back pain

Will Tiger Woods Play in the Masters?

/ Thomas Cohn, MD

The talking heads in the sports world are active again following the latest Tiger Woods saga. Tiger barely started his latest tournament and then decided to withdraw from play with an injury. He claimed his back started to hurt again and mentioned that he was having back muscle spasms. The last tournament he shot a round of 82, 10 strokes over par, the worst round in his professional career. Tiger has now become an average golfer, no longer a superstar at golf.

Tiger Woods has probably lost his edge on two fronts, his physical skill at the game and his mental focus. The physical edge is understandable. He has had low back pain, knee problems and surgery. As an athlete, he always pushed himself to the extreme in his training. With the known injuries and the wear and tear of heavy workouts, it is likely that he has multiple regions of degeneration throughout his body. I would expect that he has multiple levels of degeneration in his spine and would not be surprised if he also had more knee issues and shoulder problems that he is not talking about. All these areas of the body are prone to degeneration and injury especially as a professional athlete.

 

A small amount of degeneration, possibly in one area of the body, may easily be overcome. However as we all age, especially athletes, and Tiger is now 39, the body has diffuse degeneration. 150 years ago, old age started around age 40, and it was common for people to die before 50. The body has been built structurally to only last this long, but modern medicine has allowed us to survive much longer. Tiger is now an old man. He is definitely past his physical peak of performance, and to expect him to dominate the younger competition is unrealistic. The ability to make the body work absolutely perfectly to be the best is almost impossible if the parts are not functioning correctly, and his back and knees are definitely damaged goods.

Mental Factor

Golf is not only a physical game, it is a mental challenge to concentrate and get the body to function correctly. It also is a challenge to ignore the pressure to perform and not be disturbed by all the surrounding distractions. Mentally, with a bit of pain from his back or his knees, the ability to concentrate is broken. When you add in other mental distractions like family issues, media attention and the eyes of everyone on the course, Tiger has more than his fair share of mental obstacles to overcome.

Tiger Woods has been a great golfer. He is the ultimate competitor, which has helped him get to the top of his game, but it may also be his downfall. He needs to take time off and get his body right. This could include surgery and would definitely include rest and physical therapy. The problem is that he’s so intent on playing in major tournaments (and preparing for those tournaments with smaller events) that is doesn’t seem like he’ll ever give his body enough time to heal as fully as possible. He’s withdrawn from seven of his last nine tournaments, which is unheard of in this day and age. They say the definition of insanity is doing the same thing and expecting different results. Tiger keeps pushing his body without letting it heal, and he continues to think he can make it through 72 holes, but in the end he usually withdraws. Why should we expect the cycle to change without intervention? We all suspect Tiger will play in the Masters, but he’s much more likely to miss the cut or withdraw mid-tournament than to bring home the Green Jacket.

Signs of a Bad Disc In Your Back

/ Thomas Cohn, MD

Back pain affects 80 percent of Americans at some point in their lives. Whether it’s a twinge in the lower back or pain near the top of your spine, back pain comes in all different shapes and sizes.

One of the more common back injuries stems from a problematic disc. Often referred to as a herniated or slipped disc, painful disc injuries have numerous symptoms, including:

  • Pain in the buttock that travels down the leg while walking or while putting pressure on the sciatic nerve.
  • Tingling or numbness in your lower back, thighs, legs or feet.
  • Weakness in your legs while walking.
  • Pain in the thighs and hips.
  • Significant deep tissue pain.
  • Muscle spasms in your lower body.

Back Disc Pain

Causes of Disc Pain

Disc pain can be triggered by any number of events, but more often than not they occur by three main types of injuries:

Improper lifting – Whether you’re lifting weights or trying to pick up a box while moving into a new house, lifting a heavy object with a poor technique can throw your back out of whack.

Repetitive action – Even if you’re using good form, repetitive action will put excess wear and tear on your back. Repetitive action disc problems often occur in older individuals who have worked physical labor for the majority of their lives.

Age – Even without poor form or repetitive action, over time our bodies start to wear down.

If You’re In Pain

If you’re experiencing disc pain, the first thing you’ll want to do is visit a physical pain medicine physician. Using advanced imaging techniques, your doctor will be able to determine the root cause of your problem and plan a course of action to alleviate the pain. Some common methods to quell bothersome back pain include:

  • Injections
  • Massages
  • Prescription Medication
  • Referral to a chiropractor or physical therapist.

How Friends With Pain Affects Your Pain

/ Thomas Cohn, MD

A recent article in the journal Current Biology found that humans and mice exhibit more pain when with friends with pain than with strangers without pain issues. Those who are with friends with pain will report more severe symptoms than when they are with strangers. Furthermore, people exhibited more pain related behavior in these situations. The researchers hypothesized that when friends had pain, we make a bigger deal about it than when our companions are pain free. As a pain practitioner, it should be a shame on the researchers for jumping to such conclusions.

All pain patients find living with chronic pain is extremely difficult. Pain is mentally fatiguing and depressing. It is a constant battle to control symptoms. Most of the time the battle to control pain is fought alone. People who do not have the problem usually do not want to hear about other people’s medical issues. Others also do not want to be brought down emotionally by the struggles of someone else since they have their own problems.

Pain With Friends

When one meets another who shares the same problems you have, one may tend to be more honest in the portrayal of your own issues. It is not that you are making your pain sound worse than it is, you just are actually reporting how bad are the symptoms. A person with the same problem is likely to better understand what the other is saying. The communication is more honest and more clear cut. There is also no fear of shame that pain is a significant problem.

Pain Support Groups

The concept of a support group hinges on the fact of a common understanding of a problem. Chronic pain severely affects many people, impacting all aspects of their lives. In normal relationships, one often tries to hide medical problems. We all figure few people understand the problem and we do not need to be shamed by disbelief. Meeting someone who understands the problem of pain and the impact allows the person with pain to be honest about their concerns. To the outsider, this is likely to be seen as embellishment of the pain.

The researchers who wrote this study about pain patients being more open and “feeling worse” when with others who have pain may not be looking at the responses correctly. It is likely that those with pain were just being on honest with how they were feeling when they were with friends who had similar problems. When with strangers, people with pain will often just bite the bullet and act as if everything is okay. No one wants to be known as a complainer. The bottom line in this story is that 40% of the population suffers pain, so maybe we need to show a little more compassion for those with this problem.

Chronic Pain Treatment: A Growth Industry

/ Thomas Cohn, MD

A recent article suggested that treating pain is a “growth industry”. In reality, pain treatment has been terribly under-treated, and we are now just starting to figure out that we need to start providing more care. The statistics are clear. Over 40% of the population suffers problems associated with chronic pain. If we recognize how large the problem of pain is, then obviously, we can start increasing the number of treatments for the problems. The article is based on information from Minnesota claim data.

MN Pain Doctor with patient

It should not be shocking that we have been seeing an increase in expenditures and number of treatments being performed for those suffering from pain. The true shock is the ignorance we have about the lack of treatment provided for one of the biggest health problems. It is not surprising that from 2010 to 2012, the number of procedures performed for pain increased by 13%. The shock should be that most people are unaware of how severe the problem of pain is and the total lack of government support to guide research toward solutions.

New Solutions

Chronic pain can be a devastating problem, and studies show that it affects nearly half of the global population. The headlines often talk about problems with prescribing opioids and the subsequent drug abuse. We should not be surprised then when we see physicians trying different approaches including more interventions and injections to treat pain problems. With our awareness of problems with drug abuse, and the huge number of people having pain problems, it should be no surprise that expenditures for pain patients may be increasing. Maybe this should actually be applauded, that the underserved are getting some more attention, and we should be asking if we are spending enough yet.

Since chronic pain is such a major problem, more money is definitely needed to be spent on research and treatment. There is virtually no federal research dollars being directed toward pain. Unlike cancer or diabetes, there is no office in the National Institute of Health that is directed toward research for pain despite the size of the problems. If there is a concern about the increase in dollars being spent on pain management, then we need to seriously look at quelling those concerns. Data only tells us we are spending more money on a pain. The real issue is why are we spending a lot more money on this problem and not finding better solutions.

Acupuncture – Is it Effective for Treating Pain?

/ Thomas Cohn, MD

Acupuncture has been around for centuries and has been a part of Chinese medicine as a modality to treat a number of conditions. It is based on ancient theories of the body having flow patterns of energy. In the body there are 12 meridians for flow of energy and acupuncture either blocks bad energy flow or promotes the flow of positive energy. The placement of needles in certain places is to decrease bad pain and improve the flow energy promoting pain relief. Those who trust in acupuncture say it can treat numerous different conditions. Western medicine first was exposed to these interventions in the early 1970’s when China opened up to the western world.

Western research initially tried to discover how acupuncture worked by attempting to identify flow patterns and meridians. They looked at MRI scans to see if they could see changes in the brain scans, and none were seen initially. The research turned to studies to see if treatment with acupuncture was better than a fake treatment with only sham placement of needles, and they compared it to no treatment at all. Unfortunately, both traditional and “sham” acupuncture worked equally well, and both worked better than no treatment for many chronic pain conditions. Studies in the early 2000’s showed that for chronic low back pain, acupuncture did work better than no treatment and did have extended benefits lasting a year with increased functional ability.

Acupuncture

So How Does it Work?

The question of how and why acupuncture worked was puzzling to researchers. A neuroscientist from the University of Toronto was responsible for making the first discoveries of how acupuncture worked. Initially, animal studies showed that acupuncture blocked painful sensations to the paw of the animal, however it took about 20 minutes for this to work. This was about the same time that it took opioids to become effective, and this researcher had the insight that there might be some relationship, like it stimulated the body’s own substances to act as a natural pain reliever. Now researchers have also found that the chemical adenosine increases with acupuncture, and this is another endogenous pain reliever.

Through the use of functional MRI scans, researchers can look at the brain in real time and view activity changes of various areas. Acupuncture has effects on the hypothalamus and amygdala, areas of the brain that control fear and influence pleasure. The scans have also identified that acupuncture promotes connectedness throughout the body.

Over time, acupuncture is now being better understood. It stimulates several of the body’s own compounds that help prevent pain. It also helps in the appropriate interpretation of signals. Furthermore, studies have shown it to be effective for low back and neck pain, at least in the short term. There is also data showing it can be helpful for headaches and osteoarthritis. It does not work for everyone, but there is at least some clear scientific evidence of how it works and there are reasonable studies showing its effectiveness.