The Amazing Benefits of Tai Chi

November 26, 2018 / Thomas Cohn, MD

Tai Chi is an ancient Chinese tradition, and today it is practiced as a form of exercise. It is a series of postures and slow movements accompanied by deep breathing. Consider it a gentle form of physical exercise and stretching. It involves constant motion, moving from one posture to another without pause. It is safe for all ages including the elderly, and the low-impact movements put minimal stress on muscles and joints.

The Basics of Tai Chi

Tai Chi has many forms. There are forms that are more typical of martial arts, performed for competitive purposes, and there is the general version that is often practiced for its personal health beenfits. There have been five main family styles of Tai Chi, and all seem to based on the Chen style dating back to the 1600’s. Now, classes in Tai Chi are performed mostly for those interested in the combination of physical and mental health benefits. Movements emphasize a straight spine and natural range of motion of muscles and joints. There is also a seated form of Tai Chi that includes most of the traditional components of the art.

The health benefits of Tai Chi have been studied in a number of conditions, and has been generally accepted as beneficial in osteoarthritis, rheumatoid arthritis, fibromyalgia, Parkinson’s disease, and for general chronic pain. Once the techniques are learned, no special equipment, place or clothing is needed to practice the art. The exercises are especially good for lower body strength to improve posture, promote overall flexibility, and for the awareness of balance and position of the body in space. The goals are to minimize stress on painful areas and to foster improved circulation, relief and healing.

The studies done around the world have shown benefit, especially for those who have chronic pain. Exercise in general has been shown to be beneficial. Studies specifically with regards to Tai Chi have shown better outcomes with pain control for Fibromyalgia than with more traditional exercise like aerobic conditioning or swimming. The concentration on slow balanced movements and breathing does especially well for all aspects of improving physical abilities of those who have chronic pain.

Classes for those wanting to learn Tai Chi are easily found. Many senior centers, larger health clubs and YMCAs have programs and classes. Once the movements are learned, one can continue with group programs or perform the art on their own. Since no equipment, special space or clothing is needed, only a commitment to improve oneself is necessary. If you have chronic pain and are looking for an activity to improve fitness, Tai Chi may be beneficial.

The Benefits Of Brain Exercise

November 19, 2018 / Thomas Cohn, MD

A new study reported from the University of California – Irvine in the Proceedings of the National Academy of Sciences revealed that even a brief amount of exercise improves the brain. It is well known that prolonged exercise has benefits from the heart to the brain. Exercise improves circulation and helps to reduce the effects of aging. Animal studies have shown that exercise increases the formation of new cells in the hippocampal region of the brain. This region is essential for memory creation and storage. Unfortunately, what works in animals is not necessarily true in humans.

Your Brain on Exercise

The twist in this study was whether a memory type of activity could be improved by participating in a low grade exercise. The subjects chosen were the usual paid college student (eager victims with minimal chance of other medical issues), and they were first asked to perform a computerized memory test. They were then sat on an exercise bike for ten minutes and either asked to do nothing (the control group) or slowly pedal in order to increase the heart rate by 30% for ten minutes.

After either the rest or exercise, the memory test was repeated. Interestingly, the light exercise group showed a clear improvement in memory tasks. The reason for the immediate boost in memory ability is not clear. The main theory is that the light exercise improved blood flow to the brain and hormone levels may have been involved.

The main message is that light exercise is beneficial to the brain and memory. Light exercise can be walking or many other types of activities. The exercise does not need to be intense, and it does not need to be prolonged. Daily exercise for ten minutes at a time appears to be beneficial to the brain. As we get older, we need to keep the brain healthy. It is important to exercise and even the simple things from walking to things like yoga or tai chi move the body and improve the brain.

Son if you find yourself with 10-15 minutes of free time throughout the day, try to do something active and stimulate your brain!

Complementary Approaches Beneficial For Chronic Pain Patients

October 26, 2018 / Thomas Cohn, MD

New research out of the Hospital for Special Surgery in New York found that complementary treatment approaches can help curb pain and in some instances reduce the need for opioids in patients with chronic pain.

“Opioid misuse and addiction are a major public health issue in the United States, and approximately 70 percent of individuals who use opioids on a long-term basis have a musculoskeletal disorder, such as low back pain or arthritis,” said Maggie Wimmer, coordinator of Programs and Outcomes, Public and Patient Education at HSS. “To address this epidemic, Hospital for Special Surgery implemented a Pain and Stress Management program in its orthopedic clinic to enhance patient knowledge and encourage complementary practices as alternatives to medication.”

For the study, the center recruited 122 participants and asked them to participate in a couple different meditation techniques. Patients took part in a monthly in-person meditation workshop and a weekly meditation conference call where they practiced mindful breathing techniques and other meditation activities. Patients also completed a monthly survey on a number of factors, including pain and stress levels, their understanding of complementary medical approaches and how often they practiced the techniques in their own time.

Study Findings

After analyzing the data, researchers uncovered:

98 percent of patients said they were satisfied with the program.
95 percent said the program increased their understanding of complementary treatments and how they can help manage pain and stress.
93 percent said they would recommend the program to others.
1 in 3 patients reported using alternative techniques five or more times in the previous week in place of medication, and 11 percent used the techniques three or four times in place of medication.
More than 50 percent of participants reported that their mindful breathing techniques helped them manage their stress and chronic pain.
During monthly in-person sessions, many participants also reported an improvement in daily function, calmness and an improved state of mind.

“The results indicate that alternative approaches are effective in reducing pain and stress, and in improving self-management and general well-being,” said Robyn Wiesel, associate director, Public and Patient Education at HSS.

This is something that we’ve been preaching on the blog for years now. You need to have more than one way to treat your pain condition, and these complementary approaches can work wonders. Whether it’s yoga, balance training, mindful meditation, cycling or swimming, find an activity that allows you to de-stress and strengthen your body. Not only will you have physical and psychological benefits, but it may reduce your reliance on opioids!

Drug Screening In Chronic Pain Clinics

October 8, 2018 / Thomas Cohn, MD

Most pain practices have the occasional patient who they suspect are on controlled substances. Since drug abuse has always been a major problem in society, and because clinics prescribe medications, most practices also screen patients for appropriate drug use and abuse.

At the clinical level, drug screening is done in a number of ways, including testing blood, urine, or saliva samples for the presence of drugs. Some tests only show that a narcotic is present in the body, while others can tell how much of a drug is present. Depending on the circumstance, a provider may choose anyone of the different types of tests. Now a breathalyzer-type test is being developed to test for drugs of abuse.

Breath Tests For Drugs

A breath analyzer test has been done for decades for alcohol and now is being developed for marijuana, cocaine, fentanyl, PCP, and methamphetamine. These use a chemistry technique known as mass spectrometry so the test can identify the presence of certain chemicals and also help determine the level in the breath and possibly in the blood. Unfortunately for many of the compounds tested, there is not a standard for which these chemicals may cause impairment.

With marijuana, for example, we have no idea what level in the body correlates to any level of impairment compared to alcohol. The nice thing about this technique is that it is quick with the analysis being done in about 15 seconds. Currently the technology is very new and thus costly, but in the future it should be about $10,000 for a unit and be very portable.

For places looking to detect a very limited number of drugs of abuse, the breath analyzer will be good. For the pain practitioner, drug testing is more comprehensive. Usually a semi-quantitative screen of either urine or blood is used for drug screening. Most pain physicians want to know if the drugs a patient is supposed to be taking are in their systems and whether there are drugs that are present like street drugs that should not be in their system.

Most doctors also want to know if there are drugs not declared by the patient that may also be dangerous if taken with drugs they have prescribed. For the honest patient, drug screening should not be a worry. For those patients that are using street drugs or misusing their drugs, random testing often finds the problem. The patients who are misusing drugs often make mistakes and doctors discover them sooner or later.

In the midst of the opioid crisis and the high rate of misuse of prescription medicines, safe prescribing of any treatment for a pain patient always becomes a concern. There are many treatments for pain with medications being only a limited modality in the overall scheme of options. The use of addictive medications such as opioids is even less attractive since it often worsens pain and becomes ineffective over very short period of time for many people. Drug testing is one of the tools toward safe prescribing that needs to be implemented in pain clinics throughout the country.

Could Wearables Replace Opioids For Pain Management?

October 5, 2018 / Thomas Cohn, MD

Chronic pain affects roughly 100 million Americans, and the pain management market is estimated to be about $635 billion a year. With so many people to treat and money to be made by finding new, safer treatment options, a number of different technology companies are jumping into the world of pain management.

One area that is of particular interest to these companies is wearables and how they can be used to combat and treat chronic pain. A recent study involving more than 1,600 people with distal and proximal chronic pain focused on the Quell wearable device. The wearable allowed patients to track their pain in real time, including changes in pain intensity and pain interference with sleep, activity and mood on an 11-point scale. Patients tracked these changes over the course of two months, and researchers analyzed the findings at the conclusion of the study.

But tracking wasn’t the only feature available with the wearable. The unit actually provided high-frequency transcutaneous electric nerve stimulation. Many patients found that when they wore the device and it was emitting signals, that their pain levels decreased.

“[We found] statistically and clinically significant decreases in pain interference with activity and mood” and “a clinically significant decrease in pain intensity and less pain interference with sleep,” researchers wrote.

Wearables and the Future of Chronic Pain Management

The quell device was only helpful for a select number of people dealing with certain types of chronic pain, but the technology behind the device is exciting. It’s like a hybrid Fitbit and TENS unit, and as the technology continues to progress, we may soon see wearables that can work to drown out pain signals in all different areas of the body.

We understand the science, but because pain is such an individualized issue, there’s no one-size-fits-all wearable for chronic pain. Opioids do a better job of controlling a wider type of pain, but they come with their own potential drawbacks, including potential addiction and dependence. Wearables do not present the problem of dependence, but the tricky part is getting them to impact the specific nerve pathway that is causing pain.

We need to keep investing money in these alternative treatment options and in pain management as a whole. It seems like we’re nearing a breakthrough, not just with wearables, but as a whole. Pain is a huge industry affecting tens of millions of people, so it’s going to draw attention and investments. The first company to develop a wearable or another opioid alternative that can reliably control certain types of widespread pain will set the bar and enjoy the spoils that come with it. This will lead to more investments, better technology, and hopefully, better non-opioid patient care options for chronic pain. We’re excited to see what the future holds.