chronic pain

Managing Chronic Pain During The Holidays

/ Thomas Cohn, MD

Chronic Pain HolidaysThe holidays can be a wonderful time of year, but they can also be a time of stress, especially if you have to deal with chronic pain. Whether your pain is in the form of low back pain, arthritis or pulsing headaches, pain can make the holidays nearly unbearable. However, you can make the pain a little more manageable if you keep a few tips in mind. Today, we’re going to share four tips for keeping chronic pain under control during the holiday season.

Chronic Pain and The Holidays

Here are a few tips to keep in mind as the holidays approach.

1. Share Duties – No matter what you’re doing, be it wrapping presents, shoveling the driveway or cooking a Christmas feast, always recruit some helpers to take the burden off your body. Standing on your feet or over stressing your back can all cause inflammation to flare up, making pain worse. Always see if some friends or family are willing to lend a hand when you have a lot on your plate.

2. Travel Comfort – Whether you’re driving home from college or flying across the country to meet up with loved ones, if you aren’t prepared to travel, chronic pain can be exacerbated by the extended period in one spot. Consider these tips when attempting to keep chronic pain at bay when traveling:

  • Stand up and stretch during stops or when allowed to move about the cabin.
  • Pack a pillow to help you get comfortable in your seat.
  • Request a seat that will give you the best chance to get comfortable (aisle, captain seat, etc.).
  • Leave early so you can hit rest stops if need be.

3. Exercise – Exercise can not only help us relieve stress during the holiday season, but it can also prevent chronic pain from bubbling to the surface. Exercise helps oxygenated blood circulate through our bodies, which helps keep them in good working order, and exercise can release endorphins in your brain, which can impact our mindset and push away chronic pain triggers. If you’re feeling overwhelmed by the holidays, jump on the treadmill for a quick run.

4. Eat Right – This is one especially difficult to do during the holidays when gingerbread cookies and candy canes are bountiful. As we’ve stated on the blog before, junk foods, especially foods that are high in saturated fat and sugar, can trigger inflammation in our joints. Coupled with the cold weather, these inflammatory flare ups can trigger the onset of chronic pain. We’re not saying you can’t indulge here and there, but work in some fruits and vegetables between snacks to ensure your body is getting the right amount of vitamins and nutrients.

Preventing Chronic Pain When Shoveling

/ Thomas Cohn, MD

Chronic Pain ShovelingA big snowstorm is coming our way, and odds are you’re going to need to bust out the shovel or snowblower when it’s all said and done. Moving all that snow is never easy, but it can be an even bigger headache if you’re also dealing with chronic pain. Today, we’re going to share a few tips for how to effectively move snow without triggering a chronic pain flareup.

Chronic Pain and Shoveling

Keep these tips in mind the next time you have to head out and shovel snow:

  • Warm up your body before you head outside. Do 5-10 minutes of light stretching exercises to ensure your muscles are warm before heading outside.
  • Grab a friend. The more people helping to move snow, the quicker the job will get done.
  • Take frequent breaks. Don’t try to get everything done in one session, because if you overwork your muscles, you’re more likely to trigger a chronic pain flareup.
  • Practice proper lifting techniques. Try to push the snow off your driveway instead of lifting and throwing it, as that can lead to back problems. When bending, bend at the knees, not the waist.
  • Stay warm. Cold weather can trigger inflammation in our joints. Put on enough layers so that you’ll stay warm when shoveling, and head inside to heat up if you start to get cold.
  • Take an anti-inflammatory medication like ibuprofen prior to heading outside to shovel to help keep inflammation at bay.
  • Invest in a snowblower. They can be pretty pricey, but if they help prevent painful flareups, they are well worth the investment.
  • Talk to your doctor. If you are dealing with a specific chronic pain condition, talk to your doctor to see if they have any other specific tips for preventing chronic pain flareups while you’re removing snow from your driveway and sidewalks.

Stay safe this weekend, and follow these tips before you head outside to shovel!

Understanding Nonspecific Low Back Pain

/ Thomas Cohn, MD

nonspecific back painA recent reading in a new issue of one of the many medical journals that showed up at my home was an article on the management and treatment of low back pain for general practitioners. Usually I hope to pick up an interesting piece of knowledge to add to my treatment regimen, but unfortunately this article was a major disappointment. The focus of this article was on “nonspecific” low back pain. For a person with low back pain, this is the category of everyone who does not need surgery right away since they do not have a huge disc herniation.

Low Back Pain

Low back pain does have many specific causes and detailing the problem leads the practitioner to treatments that may be more effective. It is very important to understand that there are many structures in the low back region that can cause pain. Oftentimes multiple structures may be causing problems and treatment may need to include a number of different things. Solving only one of five problems leaves four issues that may be equal or worse and provide no relief for a patient.

To successfully treat low back pain, a practitioner must fully understand all the structures in the body and how they can contribute to pain. There multiple body parts involved including joints, nerves, discs, muscles, ligaments, bursas, and various organs in the lower abdomen and pelvis that all can contribute to pain sensations. On top of all the stuff in the direct area, the brain also can be an important factor since it is necessary to interpret the sensory signals and their meaning. If there are numerous sensory signals, the brain can short circuit on them and overly amplify the quality of pain. At this point, central sensitization occurs and normal sensory signals in the body can become interpreted as pain; the equivalent of a short circuit is present in the nervous system.

When low back pain is not easily fixed with time, simple medication and exercise, then getting higher level expertise with an expert in Physical Medicine doctor is helpful. Pain experts come in all varieties, but you should stick to those who have the broadest knowledge, since they will be more likely to be able to determine what is actually the problem and develop potential solutions. Many people claim to treat back problems, but only those who take the time to look into your history, to fully look at what has been done as far as diagnostic studies, and to conduct a physical exam will be successful.

The Pain Management Approach

Pain that has not been solved quickly is often a complex problem. Before I see a patient, I try to review their medical history and what has been done for diagnosis and treatment. A patient’s history and story about their problems often is the most important key to understanding what to do for a person. After hearing what the patient thinks is the problem, then a physical exam can often lead to a series of diagnoses. Most of the time, a person can tell me some odd information that is the absolute clue to helping a person with their pain problem. Tailoring the right treatment to a person is where experience is extremely helpful and what determines a successful management strategy. Many people are afraid that they are wasting the doctor’s time. Rarely if ever is a patient wasting my time, especially if they want to get better and are willing to try various treatments.

The human body is a wonderfully complex machine, and answering the question of what is wrong is very hard. Since in the low back, many things can be wrong, simple answers are rare. As people get older, everything in our bodies does deteriorate and degenerate. Some things in the body can be repaired, but many things like the discs and joints in the body show normal degeneration, sometimes by the age 30 or 40. Currently we have no way to reverse aging, and treatment of pain requires managing of symptoms. There often is no way to “fix” the problem, but we can find strategies to manage the symptoms better.

Pain Management Needs To Be A Complimentary Approach

/ Thomas Cohn, MD

Complementary medicineA recent publication in Mayo Clinic Proceedings explored the benefits of complementary therapy in the greater picture of pain management. This is a subject we’ve preached on the blog time and time again; There is no magic pill for chronic pain, and you need to put in the effort to have the best results. Oftentimes this comes in the form of other activities in conjunction with the standard care of rest, rehab, physical therapy, etc. Some of these complementary methods include:

“Medications may not completely relieve chronic pain or can produce unwanted side effects, including the potential for addiction. Thus, many people may turn to complementary health approaches to help manage their pain,” said Richard L. Nahin, PhD, MPH, lead epidemiologist at the National Center for Complementary and Integrative Health.

Complementary Medicine Benefits

Without going into too much detail, the article looked at a number of complementary approaches to common chronic ailments. What they found was that acupuncture and yoga were beneficial for individuals with back pain, acupuncture and tai chi had benefits for knee osteoarthritis, and massage therapy was proven useful for individuals with cervical spine and neck pain. Considering that more than 120 million Americans deal with some sort of chronic pain, these complementary approaches have the potential to positively affect millions of people.

This beneficial link is important because unfortunately many people have to pay out of pocket for some of these treatment techniques. In fact, national data suggests that people pay more than $8.5 billion annually for out of pocket complementary treatments for back pain alone. Now that there’s a link between these approaches and chronic pain improvement, there may soon be a push to make some of these options at least partially covered by insurance. It may require insurance companies to spend a little more in the short-term, but if it helps people recover faster and more fully, it could greatly reduce expenses in the long run.

We need to continue investing money into chronic pain research to find the best methods to treat pain, reduce costs and help patients.

Surgeon General Issues Report On Addiction

/ Thomas Cohn, MD

substance abuse opioidsThe Surgeon General issued a groundbreaking report of the current state of addiction in America, saying alcohol and drug abuse are some of America’s most pressing public health concerns.

Substance Abuse Disorder

According to US Surgeon General Dr. Vivek Murthy, more than 20 million Americans – more than the number of people who have all cancers combined – suffer from some form of substance abuse disorder.

“Alcohol and drug addiction take an enormous toll on individuals, families, and communities,” said US Surgeon General Dr. Vivek Murthy. “Most Americans know someone who has been touched by an alcohol or a drug use disorder. Yet 90% of people with a substance use disorder are not getting treatment. That has to change.”

The report, titled “Facing Addition in America: The Surgeon General’s Report on Alcohol, Drugs and Health,” marks the first time a US Surgeon General has dedicated a report to the problem of substance abuse and misuse. Not only does the report examine the statistics behind substance abuse in America, but it also attempts to tackle the cultural shift in how substance abuse is viewed and the stigma behind it in America.

Surgeon General’s Report

According to the Surgeon General’s Report, as many as one in seven people in the US will develop a substance use disorder at some point in their life. However, only 1 in 10 receives treatment for their disorder. The report goes on to state that nearly 48 million Americans used an illicit drug or misused a prescription in 2015, while 67 million reported binge drinking in the last month. Many of these individuals are young, but substance abuse can strike at any age.

“Although substance misuse problems and use disorders may occur at any age, adolescence and young adulthood are particularly critical at–risk periods,” Dr. Murthy said. “Preventing or even simply delaying young people from trying substances is important to reducing the likelihood of a use disorder later in life.”

The biggest finding from the report was that only 1 in 10 people with a substance abuse disorder will receive treatment for their condition. Actions like the Mental Health Parity and Addiction Equality Act of 2008 and the Affordable Care Act of 2010 have helped people get access to these services, but many people choose not to get help due to the stigma associated with substance abuse.

“Families across this country are fighting addiction –they’re fighting an illness, as well as a stigma. They’re doing all they can, and we should do no less. At the US Department of Health and Human Services, we have worked hard to make our nation healthier and save lives by increasing access to evidence–based treatment for those who need it,” said HHS Secretary Sylvia M. Burwell. “While there’s more to do, this historic report provides us guidance and outlines important steps we can take to move forward, build on our progress to address this public health crisis, and make a difference for more Americans.”

Dr. Murthy says that going forward, we need to change the way we think about substance abuse disorders to lift this stigma to ensure people who need help come out of the shadows and get the help they need.

“It’s time to change how we view addiction,” said Dr. Murthy. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”