Tips For Relieving Shoulder Pain

September 4, 2014August 25, 2016 / Thomas Cohn, MD

The shoulder is one of the more unique joints in the body. The stability of the shoulder is not due to the joint and joint capsule; instead, it’s due to the muscles and tendons as well as ligaments that hold the bones in place. Most of the stability is actually due to the muscles holding the arm into the joint. The excellent motion of the shoulder makes the joint very unstable.

The shoulder joint is like a golf ball on a tee, it is very easy to bump the ball off , unlike the hip that is more akin to a ball in a cup. The shoulder can become painful when one of the structures maintaining stability becomes strained or sprained. It is also easy to perform repetitive actions that cause the shoulder to become painful.

The Anatomy of Shoulder Pain

The anatomy of the shoulder is complex and unique. Three bones are part of the shoulder base including the scapula, the collarbone, and the humerus. Muscles and tendons maintain the position of the humerus in the joint region. The muscles and tendons cover the shoulder joint, and damage to any these structures can cause pain. Some common causes of shoulder problems include:

Bursitis
Tendonitis
Tendon tears
Impingement
Arthritis
Fractures

Examining Common Shoulder Problems

Bursitis of the shoulder is categorized by inflammation in the fluid filled sacs that provide cushioning and lubrication between muscles, tendons, and bone. In the shoulder, they are in the area of the deltoid and underneath the scapula. Repetitive motion of the shoulder or lying on your side are common causes. Rest, ice and heat, and anti-inflammatory medication often take care of the problem. Occasionally, a steroid shot in the area is helpful.

Impingement occurs when the acromion bone, the top of the shoulder blade, puts pressure on the muscles, bursa and tendons that move underneath it. The natural shape of the bone can cause this or small degenerative changes. The irritation can lead to bursitis and sometimes rotator cuff tears. If the impingement is constant, causing inflammation or tears, surgery is may be necessary to open the space and relieve the pressure.

Tendonitis and tendinopathy are irritations of the end of the muscle as it connects to the bone. Acute tendonitis is usually related to repetitive motion, such as overhead activity or throwing. If treated rapidly, often this will resolve with rest and icing. Chronic tendonitis is due to repetitive wear and can lead to tears or tendon ruptures, often seen as rotator cuff issues. These may be best treated with surgery.

Tendinopathy is chronic changes of wear and degeneration in the tendon. Since the muscles and tendons are critical to shoulder function, this is common as a person ages. These changes do not respond to treatment for inflammation, but sometimes they do well with treatments like prolotherapy to rebuild more normal tissue or surgical repair.

Since the shoulder is so mobile and unstable, damage over time can become severe. Torn muscles, ligaments, tendons and arthritic degeneration can make the shoulder painful and difficult to use. When the changes are beyond normal surgical repair, artificial joint replacement sometimes becomes an option. These decisions can only be made with the help of an Orthopedic surgeon after all conservative care has failed.

The shoulder is a complex joint. Intrinsically, it is very unstable by its design. The structures holding the parts together are easy to damage over time because we use our arms for so many activities. If pain is not going away in the shoulder with simple treatment of rest, ice, heat, and over the counter medications, then having a physician help with the diagnosis and treatment would be beneficial.

Study: Medical Marijuana Leads to Fewer Overdose Deaths

August 26, 2014February 17, 2016 / Thomas Cohn, MD

A new study published in the Journal of the American Medical Association found that states that have legalized medical marijuana report significantly fewer overdose deaths than states that haven’t legalized medical cannabis.

The Study

For their study, researchers analyzed mortality data and medical marijuana adoption across the US between 1999 and 2010. Only 13 states adopted medical marijuana by the end of data collection, but the results were fascinating.

“We found that there was about a 25% lower rate of prescription painkiller overdose deaths on average after implementation of a medical marijuana law,” said lead author Dr. Marcus Bachhuber.

Looking solely at 2010, Bachhuber said states with medical marijuana laws experienced about 1,700 fewer deaths than what would have been expected based on numbers prior to medical marijuana legislation. Bachhuber said medical marijuana can be a viable option for individuals suffering from certain chronic pain conditions.

“It can be challenging for people to control chronic pain, so I think the more potions we have, the better,” he said. “But I think it’s important, of course, to weigh the risks and benefits of medical marijuana.”

As I mentioned in previous blog posts, the issue I have with marijuana is that it contains so many compounds that haven’t been sufficiently studied. I’m all for conducting more research on medical marijuana, but I don’t think the results of this study mean every state should immediately legalize medical marijuana.

It’s certainly an eye-opening study and raises many good points, but one of the main objectives of any good pain doctor is to control for as many variables as possible. That’s much harder to do with marijuana. You don’t know how the compounds in that specific plant are going to react with that specific person.

The American Academy of Pain Medicine echoed similar sentiments when discussing the recent findings.

“AAPM believes that we need to do research on cannabinoids to determine its safety and efficacy,” said Dr. Lynn Webster, former AAPM president. “The problem with medical marijuana is that we never know using marijuana what chemicals are being ingested. That makes it really unpredictable, but the use of cannabinoids may well have a place in the treatment of pain and other diseases. The AAPM believes that the DEA should reschedule cannabinoids from Schedule I to Schedule II so that it will make it easier for research to be conducted.”

There will almost certainly be more research on medical marijuana in the near future, but until more is known, it can’t be viewed as a perfect solution.

Related source: CNN.com

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

Pain-Free Tiger Woods Struggles at PGA Championship

August 7, 2014 / Thomas Cohn, MD

Tiger Woods felt fine physically during his opening round at the PGA Championship today, but his golf game wasn’t up to par with his body as he shot a first round 74 to finish Thursday at +3.

After his exit at the Bridgestone Invitational last week, many wondered if Tiger would attempt to play in golf’s final major. Woods arrived to the tournament Wednesday morning in time to get a practice round in, telling reporters after the round he felt “pain-free.”

“I felt pretty good about how I played and the shots I hit,” Woods said of Wednesday’s practice round. “I have to get used to how this golf course is playing.”

Woods looked a little flustered by the course on Thursday, shooting +1 on the back nine and +2 on the front. Currently he sits nine strokes behind Lee Westwood and Kevin Chappell, who both carded an opening round 65.

Back to His Back

Woods opened up about the back injury he suffered at Bridgestone during Wednesday’s press conference. He said he jarred his back when he stepped into a bunker and displaced his sacrum bone.

“Yeah, basically when I landed in the bunker, my sacrum went out,” Woods said. “So pinched the nerve, and hence the spasm. My physio put it back in, and we’ve just been treating it.”

Woods added that he still needs to build strength in his ailing back.

“My physio is here,” he said. “If it does go out, he’s able to fix it. One of those things, again, I still need to build strength, still continue to get stronger. Just going to take more time.”

Woods also noted that his sacrum issue was unrelated to the microdiscetomy operation he underwent on March 31 to address a pinched nerve.

“It was a different pain than what I had been experiencing, so I knew it wasn’t the site of the surgery,” Woods said. “It was different, and obviously it was just the sacrum.”

Woods said he took anti-inflammatory medication prior to his practice round, but he didn’t take any pain meds or receive a cortisone shot. He’ll try to end up on the right side of the cut line when he tees off Friday at 1:45 pm ET.

Related source: ESPN, USA Today

Painkillers Most Often Prescribed in the South

July 31, 2014 / Thomas Cohn, MD

Many people have heard the term “Minnesota Nice,” but the term “Minnesota Tough” may soon be a new moniker after it was revealed that Minnesota was among the lowest per capita states for pain pill prescriptions.

The report published earlier this month by the Centers for Disease Control and Prevention assessed painkiller prescriptions and analyzed how they varied state to state. The study analyzed prescription totals for common painkillers including Vicodin and OxyContin, and the findings uncovered an alarming trend about painkiller prescriptions, particularly in southeast.

Alabama had the highest rate of prescriptions, followed closely by Tennessee, West Virginia, Kentucky, Oklahoma, Mississippi and Louisiana. Doctors in the south also had higher prescription rates for antibiotics and stimulants for children.

The study wanted to pinpoint the problemed states after some concerning overdose death trends emerged over the last few years. In 2011, 41 percent of the 41,000 overdose deaths were from prescription pain meds.

“Prescriptions go up, deaths go up. Prescriptions go down, deaths go down,” said CDC Director Dr. Tom Frieden.

Frieden added that more drug monitoring programs at the state level and more laws aimed at shutting down “pill mills” are two main ways local and national governments could help curb prescription painkiller overdoses.

Minnesota’s Number Encouraging

Although the exact numbers aren’t known, USA Today published a color-coded map that determined whether a state’s total painkiller prescription per capita total was low, medium, high or very high. Minnesota was one of 13 states to earn the “low” distinction along with Alaska, California, Colorado, Hawaii, Illinois, Maine, Massachusetts, New Jersey, New York, South Dakota, Vermont and Wyoming.

Aside from being tough, it appears that Minnesotans are aware that pain care needs to be a multi-faceted approach. There is no magic pain pill. Prescriptions need to be combined with diet, exercise, physical therapy and help from a trained professional if you want to give yourself the best chance to live a pain free life.

Keep it up, Minnesota.

Related source: Lee County Courier