What Pain Patients Want From Their Doctors

November 11, 2019 / Thomas Cohn, MD

Last weekend in the StarTribune there was an editorial on opioids and pain from a neurologist and Chief Medical Officer Regions Hospital. It seemed a bit self-congratulatory about how great he is doing at reducing opioids and how unnecessary they are in most pain situations. It is great to talk about not using opioid medications especially for chronic pain, however if the main job one has is to be a pain medicine specialist, a better understanding of pain and its impact on an individual’s life is needed.

The article brags how many fewer opioid prescriptions have been written by HealthPartners clinics. By the sounds of it, no one was educated on treating pain and way too many scripts were being written. Physician education on management strategies for pain is woeful and minimal time in medical school and residency is spent on training physicians about pain. The best strategy to prevent chronic pain is to aggressively treat acute pain and prevent chronic symptoms from developing. Use a comprehensive strategy early and reduce the impact of pain. Opioids are just one of many tools to treat symptoms, and many better tools are available and should be employed.

Nobody enjoys having pain. Convincing someone that pain is normal is one of the worst strategies to reduce opioid use and abuse. Patients with pain do not want to be told pain is normal, they want their physicians to help determine what is wrong and find good ways to reduce symptoms to a manageable level. Telling a patient pain is normal just informs the patient as a physician you do not care what is wrong and whatever you tell the patient next, they already have the expectation that you have only your own agenda and not their interest first.

Reading the editorial as a pain physician, it was maddening to see the lack of knowledge with regards to how patients feel about their medical problems. Almost everyone knows about the opioid epidemic, but when one has pain, they want compassion, respect and help with understanding their problem finding solutions. They do not want to hear about opioid problems. They want a physician that will help lead them to answers, listen to what they are saying and give them a pathway to improvement. The expectation is that physicians have answers beyond opioids these days, and from a patient’s perspective, bragging about your reduction of the use of these medications is snobbery. Solve the patient’s problem and be empathetic. As a medical big wig, tell your insurance company to pay for proven alternative solutions and give the clinical doctor the ability to use all the tools necessary to help their patients without fighting your bureaucracy.

Can Tumeric Help With Chronic Pain?

November 6, 2019 / Thomas Cohn, MD

tumeric In my line of work, I get a lot of people asking me about holistic remedies or alternative options to traditional manufactured opioids. I love when a patient is clearly committed to helping themselves find a solution, but sometimes they dive into the internet message boards and end up trying solutions with little clinical backing. Sometimes these alternative options can provide just the placebo effect the patient needs, while other times they can cause problems by failing to treat the underlying condition in a timely manner.

One over-the-counter option that I’ve been asked about is tumeric. Tumeric is a plant native to South Asia, and it’s one of the fastest-growing supplements in America, with sales topping $320 million in the US just last year. If that many people are buying it, it must be effective, right? Let’s take a closer look at what science has to say.

What Is Tumeric?

Tumeric is a flowering plant, known as Curcuma longa, and it’s a plant in the ginger family. The active ingredient in Tumeric is curcumin, but it only makes up about three percent of the dried spice. Many bottles advertised as tumeric will actually list curcumin on the ingredient label, but it’s one in the same.

Tumeric has been championed as a way to lower cholesterol, treat depression, prevent gingivitis, cure hangovers and even help with symptoms of chronic pain. It would be great if it could do all that, does can science back up those claims? According to research here in our own back yard, its benefits can’t be scientifically proven.

“There are claims that it can cure everything,” said Kathryn M. Nelson, a research assistant professor at the University of Minnesota and lead author of a study on the spice. “To me, that is a red flag,” she said after failing to confirm any of the purported benefits with scientific evidence.

Another study led by Dr. Amit X. Garg, a professor of medicine at Western University in London, Ontario, yielded similar results. In a randomized clinical study of more than 600 patients, there was little difference in the patients who took tumeric or the placebo for potential issues after elective heart surgery.

“It was a bit disappointing, but we couldn’t demonstrate any benefit used in this setting,” Dr. Garg said.

Finally, the National Center for Complementary and Integrative Health believes there’s not enough reliable evidence to recommend tumeric or curcumin for any medical condition. There has been some clinical evidence that tumeric has some benefits at the cellular level and in animal testing, but the benefits of preclinical research hasn’t been observed in clinical trials involving humans.

At the end of the day, there are many other proven ways to treat pain conditions and other health ailments, so opt for treatments with a better track record of success. To start your journey to better health, reach out to a pain specialist like Dr. Cohn today.

How Are Opioid Regulations Affecting Chronic Pain Patients?

October 21, 2019 / Thomas Cohn, MD

In the wake of increasing opioid overdoses across the country, lawmakers have called for much stricter regulations in how providers prescribe opioids to patients. The goal of the changes were to stop doctors from “taking the easy road” and prescribing opioids to patients because the doctor doesn’t want to take the time to dig into the problem and work towards a real solution. Lawmakers also undoubtedly thought that if fewer people have access to clinical opioids that overdoses would also decrease.

But how are these regulations actually affecting those individuals who are plagued with chronic pain? According to a new study, the changes aren’t exactly having the intended effect.

The Effects Of The Prescription Opioid Crackdown

According to a recent study published in the International Journal of Drug Policy, there have been a number of unintended and potentially harmful side effects associated with the recent prescription opioid crackdown. Researchers say that many patients on long-term opioid treatment for chronic pain reported experiencing the following in the wake of the crackdown:

Negative physical side effects
Emotional distress
Degraded relationships with their primary care provider

Although the study was relatively small in size (97 patients with chronic pain, mean age 61.3 years), the results were both interesting and alarming.

Negative physical side effects – According to the study, patients believed that their medications helped control their chronic pain, helped them sleep and provided them with the ability to think clearly without being bothered by daily pain. When they were tapered off their medications, they said their pain increased, and they had difficulty sleeping and concentrating.

Emotional distress – Many patients believed that stricter prescription opioid regulations would inhibit their access to vital pain medications and hinder their day-to-day well-being. Other patients responded that they went as far as to seek mental health counseling to deal with the stigma of being seen as an opioid user.

Degraded Relationship With Doctor – Finally, patients also reported that their relationship with their primary care physician worsened due to the new regulations. One patient felt angry with her physician for “enforcing a required opioid agreement” while another felt that he was being viewed by his doctor as a potential abuser as opposed to a patient.

“In addition to known side effects, patients also experience the burden of public discourse and associated institutional changes in opioid prescriptions as extremely stressful, placing a burden on their emotional health and relationships with their primary care providers,” noted the study authors. “ Chronic pain is a biopsychosocial phenomenon, requiring multi-faceted approaches and solutions.”

It takes a doctor who is willing to put in the time and effort with the patient, and a patient who is interested in active solutions to pain, in order to win the fight against chronic pain. Don’t get discouraged by recent regulations, just do what you can to find a specialist who takes your pain seriously and who won’t stop until you find relief. Dr. Cohn has done this for countless patients, and he can do it for you too. For more information, contact his office today.

Daily Exercise The Key To Combating Chronic Pain

October 16, 2019 / Thomas Cohn, MD

As someone who has suffered from chronic back pain for more than a decade, I know just how hard it can be to manage a chronic condition on a daily basis. You have good days where you feel like you can conquer the world, and you have bad days where you don’t even want to get out of bed. No matter what kind of day you’re having, it’s important that you push through any discomfort and find time to exercise, because that’s likely your best bet at stringing together more good days than bad.

Daily exercise isn’t something that comes easy. Most of us can find some spare time throughout the week, but we can’t always carve out time every single day, and when we do get spare time, oftentimes we’d rather use it on anything other than exercise. However, it’s this consistency that might be just what you need to put your chronic pain in the past.

The Benefits Of Daily Exercise

A recent study decided to take a closer look at the benefits of moderate versus daily exercise when it comes to helping control problems associated with chronic pain. For the study, researchers conducted a small, weeklong study of 40 healthy women on their sensitivity to pain before and after exercise. The individuals were asked to walk briskly on a treadmill for their exercise, and patients were separated into three different groups. One group walked three times per week, another group walked five times a week, and the final group walked 10 times a week.

After reviewing the data, researchers found no differences in pain perception following exercise for those who exercised three times a week, but the findings were significantly different for those who exercised at least five times a week.

“We asked them to rate that pain,” said neuroscientist Benedict Kolber, lead researcher on the study. “And at the end of the study, they rated the same pressure — the exact same pressure — as 60% less painful than they rated it at the beginning of the study.”

In other words, a small dose of exercise did nothing for helping manage chronic pain, but a bigger dose worked wonders. A good motto to live by is to “Strive For Five” in terms of striving to exercise at least five times a week. However, it’s also worth remembering that you need to start slow. If you haven’t been a frequent exerciser, don’t go straight to exercising for an hour each day. Ramping up your activity too quickly can lead to overstress injuries and exacerbate inflammation. Start slow, be it 5-10 minutes a day, and work your way up from there. Focus on doing small amounts daily instead of a longer session 1-2 times a week, and work your way to longer durations.

There have been days where the last thing that I wanted to do was get up before work and work out, but I knew I needed to do it if I wanted to function at my best throughout the day. I try my best to work out every day, and my back pain has been much more controlled than in years past, even though I’m years older. Controlled exercise can be your best friend when it comes to caring for your pain condition. If you need help developing a safe exercise routine, or you want some tips on what types of activity might be best considering your condition, reach out to Dr. Cohn’s office today.

A Closer Look At Acute And Chronic Pain

October 7, 2019 / Thomas Cohn, MD

Chronic pain is usually different from acute pain. Acute pain is considered to be directly related to stimulation of sensory receptors for noxious stimuli located throughout the body. It is often related to direct damage or trauma to the body. It also is the normal physiologic response to the various types of sensory receptors that is perceived as noxious or painful. Acute pain is relatively short lasting and is a direct response to direct stimulation of sensory receptors with lengths from seconds to usually less than several months. Chronic pain however is long in duration, lasting over three months and becomes independent of direct stimulation of sensory receptors for acute stimuli.

Chronic and Acute Pain

Chronic pain most often is characteristically different from acute pain. It often involves the nervous system changing on a peripheral and central basis such that sensory signals are perceived differently. In the limbs or other areas, sensory receptors become increasingly able to respond to any stimuli and then sending a signal out into the central nervous system. The nervous system essentially becomes primed for responding to sensory inputs and blasts out a powerful danger signal out of proportion to the intensity of the event. A small touch on the arm could feel like being hit by a sledgehammer.

Chronic pain is divided medically into three types;

Nociceptive
Neuropathic
Central sensitization

It can also be a combination of these. As pain becomes more chronic, the central nervous system becomes more involved and pain has more centralized components. The secondary outcomes of chronic pain over time also become prominent with increased healthcare utilization and often decreased quality of life.

There are multiple correlations in a person’s life that are associated with chronic pain. Common attributes include being female, early life trauma, family history of pain and mood disorders, genetics, sleep disturbances and mood disorders. Certain types of pain that more commonly become chronic include headaches, low back pain and fibromyalgia/diffuse myofascial pain, while the psychological factors of anxiety, depression, catastrophizing, and PTSD are linked to developing chronic pain.

Well-managed and aggressively treated chronic pain comprehensively reduces the incident of chronic pain, but as pain continues ongoing aggressive management can impact the intensity of long-term issues. It is important to treat all aspects of a painful condition. Often there are multiple factors stimulating pain and all the physical problems need to be addressed from muscles, nerves, tendons, ligaments, joints, bones and any other system involved as well as the psychological impacts.

Comprehensive management of symptoms is one of the keys to successful outcomes. Using traditional medical strategies including medications and physical therapy in conjunction with techniques like acupuncture, meditation and improving sleep hygiene may all be necessary in managing pain. Aggressive management of acute pain, especially traumatic or post-surgical, helps reduce the incident of the development of chronic symptoms.

Acute pain is a common arena for most regular physicians. Comprehensive initial management of acute painful conditions reduces the development of more chronic problems. If the pain is showing tendencies toward becoming chronic, involvement of a pain specialist can reduce the impact of the long-term symptoms.