leg pain

Does Anyone Understand My Pain?

/ Thomas Cohn, MD

understand chronic painMost people who have chronic pain, no matter what the source, believe they are alone in the world and that no one has similar problems and no one in medicine can appreciate the problems they suffer. However, as I have often said, about 30 percent of the population in the world has problems of some type with pain. It is the same in the United States as it is in the undeveloped world in Africa or in the industrial world of Europe or Japan. If so many people have pain, a lot of people have similar types of problems and there are likely medical professionals that do understand pain problems. There are many types of medical professionals that see pain patients, including Chiropractors, Physical Therapists and Psychologists, to all kinds of physicians including Physiatrists to surgeons.

Who Should I See For My Pain?

The best person for one to see is someone who may understand whatever problems are causing pain. If the problem is simple, it may not matter who you see because many professionals understand and are trained on that care. The more complex the problem, the harder it becomes to find professionals who care and understand the issues and have the expertise to coordinate management. My personal bias for the complex patient is to find a pain clinic that is led by a specialist in Physical Medicine and Rehabilitation – a Physiatrist. These are the physicians that have been crossed trained across multiple specialties including internal medicine, rheumatology (arthritis), neurology and orthopedics among many disciplines. Most of these doctors are good at coordinating a team effort to help patients. As with any doctor or specialist, 90 percent of them will do a good job and 10 percent will be outstanding.

Finding an outstanding doctor is always difficult. Sometimes it is a gift of a good personality, others listen well, and some just have so much experience that they can help those who want help and are willing to work toward a solution. Every patient has a different need and many patients will define good doctors and professionals in their own ways. Some doctors just understand things better because they have been through the problems personally.

My Personal Experience

To tell the truth, when I was in my medical training, the experience I had treating pain patients was one of my least favorite areas. I always was looking for other things to treat, including pediatrics, spinal cord injuries, electrodiagnostics and inpatient rehabilitation. As I entered private practice 30 years ago, I did inpatient rehabilitation of devastating problems like stroke and spinal cord injury, and outpatient care of every type of medical problem that could cause pain. After about five years I was doing more outpatient than inpatient, and eventually I transitioned to all outpatient practice. Most of my patients had medical problems or injuries that somehow caused pain. Either I needed to get good with diagnosis and treatment or else find something else to do, so I worked at getting good at that special area.

Unfortunately as I became older, I not only became wiser, but also had back pain problems from an injury to my lumbar spine as a medical student when I tried weightlifting. I also saw close people around me have issues with pain, from my wife to all my children at times. Some of the problems have been easy to help manage, some I struggle with daily and are heartbreaking even for me. The most important thing about the overall experience is that it develops a level of empathy and knowledge that it takes a ton of work on both the patient’s part and the treating physician to provide good care and help with a management plan. Furthermore, for many people pain never goes away, but is something that gets managed. It is physical and it is mental, in your brain and it affects the perception of life. It can be time consuming, tiring and often it seems depressing. Despite all the problems, the reward is moving forward and seeing the world change.

If you have pain, you are part of a third of the world population who does have pain. There are many people out in this world that can help guide you through the maze of pain management. Finding the right person for you may take time. There are multiple choices and multiple providers that may help. Yes, some people are better than others, and some will be more helpful, and lastly you may not like some of the people who may actually have the best answers. Life is tough, but it will be a team effort to move forward, and the most important person to move forward is you.

5 Things People With Chronic Pain Want You To Know

/ Thomas Cohn, MD

chronic pain knowLiving with chronic pain is difficult enough before you add in the stigma you have to deal with from other people. Hopefully your friends and family members are sympathetic to your condition, but even they don’t fully understand what you’re going through. Today, we want to share five things that people with chronic pain want you to know about their condition.

What We Want You To Know

Here are five things that patients with chronic conditions wish others knew about their condition.

We don’t want to be in pain

This may sound obvious, but sometimes people think individuals are just playing up their pain to get attention. Trust me, they’d trade all the attention in the world if they could live a pain free life. If they are talking about their pain, it’s because they want you to try and understand what they’re going through, not because they are craving attention.

Just because we don’t show it, doesn’t mean we’re not in pain

We put on a brave face and go about our daily life, but just because we’re smiling doesn’t mean we’re not in pain. Chronic pain patients often try to mask their pain because they don’t want to be seen as weak or injured, and some are great at hiding their pain. But that doesn’t mean we don’t feel it with each step.

Keep reaching out

It’s impossible to predict when a flareup is going to occur, so if we say we can’t make it out to the mall or we cancel on movie plans at the last minute, we’re not trying to avoid you. We’re just dealing with a lot of pain and we’d be miserable, but we love that you’re reaching out. Keep texting and calling us, because we really do want to hang out. Don’t assume that we’re intentionally trying to avoid you, because we’re not.

We’re not in it for the drugs

We don’t want to be taking pain pills, but sometimes they are the only thing that makes it bearable to get through our physical therapy session. We’re not just popping pills and hoping the problem gets better, we’re actively working towards finding a solution through a combination of therapy techniques.

We’re not lazy

What’s easy for some is a huge burden to others. When chronic pain is at it’s worst, even getting out of bed in the morning can be difficult. Again, we’d trade anything for the chance to live without constant pain, but life doesn’t work like that. We’re not using chronic pain as a way to get out of work or doing chores. We’re trying our best, even if it doesn’t look like it.

Spinal Cord Stimulation For Chronic Back Pain

/ Thomas Cohn, MD

Pain is something that can quickly take over our lives. Pain can lead us to be more emotional and less empathetic with family and friends. It can hinder our ability to do things that make us feel better, such as exercise. It can take away our earning potential if we are unable to work because of the pain. In other words, pain can upend what you do and who you are.

And chronic pain like back or leg pain can be particularly overwhelming. It’s different than pain in an extremity like a finger or toe; leg or back pain starts in one spot and can radiate elsewhere and be unrelenting.

Many people start with traditional medicine such as pills or doctor visits, but those may have limited impact. They may also try natural healing, but again—the person may determine how effective those are. One treatment that works for many is spinal cord stimulation; this graphic explains what it is and how it might help.

What Is Spinal Cord Stimulation?

Spinal cord stimulation is a safe and relatively effective treatment option for certain individuals suffering from chronic back or leg pain. Roughly 80 percent of individuals who undergo SCS experience some form of relief, whether it be in the form of decreased pain, a reduction in the need for opioids or better sleep quality.

Our friends at PainInjuryRelief.com recently reached out to us with an infographic about spinal cord stimulation and asked if we’d be interested in sharing it with our readers. We are always happy to discuss new technologies and potential treatment options, so we’ve included it below. Check it out if you believe spinal cord stimulation may be something that you could benefit from.

Block Pain and Get Back to Your Life with Spinal Cord Stimulation

Sleep and Caffeine May Play Key Role In Controlling Chronic Pain

/ Thomas Cohn, MD

sleep caffeineNew research out of Boston suggests that sleep and caffeine may play integral roles in controlling chronic pain flareups.

It’s probably not a huge surprise that sleep is beneficial for controlling chronic pain, as we’ve talked about the restorative benefits of sleep on our blog many times before, but the part about caffeine is interesting. Here’s what the researchers had to say.

Benefits of Sleep and Caffeine

For their study, researchers looked at the effects of sleep (or lack thereof) and caffeine on mice and their pain sensitivity. Researchers began by tracking normal sleep cycles and measuring brain activity, then they began to disrupt this healthy sleep cycle by giving mice toys and activities that entertained them and kept them awake (much like Netflix or our iPads do for humans).

“Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball,” says Dr. Alban Latremoliere, PhD and pain expert at Boston Children’s Hospital. “Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball.”

Researchers kept mice awake for up to 12 hours in one night or for six hours five nights in a row. They examined that fatigue, stress and pain sensitivity all increased during this time.

“We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice,” says Dr. Chloe Alexandre, a sleep physiologist.

Caffeine’s Role

According to researchers, common painkillers did not help mice combat pain, and morphine was less effective in sleep-deprived mice, meaning chronic pain patients who are tired may have to up their morphine dose in order for it to be effective. However, researchers found that caffeine helped to block pain sensitivity.

This led researchers to conclude that a good night’s sleep combined with caffeine during the day (along with other good habits like regular exercise and a healthy diet) may be more effective for managing chronic pain than simply relaying on analgesic medications.

“Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities,” Dr. Kiran Maski, M.D. at Boston Children’s hospital who studies sleep disorders. “This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care.”

PTSD An Approved Condition For Medical Marijuana In Minnesota

/ Thomas Cohn, MD

PTSD medical marijuanaThe Minnesota Department of Health added post-traumatic stress disorder as a qualifying condition under the state’s medical marijuana program on Thursday.

“PTSD presented the strongest case for potential benefits and a … lack of treatment alternatives,” said MDH Commissioner Dr. Ed Ehlinger.

PTSD comes in many forms, and there’s no one-size-fits-all treatment for individuals who are dealing with the psychological condition. Medical marijuana will not work for everyone, but like we mentioned in our post on Daith piercings for migraines, medical marijuana will provide another potential low-cost treatment option. Medical marijuana is by no means cheap, but trying the initial treatment is much less costly then certain therapy sessions or countless doctor visits, so it opens a new door for individuals with PTSD.

Coming In 2017

Although PTSD has been added to the list of approved conditions for medical marijuana in the state, it was not granted immediate approval. PTSD won’t be considered an active condition until August 1, 2017. However, this doesn’t mean that it will be easy to get clearance from a doctor for PTSD. Military veterans will need to get a doctor’s diagnosis and approval in order to be eligible, but that recommendation cannot come from any Veterans Affairs hospital because marijuana is considered illegal under federal guidelines. They will need to get approval from another physician, and oftentimes it’s difficult to get a new physician to declare you eligible for the medical marijuana program, as doctors are leery of patients jumping from doctor to doctor to try and find a doctor that will grant them approval.

PTSD was the only condition added to the list of approved conditions on Thursday, as Ehlinger and the Minnesota Department of Health shot down proposals for other conditions like arthritis and depression.