Chronic Nerve Pain Can Impact Mood and Motivation

June 10, 2015June 10, 2015 / Thomas Cohn, MD

Chronic nerve pain doesn’t just make it painful to go through your daily routine, it may actually make it psychologically harder for your brain to get motivated to complete certain tasks, according to California researchers.

Researchers at UC-Irving and UCLA say their findings suggest that brain inflammation caused by chronic nerve pain can have significant psychological effects. In a lab study, researchers uncovered that rodents with brain inflammation exhibited “accelerated growth and activation” of immune cells known as microglia. These microglia cells cause chemical signals that restrict the release of dopamine, a chemical that helps control our brain’s reward and pleasure centers.

New Approaches To Chronic Pain Care

What’s more, the researchers may have uncovered new evidence in the battle to control and conquer chronic pain. Researchers found that certain opioids designed to spur the release of morphine may actually be ineffective in certain cases. One such case occurred with these rats. In rodents with brain inflammation, these opioids did not stimulate dopamine release as designed.

Instead, when the same rodents were treated with an opioid designed to inhibit the release of the microglial cells, dopamine levels returned to normal.

“For over 20 years, scientists have been trying to unlock the mechanisms at work that connect opioid use, pain relief, depression and addiction,” said Catherine Cahill, an associate professor of anesthesiology & perioperative care at UCI. “Our findings represent a paradigm shift which has broad implications that are not restricted to the problem of pain and may translate to other disorders.”

Cahill and her team hope to recreate the study in humans in order to combat mood swings, depressive attitudes and behavioral disorders.

“We have a drug compound that has the potential to normalize reward-like behavior,” she said, “and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuity found in rodents occurs in chronic pain patients.”

Regular Exercise Isn’t Easy, But It’s Worth It

June 3, 2015June 3, 2015 / Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.

How Exercise Affects Your Brain

June 2, 2015June 3, 2015 / Thomas Cohn, MD

A recent article in the Chicago Tribune by Julie Deardorff gives a person another reason to exercise. Physical fitness has a crucial role in how the brain develops and functions. From infancy to old age, exercise is linked to positive changes in the brain.

Starting in infancy, movement is necessary for proper development. In children, exercise has been shown to improve attention and focus, as well as developing coordination and ability to perform complex motions. In the elderly, new work is showing the benefit of physical exercise in staving off dementia.

Brain Benefits

Physical exercise has a broad range of benefits for the brain. These effects are true across our whole life span. Higher cognitive functions of attention, memory and multi-tasking are improved by exercise. In the 1990’s, the protein brain-derived neurotropic factor (BDNF) was found. This protein supports the growth of brain cells. Exercise triggers the production of BDNF.

Now we know exercise is good for all aspects of the body, and doctors and health associations are taking note. The American Heart Association has promoted exercise for the improving your heart health. Pain physicians have promoted exercise to reduce pain by elevating endogenous opioids in the body. All physicians promote exercise to help in healing injuries, as exercise is critical to keep us healthy in mind and body. There is no perfect pill that will alleviate your ailments; sometimes the best course of action is to get off the couch and go for a run.

Addressing The Problem Of Physician Burnout

May 27, 2015May 28, 2015 / Thomas Cohn, MD

One of the front page articles this week in the StarTribune explored the subject of doctor burnout. Every job comes with stress; Medicine is not immune to stress and burnout is becoming a more recognized phenomenon. Many jobs have the pressure to perform, but many doctors try harder to push through the stress and daily duties. Recently, we began to realize we are no different than everyone else.

Medicine has for a long time been a very strenuous career. The academic requirements and training are very difficult. Most of us started our careers with residency training involving workweeks that exceeded 80 hours, and we continued working 50-60 hours each week after residency was complete. The time spent seeing patients is only a fraction of the time spent – many more hours involve paperwork, patient preparation, administrative tasks, and continuing education. Family and fun time become eclipsed by work requirements, and sleep is an afterthought.

Daily Doctor Stresses

Stress becomes a lifestyle. Seeing patients and being able to identify the correct diagnosis and treatment is always a challenge. Many physicians also perform complex procedures that could easily cause significant damage if something goes wrong, adding to the stress. Then, if patient is at all unhappy, we may have to deal with administrators questioning the encounter or the possibility of being sued.

Preventing stress and burnout in any profession is necessary. One may be busy, but to prevent burnout, one needs to take time out from work. Physicians need to do this just like everyone else. Some physicians take extended breaks from practice, taking months off at a time. They do charity work and get away from their normal practice. Others limit their work hours. Many try to find outside interests to focus on to reduce stress. No one goes to their graves saying that they wished they spent more time at work.

Work is only a small part of life. Maintaining outside interests is essential. Stress comes as part of the profession. Ways to handle the stress include maintaining good fitness and having outside interests that you enjoy. Often, the outside interests of a physician can be seen readily at their offices. A physician with no outside life besides medicine may be more likely to become burned out. Stress reduction for everyone is necessary. It is summer time and now is a time to be outside and enjoy the world.

Exercises Can Alleviate Fibromyalgia Pain

May 20, 2015 / Thomas Cohn, MD

Research out of Spain confirmed the belief that exercise and physical fitness can help relieve symptoms due to chronic pain and fibromyalgia.

To conduct their experiment, researchers asked participants to refrain from using pain medications for at least 24 hours, then they measured their pain levels using a number of different scales, including the Visual Analog Scale (VAS), the Pain Catastrophizing Scale (PCS) and the Chronic Pain Self-Efficacy Scale. After pain was measured, researchers surveyed patients about their exercise habits. Although the findings don’t prove causation, researchers uncovered:

Patients with higher physical activity exhibited lower levels of pain.

Those who exercised more had a lower psychological overreaction to pain.

Fitness appeared to decrease negative thoughts about chronic pain.

“These results might have implications for future intervention studies in this population,” the investigators wrote in Arthritis Care and Research. “In general, there was a linear (dose-response) relationship so that higher levels of fitness were associated with lower levels of pain and catastrophizing and higher self-efficacy.”

The team concluded that fitness helped improve overall agility, flexibility and mobility. They believe strength conditioning can help increase pain tolerance, while aerobic exercises can help a person with some of the mental aspects of chronic pain and fibromyalgia.

“Our exploratory analyses suggest that muscle strength and flexibility could be the fitness components most strongly associated with pain levels, while aerobic fitness and flexibility could be the fitness components most strongly associated with the psychological experience (i.e. catastrophizing and self-efficacy) of pain,” wrote the authors.

Dr. Cohn Comments

The benefits of exercise for chronic pain have been well documented, so it should come as no surprise that regular exercise can help alleviate problems associated with fibromyalgia.

I’ve even written about how exercise has helped me control my pain condition. If you’re suffering from chronic pain, try to squeeze in some regular exercise. Even 15 minutes of walking can do wonders for your mind and body. If some exercises are too trying, try to find an activity that works for your condition. Whether it’s running, walking or swimming find an activity that works for you!