Chronic Pain as a College Student

November 16, 2015May 10, 2016 / Thomas Cohn, MD

Having chronic pain problems as a college student sucks. There are multiple problems and too many compromises that need to be made. You can’t just live a normal life, and the ability to be spontaneous does not easily happen. Everything is affected, from the living situation, to study habits and working with groups and exam schedules can be a problem. Name the situation, and it may be a problem, especially if you just want to be normal.

Chronic Pain in College

No day is typical, and just starting the day may be a problem. Waking up in the morning is often very painful. First, one may not have slept very well because pain kept waking you up at night, or it was extremely restless. Then one is sore and you need to start stretching and doing some morning exercises just to get moving. There is no last minute rolling out of bed and running off to class, you just can’t move fast without the morning routine.

Once you are at class, most lecture rooms and other classrooms have bad stadium seats or very uncomfortable chairs without any back support. Sitting in these chairs worsens the back and neck pain, and trying to take notes and concentrate is an effort. If you are lucky, they may provide a special chair to sit in, but good luck at getting the right seating in every classroom. It is also weird when you need to get up for a minute, stand in the back of the room and stretch to help relieve the pain. Lastly, making to the professor’s office hours when you are in pain is an added burden. Then you may also need to explain the need for accommodations due to your situation, adding again more stress to the pain.

As the day goes on, your back and neck may start to hurt more. Standing, stretching or walking around may not help and the best option for your back may be to lie down. Well, there are not many places to rest and lay down on campus.

After you made it through your classes, then there is the homework, group projects, and social life. Studying may be a challenge at times due to back pain and fatigue. Concentration is reduced by pain and more breaks are needed. Planning ahead is essential and leaving stuff to the last minute does not work since you may be having a bad day with pain at the wrong time. Further stress will worsen the pain, lower the concentration ability, and it definitely increases as deadlines for tests and big projects near. The group projects for some classes also are often a problem, you have to ignore your pain needs often to match the schedules of everyone else in the group, and at the end of the day, you may be just about in tears since you hurt so much and you still have a ton of stuff to get done.

Chronic Pain and Your Social Life

A big part of college is developing oneself in a new social environment. One wants to be just like everyone else, carefree and happy. When you are sleep deprived from pain, stressed out, and uncomfortable sitting in most chairs or standing long times, participating in social activities is tough. Ignoring the pain works at times, but sometimes it comes back to bite you and you are down for the count for several days because you did too much. Normal kids do all those things without a problem, for you it can be a nightmare, and you are physically sick for a week afterward.

There is no secret solution for having success as a college student when having chronic pain. It is a constant effort to be your best, and keep moving forward. Those who do manage this tight rope act are some of the toughest, smartest and grittiest kids imaginable. It takes a huge amount of effort, often alone and without good medical guidance. There are very few doctors who understand the challenges and can adequately help find the additional resources to ease some of the problems. Furthermore, there are few resources and pain treatments that make a difference for many young adults. The struggle is very real, and the problems of living with chronic pain just sucks.

Medical Marijuana: Why It’s Different

November 11, 2015May 10, 2016 / Thomas Cohn, MD

Recently, one of the two suppliers of medical marijuana to patients in Minnesota offered a tour of their facility to a small group of leading pain physicians. The business is fascinating and a completely different model from anywhere else in the country. In the rest of America, marijuana for medical purposes is not highly regulated, and is sold by minimally regulated distributors selling whatever types of marijuana they feel might be useful. Needless to say, it is basically the same marijuana that is being sold for recreational purposes to get high.

Minnesota has taken a very different approach to the legalization of marijuana. First, the legislature has recognized that there may be some legitimate medicinal value to marijuana, and that for certain conditions it may be helpful. The legislature also felt recreational marijuana had a spectrum of problems and wanted to avoid adding to the problems of abused substances. Therefore, in Minnesota, only medical marijuana is available, and it is tightly regulated.

There are only two producers of medical marijuana currently allowed in Minnesota. These producers can provide only to patients that have been certified with certain conditions approved to receive such medication. The patient receives extracts from the marijuana plant to ingest as a pill, concentrated liquid, or to inhale as a vapor. It is not available for smoking or as an additive in food. The formulation received by the patient is determined by a pharmacist, and adjusted as well as titrated to help with a patient’s particular symptoms. The pharmacist also will evaluate the effectiveness of the treatment every time the patient is seen, and information for the State is being kept on the treatment, its effectiveness, and what is being given to the patient.

Medical Vs. Recreational Marijuana in Minnesota

Medical marijuana is usually very different than the marijuana found on the street. For most medical conditions, the cannabinoids of interest are the “CBDs” and not THC, the part that gets one “high.” From research done around the world, plants with different amounts of CBD to THC are being grown to produce the desired amounts of these compounds to be used in the medications. Unfortunately at this time, isolating specific CBDs known to exist has not yet been the focus of manufacturing. The medications manufactured currently just have specific amounts and ratios of CBD and THC.

The producer that I visited was extremely interesting. The growing of the plants is very high tech. From the plants used to the growing conditions, all aspects are tightly controlled. After the plants are harvested, the components are isolated and carefully extracted and made into the medicines for each particular individual.

Not all patients who have been qualified by a physician will be accepted by the medical marijuana distributors. Further, since all medical marijuana is considered experimental, none of the cost of treatment is covered by insurance. Doctor visits regarding certification, follow up visits, and all drug and pharmacy costs are cash only and no credit cards are accepted. Medication costs are also fairly expensive since they are made at a custom pharmacy with strict quality controls for safety and purity.

Medical marijuana is truly a product currently for those who have failed conventional treatment. The treatment is only now for certain conditions. If qualified, it may or may not work for any individual. The cost is quite expensive, not supported by insurance, and is cash only. The benefit is medical marijuana is designed as another medication tool to help control symptoms of certain conditions. It is consistent and manufactured like most other drugs to be pure and safe. It is not designed for recreational use and getting high.

Intractable Pain and Medical Marijuana

November 9, 2015 / Thomas Cohn, MD

Medical marijuana for intractable pain is now on the agenda for Minnesota. The commissioner for the Department of Health is now evaluating whether to add intractable pain as a condition that will be included in its medical marijuana program. The commissioner received recommendations against adding pain from the medical advisory committee. There will be a public hearing this week and comments can be sent directly to the Department of Health, at health.cannabis@state.mn.us.

In Minnesota, intractable pain would most likely be handled differently than any other diagnosis for medical marijuana. Already, the medical panel has advised that it be restricted to people over the age of 21. Further, they want to make sure that anyone prescribed is not pregnant and that conventional treatments for pain have already failed.

What is Intractable Pain?

In Minnesota, intractable chronic pain is a legal definition set up by the legislature in the 1990’s. It means pain caused by some medical condition that is unresponsive to normal medical care including medication, physical therapy, and other management. If a patient has intractable pain, then they qualify for the use of opioid medication for management of symptoms. One other component of chronic intractable pain is that it must be certified by two different physicians. Unless new legislation is passed, chronic intractable pain would need to be certified by two physicians, not just one provider in order to qualify for the medical marijuana program.

Over the next month the Minnesota Health Commissioner is going to make a decision on adding intractable pain as a condition for medical marijuana, and it will affect both patients and healthcare providers. If you want to have input on the decision, now is the time. Past history has shown that the most vocal and persuasive voices will influence the decision on what diagnoses are on the list to receive medical marijuana. Mothers with children that had severe seizures were the main force that started the legalization in Minnesota. Patients and medical providers will be the force that determines if intractable pain is added to Minnesota’s list of conditions that are accepted for medical marijuana.

Cognitive Behavior Therapy Helps Those With Chronic Pain

November 3, 2015May 10, 2016 / Thomas Cohn, MD

Research out of Europe suggests that cognitive behavior therapy (CBT) could help control or reduce chronic pain by helping patients sleep better.

We’ve discussed the link between poor sleep and chronic pain on the blog before, and while we’ve shared some tips for falling asleep and staying asleep, we’ve never examined CBT’s role in the equation. According to the University of Warwick, cognitive behavioral therapy was found to be moderately or strongly effective in the majority of chronic pain patients who suffered from insomnia. Lead research Nicole Tang, PhD, from the University’s Psychology department, said CBT is better alternative that long-term drug treatment for insomnia.

“This study is particularly important because the use of drugs to treat insomnia is not recommended over a long period of time therefore the condition needs to be addressed using a non-pharmacological treatment,” said Dr. Tang. “We believe that our results will be of particular interest to primary care physicians and allied health professionals who are taking up an increasingly important role in preventing and managing long-term conditions.”

CBT and Chronic Pain

For their study, researchers conducted a meta-analysis of 72 studies involving more than 1,000 chronic pain sufferers with insomnia. Treatments varied in the individual studies, but the most popular intervention strategies were education about sleep hygiene, stimulus control, sleep restriction and cognitive therapy. They also analyzed how these approaches were delivered to the subjects. Finally, researchers looked at documented pain levels before and after intervention techniques were administered.

After conducting the meta-analysis, researchers uncovered:

CBT was associated with a decrease in insomnia and mild to moderate decreases in pain levels.

Improved sleep was associated with a decrease in depressive feelings.

Chronic pain sufferers who received CBT experienced improved sleep and had a wider positive impact on pain, fatigue and depression feelings.

Interestingly, intervention techniques were less effective if they were delivered electronically, either by phone or the internet.

“We found little evidence that using therapies delivered either by phone or computer benefited insomniacs. The jury is still out on the effectiveness of using automated sleep treatments. We found that, at the moment at least, delivering therapies personally had the most positive effect on sleeplessness,” Dr. Tang said.

Dr. Tang said they want to pursue further research to establish if CBT is feasible and cost effective for treating chronic pain in the long run.

Related source: Sleep Review Magazine

Could Cutting Sugar Curb Chronic Pain?

October 29, 2015 / Thomas Cohn, MD

Everyone knows that there’s a correlation between sugar intake and complications from diabetes, but excess sugar intake could also exacerbate symptoms caused by chronic pain.

For starters, there’s a known link between excess sugar and obesity, and extra weight can put added stress on your joints. If you’re dealing with chronic pain caused by inflammation, this extra stress can make movement extremely painful. But there’s more:

“While weight gain and teeth decay may be the most obvious consequences of excessive sugar consumption, there are many other ‘hidden’ effects of consuming too much of the sweet stuff,” according to Dana Dovey in a recent Medical Daily article.

Dovey said excess sugar can cause heart failure and heart disease, kidney disease, high blood pressure, erectile dysfunction and fatty liver disease. But she also details how extra sugar can make chronic pain worse.

The Brain and the Joints

Let’s start with the brain. According to a recent article published in Neuroscience, excess sugar levels can reduce a chemical called “brain-derived neurotropic factor.” When this occurs, normal cognitive tasks like learning, memory, reading and sleep all become more difficult, and we’ve already explained how inadequate sleep can make chronic pain even worse.

Chronic pain also negatively affects the joints. According to a study published in 2002, elevated levels of processed sugar can lead to excess inflammation in your joints. Inflammation is the main source of pain for most chronic pain sufferers. Arthritis is caused by chronic inflammation, which is why many arthritis sufferers are told by their doctors to limit their sugar intake.

You don’t need to quit sugar cold turkey, but be cognizant of how much sugar you’re putting in your body, and try to slowly curb it. Start with something simple, like sugary drinks. If you have a soda with lunch every day, try to cut down to one soda every other day, or swap out your sugary cereal for something healthier. Wean yourself away from sugar, and you’ll have a clearer mind and less pain in your joints.