Pain As We Age – Why Your Body Is Like A Car

September 17, 2014August 25, 2016 / Thomas Cohn, MD

Our bodies are similar to our cars. When new, everything is beautiful and works as it should. As they age, it takes regular maintenance to keep things running correctly. Initially, we may have to fix little things, like bumps and bruises. As we get older, the problems are more complex. Things start to show wear, and parts may need significant repair or replacement. Keeping everything looking good becomes an effort since the beast is being used and abused daily.

Every part of our body ages as we age. The joints that allow us to move smoothly all eventually show some degeneration. The muscles, tendons and ligaments that control motion get strained and sprained. The body fatigues and moves less well at 40 then at 20 years, and as we get past 50, most of us can readily feel the changes. Despite the wear and degeneration, the trick is to keep moving and do the daily maintenance to keep the body going. If one does not do the work to keep the body maintained, just like an old car, it will definitely stop working.

Pain and Aging

Everyone has pain in their life at some point in their life. When you are young, it is due to injury, it is acute, and it is short term. As we get older, it may become chronic, and it usually becomes more persistent. Acute injuries are usually related to trauma, and are isolated, small and heal quickly. Chronic injuries stem form repeated wear and tear, degeneration and aging. Chronic damage can be permanent and tends to cause ongoing stimulation of the sensory nervous system. The older we get, the more likely we are to have degeneration. The expectation that one would have no pain as we age is unrealistic.

The goal in life is to stay healthy and minimize the trauma to body. Unfortunately, many of the things that we have done to stay healthy may cause extra wear to the body. The sports we play often stress the joints of our bodies like the shoulders when we throw, or our hips, knees and feet when we run. We do heavy lifting regularly, and have accidents that cause whiplash and injury to the low back and neck areas. Being healthy means being active, moving and using the body.

The Human Body

The human body is amazing in its design and ability. We have tried to make robots as sophisticated as we are, but at best they are currently crude approximations. Historically, the human body has been designed to last between 40 and 50 years. In the 1700 and 1800’s, the average lifespan was about 45 years. Trauma, injuries, infection, and heart disease and many other problems would kill us. The design of our bodies was to maximize our abilities for that life span. As the world became more industrialized, science and medicine discovered ways to fight disease and prolong our lives. However, the sophistication and design of our bodies is the same. We have not evolved into any different species or body design. The life expectancy has gone from 40 to 75-80 years. Our bodies are the same, they are just getting older.

Life is tough on our bodies. We are out living the design of the parts, and they are degenerating slowly. With degeneration, the body sends us signals that everything is not working smoothly. Those sensory signals are perceived as pain. However, most of the time it is ok to acknowledge the signals and keep moving to stay healthy. Staying active, maintaining strength and aerobic conditioning helps the body and prevents further deterioration. Age and pain signals often go together. The goal is to understand the signals and keep moving forward. Life without pain is unlikely, just keep up the regular maintenance and keep going. Don’t become a couch potato.

Spinal Disc Imaging and Discograms for Back Pain Problems

September 15, 2014August 25, 2016 / Thomas Cohn, MD

The spine has discs between each vertebral body in the cervical, thoracic, and lumbar spine. These discs are dynamic spacers between the bones and facilitate the motion between segments. The structure of the disc varies between the cervical, thoracic and lumbar levels. The differences in structure lead to different stabilization patterns in each area of the spine. The strongest discs are in the lumbar region and the weakest are in the neck, with the thoracic discs being of moderate strength.

The discs have two components, the outer anulous fibrosus, and inner nucleous pulposus. The outer ring is made of interlaced collagen fibers. The nucleous is a loose fibrous network with a gelatinous acidic mucoprotein. The combination of the outer core and inner gel is to provide the ability to absorb forces between the bones as the body moves. Extreme forces and sudden movements as well as age can damage the disc integrity. The strength and weave of the fibers is the strongest in the lumbar region and the weakest in the cervical region. Lifting and twisting heavy objects is main primary reason a person suffers a low back injury, while whiplash injuries account for the majority of neck problems. Repetitive activities and age can also damage the discs throughout the spine. Damaged discs can bulge, crack and leak, and herniate. The discs injuries can be very painful, and treatment should not be ignored.

Diagnosing Disc Injuries

Studying the spine is done in multiple ways. The simplest is by an X-ray; They can give basic information on the integrity and alignment of the bones, the height of discs, and the presence of degenerative changes. In a young person, X-rays are usually normal, but in the older person they tend to show age related changes. The problem with an X-ray is that it often can identify the area of pain, but it gives very little information about a cause of pain. CT-scans are sophisticated computer enhanced X-rays that give significantly more information about the bony structure of the spine and some limited information about the discs and spinal nerves. An MRI scan can give significant information about the discs, spinal nerves and cord, joints and bones of the spine. Electromyography can map whether the nerves of the spine are functioning properly. Discograms pressurize the disc with contrast and then they are viewed under X-ray or CT scan to determine the integrity of the disc and whether they are painful. Your doctor will determine which method is best for identifying your issue.

Discograms & MRI Scans

Discograms can tell valuable information in the lumbar region, however, in the thoracic and cervical region the data is of questionable value. In the lumbar region, a discogram can help identify whether a disc has internal disruption and if it is painful. If only one disc is painful, a doctor may be able to preform routine surgery to address the problemed disc. That said, multiple painful lumbar discs do poorly with surgical management. Often, MRI scans can give sufficient information such that a discogram is not necessary. In the thoracic region, a discogram would not clarify surgical options since the MRI can provide sufficient information along with physical exam. The nature of the discs in the cervical region makes discograms vary unreliable for useful information.

I typically suggest that a patient undergoes an MRI if they are experiencing back pain, as it provides a comprehensive look into the inner workings of the back. If you are plagued by constant low back, spine or neck pain, stop in for an assessment. We’ll work with you to find a solution to your pain.

Marijuana and the Reduction in Painkiller Overdoses – Part 2

September 10, 2014 / Thomas Cohn, MD

Last month we discussed the new study published in JAMA (The Journal of the American Medical Association) showing that drug overdose deaths due to opioids declined in 13 states that legalized medical marijuana. The study just looked at death rates overall due to opioids and noted that they happened to decline up to 30% in states that legalized medical marijuana. Today, I expand on the findings.

This study is great, sensational news, but in reality, it is a leap of faith that these two subjects are truly correlated. Opioid overdose and deaths are a very complex issue. The overdose of opioids is linked to many things, especially recreational use. The death rate from overdose is related to many factors, including whether the overdose was accidental or on purpose, such as a suicide. Furthermore, the access to treatment for overdose is important, especially whether first responders can recognize it and provide drug reversal rapidly and then get a person to a hospital for support. So, if you are using opioids to get high, it does not matter if marijuana for medical use is legal since they are not using it.

Medical marijuana is used for a variety of problems, including nausea related to cancer, seizures, and glaucoma. None of those conditions have much to do with opioids and drug overdoses. So if marijuana is legal for glaucoma or treating seizures, why would death rate due to narcotic overdose change? Rationally, it would not.

Unfortunately, this is just another example of a study finding a nice statistic that has no true correlation to the data. This study did not specifically look at factors that are related to opioid overdose death. If the study actually looked at reasons related to opioid overdoses, treatments, and deaths, there may be some validity. Rewarding medical marijuana with this lofty success is poor research and data interpretation. A prestigious journal, JAMA, should do much better at critically analyzing research and publishing articles. This is an amazingly poor job of data analysis and conclusions with an over simplification of causes of opioid related deaths.

Cowboys’ Romo Looks to Rebound After Back Surgery

August 28, 2014 / Thomas Cohn, MD

The National Football League kicks off exactly one week from today when the Green Bay Packers travel to Seattle to take on the defending champion Seahawks. With the regular season fast approaching, teams are doing everything in their power to ensure their players enter the season with a clean bill of health. One such player is Dallas Cowboys quarterback Tony Romo, who missed the end of last season after undergoing surgery to address his ailing back.

Romo initially hurt his back right before Christmas last year, and he needed an epidural injection and eventually surgery to fix a herniated disc in his lower back. Romo has been rehabbing ever since, and Cowboys owner Jerry Jones said it won’t be an issue for the quarterback in 2014.

“No issue with his back at all,” said Jones. “As a matter of fact, we all were pleased that he got the kind of test he got, and he is too. There is no issue, after being sacked three times, other than we need everybody to get in there and move in ways that we can keep that from happening.”

The three sacks Jones is referring to occurred during the team’s third preseason game against the Miami Dolphins. Keeping Romo upright will be key for the Cowboys, something they were able to do well last year. The Cowboys allowed the seventh-fewest sacks in the league in 2013, and the third-fewest quarterback hits.

“I took some hits; that was good just in regard to getting up and keep playing,” Romo said about the shots he took in the third preseason game. “That part of it was positive. The hits in general, hopefully we can avoid, but it was good to get back up and keep going and see how I felt and go play football.”

The Cowboys are set to play their final preseason game tonight against the Denver Broncos, but don’t expect to see Romo under center. Regardless of previous injuries, the majority of teams hold most of their starters out of the final preseason game to help their bodies recover before playing 16 games in 17 weeks. The Cowboys have already announced that Romo won’t play.

It will be interesting to see how Tony Romo preforms this season. He’s getting up there in age – he’s 34 years old entering this season – and although geezers like Peyton Manning and Tom Brady have proven that you don’t need to be young to preform at the highest levels, recovering from a back injury to play on the biggest stage can be extremely difficult. Don’t believe me? Just ask Tiger Woods.

Related source: ESPN

Can Exercise Help Relieve Pain?

August 20, 2014August 25, 2016 / Thomas Cohn, MD

A new study suggests that regular exercise can improve a person’s tolerance for pain and discomfort.

The study was conducted by researchers at the University of New South Wales and published earlier this month in Medicine & Science in Sports & Exercise. For their research, scientists recruited 24 healthy but inactive individuals. 12 of the people said they were inactive but were interested in exercising, while the other 12 said they preferred not to exercise.

After the groups were separated they each were put through similar tests to create a baseline pain threshold. This involved putting pressure on a person’s arm until they said the pressure went from unpleasant to painful. Researchers later put individuals through a second pain threshold test, this time asking users to squeeze a device while a blood pressure cuff tightened on their forearm until it became too painful.

After their pain threshold was documented, participants interested in exercise undertook a moderate stationary bike workout three times a week, for six weeks. Researchers noted an improvement in fitness levels as cycling workloads increased each week. The other group continued with their lives as they had prior to the study.

Results

Both groups returned to the testing lab six weeks after the study first began. Volunteers not interested in exercise showed no changes in their pain threshold, but participants in the exercise program saw a noticeable spike in pain tolerance. They experienced pain at the time point they had during the initial test, but they were able to withstand the pain for much longer at the end of the program.

“To me,” said Matthew Jones, lead researcher of the study, the results “suggest that the participants who exercised had become more stoical and perhaps did not find the pain as threatening after exercise training, even though it still hurt as much.”

Scientists have previously hypothesized that a person’s body will emit opitates, such as endorphins, during exercise to slightly decrease discomfort. This process is known as “exercise-induced hypoalgesia,” and usually occurs during a workout and lingers for about a half hour after the workout is completed.

The study didn’t examine the physiological principles at play, but Jones noted that the decision to use a predominately leg-focused workout and an arm-based pain threshold test suggests that “something occurring in the brain was probably responsible for the change.”

If pain is too crippling to begin an exercise regimen, a person may do more harm than good by trying to exercise through the pain, but if you can tolerate even a moderate amount of exercise, you may be able to increase your pain threshold. Consult your doctor if you have questions or concerns.

Related source: NY Times