Acetaminophen May Not Aid Back Pain Woes

July 29, 2014February 17, 2016 / Thomas Cohn, MD

A new study out of Australia found that Acetaminophen, also known as Tylenol, did little to relieve back pain woes in more than 1,600 patients suffering from back issues.

The study compared Acetaminophen to a placebo pill and found that neither pill proved more effective in:

Pain relief

Easing discomfort caused by back pain

Helping patients fall asleep faster

Improving overall quality of life

Recovery time

Researchers say their findings may change the way doctors issue prescriptions for back pain.

“[Acetaminophen] might not be of primary importance in the management of acute lower back pain,” said study author Dr. Christopher Williams.

Others were not so quick to consider changing prior practices.

“While this is a fascinating study, it is only one study and should change clinical behavior,” said Dr. Houman Danesh. Another expert, Dr. Michael Mizhiritsky, agreed with Danesh and questioned some of the study’s techniques, saying, “The drawback I see is there was no group that did not receive treatment – meaning there could be a placebo effect” at work.

I agree with Dr. Danesh, and his final thoughts on the study perfectly sum up that pain management needs to be a multi-faceted approach.

“Most back pain patients improve in 6-8 weeks,” Danesh said. “It is important to note that the best treatment of back pain involves not only pain medication, but also physical therapy to address muscle imbalances. Acupuncture for back pain has also been researched by the U.S. National Institute of Health, and after reviewing the literature they state that there is evidence to support the use of acupuncture for back pain.”

Pain Care: The Benefits of Pain Management

July 9, 2014February 17, 2016 / Thomas Cohn, MD

Pain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition. As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Pain Making it Hard To Sleep? We Can Help

June 25, 2014 / Thomas Cohn, MD

Pain often causes sleep problems. In patients with chronic pain, sleep problems occur in over 50 percent of patients. Problems with sleep can worsen pain and affect your whole life. Patients will often feel rundown, tired, depressed and very stressed. Relationships with your family, your spouse, and at work may be affected. Solving the issue if a complex process, and it won’t happen overnight.

4 Pain-Related Sleep Problems

Sleep problems can be divided into four categories:

Pain making it difficult to fall asleep
Chronic pain causing frequent awakening during the night
Pain may prevent restorative deep sleep
Waking up too early each morning because pain makes it impossible to fall back asleep

Each type of problem may need a different solution, and patients often experience more than one of the above conditions. The first step in treating the issue is by practicing good sleep hygiene. Activities that cause problems prior to sleeping include drinking caffeinated beverages and alcohol. Alcohol may initially cause tiredness but later in the night often disrupts sleep cycles.

Exercising late at night is another no-no. Exercise will help keep you awake, and napping during the day may also lead to decreased tiredness. The bedroom should be considered place only for sleeping and not for watching TV or doing work-related activities. The bedroom should be considered a calming and relaxing place.

Physician Treatment

When the simple things and conservative treatment does not help improve sleep, working with your physician for a more comprehensive treatment strategy is beneficial. A sleep study is often especially helpful in determining the issues that are preventing good sleep, and they can help formulate a plan to combat the problem. Multiple medications are available to help with sleep, but many can actually interfere with parts of this sleep cycle. Narcotic medications and older antidepressants may help with pain at night but often interfere with portions of the deep sleep cycle. Newer medications like Ambien and Lunesta are helpful in allowing the patient to fall asleep, but may not be helpful to keep a person asleep. Recently, melatonin at doses of 5-10 mg has been found to be helpful in maintaining good sleep cycles and reducing pain. Sleep studies can also be helpful to determine other medical problems that need to be treated to improve sleep.

Chronic pain often interferes with sleep, and poor sleep can lead to worsening pain. Improving sleep at night can often greatly improve the quality of life. Sleep problems can be simple, but often with chronic pain they are complex. A sleep study is sometimes needed to determine all problems associated with the lack of sleep. The solution to a good night sleep may require multiple changes and routines. The help of a pain specialist or a sleep expert may be necessary to find the right solution.

Therapeutic Pillows and Mattresses For Pain

June 16, 2014June 23, 2014 / Thomas Cohn, MD

Patients often ask me if they should buy a new pillow or mattress to help alleviate their chronic pain. The answered is complex. If your pillow or mattress is worn out, it may need replacing. Many pillows only will last one or two years. Mattresses on the other hand can last 10 or more years depending on the design. Pillows are often not too expensive, while mattresses can be quite costly. Unfortunately, the ideal mattress or pillow will always be a personal choice based on what is comfortable for the individual. There is very little medical research identifying the best pillow or mattress.

The Perfect Pillow

Comfortable pillows are very much a personal preference. Finding the perfect pillow depends on what position you usually sleep in. Some people sleep on their back, while others are more comfortable on their side or stomach. Find a pillow that gives your head support in a neutral position without bending your neck while you sleep.

What’s inside the pillow is also important. Some people prefer feathers, artificial down, or memory foam. The contour of the pillow may or may not be comfortable for each person. Most people need to try a variety of pillows to find their ideal design and comfort.

Magnificent Mattress

A good mattress provides support for the body in a natural position. Ideally, support should be evenly distributed along the whole body in whatever position a person is laying. A traditional mattress often does not supply even support to the body. Extra pillows often can help improve a person’s position in bed. If you lay on your back, a pillow under the knees flattens the spine and may increase the comfort in the low back. People who lay on their side, should try a pillow in between the knees for comfort. A mattress topper made of memory foam may also be helpful to improve comfort and prevent the need to replace a mattress.

The choices for new mattresses are complex. Some people like to have a firm mattress while others prefer a soft mattress. Some mattresses bend to raise the head or the legs. The more features a mattress has, the more expensive it will be. Mattresses that include a memory foam top layer help conform to the body and maintain a neutral position. An adjustable air mattress allows a person to determine the right firmness that is best for their sleep. A bed that changes position may allow adjustments for the best sleep position for the individual. Finding the right bed with the right features at the right cost is always a personal choice, and unfortunately, there is not a medically perfect bed, mattress or pillow.

Dealing With Pain After A Car Accident

June 11, 2014June 23, 2014 / Thomas Cohn, MD

Trauma from motor vehicle accidents can cause significant ongoing injuries. Typically, lingering injuries that require medical care resulting from a car accident include:

Lower back injuries
Spine injuries
Headaches and neck injuries
Broken bones and and large lacerations
Whiplash injuries to the head and neck

Treatments For Car Accident Injuries

Treating acute pain is done symptomatically. Ice and heat for muscle strains in both the neck and the low back region is recommended. Immobilizing the neck with a brace for several days to rest the muscles may also be helpful. That said, wearing a neck or back brace for more than a week or two is not a good idea as the muscles need to move in order to heal correctly. Restoring normal movements is one of the main objectives in early treatment. In most cases, the muscles are only strained and not torn and will heal within a short period of time. Restoring movement and strength may require assistance and physical therapy. Chiropractic or massage treatments may also be helpful in the short term, but continued passive treatments are usually not helpful for larger issues.

If pain is a significant issue, over-the-counter medications are often very helpful. Initially, acetaminophen and nonsteroidal anti-inflammatory medications like Advil or Aleve may provide significant pain relief. If the nonprescription medications aren’t providing sufficient relief, it is time to see a physician. The physician may opt for a short course of narcotics along with regular physical therapy. With aggressive early treatment, most people will resolve their injuries within a month or two.

Continued Pain

If your pain has not resolved in two months, at that time, asking your doctor to be referred to a pain specialist would be beneficial. A pain specialist can perform a comprehensive evaluation and determine further tests and treatment that would help resolve your ongoing medical problems. Sometimes injuries such as whiplash cause microscopic damage to the spine and joints, and the use of injections along with other medications and physical therapy will allow for almost complete resolution of symptoms. There are many options in managing pain related to a motor vehicle accident, and depending on the unique characteristics of each person, a program can be found that meets any individual’s needs. A pain specialist is an expert in the complex problems that cause ongoing symptoms and is extremely knowledgeable about all the possible treatment options that will allow you to return to a full life.