Sex and Chronic Pain

June 30, 2014February 17, 2016 / Thomas Cohn, MD

Many patients who have chronic pain say they have no interest in sex, that sexual intercourse causes too much pain, or that they feel unattractive or undesirable because of the pain. It’s important to remember that emotional intimacy is as important as food and shelter for overall health. Sexuality is a normal part of living and is an important aspect of your identity. Chronic pain often invades the pleasures of life and destroys your sexuality.

Chronic pain affects the patient emotionally and physically. The psychological problems that chronic pain causes include:

Stress
Depression
Anxiety
Diminished self-esteem

If the brain cannot desire sex, the body certainly will not perform. The core problem may simply be the pain, but often it is much more complex. Receiving help requires the patient to identify that they are having sexual issues.

The most common direct causes of sexual problems include too much pain and medication side effects. Adjusting pain treatments may be the only necessary intervention. It also may be necessary to become more aggressive in the overall management and intervention for the painful condition. Many medications used in pain management (as well as medications for common problems) can cause sexual problems, including narcotics, anti-inflammatories and even antidepressants. A comprehensive strategy may be necessary and working with a pain physician may be the best approach.

Emotional Issues

Chronic pain often causes emotional problems, including stress, anxiety and depression. These problems all contribute to sexual difficulties. Until the psychological issues are being addressed successfully, it is often hard to control pain and have interest in sex. If simple medication management is not controlling emotional issues, professional help with a psychologist may be extremely beneficial.

Working with your partner is also necessary, especially when it comes to expressing your needs and concerns. Doctors cannot read your mind and if you do not tell them you are having problems, they will not be able to help you develop solutions. A comprehensive approach will often be necessary, since most problems involve a complex interaction between the emotional and physical causes. Working closely with your partner and professionals is often the solution. Most problems can be greatly improved with a little bit of support and creativity.

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.

Hands and Head Most Sensitive to Pain

June 6, 2014June 23, 2014 / Thomas Cohn, MD

A recent study by researchers in the United Kingdom found that a person’s forehead and fingertips were the parts of the body most sensitive to pain.

Researchers believe their findings could help better understand the progression or regression of chronic pain or other pain related conditions. They said their findings have the potential to help millions.

“This measure tells us how precisely people can locate the source of pain on different parts of their body,” said senior author Dr. Giandomenico Iannetti of the UCL department of neuroscience, physiology and pharmacology. “Touch and pain are mediated by different sensory systems.

Laser Study

To better understand how individuals sense pain, researchers blindfolded 26 individuals and used a pair of lasers to simulate a pinprick sensation on various parts of their bodies. Researchers would either use one or both lasers, and they asked participants whether they felt one or two pinpricks. By blindfolding the participants and causing the pain without touch, researchers were better able to track what they call “spatial acuity.”

“This method offers an exciting, non-invasive way to test the state of pain networks across the body,” said Dr. Roman Cregg, clinical expert on chronic pain.

After analyzing the data, researchers found that touch acuity is best at a person’s extremities and forehead. Cregg concluded that the study offers a deeper understanding of the nerves and sensory systems in our bodies.

“Chronic pain is often caused by damaged nerves, but this is incredibly difficult to monitor and treat. The laser method may enable us to monitor nerve damage across the body, offering a quantitative way to see if a condition is getting better or worse”.

Related source: The Guardian

Back Pain Could Force Jeff Gordon Into Retirement

June 2, 2014June 23, 2014 / Thomas Cohn, MD

NASCAR champion and fan favorite Jeff Gordon said he may be forced to retire if he continues to experience back pain similar to the spasms he had prior to last weekend’s Coca-Cola 600.

Gordon was forced to cut his practice runs short after back spasms jeopardized his safety on the track. He received treatment after qualifying and alternate Regan Smith was ready to race in his position if Gordon couldn’t go on Sunday, but the four-time Sprint Cup champion toughed it out, finishing seventh for his ninth top-10 finish this season. Despite the promising finish, Gordon said he may be forced into early retirement if the pain persists.

”I can tell you, if that happens many more times, I won’t have a choice,” Gordon said prior to Sunday’s race at Dover Motor Speedway.

Gordon said he felt sore following the Coca-Cola 600, but he added that it wasn’t much different than the soreness he feels after any long race. He also noted that his back wasn’t back to 100 percent heading into the race at Dover, and he doubted that it ever would be fully healthy while he’s behind the wheel.

Not The First Time

The last few weeks weren’t the first time Gordon has dealt with nagging back pain. In 2008 he needed regular treatment on his back, seeking out professional treatment, anti-inflammatory medication, and strengthening exercises with a trainer. He went winless in 2008 and contemplated retirement, but the pain eventually dulled. He dealt with on and off pain over the next six years, but he said he never felt a stabbing back pain like the pain he experienced last weekend.

“There was nothing that was going to fix it until I had those injections on Saturday,” Gordon said.

The injection clearly helped him finish seventh in the Coca-Cola 600, and he came in 15th at Dover this past weekend. Gordon noted that he’ll just have to push through the discomfort if he wants a chance to capture an elusive fifth Sprint Cup Championship.

”It’s just something I continue to learn and push through,” he said. ”It’s no big deal.”

Related Source: Yahoo