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.

What Science Says About CBD Oil For Chronic Pain

August 5, 2019 / Thomas Cohn, MD

cbd oil Cannabidiol, commonly referred to as CBD, is a compound found in the cannabis plant that many people swear by for its benefits when it comes to pain management, anxiety, stress or other health issues. We want you to find relief with whatever works, but what does science say about CBD’s effectiveness for pain management? Let’s take a look.

CBD and Pain Relief

If you’re like me, you can’t go a couple blocks it seems without seeing another business offering CBD products. Pizza places, movie stores, bakeries and wellness shops are all places where we’ve seen CBD being offered, but just how effective is it for your health condition? Scientifically, the jury is still out, but researchers are cautiously optimistic.

One of the reasons why we don’t have a lot of scientific data on CBD’s effectiveness for different pain conditions is because up until December 2018, cannabidiol was classified as a Schedule I substance. Now that it has been removed from that list, we’re quickly working to figure out its medical capabilities. Early studies have come to mixed conclusions, with some saying that the right combination of CBD products can help calm symptoms, while others say there exists a lack of good evidence that CBD can help with chronic neuropathic pain.

With that said, many researchers are still hopeful about CBD and it’s health uses in the future. The previous studies have had many limitations, so their conclusions may not be as accurate as we’d like. For example, many of these studies looked at the short-term impact of CBD in patients with a number of different pain conditions. Pain is the most unique health condition in the world, and everyone’s pain is unique to them.

We very well may eventually learn that CBD can help treat symptoms of certain types of arthritis or nerve pain, but it takes time to isolate all the variables and make these breakthroughs. In fact, a study published this year in the journal Pain found that CBD interacts with serotonin receptors in animals, which are believed to play a role in pain, depression and anxiety. By building on these studies, we may be able to come to stronger conclusions and better help patients in the not so distant future.

So as it currently stands, the jury is still out on the effectiveness of CBD oil for a variety of pain conditions. But as we said above, if you’re dealing with a pain condition, we want you to be able to find relief one way or the other. Some people find relief with diet and exercise, others with physical therapy, and others with CBD. What we will say is that while CBD may help your pain condition, it shouldn’t be your only form of treatment. Substances like CBD are a passive treatment, and they need to be combined with active treatments like stretching or exercise therapy to really help the underlying problem. Here’s hoping we learn more about CBD so we can best help our patients.

The Benefits and Drawbacks Of Extended Release Opioids

July 29, 2019 / Thomas Cohn, MD

We are always looking for new ways to make painkillers safer for those individuals who suffer from acute or chronic pain conditions, and one such improvement was the shift to extended release opioids. These types of pills were promoted as safer than traditional opioids, and while they are in some aspects, they are far from a perfect solution. In today’s blog, we take a closer look at the benefits and drawbacks of extended release painkillers.

Extended Release Painkiller Benefits and Drawbacks

Here’s a look at some of the benefits of extended release painkillers, as well as some reasons why these benefits may not be a perfect solution to the problem.

Abuse Deterrent – Some painkillers were redesigned, making them harder to crush and snort. While this has been successful in preventing abuse of some opioids, it has led some abusers to try even more dangerous methods to get their quick fix, like in the form of injections with shared needles. Other types of abuse deterrent drugs actually were designed such that if they were crushed, the active ingredient would fail and the user would not be able to experience the drug’s effects, which helped prevent abuse.

Overdose Deterrent – Extended release formulas of some opioids mean that the individual taking the medication gets a mild amount of the drug over an extended period of time, as opposed to a quicker feeling of pain relief that patients might feel with normal formulas of the drug. This also means patients may need less of the drug because it provides longer and consistent relief instead of a stronger relief that fades over time. That being said, some people may be expecting quicker pain relief, and when they don’t achieve that soon after taking the pill, they could end up taking additional pills to quell their pain. This can lead to an increased likelihood of abuse, addiction or accidental overdose.

Easy To Find – Many companies were forced to invest in developing abuse-deterrent versions of their drugs, so there are a number of different ER opioid options. However, since companies needed to invest more time and money into developing these drugs, they are often more costly than the normal pills. Many patients don’t want to spend more on painkillers than they need to, meaning many opt against the extended release options.

Effective – The good news is that for many patients, ER opioids are effective at helping them manage pain. One thing many pain sufferers want is consistency, and a consistent, long-release drug can do all that. This can help them plan their day, including when they need to take the pills in order to participate in physical therapy or other active treatment options. The only issue is, like any drug taken over a long period of time, the body gets used to the drug and a higher dose is needed to achieve the same level of relief. ER opioids are great in the short-term when working towards a longer recovery goal, but like any opioid, should not be viewed as a long term solution if at all possible.

Chronic Pain Patients Struggling To Find Primary Care Services

July 15, 2019 / Thomas Cohn, MD

A new study published in JAMA Network Open found that chronic pain sufferers have a harder time finding primary health care because they have an active prescription for opioids.

According to the study, 40 percent of the nearly 200 primary care clinics contacted as part of study said they would not accept a new patient who takes Percocet daily for chronic pain as a result of a past injury, no matter what type of health insurance they had. An additional 17 percent of clinics said they would want more information about the patient before deciding if they would take them on, with two-thirds of this subset saying the patient would be required to come into a preliminary appointment before a decision could be made. Despite these findings, all of the clinics said they were currently accepting new patients.

The findings suggest patients with a history of chronic pain could face health care access problems.

“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees’, being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” said study lead researcher Pooja Lagisetty, M.D., M.Sc. “However, there have been no studies to quantify the extent of the problem. These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician.”

Slippery Slope

Dr. Lagisetty said for patients with chronic pain conditions, getting access to primary care goes beyond just checkups and preventative care. Having a regular physician could allow them to receive other pain-relieving treatments, and in some cases, work with the new provider to gradually and safely taper off their use of opioids. Primary care providers can also help recognize the signs of opioid use disorders or addictions, so not accepting patients simply because they are trying to manage their pain only works to further the crisis.

“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” said Dr. Lagisetty. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”

It’s easy to accept the healthy young adult at your clinic, and it can be harder to take on the patient managing multiple health conditions, but both should be guaranteed access to primary care providers. We need more doctors who are willing to take on the harder patient.