Working Through Chronic Pain

May 18, 2015 / Thomas Cohn, MD

Living with chronic pain isn’t easy. Some people are awarded full or partial disability, but for many people, those benefits eventually run out or their claim is denied altogether. Because of this, many people are forced to work, even with debilitating chronic pain. Today, we share some tips for getting through the work day with chronic pain.

1. Move Around

You might think you’re making your pain problem worse by moving around, but staying sedentary for long periods can actually trigger chronic pain. For example, if you’re dealing with chronic back pain, staying seated in one position can actually put more strain on your back. Moving around helps build muscle and helps regulate blood flow to affected areas. Try to get up and walk around for five minutes every hour. This doesn’t necessarily mean you need to take a break every 60 minutes – just find an excuse to walk around. Deliver those memos to accounting by hand or walk around while you’re talking on the phone.

2. Don’t Overdo It

While you want to move around, you don’t want to overdo it at work. It may sound obvious, but a lot of workers want to prove to themselves and their coworkers that their pain condition won’t hold them back at work. Lifting heavy boxes or equipment can exacerbate a previous pain condition. Talk to your boss about your condition so there are no surprises when you return to work. If you can’t preform all the typical duties, talk with your boss or your coworkers about other ways you can contribute. For example, instead of loading boxes onto the truck every Friday, maybe you can compile the weekly productivity reports. Being open and honest about your limitations means there will be no confusion about your job duties.

3. Tell Your Boss

As we mentioned above, it’s important to talk to your work superiors about any limitations you might have because of your chronic pain. Lying or trying to hide your pain can be extremely problematic. First, it can affect your disability benefits. If you tell your insurance company that your injury is preventing you from completing all your tasks, but you attempt to push through the pain and complete them anyway, your insurance can deny your claim. On the other hand, if you don’t open up about your condition to your boss, he or she might not be as open to hearing why you didn’t finish a certain task.

4. Adjust Your Schedule

This one again goes hand in hand with the above point. If possible, try to adjust your schedule to accommodate your pain. For example, if you are supposed to take water therapy classes to alleviate your back pain, and the classes are only offered at 8am on weekdays, but you normally work 8am-5pm, ask your boss if you can work from 9am-6pm on Tuesdays and Thursdays so you can get to your treatment. If you can’t adjust your work schedule, do your best to adjust your personal schedule so you can best manage your pain condition.

Insomniacs More Prone to Chronic Pain

May 14, 2015 / Thomas Cohn, MD

Findings out of the Norwegian Institute of Public Health suggest that people who have trouble sleeping are more likely to have an increased sensitivity to pain.

Although the study didn’t show a cause-and-effect relationship, researchers said insomniacs were more likely to be sensitive to pain. For the study, researchers asked more than 10,000 adults to dip their hands in cold water for 1 minute and 46 seconds. If they felt the cold water was causing too much pain, participants could remove their hands from the water prior to the completion of the timer.

After their reading was recorded, researchers asked participants a bunch of questions about their sleeping habits, including how long they typically sleep, how long it takes them to fall asleep, and if they suffer from insomnia. Researchers also asked questions about related issues that can make it hard to fall asleep, like anxiety, stress and depression.

Study Results

After looking at the findings, researchers uncovered:

Nearly 1/3 of participants were able to keep their hands in the water for the entire test.

42 percent of people with insomnia pulled their hands out of the water early.

31 percent of people without the sleep disorder pulled their hands out of the water early.

Participants with frequent insomnia were more likely to remove their hands from the water than people who have insomnia once a month.

People with insomnia and chronic pain were twice as likely to have a reduced pain tolerance than participants without those conditions.

“While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain,” researchers wrote, “it is not clear exactly why this is the case.”

Dr. Cohn Comments

Although the findings are interesting, they are hardly revolutionary. In fact, it’s more of a chicken-and-the-egg type argument. People who have chronic pain are more likely to be plagued by nagging pain, which can make it difficult to fall asleep and stay asleep, and if you don’t get a full night’s sleep, your body can fully recover from the activities of the day, contributing to more pain. So what came first, the chronic pain or the insomnia?

Related source: Health.com

Dopamine May Be Key To Unlocking Chronic Pain

May 11, 2015 / Thomas Cohn, MD

Medical researchers at the University of Texas say dopamine – the mechanism in your brain responsible for movement, memory and reward – could provide the key to unlocking the problem of chronic pain.

Dopamine is vital for several different brain functions, but its contributions to the problem of chronic pain are not well known. To better understand dopamine’s role in chronic pain transmission, researchers began studying its effect in mice. Researchers noted that removing a specific collection of neurons -known as A11 – helped diminish the perception of chronic pain. The cluster of A11 neurons contained high levels of dopamine.

“These findings demonstrate a novel role for how dopamine contributes to maintaining chronic pain states,” said associate professor Dr. Ted Price.

How it Works

When a person gets injured, neurons inside the body send pain signals to the brain. In someone with chronic pain, these neurons send pain signals to the brain even when an injury isn’t present. A physical medicine pain specialist’s job is to determine what is causing these neurons to fire, and how to stop them from incorrectly firing.

The A11 cluster might be causing some of these neurons to fire. In fact, when removed, mice were still able to feel acute pain (an actual physical injury), but they exhibited a lesser response to chronic pain.

“We used a toxin that affected A11 neurons, and that’s when we found that acute pain signals were still normal, but chronic pain was absent,” said Dr. Price. “This may open up new opportunities to target medicines that could reverse chronic pain,” said Dr. Price.

Dr. Price and colleagues want to continue studying dopamine receptors in relation to chronic pain perception.

“In future studies, we would like to gain a better understanding of how stress interacts with A11. And we’d like to know more about the interaction between molecular mechanisms that promote chronic pain and dopamine.”

Finding Compassion in Medicine

May 4, 2015May 4, 2015 / Thomas Cohn, MD

Medicine has become a tough endeavor recently, as the physician is routinely under many pressures. Institutions and employers want as many patients seen as possible in an effort to increase their bottom line, while staff to assist the physician are often kept at a minimum to keep costs low. Tests and procedures should not be ordered or they need to be ordered more frequently, depending on who is paying the bill, and of course the physician should know which is the pertinent case. The physician also is getting paid too much and does not work enough hours. The physician also should do administrative work, read more current journals, and be responsible for quality improvement projects for the practice. They also must attend continuing education courses and constantly recertify their qualifications. The demands are endless.

As for the patient, they only want a good physician that can solve their problems quickly. Now that medicine has become more of a business, finding a good and caring physician is even harder. Physicians often feel they need to be done seeing a patient as quickly as possible. This is just the opposite of the needs of the patient. Many physicians have just given up with the pressures of the business, and have become mediocre at all aspects of medicine.

Striking a Compassion Balance

Finding the physician who has found the balance in medicine and who has the desire to provide high quality care is difficult. There is no magical way to find those special physicians, and word of mouth is often still the best method. There are rating services, but unfortunately most physicians try to hide from them and may not be very well represented. Furthermore, many of the best physicians let their skill be their only voice, and the best physicians often feel no need to advertise, as their work should speak for themselves.

In any profession, 90% of the practitioners are good, and 10% are exceptional. In medicine, this also holds true. The best physicians find a way to balance all the needs of the changes in the business of providing care. The most telling sign is that the patient always comes first. The physician will know his patients and their history, and will be willing to develop a joint treatment plan. They are up-to-date on research, and can explain complex medical problems without being flustered. Often they are experienced and can figure out what is wrong and what needs to be done quickly.

Medicine has become increasingly complex for both the patient and physician. Finding good medical care is difficult. Word of mouth, and sometimes the Internet can help find the better caregivers. Even good physicians are hampered by their surroundings and the business aspects of their offices. Every visit may not run smoothly, but having a physician that really knows how to help you is worth some inconveniences. Look for a physician who is mature, board certified in his specialty, and is prepared whenever they see you.

5 Famous People Who Battle Chronic Pain

April 27, 2015 / Thomas Cohn, MD

More than 40 percent of the population suffers from some type of chronic pain, so it’s no surprise that some big names deal with pain. Today, we show you that you’re not alone in combating chronic pain. Here’s a look at five celebrities who are continually battling chronic pain.

1. George Clooney – The famous actor nearly called it a career back in 2005 after he suffered an extremely painful back injury while filming the movie Syriana. Clooney struck his head during a particularly action packed scene, and he suffered a torn dora – the area around the spine that holds in spinal fluid. Before several surgeries were able to correct the issue, Clooney told reporters that he thought about ending his acting career once and for all.

2. Jillian Michaels – Micheals, best known for her role as a trainer on The Biggest Loser, deals with endometriosis and Polycystic Ovary Syndrome on a regular basis. The conditions cause debilitating abdominal pain and can cause complications during pregnancy. Michaels eats healthy meals and exercises regularly to help keep her symptoms at bay, but she has decided to adopt in lieu of pursuing a painful and potentially dangerous pregnancy.

3. Montel Williams – Williams had been misdiagnosed as having chronic pain for 10 years before he was correctly diagnosed with multiple sclerosis back in 1999. The talk show host said he viewed the diagnosis as a “call to action,” and he went public with his diagnosis in an effort to raise public awareness as well as funding for a cure. He runs the Montel Williams Foundation, which raises money for MS research, and he noted that he exercises for 75 minutes a day to keep symptoms from flaring.

4. Sinead O’Connor – Mrs. O’Connor had to step away from her music career in 2003 to deal with her painful Fibromyalgia. She returned to her career two years later, noting “Fibromyalgia is not curable. But it’s manageable. You get to know your patterns and limits, so you can work and plan around it.”

5. Kathleen Turner – The two-time Golden Globe award winning actress has battled with rheumatoid arthritis for over 20 years. The condition attacks the body’s soft tissue and joints. Just like the above celebrities, Turner said the diagnosis gave her a fresh perspective on life, saying “Suddenly all that stuff about having good looks and being sexy took secondary position to being able to walk without pain.” She now speaks out about the condition with hopes of raising awareness and finding a cure, and she earned a lifetime achievement award from the Massachusetts Arthritis Foundation for her efforts.

Related source: Prevention.com