his back, Gordon has already announced that this season would be his last full-time season in the Sprint Cup Series.

I’ll keep tabs on Gordon and Hamlin as the NASCAR season progresses, but under the playoff structure, Hamlin has already qualified for the Chase for the Sprint Cup championship, so it wouldn’t be surprising if he missed some races to ensure he enters the Chase as healthy as possible.

1 in 4 Misuses Chronic Pain Meds

April 15, 2015 / Thomas Cohn, MD

New research published in the journal PAIN suggests that approximately 20 to 30 percent of opioids prescribed for chronic pain are misused. Additionally, the current rate of opioids addiction hovers around 10 percent.

“On average, misuse was documented in approximately one out of four or five patients and addiction in approximately one out of ten or eleven patients,” who were prescribed pain pills as part of their treatment for chronic pain, said Dr. Kevin E. Vowles and colleagues. They added that the new findings provide “updated and expanded” estimates of the opioid problem in America.

Increased Prescriptions, Increased Addictions

To see how increased opioid prescriptions have fueled pain pill addictions, researchers analyzed 38 reports to measure three separate opioid-related problems:

Misuse
Abuse
Addiction

Researchers examined documented cases of dependence, withdrawal and overdose to come to their conclusion. Opioid misuse was classified as “using opioids contrary to instructions, regardless of harmful or adverse effects.” After adjusting for variables, researchers concluded that between 21 and 29 percent of people who are prescribed opioids misuse them.

“If it is accurate that approximately one in four patients on opioids display patterns of opioid misuse, but not addiction, then perhaps more efficient targeting of treatment resources would be of benefit,” said Dr. Vowles.

As for opioid abuse, which is classified as continued opioid use with actual or potential harmful effects, researchers suggested that about 8 to 12 percent of patients abuse their medications.

Dr. Vowles and colleagues concluded by saying that physicians should seriously evaluate if a patient is a good candidate for an opioid prescription, as the dangers seem to be outweighing the benefits.

“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”

Related source: Medical News Today

Back Pain Can’t Keep Tiger Woods From The Masters

April 8, 2015 / Thomas Cohn, MD

Tiger Woods will end his nine week hiatus from professional golf this week as he prepares to tee up for the Masters.

Tiger’s 2015 season got off to a rough start when he missed the cut in his first event and withdrew from his second event with back pain. After withdrawing in his second tournament, Tiger decided to take some time off to get his head and health in the right position to complete for a major championship.

I actually predicted that Tiger would take some time off after withdrawing from a tournament in early February. After that tournament, Tiger had withdrawn from 7 of his last 9 tournaments, which is unheard of in today’s game. Instead of continuing to play through the pain and just hoping things got better, Tiger decided to step away from the game and focus on getting his body right.

When asked about his rehab and strength conditioning leading up to the Masters, Woods said that he “worked his ass off. That’s the easiest way to kind of describe it. I worked hard.”

The Importance of Exercise As We Age

Exercise is important at any age, but it’s even more important as we get older. Tiger Woods turns 40-years-old this year, and he can no longer get by on his talent alone, especially when his body is breaking down from years of strenuous twisting and torquing. He’s had documented problems with his back, knees and shoulder, and although he would ideally take more than nine weeks off, he made the right choice to leave the tour and re-work his health and his game.

As I always tell my patients, there is no magical pill or injection that will completely cure you of your condition. Many options provide short-term or temporary relief, but patients also need to put in work in the form of exercise, physical therapy and rehabilitation. It’s not going to be easy, but it’s going to be worth it. This quote from Woods perfectly exemplifies that notion.

“People would never understand how much work I put into it to come back and do this again,” Woods said. “But it was sunup to sundown, and whenever I had free time; if the kids were asleep, I’d still be doing it, and then when they were in school, I’d still be doing it. So it was a lot of work.”

Despite his return to the course, I stand by my prediction from back in February. I believe Woods is more likely to withdraw or miss the cut than to be in serious contention in Sunday. Based on his quotes, it truly sounds like his health and his game are in their best forms of the year, but he’s still not 100%. I believe the tournament means a lot to Tiger, and barring significant back pain, I think he’ll go without withdrawing at Augusta, but the competition is fierce, and I just think Tiger will be fighting to make the cut instead of trying to get in Sunday’s final grouping. I wish him and the rest of the field the best of luck at the Masters this weekend.

Related source: Bloomberg

Massages For Pain Management

February 16, 2015March 18, 2016 / Thomas Cohn, MD

Massage therapy is a multi-billion dollar business. Many people who have pain love getting a massage. For pain practitioners, it is a common question whether it can be prescribed and whether insurance will pay for it. Massage definitely feels good, but it does have limited benefits. In acute pain, it does not speed recovery and studies do not support its use. In chronic pain, it does help reduce pain perception, but the mechanism of action is not well known.

There are many different types of massage; research has yet to show whether a particular form is better. Some common types of massage include:

Deep tissue

Swedish

Structural

Other specific targeted techniques.

Structural, which works on actual muscle activity and is often performed by physical therapists as part of a comprehensive exercise process, may be covered by insurance.

Massage is clearly a hands-on activity. A therapist often spends 45 minutes with direct contact with the patient. The interaction between patient and practitioner is prolonged and personal. The end result is often significant relaxation, which leads to less muscle discomfort and less pain. Whether massage changes anything physically in the body is unknown. Research has not been able to show any actual structural or hormonal changes in the body associated with massage.

Prescription Massages?

Pain practitioners are often reluctant to prescribe massage. In general, massage is considered a passive modality in treatment of a condition. Massage is something done to the patient while the patient lays still. Physical therapy and exercise requires action and activity on the part of a patient. Most pain conditions are worsened by inactivity. Pain experts try to promote a return to normal levels of activity. Being passive in treatment, which is part of massage, is not ideal in the overall management of pain. Since the goal of pain management is to have people active and moving, laying still and receiving a massage is felt to be a negative pathway.

Massage may feel good, it may reduce pain on a temporary basis, but it does not change the body and does not heal the pain. Activity, exercise, strengthening and conditioning are all essential in the long term management of pain. The goal of pain care is to improve function. Massages for pain certainly have short term benefits, but they should not be viewed as a long term solution.