The Connection Between Menopause and Chronic Pain

March 7, 2019 / Thomas Cohn, MD

Research has shown that middle-aged women are more likely to experience chronic pain than middle-aged men, and a new study suggests that menopause may play a role in that pain expression.

For the study, researchers with the Veterans Affairs took a closer look at the health data of more than 200,000 female veterans between the age of 45 and 64. In that group, researchers found that women with menopause symptoms were nearly twice as likely to have chronic pain and additional chronic pain diagnoses.

“Changing levels of hormones around menopause have complex interactions with pain modulation and pain sensitivity, which may be associated with vulnerability to either the development or exacerbation of pain conditions,” says JoAnn Pinkerton, MD, Executive Director of the North American Menopause Society (NAMS). “This study suggests that menopause symptom burden may also be related to chronic pain experience.”

Menopause and Chronic Pain

However, hormonal changes weren’t the only factor driving an increased likelihood of chronic pain conditions. Other factors include:

Being overweight or obese
Having a mental health diagnosis

Researchers found that 18 percent of women with chronic pain had been diagnosed with PTSD, 15 percent had anxiety and 13 percent suffered from depression. The above factors go hand in hand with menopause and aging, which often include weight gain, decreased physical activity, mood changes and impaired sleep, which can all also affect pain sensitivity and pain tolerance.

“Both chronic pain and menopause symptoms are strongly and consistently associated with psychosocial factors and health risk behaviors prevalent in and after the menopause transition,” said study lead author Carolyn Gibson, PhD, San Francisco VA Health Care System. “Consideration should be given to integrated approaches to comprehensive care for midlife and older women with chronic pain, such as targeted cognitive behavioral therapy coordinated with interdisciplinary care providers.”

This is not the first study to find a link between menopause and certain health conditions. A large study conducted last year found a strong association between the onset of menopause and rheumatoid arthritis. The study also found that menopause was associated with a worsening progression of rheumatoid arthritis, and post-menopausal women with RA had a significant increase in functional physical decline.

If you are getting nearly menopause or working through it, it’s more important than ever to focus on aspects of your health that can help reduce pain sensitivity. Make sure you are eating a healthy diet and getting plenty of regular exercise, and be sure to talk to your pain specialist if you have any questions or need assistance with an issue!

FDA Reexamining Opioids For Chronic Pain

February 26, 2019 / Thomas Cohn, MD

The Food and Drug Administration has announced that it will require drug companies to conduct studies to determine if prescription opioids are effective in treating chronic pain.

A number of studies have already suggested that pain controlling opioids are ineffective beyond 12 weeks, and many industry professionals say that continued opioid use after this period can increase a person’s likelihood of developing a dependence or addiction. The FDA wants to supervise the new studies to determine if certain changes, like the following, need to be made:

Changing the labeling on certain opioids
Imposing special rules for prescribing, dispensing and taking certain opioids
Prohibiting use of certain opioids in some cases

“We are going to impose a mandate on existing products . . . to answer the question that people have been posing for years: whether you have declining efficacy, and whether that declining efficacy can lead to addiction,” said FDA Commissioner Scott Gottlieb.

Some Don’t Agree

While it may seem like a good move that the FDA is appearing to take a step in the right direction of opioid abuse, others say the new measures are nothing more than a stall tactic for big pharma. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, said the FDA ordered a similar measure in 2013 and that they already have all the research they need to make changes that could help protect the public.

“Here we go again,” Kolodny said in an interview. “That’s exactly what the FDA said to us in 2013. . . . Five years later, we don’t have the studies and another FDA commissioner says, ‘We’re going to do the studies.’ ”

However, Gottlieb argued that the research would be aimed at immediate, extended-released and long-acting opioid tablets that are given for pain care outside the healthcare facility. The studies would also cover current medications on the market to examine if new applications of the pain reliever could be more effective. The FDA will also be conducting a second study that is out to determine if opioids can actually cause users to become more sensitive to pain.

A similar study was carried out back in 2013, but Gottlieb said those studies were difficult to carry out because the FDA could only ensure post-marketing studies on safety, not effectiveness. They now have the authority to demand effectiveness research as part of an act passed back in October.

The opioid crisis killed 47,600 people in 2017, but there’s hope that the new research can lead to effective changes. There’s still plenty of work to be done, but with more control over effectiveness research, there’s hope on the horizon.

Cardiac-Powered Pacemakers and Implantable Pain Devices

February 19, 2019 / Thomas Cohn, MD

A team of scientists at Dartmouth College have developed what they believe is the future of implantable devices. Their dime-sized device turns kinetic energy of the heart into electricity that can power pacemakers and other implantable devices.

The invention works by adding a small piece of polymer piezoelectric film, called “PVDF,” to current implantable devices. This film converts the smallest motions into electricity, which can be used to power or recharge the device. The electricity can also be used to help implanted sensors collect other vital health information.

“We knew it had to be biocompatible, lightweight, flexible, and low profile, so it not only fits into the current pacemaker structure but is also scalable for future multi-functionality,” said research associate Lin Dong, who added that it is “of equal importance is that the device not interfere with the body’s function.”

Powering Pain Control Devices

The team noted that they just completed their first round of animal testing, and the study produced “great results.” If things stay on track, they believe the device could be ready for commercial release within five years.

This could be a gamechanger for individuals with implantable devices, because oftentimes they need to have their batteries replaced every 5-10 years. This means subsequent surgeries, which is not only costly for the patient, but every surgery carries potential risks. By developing a device that can prevent the need for excessive surgeries, we can save patients time, money and risk.

Hopefully the device continues to progress through the necessary stages in clinical trials. It sounds like it’s primarily being used in pacemakers, but it would be great if it could also become mainstream in implantable pain devices. These implantable devices also need to have their batteries changed every so often, so to be able to save patients the hassle of a battery change would be incredible. It’s all about providing the patient with the best care, and this device has the ability to do just that.

I’ll be keeping an eye on this device in the coming years, and I hope to see it commercially available in the not-so-distant future.

Chronic Pain The Most Common Reason Patients Seek Medical Marijuana

February 14, 2019 / Thomas Cohn, MD

A new study found that chronic pain was the most common reason why individuals in state-approved medical marijuana programs turned to cannabis to help with their health condition.

The study looked at data from 15 states who have legalized marijuana for medicinal purposes. Here’s a look at the top three reasons why people turned to medical marijuana:

Chronic Pain
Stitfness related to Multiple Sclerosis
Chemotherapy-related nausea

“The majority of patients for whom we have data are using cannabis for reasons where the science is the strongest,” said lead author Kevin Boehnke of the University of Michigan.

Marijuana For Chronic Pain

More than 30 states allow the use of medical marijuana, but the conditions that are eligible for the product vary from state to state. For example, Minnesota allows medical marijuana to be used to alleviate symptoms from conditions like glaucoma, chronic pain, PTSD, seizures and much more. They are always evaluating which conditions meet the requirements, and Minnesota will add Alzheimer’s Disease to the list of approved conditions in July of this year.

When taking a closer look at the study results, researchers found that about two-thirds of the roughly 730,000 reasons listed for taking medical marijuana were related to chronic pain. Since patients could report more than one pain condition, researchers say the figure may be a little over-inflated, but it still speaks to how many people are looking for a better way to deal with their chronic pain condition.

“Cannabis is the first thing I’ve found that actually makes the pain go away and not leave me so high that I can’t enjoy my day,” said Brandian Smith, 37, of Illinois, who takes medical marijuana for her fibromyalgia.

Researchers also noted that in Arizona, Colorado, Nevada and Oregon, there was a noticeable decline in medical marijuana patients after those states legalized recreational marijuana. Currently there are about two million people in the United States who use medical marijuana for their pain condition.

Is you need help managing your pain condition, set up an appointment with a pain specialist like Dr. Cohn.

Why Is There No Clinical Test For Pain?

February 5, 2019 / Thomas Cohn, MD

Many people who have chronic pain wonder why we just do not have a test to prove they have pain. To every person who has pain, it is obvious that something is wrong. With so many people having pain, most people wonder why there is no test for it. It is considered so important that it has been termed the fifth vital sign. The other vitals like pulse or blood pressure can all be measured, so when are we going to be able to measure pain?

Recently there have been several articles in the press about techniques to measure pain. One of these is to measure pupil reactions to light and other reactions to stimuli to determine whether something is painful or not. So far, information obtained is just correlated on an individual basis and is not helpful to determine if a particular person has pain.

Quantifying Pain

Scientists have been looking for a definitive measure of pain for years. The NIH (National Institutes of Health) has looked at everything from brain scans to blood tests and measuring various body signals from pupils to pulses for a quantifiable way to determine pain. The overall problem is pain is subjective and based on the emotional interpretation of sensory signals. Simply put, everyone feels sensory signals differently and they can vary even with the same person depending on the circumstances at the time. The same pain sensations can be horrible one day and mildly annoying at a different time. It is totally dependent on all the other signals that the brain has to concentrate and interpret. If I am distracted by pleasurable visual sensations, I may not realize pain. If I am emotionally distraught, a painful stimulus may be excruciating.

To measure pain, one needs to measure the brain’s level of perception and interpretation of a variety of sensory signals. We also need to know what are the significant areas in the brain that are interconnected and how they determine our perceptions of pain. At this time we know there are sensory signals triggered in the body and we know the brain receives these signals. We do not know why one input may be horrible pain and another similar signal is mild pain. We do know pain is what each person perceives it to be in his or her own individual interpretation. Your pain is not the same as mine, even if the physical problem is the same.

Pain is a problem because it is difficult to measure and it is a different experience for every person. The impact of pain on the quality of life is tremendous since 30 percent of the world population suffers chronically from pain. Better understanding of pain is necessary to develop strategies to manage the problems associated with it.