The Link Between Chronic Pain And Borderline Personality Disorder

March 3, 2020 / Thomas Cohn, MD

bpd New research presented at the American Academy of Pain Medicine 2020 Annual Meeting found a significant connection between patients with chronic pain and borderline personality disorder (BPD).

Results of a systemic review found that nearly 1 in 4 patients with chronic noncancer pain had some features of borderline personality disorder, including mood instability and difficultly maintaining relationships.

“The fact that one fourth of individuals with CNCP could have co-occurring BPD underscores the need for improved access to good psychological care,” lead investigator Fei Cao, MD, PhD, University of Missouri at Kansas City, told Medscape Medical News in an interview.

Chronic Pain and BPD

For the study, Cao and colleagues reviewed 11 studies published between 1994 and 2019. During their investigation, they found that 23.3 percent of patients with chronic pain expressed traits of BPD. Some of the conditions that expressed BPD traits included:

Chronic headaches (11.3%)
Arthritis (27.5%)
Chronic spinal cord pain (24.3%)

The biggest takeaway for Cao and his team was that doctors can’t just focus on chronic pain, there needs to be a comprehensive approach to total body wellness.

“The point of this research is that you cannot help these patients in the long-run if you only treat their pain. We also have to treat their BPD. This can then make pain easier to control,” said Cao. “If we treat the borderline personality disorder and address the psychiatric needs as well as the pain needs of the patient, then we will be able to treat their pain more successfully.”

Not everyone with chronic pain suffers from BPD, but this study speaks to how underlying conditions can oftentimes make chronic pain more difficult to treat. If we’re not treating the whole patient, treatment success can be undermined, especially when it’s a psychological component at play. Having healthy mental and emotional health can help to improve functional physical outcomes, and the opposite is also true. If we ignore our mental and emotional health, some of the treatments were’ trying for physical ailments may not be as successful because we’re not treating the totality of our issues.

Cao concluded by saying that physicians should consider screening patients with unresponsive chronic pain that may or may not be showing signs of BPD. Not only can it help the patient improve their mental health, but it may also help increase the success of current treatments for chronic pain.

So if you’ve been dealing with chronic pain and it’s affecting your mood or your mental state, reach out to a physical medicine specialist to get a comprehensive diagnosis and a treatment plan suited to your individual needs.

How To Battle Back Against Nagging Spine Pain

February 25, 2020 / Thomas Cohn, MD

Back pain is one of the most common health conditions in the world, and tens of millions Americans deal with one form of the condition every single day. Spine pain can make even the most mundane activities painful, and it can really impact our quality of life, so it’s not something you should try to ignore and push through. Only treating the problem head-on will help put an end to your nagging back pain. We explore some ways to fight back against nagging back pain in today’s blog.

Treating Chronic Back Pain

This is far from a one-size-fits-all solution to chronic back pain, but odds are you’ll find some form of relief by pursuing one or more of the following techniques. So if you want to take back control over your nagging back pain, consider:

Getting A True Diagnosis – The spine is a complex structure, so if we’re researching our symptoms online, it can seem like we’re dealing with one thing when we’re actually dealing with something else. If you treat the wrong underlying condition, odds are you aren’t going to find relief. Head to a pain management specialist to get a comprehensive diagnosis and a treatment plan catered to your individual needs.

Pursue Active Treatment – For the majority of spinal conditions, rest alone isn’t going to solve the problem. We need to actively work to strengthen injured or nearby structures so that our body is up to the physical tasks we demand of it. Exercise, targeted stretching and physical therapy are all great ways to strengthen your spine and help achieve symptom relief.

Proper Medication Management – We’re not here to tell you to ditch the opioids and pain medications because we know from first hand experience just how integral they are to some patient’s pain care plan. However, you need to make sure that you are maximizing the benefits of these opioids, because eventually you’re going to build up a tolerance. If painkillers help make movements less painful, use that time to go to the gym or perform your PT exercises. Pain medications play a key part in pain management, but for full benefit they need to be paired with active treatment options.

Treat Your Mind – It’s also important to care for your mental health while you’re trying to tackle back pain. Your mindset plays a key role in the success of treatment as well as your willingness to partake in helpful activities like rehab or PT. Talk to your doctor about any negative thoughts or anxious feelings you’re having, and find healthy ways to help take your mind off back pain. Psychological and physical well-being are often connected, so don’t ignore one while trying to treat the other.

Stick With It – Finally, really dive into a care plan routine and see it through. You’re not going to lose weight and make your New Year’s resolutions if you stop going to the gym after a week, and you’re not going to see much progress if you skip physical therapy sessions or make poor dietary choices. Really commit to a back pain treatment plan, and we’re confident you’ll see positive results soon enough.

For help with any aspect of your back pain management, reach out to Dr. Cohn’s office today.

A Doctor’s Perspective On Daith Piercings For Migraines

February 19, 2020 / Thomas Cohn, MD

Nobody wants to have to deal with a headache, or worse, a migraine, but oftentimes patients feel helpless to control and prevent their onset. Some people have found that improvements to daily exercise and dietary habits can help a little, but others can’t seem to find treatment success no matter what route they pursue.

One treatment option that we’ve recommended in the past for patients who have failed to find relief with more standard treatment options is the Daith piercing. It involves piercing part of the cartilage in a person’s ear in order to stimulate that vagus nerve. As we’ve talked about in previous blogs, stimulating the vagus nerve may increase parasympathetic activity and decrease excessive sympathetic activity in the region, which would likely decrease the vascular events that surround migraine headaches.

Now, it’s worth noting that our understanding of the inner workings of vagus nerve stimulation is still in its infancy. In fact, the first handheld non-invasive electrical vagus nerve stimulating device only recently received FDA clearance, but it’s a huge step in the right direction in terms of helping people find the right way to prevent and treat their headaches. In our understanding, there certainly appears to be a correlation between vagus nerve stimulation and certain headache relief, but we need to better understand the science between these connections. Simply put, we’re not saying that this is a perfectly wonderful and clinically-proven treatment option for headaches. What we will say is that we’ve seen it work for a number of patients.

Why Consider Daith

When it comes to considering the Daith piercing to help control your headaches, it really comes down to a value proposition. Many patients have spent thousands of dollars on treatments that haven’t proven successful, so when they hear about the Daith piercing, it’s often viewed as a relatively low-risk option from a cost standpoint. The piercing can run anywhere from $30-$100 and you’ll want to find someone with specific Daith piercing experience to place the piercing in the right spot, but it’s often far cheaper than other headache treatment options, so for many it’s worth consideration.

If you’re battling frequent headaches and you’ve tried other options, consider reaching out to a pain management specialist to learn more about vagus nerve stimulation. Some patients have even found some relief by gently massaging their ear in the location of the vagus nerve (see the center piercing in the photo for the correct location) when they feel a headache coming on. Try massaging one side and then work on the other ear. If massaging one side seems to help, that may be the ear to get the piercing in.

At the end of the day, we can’t reiterate enough that this treatment isn’t fully researched and shouldn’t be your first option. However, our goal as clinicians is to help our patients find pain relief, and if other treatments have failed, maybe vagus nerve stimulation is something to consider. You have a lot to gain and little to lose, and we’d be more than happy to go into more specifics during a pain management appointment. We can’t perform the piercing and we don’t refer you to any piercers in the area, but we can talk about the connection between nerve stimulation and headache relief. We may recommend other options, but we want to do what’s right for you. Whether that’s in the form of hands-on treatment or patient education, we want to help you find a solution to your headaches. Give our office a call today if you’ve been battling chronic headaches or migraines.

The Daily Challenges Faced By Those With Chronic Pain

February 12, 2020 / Thomas Cohn, MD

Living with chronic pain can be extremely frustrating, and for a number of reasons outside of the actual pain. There are so many daily challenges faced by those with chronic pain that often go overlooked or ignored, so we wanted to bring awareness to the reality that many individuals with chronic pain go through on a regular basis. Here’s a look at some of the daily challenges faced by those with chronic pain outside of the pain itself.

Life With Chronic Pain

Chronic pain is so much more than physical pain. Here’s a look at the struggle of trying to get through your day with chronic pain.

1. You Don’t Look In Pain – A cold can take the color from your face and a broken arm will require a noticeable sling, but for many patients battling chronic pain, there are few outward symptoms. They may put on a brave face, but their neural network inside their body may be telling a different story. Because they may not look like they are in pain, many people without chronic pain can’t relate to the pain you’re dealing with on the inside. They may think you’re faking it or playing up your pain because you “look fine,” but that couldn’t be further from the truth. Chronic pain patients are often stuck between a rock and a hard place. They either have to pretend like everything is alright when it’s not or be accused of faking or embellishing their pain.

2. Treatment Isn’t Always Straightforward – For a lot of medical conditions, we have a standard care plan in place. If you sprain your ankle, you RICE (Rest, Ice, Compress and Elevate), or you take antibiotics for certain infections. However, chronic pain is so unique to the individual that there’s no one-size-fits-all care plan. Patients often have to see multiple doctors and try a range of treatments before they find something that works for them. This process can be very exhausting and even compound the problem.

3. Social Effects – Chronic pain can also wreck havoc on your social life. Pain can keep you from wanting to head to the movies or play Frisbee in the park with some friends, but pain doesn’t even have to exist to cause these concerns. The possibility of a painful flareup is enough for some people to play it safe and stay home, which can lead to further feelings of isolation. Oftentimes patients with chronic pain want to participate, but their pain or its potential hinders their ability.

4. Pain Is So Inconsistent – It would be a lot easier to plan your life if you knew when a flareup was going to occur and when your good or bad days were going to be. Unfortunately, chronic pain doesn’t work like this. The inconsistency of chronic pain can really affect your mental and emotional state, furthering the problem.

These are just a few of the ways chronic pain can impact a person’s daily life. If you or someone you know is struggling with chronic pain, reach out to Dr. Cohn’s office to see how we can help.

Could Deep Brain Stimulation Help Treat Chronic Pain?

February 4, 2020 / Thomas Cohn, MD

Nearly one in three adults in the US suffers from some form of chronic pain, and despite everyone’s best efforts, it’s not always easy to treat. We’re always looking for new ways to best help our patients decrease and eliminate their chronic pain, and one new treatment that is being closely monitored and tested is deep brain stimulation.

Deep brain stimulation (DBS) may sound like some futuristic medical experiment, but it’s already being used to treat some cognitive impairments. It has been successful in helping limit symptoms in conditions like Parkinson’s disease, dystonia and tremors, and now doctors are wondering if it could be useful in managing some types of chronic pain.

DBS works by implanting electrodes deep into a person’s brain in the areas that help control movement. A stimulator is also implanted in the chest, and the stimulator can help drown out problematic brain signals. The only issue is that it’s not a perfect science, and you’d like it to be perfect when you’re implanting a device in a person’s head. The electrical current relayed through the stimulators is constant, meaning it can’t adjust to what’s going on in the brain, it simply operates as a way to drown out problematic signals.

Because of this, some patients have experienced changes in personality or problems speaking, and like many treatments, the brain can get used to the stimulation and find ways to drown out the signal that is supposed to be drowning out the problematic signals. So while it’s not a perfect system, medical experts are always trying to improve it, and now they are researching whether it could be a viable option for chronic pain patients.

Deep Brain Stimulation For Chronic Pain

Researchers at the UCSF Weill Institute for Neurosciences recently received a $7.56 million, five-year grant to see if DBS could be used as a treatment for some forms of chronic pain. However, their goal is to develop the technology so that the current can be harnessed and used based on signals from the brain in real-time, instead of as a constant current.

Researchers likened the system to a space heater and a thermostat. The space heater provides constant heat, whereas a thermostat can turn the heating system on and off based on the current temperature and a desired setting. Right now DBS is a space heater, but researchers say they hope to use the grant to help develop a more thermostat-style model.

“We are trying to build a model to serve as a thermostat to control electronic stimulation to provide pain relief,” said Dr. Prasad Shirvalker, assistant professor of Anesthesiology at UC San Francisco. “We’re at the front edge of trying to open up new indications for DBS.”

Hopefully researchers can figure out how to control DBS in the most complex system in our body so that chronic pain patients can have another avenue to pursue relief. We’ll keep tabs on this research as it progresses.