chronic pain

Tips For Being A Great Friend To Someone With Chronic Pain

/ Thomas Cohn, MD

chronic pain friendLiving with chronic pain can be extremely challenging for a number of reasons, and as we’ve talked about on the blog in the past, it can have a significant effect on your social life. You don’t want your friends to feel isolated or alone because of their pain condition, but being a great friend can take a little extra work because of the complexity and unpredictable nature of a chronic pain condition.

Because of this, we wanted to use today’s blog to highlight some of the ways you can be a great friend to someone with chronic pain.

Supporting A Friend Who Is Dealing With A Chronic Pain Condition

Here are some ways you can be a supportive friend to someone who is battling a chronic pain condition.

Listen More Than You Talk – As the old adage goes, we have two ears and one mouth, so we should do twice as much listening as we do talking, and that’s especially true when supporting a friend with a chronic pain condition. Let them vent their frustrations to you, or keep the conversation about anything other than their pain condition. Be a good listener and really hear them when they talk.

Know That Cancellations Aren’t Personal – You may have had those plans on the books for months, but temper your expectations and know that a last-minute cancellation is possible and that it is nothing personal. Many chronic pain patients don’t know when their next flare up is coming, and despite their best efforts, they may be having a bad day at the absolute worst time. Be understanding if they have to back out of a commitment and know that their decision to cancel plans isn’t anything personal.

Be A Positive Voice – It can be easy to focus on the negatives of a chronic pain condition, but doing so isn’t good for your mental and emotional health. Do what you can to be a positive voice of encouragement. If you notice that your friend is more physically capable or has made strides since the last time you saw them, let them know. This encouragement and positive talk may be more important to them than you’ll ever know, so try to avoid focusing on the negatives associated with a pain condition.

Be Persistent – Those dealing with a chronic pain condition are less likely to make plans or meet you out on a moment’s notice, so you can be a great friend by regularly asking them to do things. Remember that cancellations or unaccepted invites aren’t personal, but they’ll love that you’re reaching out and wanting to connect. Don’t stop reaching out even if most plans don’t come to fruition. It’s easy for social circles to get smaller and smaller as a result of chronic pain, so don’t stop reaching out even if it takes a while to make plans.

If you do these things and practice patience, you’ll be a great and supportive friend to someone battling a chronic pain condition. It takes a little extra effort, but we know from first hand experience how important it is to have friends like this if you’re working to overcome a chronic pain condition. For more information, or for help with a different chronic pain issue, reach out to Dr. Cohn today at (952) 438-4580.

Opioids – Damned If You Do, Damned If You Don’t

/ Thomas Cohn, MD

painkillersIf you’re a regular reader of our blog, you know our views on opioids for pain management. Used correctly, opioids can be a wonderful compliment to a chronic pain management program, but their use can also cause some health issues even when carefully taken. According to a new study, not only can starting an opioid regimen be potentially hazardous to your health, so too can stopping opioid use. This doesn’t mean that you should plan to take opioids indefinitely, but it speaks to the importance of working with a pain management provider when starting and stopping an opioid regimen.

According to a recent study published in the journal PLOS Medicine, stopping a prescription opioid regimen can actually increase a person’s risk of overdose death. Opioid-related overdoses are a major concern here and in Canada where the study was conducted, and researchers wanted to learn more about the potential impact of discontinuing an opioid treatment plan. You might inherently believe that your risk of overdose falls to zero if you stop taking opioids, and in a perfect world, you’d be right. However, not everyone who stops taking opioids can do so easily, and therein lies the risk of eventual overdose.

Safely Stopping Opioid Use

For the study, researchers reviewed the medical records of more than 14,000 patients in British Columbia who had been on opioid therapy for at least 90 days. After reviewing the records, researchers found that discontinuing opioid therapy for chronic pain was associated with an increased overdose risk for people without an opioid use disorder (OUD). An inverse effect was seen in patients who tapered off of opioid use, as their overall risk of overdose decreased. Researchers concluded that abrupt opioid stoppage could be dangerous, and that patients should work with a provider to taper off of medications so as not to increase their risk of overdose as they seek to end an opioid regimen.

While there were some limitations in the study, including whether or not associated overdoses occurred with prescription medications or those obtained illegally, the general message holds true in that it is extremely important that you work with a physician when working to stop an opioid treatment plan. We understand that you are aware of some of the potential issues associated with opioid use, and we commend you on wanting to curb or eliminate your reliance on these medications. However, there is a right way to go about cutting prescription medications out of your system. Sometimes slow and steady wins the race, and cutting opioids cold turkey could have some unintended withdrawal effects.

If your current medication plan isn’t getting you where you want to be, talk to a doctor about safely adjusting your medication program. We want to help you find the right solution, but finding the right treatment is only part of the battle. You also need to approach the treatment in the right manner, otherwise you may face some unexpected obstacles.

For more information, or for help with a chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

New Findings On Why Poor Sleep May Lead To Chronic Pain

/ Thomas Cohn, MD

sleepA new study involving mice may have provided some more insights into why poor sleep and chronic pain may be linked.

According to the study, nerve injuries may cause certain brain cells to act excitedly during sleep, and this sudden excitement may lead to chronic pain onset. On a positive note, researchers say that stopping this hyperactivity during sleep could help provide significant pain relief

As we’ve talked about on the blog in the past, sleep disorders and chronic pain are closely related, but the exact nature of why certain sleep problems increase the risk of different types of chronic pain is not well understood. We’ve talked about how it can be hard to break out of the sleep-pain cycle, which theorizes that chronic pain makes it hard to fall asleep and stay asleep, and poor sleep quality can intensify pain sensations, but this recent study wanted to learn more about the exact connection between the two.

Sleep And Chronic Pain

For the study, researchers honed in on neuropathic pain, which is pain that derives from an injury or disease in the nerves that relays sensory information from the body to the brain. Researchers studied mice with injuries in one of the sciatic nerves, the large nerve that branches from the spinal cord through the hind legs. The team analyzed brain activity in the mice both before and after the sciatic nerve injury in order to see how the brain responded to this new pain. The team found that there were significant changes after the injury in the wrinkled cerebral cortex, which is the area that receives and stores sensory data from the hind legs. Moreover, certain brain cells became progressively more active in the weeks after the injury as the mice’s pain became chronic.

Perhaps most interestingly, this brain cell activity peaked during non-rapid eye movement sleep (NREM), which is when deep sleep occurs. Researchers said these neurons became hyperactive during NREM sleep as a result of an issue with the anterior nucleus basalis, a cluster of neurons located deep in the front of the brain. Researchers noted that the activity of the anterior nucleus basalis also increased after the nerve injury, and this triggered the cells to send a chemical response to the cerebral cortex. As a result of this chain reaction, the previously mentioned brain cells shifted into overdrive during NREM sleep.

This increase in brain activity was linked to an increase in pain sensitivity in mice, as researchers stated that once-painless stimuli suddenly became painful. In follow up experiments, researchers were able to relieve this pain by blocking cell hyperactivity along certain neural pathways during NREM sleep.

“Inhibition of this pathway during NREM sleep, but not wakefulness, corrects neuronal hyperactivation and alleviates pain,” the researchers concluded.

So while the study only examined mice, it does provide insights into how neural action during sleep can lead to increased pain during wake periods, and researchers are hoping that some of the findings would be similar in a human population. Future studies are sure to follow, and hopefully we continue to learn more about the connection between poor sleep and chronic pain onset.

For now, do what you can to prioritize healthy sleep if you have a chronic pain condition. Avoid caffeine late in the day, get regular exercise, go to bed around the same time each night and keep electronics out of the bedroom so that you have an ideal sleep environment. You may not be able to control what happens during NREM sleep, but you can work to break out of the sleep-pain cycle by making it easier for your body to fall asleep and stay asleep.

If you’re dealing with sleep issues as a result of your chronic pain condition, or you want help with a different pain issue, reach out to Dr. Cohn and his team today.

Tips For Preventing Pain Catastrophizing

/ Thomas Cohn, MD

Pain CatastrophizingChronic pain is challenging enough even when we attack the problem with a healthy mindset, and it only gets harder to manage if we catastrophize pain in our heads. Pain catastrophizing occurs when we overestimate the negative effects of pain and place significant focus on the presence of pain and the helplessness that can accompany a pain condition. Not only can pain catastrophizing make symptoms of chronic pain seem more intense, but it can also negatively affect your ability to overcome your pain condition.

With that in mind, we wanted to use today’s blog to share some tips for preventing pain catastrophizing and reducing pain’s impact on your psyche.

How To Avoid Pain Catastrophizing

Here are some tips to work towards a healthy mindset over your pain and prevent pain catastrophizing.

1. Control What You Can Control – This is a tip we’ve shared on the past when it comes to chronic pain care, but it can’t be understated. One of the most frustrating things about a chronic pain condition is the uncertainty that surrounds it. You never know when a flare up may occur and or whether tomorrow will be a good day or a bad day, but if you focus on controlling the controllable aspects of your life, you may find that it’s easier to manage pain in your mind. You may not be able to control every aspect of your day, but if you make positive strides in the modifiable areas of your life, you can take solace in knowing that you’ve done your part to gain control over your condition. Knowing that you’ve put in the work can help you avoid pain catastrophizing.

2. Understand What You’re Up Against – Misconceptions about your pain condition and your treatment can lead to pain catastrophizing. When you understand your condition and the best ways to manage symptoms and treat the underlying problem, you’re less likely to start catastrophizing.

3. Mindfulness, Meditation And Stress Relief – Studies have shown that stress can amplify pain sensations. When we’re stressed, not only can it lead to a pain flare up, but it can also lead to more intense pain sensations, and when this happens, it’s easier to start catastrophizing your pain. Instead, find a healthy way to manage stress and work to identify it and eliminate it from your life. Some people turn to exercise, others turn to mindfulness, while others turn to meditation or deep breathing techniques. Find a stress relief technique that works for you, and you can have a healthier mindset in regards to your pain condition.

4. Care For Your Mental Health – Finally, we oftentimes focus too intensely on the physical affects of a chronic pain condition. After all, pain is the most common and bothersome physical condition, but it’s important to remember that chronic pain affects our physical, mental and emotional health. There is a distinct possibility that your pain catastrophizing is connected to an underlying mental health issue like depression or anxiety that is being overlooked. Make sure that your chronic pain provider is willing to treat the totality of your pain condition, and that means understanding how pain impacts more than just your physical health.

Pain catastrophizing can be a significant hindrance to chronic pain treatment, so talk with your pain care provider if you believe that you could benefit from reframing your mental approach to pain care. For more information, or for help with a different aspect of chronic pain management, reach out to Dr. Cohn and his team today at (952) 738-4580.

More Patients Swapping Out Opioids For Medical Marijuana To Manage Pain

/ Thomas Cohn, MD

medical marijuana programNew research has found that nearly one-third of patients with chronic pain report using medical cannabis to manage their pain, with more than half of them decreasing their reliance on other pain medications, like opioids, in the process.

“That patients report substituting cannabis for pain medicines so much really underscores the need for research on the benefits and risks of using cannabis for chronic pain,” said lead author Mark C. Bicket, MD, PhD, assistant professor, Department of Anesthesiology, and director, Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, in an interview with Medscape Medical News.

Medical Cannabis Use

For the study, researchers surveyed 1,724 Americans over the age of 18 with chronic noncancer pain living in areas where medical cannabis was available. Participants were asked about their use of three different types of pain management:

  • Medical marijuana
  • Pharmacologic treatments like opioids, non-opioid analgesics and over-the-counter medications
  • Non-pharmacologic treatments like physical therapy, cognitive behavioral therapy or mindfulness

After looking at the survey results, researchers found that 25.9 percent of respondents reported using medical cannabis within the last year, and 23.2 percent reported using it within the past 30 days. More than half of patients who said they used medical cannabis said this also led to a decrease in prescription opioid use, prescription non-opioids and over-the-counter medications. “Almost no one” said that medical cannabis led to a higher use of these medications, said Dr. Bicket.

Medical cannabis use also impacted other treatments as well, for the good and the bad. 38.7 percent of people said that cannabis use led to decreased physical therapy sessions, 19.1 percent said it led to lower use of meditation, and 26 percent said it led to less CBT. Conversely, 5.9 percent of patients said cannabis use led to more physical therapy, 23.7 percent said it led to more meditation therapy, and 17.1 percent said it led to more CBT, so cannabis use clearly had a more widespread variance on other therapies than it did on pharmacological treatments, which saw a very obvious decreased correlation.

While Bicket was pleased with the findings, he noted that the current environment – where cannabis use is medically approved on some state levels but illegal on the federal level – makes it harder to accurately study the best ways to implement cannabis use for a patient population.

“We really don’t have a good sense of the relative risks and benefits that could come from cannabis as a treatment for chronic pain,” said Bicket. “As a physician, it’s difficult to have discussions with patients because I’m not able to understand the products they’re using based on this regulatory environment we have.”

Bicket seems to have the same gripes about the current medical marijuana climate that we have about chronic pain care in general. For one reason or another, we’re not able to easily study the best ways to treat chronic pain or harness the power of certain treatments like medical marijuana. Hopefully the landscape changes in the near future so that patients can have better access to the right treatments for their individual needs.