Chronic Pain The Most Common Reason Patients Seek Medical Marijuana

February 14, 2019 / Thomas Cohn, MD

A new study found that chronic pain was the most common reason why individuals in state-approved medical marijuana programs turned to cannabis to help with their health condition.

The study looked at data from 15 states who have legalized marijuana for medicinal purposes. Here’s a look at the top three reasons why people turned to medical marijuana:

Chronic Pain
Stitfness related to Multiple Sclerosis
Chemotherapy-related nausea

“The majority of patients for whom we have data are using cannabis for reasons where the science is the strongest,” said lead author Kevin Boehnke of the University of Michigan.

Marijuana For Chronic Pain

More than 30 states allow the use of medical marijuana, but the conditions that are eligible for the product vary from state to state. For example, Minnesota allows medical marijuana to be used to alleviate symptoms from conditions like glaucoma, chronic pain, PTSD, seizures and much more. They are always evaluating which conditions meet the requirements, and Minnesota will add Alzheimer’s Disease to the list of approved conditions in July of this year.

When taking a closer look at the study results, researchers found that about two-thirds of the roughly 730,000 reasons listed for taking medical marijuana were related to chronic pain. Since patients could report more than one pain condition, researchers say the figure may be a little over-inflated, but it still speaks to how many people are looking for a better way to deal with their chronic pain condition.

“Cannabis is the first thing I’ve found that actually makes the pain go away and not leave me so high that I can’t enjoy my day,” said Brandian Smith, 37, of Illinois, who takes medical marijuana for her fibromyalgia.

Researchers also noted that in Arizona, Colorado, Nevada and Oregon, there was a noticeable decline in medical marijuana patients after those states legalized recreational marijuana. Currently there are about two million people in the United States who use medical marijuana for their pain condition.

Is you need help managing your pain condition, set up an appointment with a pain specialist like Dr. Cohn.

Why Is There No Clinical Test For Pain?

February 5, 2019 / Thomas Cohn, MD

Many people who have chronic pain wonder why we just do not have a test to prove they have pain. To every person who has pain, it is obvious that something is wrong. With so many people having pain, most people wonder why there is no test for it. It is considered so important that it has been termed the fifth vital sign. The other vitals like pulse or blood pressure can all be measured, so when are we going to be able to measure pain?

Recently there have been several articles in the press about techniques to measure pain. One of these is to measure pupil reactions to light and other reactions to stimuli to determine whether something is painful or not. So far, information obtained is just correlated on an individual basis and is not helpful to determine if a particular person has pain.

Quantifying Pain

Scientists have been looking for a definitive measure of pain for years. The NIH (National Institutes of Health) has looked at everything from brain scans to blood tests and measuring various body signals from pupils to pulses for a quantifiable way to determine pain. The overall problem is pain is subjective and based on the emotional interpretation of sensory signals. Simply put, everyone feels sensory signals differently and they can vary even with the same person depending on the circumstances at the time. The same pain sensations can be horrible one day and mildly annoying at a different time. It is totally dependent on all the other signals that the brain has to concentrate and interpret. If I am distracted by pleasurable visual sensations, I may not realize pain. If I am emotionally distraught, a painful stimulus may be excruciating.

To measure pain, one needs to measure the brain’s level of perception and interpretation of a variety of sensory signals. We also need to know what are the significant areas in the brain that are interconnected and how they determine our perceptions of pain. At this time we know there are sensory signals triggered in the body and we know the brain receives these signals. We do not know why one input may be horrible pain and another similar signal is mild pain. We do know pain is what each person perceives it to be in his or her own individual interpretation. Your pain is not the same as mine, even if the physical problem is the same.

Pain is a problem because it is difficult to measure and it is a different experience for every person. The impact of pain on the quality of life is tremendous since 30 percent of the world population suffers chronically from pain. Better understanding of pain is necessary to develop strategies to manage the problems associated with it.

Resolve To Care For Your Mental Health This Year

January 28, 2019January 28, 2019 / Thomas Cohn, MD

Making New Year’s resolutions has always seemed to be a tradition. This year, instead of resolutions, I thought to myself, “What is something important to my health that I should be doing more on a daily basis?”

What change can I make in my life that would be positive? Is there something I need to do regularly? Lastly, is it something only I should care about? I came up with two things:

Be responsible, and;
Take care of myself mentally

As I grow older, the one truth that seems to be so important is to have good mental health. In general, it is easy to care for one’s physical needs. Exercise, eating, sleeping and those things are more straightforward. Keeping going mentally is more challenging. Everyone has a lot of responsibilities. Taking time to relax and enjoy the world and do things that make one happy are important. Remembering not to get upset about the petty stuff and things that are not controllable is also key. Spend time with family and friends, and do things besides work. Look for the beauty that surrounds us. Maybe consider more time away from work.

Caring For Your Mental Health

Mental health seems to be critical for physical health. All sorts of mental problems, especially stress, anxiety and depression adversely affect how one feels. With prolonged mental stress, physical health is almost impossible to achieve. Once stable mentally, physical problems can be much more easily addressed. If one has significant mental health issues, one often does not have insight into the relationship of those issues to physical problems. This is especially true with regards to pain and anxiety.

All physicians generally want to help their patients feel better. In Pain Medicine, we often want to try to cure the pain. However, pain is more complicated than something like sprain or a bruise. Almost all pain that lasts a length of time has emotional components. It is not just a physical sensation, but it is also tied to how we feel and often is associated with stress, anxiety and depression.

This is not a coincidence, and it is due to the fact that areas of the brain that interpret sensations related to painful stimuli are located next to emotional centers. Sensory input and emotions become entangled and then the brain stops being able to distinguish between them. Emotions soon are perceived as a variety of pains in the body. When this happens, solving physical sensory stimuli that produce pain is not helpful and the psychological issues must be addressed to move forward.

The recognition by a patient of the entanglement of stress, anxiety, and depression and the perception of having pain is a major milestone for people. Once an understanding of the role of emotions becomes evident to a person and how it influences physical well being, progress can often be made toward better treating abnormal sensations that may be considered painful. Improving anxiety and depression almost universally helps in the management of pain. It is not because you are “crazy” and the pain is all in your head, but it is that the painful sensations are entangled with emotions and these feelings need to be treated as importantly as the physical symptoms. Treating only the physical is only treating half of the problem and not solving the whole situation. However, patients have to admit to themselves that the other problems exist and need help. It is amazing how physical problems improve when emotional problems are treated.

The best wish for the new year is to improve both physical and mental health. If one treats oneself correctly mentally and emotionally, our physical health is much easier to work on. Without being stable emotionally it is hard to have the energy to solve other problems. Usually, it is much harder work to solve emotional trauma than physical problems. The first step is recognizing that there may be emotional issues and then seek out help. It is not a sign of weakness to have help solving mental health problems. These are very tough and often complex situations with difficult and less than perfect solutions. If physical problems exist and are not improving, take some time and look for the entangled emotions. Both probably exist and at least one of the areas is being ignored. Seek out help and amazing results often occur.

4 Benefits Of Virtual Reality For Chronic Pain

January 16, 2019 / Thomas Cohn, MD

Virtual reality has made waves in the gaming community in recent years, but it has another potential use in the chronic pain community. These virtual reality headsets can provide patients with detailed information about how their pain condition is affecting their body, which in turn helps patients understand why certain movements or actions lead to pain, and they can also teach relaxation and breathing techniques. As a pain specialist, I can’t tell you how important mental health and mindfulness is during a flareup.

But virtual reality can be beneficial for more reasons. In fact, we’ve highlighted four benefits the therapy technique can provide for patients dealing with a range of pain conditions.

Benefits of VR for Chronic Pain

Here’s a look at four ways virtual reality therapy may be helpful for your pain condition.

1. Better Pain Management – Research into virtual reality has shown that it can help to alleviate or distract the pain from a wide variety of pain conditions, including burns, wounds, surgeries and some chronic pain conditions. In fact, virtual reality headsets are becoming more popular in emergency departments to help distract patients from pain who are dealing with acute injuries. By helping to take our mind off of our pain condition, virtual reality can help to improve pain management.

2. Opioid Reduction – Virtual reality may not be able to put a stop to your pain condition for good, but it can help train your brain to relax, which is key during a flareup. By being able to better control your breathing and keeping yourself relaxed, we can take control over our pain. This in turn can lead to a reduction in pain medications, as instead of reaching for your prescription bottle during a flareup, you may be able to reach for your VR headset or implement the strategies you’ve learned from the device.

3. Decreased Patient Costs – Other studies have shown that the use of VR headsets in medical settings can help to reduce costs on the patient. Instead of being billed by a doctor or a therapist for their time spent educating the patient about their condition, these headsets can provide an immersive look into your condition without tacking on extra expenses. And as we noted above, if it reduces your need for medications, it will also save you money on your prescription.

4. Increased Activity – Finally, virtual reality can be a game changer for patients with chronic pain because it can help lead to exercise, movement and active treatment techniques. These devices can also teach patients breathing and meditation techniques, which can help them manage symptoms and in turn leads to more activity participation. As physical activity increases, so too do healing rates, as movement helps to lubricate joints and promote healthy blood flow throughout the body.

Can Using A Sauna Be Considered Exercise?

December 4, 2018 / Thomas Cohn, MD

sauna Scandinavians have had healthy lifestyles for centuries. One of their traditions has been saunas, often followed by the quick jump into the snow bank or into a cold lake. New research published in the Mayo Clinic Proceedings indicates that frequent sauna use can have the same effect on the body as regular exercise. Yes, sitting in a sauna is similar to a workout. To be beneficial like exercise, however, it has to be done about five times a week. Occasional saunas do not have a benefit.

How Saunas Simulate Exercise

A typical sauna is heated upwards of 175 degrees Fahrenheit or hotter. Spending five to twenty minutes in the sauna will normally get the heart rate to increase to 120 to 150 beats a minute. This is the same range that the heart would beat at when exercising moderately. At the same time that the heart rate increases, blood flow also increases to the skin, and that is an important factor seen in cardiovascular exercise.

The health benefits of sauna baths were studied in Finland. In the people who frequently used saunas, the same benefits of exercise were noted. These people had a 60 percent decease in heart disease and stroke. There was also evidence of improvements in other diseases such as some pulmonary conditions, arthritis, headaches and the flu. Direct findings included decreased blood pressure and decreased artery stiffness.

The effects of frequent sauna sauna use are the same as aerobic exercise. For those with pain and difficulty walking or exercising, the use of a sauna may have a significant benefit to improve cardiovascular fitness. The extreme heat forces increased heart rates and peripheral vascular flow. Since this is pushing your heart rate up, starting a sauna routine should involve the same cautions as an exercise program. Make sure that your heart can tolerate the increased heart rate and the extra work. Consult your physician and get approval to be exercising before you start using a sauna. Other precautions include drink plenty of water and do not drink alcohol.

For more information about using a sauna for your pain condition, reach out to Dr. Cohn’s office today.