Safety First: Surgical Centers vs. Pain Specialists

January 19, 2015January 16, 2015 / Thomas Cohn, MD

Recently there was an article on whether having a procedure done in a surgery center is safe. In the world of pain management, some practitioners only do procedures in these facilities (or hospitals) while others do most of their procedures in the office. Surgery centers can handle more complex procedures, and can typically handle a deeper level of sedation. In pain management, surgery centers can be beneficial for complex procedures such as implants, but often they rarely are necessary. Sedation for a pain management procedure usually does not need to be very deep, and should be able to be done without a surgery center.

The safety of a surgery center and a procedure in reality is no better than the quality, skill, and experience of the practitioner. After spending more than 20 years performing complex spinal procedures, as well as teaching courses to other physicians, it is the ability of the physician that really matters. Surgery centers are often profit centers for the physicians working in them. Furthermore, a physician who sedates most patients for procedures is often using the sedation to cover for a technique that may cause pain. A skilled interventionist should be able to do most procedures with a local anesthetic and ensure they are practically painless. The use of sedation for many practitioners is a crutch to reduce the need to talk to the patient and to perform the procedure with the least painful technique.

Pain Medicine Safety

In pain medicine, the most common injections – spinal and joint related procedures – should be able to be done quickly and comfortably. The main issue that most practitioners should be treating is the anxiety of the patient. Light medication to treat the anxiety can often be given orally. For longer procedures, IV medication is sometimes easier to use. Universally, procedures that are painful are most often due to the technique and experience of the provider. Experience often allows the practitioner the knowledge of how to perform a procedure when a patient presents a more complex situation.

In the end, safety of a center is dependent on the practitioners. If the provider does not fully know what they are doing or the best techniques, the patient is more likely to have issues with the procedure. Further, if the patient is significantly sedated, the patient will not react when the practitioner does something wrong, making it more likely that significant damage may occur. The best physicians will always care most about the patient and the problem, not the payment they might receive from doing an intervention. The best physicians have years of experience, are board certified, and have an intense, loyal patient following. Skill and experience help keep a patient safe and make a procedure safe and effective. Errors in pain management procedures are generally rare. Surgical centers and sedation are not important in patient safety; the quality of the practitioner is the most important variable.

Baby it’s Cold Outside: Chronic Pain and the Cold

December 26, 2014December 29, 2015 / Thomas Cohn, MD

Many people who suffer from pain feel worse when it is cold outside. Those who have joint problems like osteoarthritis and rheumatoid arthritis, fibromyalgia, nerve damage and muscle disease have more pain when the temperature drops. If we have been told to use ice to prevent injuries from hurting, many ask why they feel worse when cold weather settles in. The reason for feeling pain is the same reason we actually use ice packs to prevent pain. Cold can slow the transmission of the nerves. Placing ice on an injury keeps inflammation down and reduces the ability to transmit pain signals.

Chronic conditions that cause pain often become worse with the cold. When the body is cold, muscles, tendons, ligaments and joints do not move as well as when they are warm. Joints become stiff from the joint fluid not flowing as smoothly.

In the cold, muscles, ligaments and tendons are also stiff. The body is not much different than many other materials when exposed to cold. Materials like plastic become brittle when exposed to cold and become more pliable when warm. The body is not much different. When cold, many structures become stiff and do not move as well. As the structures in the body are warmed up, they move better and smoother. If a structure is not moving well, it is likely we feel it and sense the abnormality of movement. Most people feel the change in sensation of movement as discomfort, stiffness, aches or pain.

Frozen Nerves

Cold can also stimulate nerves. Some pain fibers respond specifically to the cold and send signals of pain when they sense it. Furthermore, a large portion of the nervous system functions to inhibit abnormal signals. Cold slows nerve transmission in general and thus slows the body’s ability to inhibit signals. The body’s ability to control pain signals are also impaired and slowed by cold.

Winter is here, and the weather is unlikely to get much better for several months. When it is cold outside, it is important to keep your body warm to reduce pain. Warmth allows the body to function more normally. Normal body temperature allows the fabric of the body to move smoothly. Keeping the body close to normal temperature allows its structure to function the best with the least amount of pain.

5 Tips For Dealing With Chronic Pain During The Holidays

December 17, 2014 / Thomas Cohn, MD

Chronic pain is never fun to deal with, but it can be especially difficult to manage during the holidays. Your diet, sleep schedule and travel plans can get your body out of whack, so today I’m sharing some tips to help you control your chronic pain during the holidays.

1. Travel Tips – If you’re dealing with chronic back or neck pain, being crammed on a plane or in a car for hours on end can be painful. That said, there’s still some ways to make yourself more comfort while traveling. If you’re traveling on a plane, see if you can get an aisle seat. That way you can stand up and stretch if needed without waking up any sleeping patrons in your aisle. If you’re in a car, leave earlier so you have time to stop at a rest stop and move around if your joints start to get stiff.

2. Eat Right – The holidays are a time when our waistbands can expand to Santa’s size, so be cognizant of what you eat. Eating junk food can aid to your chronic pain, make you more lethargic, and as a result, keep you from exercising, which is beneficial in chronic pain management. If you have to travel, pack a healthy option so you’re not gorging on fast food during your travels.

3. Keep Exercising – As I’ve said in earlier posts, regular exercise is crucial in controlling and preventing chronic pain symptoms. Getting your regular workout in during the holidays is no easy task, but don’t use the company party or a family visit as a reason to skip your exercise. Wake up early or carve out some time – even if it’s only 15 minutes – to exercise. Getting out of a routine makes it easier to stay out of your exercise routine, so don’t let the holidays slow you down.

4. Medication Management – Most people who take medications to help with their chronic pain have a pretty set schedule for managing their meds, but as this post suggests, the holidays can throw your routine out of whack. Double check to make sure you have all your medications for a long stay, but also be aware of where you store them so young nieces and nephews can’t accidentally access your medications. If you’re going to run out of a prescription while out of town, contact your doctor before you leave instead of having to jump through hoops from afar.

5. Rest Up – Sleep is a restorative process where your mind and body relax and rejuvenate, so try not to skimp on sleep this holiday season. It may be easier said than done, but it’s important nonetheless. That means no staying up in the wee hours of the night trying to catch Santa Claus!

Follow these tips to have a pain free (or at least a little less painful) holiday break! If you have any tips on how you manage chronic pain during the holidays, please share in the comments section.

Smoking Increases Risk of Chronic Back Pain

December 2, 2014 / Thomas Cohn, MD

A new study conducted at Northwestern University found further evidence that smokers are at an increased risk for developing chronic back pain.

While medical experts have known for a while that smoking increases a person’s risk of chronic back pain, this study examines why that’s the case. Researchers were keen to learn more about the link between back pain and smoking as back pain affects more than 80 percent of the population at some point in their life. According to the folks at the American Chiropractic Association, back pain is the number one reason for missed work and the second most common reason for doctor’s visits.

Smoking Study

For their study, researchers examined 160 individuals who had developed subacute back pain, which is defined as back pain lasting between 1-3 months. In addition, researchers analyzed 32 participants with chronic back pain – back pain for more than five years – and 35 people with no symptoms of back pain. Patients were asked to complete a health and wellness questionnaire once a year for a period of five years, and they also underwent MRI brain scans to analyze brain activity in the nucleus accumbens and the medial prefrontal cortex. These areas play a role in a person’s addictive behavior and motivated learning.

Without getting too technical, researchers say there is a crucial connection between these two areas of the brain. The stronger the connection between the too, the less resilient a person is to chronic pain. According to researchers, smokers had a stronger connection between these two areas of the brain compared to non-smokers, meaning smokers were more likely to develop chronic pain. In fact, researchers suggest that a smoker is three times more likely to develop chronic back pain than a non-smoker.

But there is good news. Dr. Bogdan Petre said the connection between the nucleus accumbens and the medial prefrontal cortex can be decreased by kicking the habit.

“We saw a dramatic drop in this circuit’s activity in smokers who – of their own will – quit smoking during the study,” said Petre. “So when they stopped smoking, their vulnerability to chronic pain also decreased.”

Petre concluded that his team’s findings are only further evidence that smokers are putting themselves at risk for chronic back pain.

“We conclude that smoking increases risk of transitioning to chronic back pain, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning.”

Can Alternative Medicine Really Help Your Back?

November 12, 2014 / Thomas Cohn, MD

The following is a guest blog post from our friends at North American Spine.

If you’re experiencing mild or chronic back pain, there are a variety of traditional and alternative treatments that can both ease the pain and help address the root cause. When most patients complain of back pain, their doctor’s first reaction may be to refer them to an orthopedic or osteopathic surgeon. However, there are other options that have been effective in treating patients for centuries. These include:

Acupuncture

A diet rich in anti-inflammatory foods

Myofascial release

Physical manipulation

Back-strengthening exercises

Yoga and meditation

A Physical Medicine Pain Doctor

Help a Bad Back by Sticking Needles in It

That’s right. Acupuncture, which is the art of inserting thin needles into certain parts of your body to help reduce or relive discomfort, is an effective drug-free method for relieving back pain. Although the results are not long-lived, treatments help when pain medicine and other therapies have failed.

Scientists are still working to understand how acupuncture relieves pain and stimulates endorphins. Acupuncture is endorsed by the American Pain Society, the American College of Physicians and the National Institute for Complementary and Alternative Medicine. In fact, one of the main reasons people choose acupuncture is because it’s been so successful at treating back pain. If you’re worried about being stuck with needles, don’t be. Patients rarely feel pain. If anything, it’s more of a slight tingling sensation.

Rest, Relaxation and Less Pain

Myofascial release is another type of therapy that uses pressure to effectively loosen the tension and tightness that contributes to upper and lower back pain. Myofascial techniques are often included in massage therapy and chiropractic care. When done correctly, these techniques can both decrease pain and increase your range of motion.

Down Dog Your Way to Less Back Pain

Yoga is a unique method for treating back pain because it stimulates the mind AND the body. Breathing and meditation coupled with low-impact exercises calms the mind and relieves the stress that is caused by chronic pain. With help from cushions, certain yoga poses are great for stretching and strengthening the back.

A 2011 study conducted by the National Center for Complementary and Alternative Medicine found that 12 weekly yoga classes improved function and mobility for patients with recurring or chronic back pain better than traditional therapies.

Eat Better, Feel Better

Just as certain medicines relieve inflammation, a healthy diet can reduce the swelling that may cause back pain in the first place. A good anti-inflammatory diet includes vegetables, fruits, fish, high-fiber foods and certain spices. North American Spine recently talked about the correlation between your diet and your back in a back pain eBook.

If possible, try to shy away from eating too many carbohydrates, as they affect insulin levels and promote inflammation. The same holds true for dairy, eggs and wheat—especially if you’re sensitive to these foods. The key to a healthy back is a healthy diet, so be sure to eat foods rich in zinc, iron and fiber and less rich in hydrogenated oils and fats.

The goal of alternative treatments is to increase mobility, reduce pain and lessen your dependence on medications. Above all, these simple methods should encourage you to take an active role in your care.