The Risks of Complications From Pain Injections

October 20, 2014 / Thomas Cohn, MD

Every action has risks and benefits. In the medical world, every medication has risks, and sometimes the risk of doing nothing is worse than treating the issue. This is especially true in many medical conditions such as hypertension or diabetes. The same goes for pain medicine. There are risks and benefits for everything that is done, but there are also many alternatives to treat any particular problem. Choosing the right treatment plan is an individualized decision between the patient and the physician.

Interventional pain treatment has risks and benefits, and there are well known complications from most procedures. The main risks are fairly clear, but there are four complications that arise more often than others. They are:

Infection. Whenever the skin is broken, this is a possibility, and is prevented usually by cleansing the skin with alcohol or special antibacterial soap.

Bleeding. Most procedures are done with a fairly small needle. If a patient is not on a blood thinner or does not have a bleeding disorder, this complication is uncommon.

Allergic reaction. This is rare, but if it does occur, it can be treated.

Damage to another critical structure with the interventional equipment. This can usually be avoided by taking routine precautions and by having a skilled physician preform the procedure.

Complication Likelihood

Recently, a study was done recording complications from many of the common injection type procedures preformed by pain physicians. Almost 20,000 procedures were done, and the rate of anything abnormal was found to be less than two percent. The most common minor problem was a vasovagal reaction (Feeling like one is going to faint). The next most common issue was an increase in pain, which resulted in the procedure being stopped prior to completion. Other notable problems included one serious allergic reaction (1 in 20,000), and 10 dural punctures (1 in 2000). There were no major complications resulting in any serious injury or permanent neurologic damage.

Treating pain is a complex problem. For every problem, there are often multiple options and pathways to improvement. Sometimes, the pain physician may suggest an interventional procedure to help one improve function and decrease pain. As noted above, the risks of most of these procedures are extremely small. The most common issues are feeling faint or light headed and having increased pain during the procedure and temporary increased symptoms. An experienced interventionalist will make the procedure beneficial and minimize risk to the patient.

Theramine and Chronic Pain Prevention

October 15, 2014 / Thomas Cohn, MD

Thermaine is a relatively new drug that is being used to treat chronic pain, typically in individuals suffering from low back pain. Theramine is a proprietary formulation of neurotransmitters, amino acids, antioxidants, neuromodulators, anti-inflammatory and immunomodulatory peptides, whey protein, and adenosinsine antagonists.

It is a trademarked formulation of compounds and considered a food supplement. It was designed to be used to treat a variety of pain syndromes, including acute and chronic pain. Each ingredient in the capsule was determined based on its ability to modulate an aspect of the sensory processes involved with pain signals. It is meant to moderate the effects of inflammation on the pain response. All of the ingredients that make up the compound have been approved by the Food and Drug Administration.

A recent article in the American Journal of Therapeutics suggested that Theramine was more effective than low dose ibuprofen for chronic low back pain. It was found to effective in decreasing both pain and inflammation in chronic low back pain sufferers. Part of the theory about why this supplement is helpful because it is thought that the chemicals present help restore certain compounds that are depleted or not present in individuals suffering form chronic pain.

It’s effectiveness means that the product is not cheap. A simple online search reveals that a one month supply costs over $300. If one has money to spare, it may be a safe consideration. It appears to be safe, with reasonable science behind its development. For a greater look into Theramine and its inner workings, check out this website.

Age and Professional Sports

September 29, 2014August 25, 2016 / Thomas Cohn, MD

The prime of our lives is in our 20s. During the decade of time from age 20 to 30 years of age, our bodies and brains become fully mature. We are at our peak performance both physically and mentally. The body is the most flexible and heals quickly from minor trauma. Mentally, the brain becomes mature and can perform at a high level. For most sports, the best athletes are at their prime when the body reaches physical maturity. The length of time at a prime level is often about ten years. After that time, the body starts showing signs of wear and tear.

Professional athletes stress their bodies to the extreme on a daily basis to maximize training for their sport. Most are a bit sore every day from the hours of training and stressing of the muscles and joints. In general, the level of exercise completed is usually a bit beyond what the body was meant to endure. Structures of the body slowly start wearing out. Multiple injuries often start occurring, and it takes longer and longer for the person to return to full health.

The good news is that most of us our not professional athletes, so we are not dependent on an extreme level of activity for our livelihood. The bad news is we still are wearing out our bodies over time, but just not as fast as most athletes. Activity keeps us healthy as long as we do not overexert our bodies. Doing strength training keeps muscles strong and bones healthy. Aerobic conditioning is necessary to maintain good cardiovascular health. Being normal weight for our height keeps us from stressing the body structure as a whole. The average body starts to show signs of wear and tear in our 40s and 50s.

Historically, the body was designed to get us to about age fifty. In centuries past, before modern medicine and the industrial revolution, death often came by age fifty due to trauma, disease, or other natural causes. Now, we have learned to survive into our late seventies or eighties. As we grow older, age affects every organ including the muscles, tendons, joints and bones. The degeneration often causes aches and pains as we try to compensate for the changes that are occurring.

As I’ve said before, your body is like a car. A new car is beautiful and performs well with very little maintenance. As the car gets older, it takes more and more care to keep it running smoothly. If it is not maintained, it will likely fall apart. If we drive it hard and beat it up, it will fall apart sooner. If we baby it, it will become a precious antique. The body is not much different. We last longer and stay healthier if we take care of our body. Doing the work to keep healthy is beneficial to live a happy life.

Men and Women Similar When It Comes To Chronic Pain

September 25, 2014 / Thomas Cohn, MD

Although there have been previous studies that suggest women have a higher pain tolerance than men, a new study out of the University of Malaga suggests that a person’s resiliency, not their sex, determines how well they handle chronic pain.

For their study, researchers analyzed numerous traits among 400 patients suffering from chronic spine pain (210 women and 190 men). What they found was that personal qualities, not genetic differences, was the best indicator of how a person dealt with chronic pain.

In essence, certain men and women have a very difficult time managing chronic symptoms, while others are able to work through the discomfort. The people who don’t let the pain bog them down are the same people you’d want on your basketball team when you’re down 10 points in the fourth quarter or if you need a big last week to meet your quarterly sales goals, because the research suggests that how a person handles adverse circumstances is the primary quality linked to an individual’s pain tolerance and how they adjust to chronic pain.

According to the researchers, the findings suggest more similarities than differences between men and women.

“More resilient individuals tend to accept their pain, that is, they tend to understand that their ailment is chronic and they stop focusing on trying to get the pain to disappear, to focus their energy on enhancing their quality of life, despite the pain, said Carmen Ramirez-Maestra, the study’s lead author. “In this regard, patients who are able to accept their pain feel less pain, they are more active on a daily basis and have a better mood.”

So remember, treating chronic pain is only half the battle. Dealing with, accepting, and not letting pain wear you down are other pieces to the pain puzzle.

Related source: Daily Digest News

Practicing What You Preach

September 23, 2014February 17, 2016 / Thomas Cohn, MD

There is an old adage that suggests a person should be wary to trust a skinny chef, and a similar principle can be applied to the medical world. Would you trust a doctor who is obese, waddles into the room, and smells of smoke to advise you on diet, exercise, and healthy living? Probably not, because they are not following their own advice.

At some level, the medical practitioner must be able to communicate and relate to their patients. Sometimes, it is their level of knowledge and experience that is obviously superior that helps invoke trust. At another level, sometimes it is the personal experience that may make an added difference.

As a Physical Medicine physician specializing in pain medicine, I have spent years studying and providing care to thousands of patients. I try to keep up with new research and treatments, reading journals and even attending conferences. During the course of countless evaluations, a doctor learns how to address a problem and that there may be many different treatment approaches to the same problem. One thing I didn’t expect to learn was that I would have to apply my knowledge to my own problems.

Back pain affects about 85% of the population at some point in their lives. My first bout occurred during my second year of medical school. I was lifting free weights with the bar at an awkward angle, and the next thing I knew my back had given out. Since I had no weakness, just pain, the physician treated it conservatively with ice, heat, physical therapy and anti-inflammatories. It took months to resolve, but as long as I was careful about using proper body mechanics when lifting, I was fine.

Years later, when I was in my late forties, I started noticing my back more regularly, and it occasionally flared with bouts of pain down my legs. This was when I underwent my first MRI – 25 years after my back was first injured. The scan showed a significant L5/S1 spondylolisthesis with narrowing where the nerve roots exit. A radiologist friend who read the scan asked me which colleague I planned to see for surgery. I tried injections, massage, exercise and anti-inflammatory medications to control pain at times, but they only stifled the pain, they didn’t resolve it. Aerobic conditioning was probably the most helpful, but I still dealt with pain from time to time.

Unfortunately, a couple of years ago it flared worse, brought on by no special aggravating factor. A new MRI showed severe narrowing where the nerves exit at the L5/S1 level. A couple of injections calmed my spine down, and I again was given a lesson in the importance of exercise. Regular exercise has been essential to control symptoms. If I do not exercise, my back begins to ache. Stretching and loosening up the back muscles is necessary multiple times a day, and anti-inflammatories help control stiffness. I also use a neuropathic medication to keep some of the sensitivity of the nerves down.

Despite back pain, life can still go on and be pretty normal. I do most everything I want to do, but running and jogging is off my list. I still exercise, but strengthening my core is not optional any longer. Core strengthening is definitely boring, but it helps immensely. I prefer aerobic activities like biking, using an elliptical or walking long distances. Long walks usually require stretching breaks, but as my dog gets her exercise, so do I.

So far, I have no absolute loss of muscle function in my legs and no trouble controlling my bladder or bowel related to my back. Still the most important aspect of treatment is taking care of myself and exercising. To get that done, I have to wake up very early each day and make it a priority. If a doctor does not take care of himself, it is not possible to take care of others. At this time, listening to my own advice of exercise, take your medications, don’t complain and stick with the routine are working for me. For me, I must practice what I preach.