pain medication

Brain Implants Are Helping To Decode Chronic Pain

/ Thomas Cohn, MD

brainChronic pain is one of the most common reasons why people visit a doctor’s office, but because of the highly individualized nature of chronic pain, figuring out a diagnosis and effective treatment plan isn’t always easy. It’s tough to really get inside the brain of a person who is battling a chronic pain condition, but that’s exactly what researchers tried to do with this most recent study.

To get a better understanding of chronic pain pathways, researchers implanted electrodes into the brains of four volunteers who were experiencing pain following an amputation (known as phantom limb pain). The participants went about their day as normal while the implants recorded activity in two specific brain regions where researchers believe pain responses occur – the anterior cingulate cortex and the orbitofrontal cortex. Patients were also asked to rate their pain levels on a standard scale several times a day over the course of six months, and when they would do this, they would also press a button that would cause the implants to record their brain signals for 30 seconds.

The captured information was then fed through a machine learning model that could find patterns in the data and predict each patient’s pain level based on the signals in their brain.

“From these models, we found that [electrical waves with] low frequencies in the orbitofrontal cortex corresponded with each of the patients’ subjective pain intensities, providing an objective measure of chronic pain,” said Prasad Shirvalker, a neurologist at the University of California, San Francisco and a co-author of the study, writes in the Conversation. “The larger the shift in low-frequency activity we measured, the more likely the patient was experiencing intense pain.”

Chronic Pain Brain Signals

Shirvalker went on to say that pain is highly individualized, but eventually they hope to decode unique pain signals to come up with patient-specific treatment plans.

“This is the first time ever chronic pain has been measured in the real world,” Shirvalkar tells the New York Times’ Priyanka Runwal. “Every patient actually had a different fingerprint for their pain.”

Researchers also wanted to better understand how the brain responded to painful stimuli, so they applied heat to each patient’s body to see how their brains reacted. They found that acute pain led to a more involved response from the anterior cingulate cortex. Because chronic pain involved a greater reaction from the orbitofrontal cortex, researchers say it’s the first time that there is direct evidence that chronic pain and acute pain involve different areas of the brain.

The data is extremely limited and was only collected on individuals who underwent amputation, but it is a step in the right direction for better understanding chronic pain and how our brains respond to these stimuli. Hopefully future research can continue to build on these findings and focus on more discoveries around the orbitofrontal cortex and its response to pain. The more we learn about how our brains react to chronic pain, the easier it will be to come up with targeted treatments.

In the meantime, if you need a more traditional approach to diagnosing and treating your chronic pain, reach out to Dr. Cohn and his team today at (952) 738-4580

Drinking To Cope With Chronic Pain May Lead To Worse Pain

/ Thomas Cohn, MD

chronic pain alcoholAlcohol has a number of effects on our brain and body, and while it may be able to seemingly drown out some pain sensations in a very short-term manner, it’s obvious that turning to alcohol is not a smart or healthy way to cope with your chronic pain condition. That sentiment only becomes more true on the heels of a new study that found that turning to alcohol to cope with chronic pain can actually lead to worsening pain sensations.

Chronic Pain And Alcohol Use

To get a better understanding of the effects of alcohol and pain perception, researchers turned their attention to three groups of mice. One group was dependent on alcohol (excessive drinkers), another had limited access to alcohol (moderate drinkers), and the final group had never been given alcohol. The mice then had their access to alcohol restricted before having it reintroduced.

Researchers found that in mice that were dependent on alcohol, allodynia was a common symptom during alcohol withdrawal. Allodynia is a condition in which a normally harmless nerve stimulus is perceived as painful by the brain. In other words, the mice going through withdrawals were more likely to experience phantom pain.

Interestingly when these mice were reintroduced to alcohol, pain sensitivity decreased, which would likely only continue to worsen a dependency issue. However, that decrease in pain sensitivity was not the same across the board. About half of the mice in the moderate groups showed signs of increased pain sensitivity during alcohol withdrawal, but they did not see pain sensitivity decrease when reintroduced to alcohol.

Additionally, when researchers measured the level of inflammatory proteins in the animals, they discovered that specific inflammatory molecules were only increased in dependent mice. This suggests that different molecular mechanisms may be driving the two types of pain, but on a positive note, it may make it easier to create medications that targets these specific proteins.

“These two types of pain vary greatly, which is why it is important to be able to distinguish between them and develop different ways to treat each type,” said study first author Vittoria Borgonetti, PhD, a postdoctoral associate at Scripps Research.

The team hopes that their findings and their future research will be make it easier for medical experts to help treat chronic pain conditions that are being fueled or worsened by alcohol.

“Our goal is to unveil new potential molecular targets that can be used to distinguish these types of pain and potentially be used in the future for the development of therapies,” said co-senior author Nicoletta Galeotti, PhD, associate professor of preclinical pharmacology at the University of Florence.

So not only is alcohol unhelpful at treating the underlying cause of chronic pain, it can actually increase your risk of phantom pain signals. Instead of turning to alcohol, turn to a pain care provider like Dr. Cohn. We’re confident we can find the right treatment option for your unique pain condition. For more information, or to set up an appointment with Dr. Cohn, give his office a call today at (952) 738-4580.

6 Tips For Controlling Pain After Surgery

/ Thomas Cohn, MD

chronic painSurgery can be just what you need to overcome a painful and debilitating condition, but odds are you won’t experience that relief overnight. In fact, it’s common to experience pain and discomfort for a short period of time after the operation as your body works to adapt to the trauma of surgery. You can take solace in knowing that this post-surgical discomfort will fade, but life can be a little more comfortable if you work to control your post-op pain.

In today’s blog, we share six tips for controlling pain after surgery.

Managing Pain After An Operation

Here’s a look at six ways that you can work to control and decrease post-surgical discomfort.

1. Prehab – You don’t have to wait until after your surgery is complete to start working to become physically stronger. The stronger you are prior to surgery, the stronger you will be after your operation, and that can help to support joints and other structures that have been addressed during surgery. Ask your doctor for some exercises that you can perform before your operation.

2. Medication Management – Odds are you are going to be given some medications to help manage discomfort following your operation, but you need to take them in a specific manner in order for them to be most effective. Your care team will provide you with dosage instructions, but make sure that you understand how you are expected to handle your medications before you discharge or leave the pharmacy. Taking medications outside of your dosage instructions can lead to a number of issues, so if you have questions or are running into any issues, reach out to your care team.

3. Early Movement – You should always follow the specific recovery instructions of your treating physician, but don’t be surprised if they recommend early movement and activity. Odds are you won’t be told to stay in bed for weeks while your body recovers, because your body needs movement and controlled stress to improve circulation and become stronger. If allowed by your surgeon, make sure that you are up and moving as soon as it is allowed to help jump start the recovery process and limit pain or discomfort.

4. Physical Therapy –  In many instances, physical therapy will be the most effective treatment following an operation in terms of pain control and functional improvement. PT will help your structures become stronger, mobile and more stable, all of which help to control pain. Make sure that you are doing your PT exercises as directed and you never skip an appointment during your recovery.

5. Mind Your Mental Health – It’s easy to focus on your physical condition after surgery, but don’t overlook your mental and emotional health, because they are closely tied to your pain levels. Anxiety and depression can intensify pain sensations and our perception of pain, so make sure that you are caring for your mental health after an operation. Get outside, talk with friends or family and partake in activities that are energizing to your physical and mental health.

6. Connect With A Pain Specialist – If you are dealing with lingering pain or you just want to have some additional assistance managing a pain condition following your operation, connect with a specialist like Dr. Cohn. Pain is highly unique to the individual, but we will work hard to help find personalized ways to help you overcome your pain and improve your overall physical function. For more information, or for help with a different pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

Minnesota Considering Price Hikes On Chronic Pain Prescriptions

/ Thomas Cohn, MD

opioidsIf you’re dealing with a chronic pain condition, it’s entirely possible that it has impacted your financial earnings ability or led to increased expenses due to extra medical appointments. In other words, chronic pain can be a significant financial burden for many, and that burden may grow even stronger if Minnesota legislators end up passing HF 1728/SF 2142.

The proposal would add additional fees to opioid prescriptions, and these fees would be passed down to the patient. Legitimate medication has become much harder to get now that the US is really attempting to crack down on the rising opioid-related deaths, but for the patients with chronic pain or those with cancer who truly need their medication, not only are they having a harder time getting their prescription, but it may soon be more expensive. Passing these expenses onto the patients will only cause more strife for patients who are already financially burdened by their medical condition.

The Opioid Price Hike Problem

These price hikes would cause much more harm to legitimate chronic pain patients than it would help in curbing the opioid crisis. This is especially concerning because most chronic pain specialists advise their patients not to rely on pain medications as their main form of treatment. As we’ve preached on the blog in the past, opioids can absolutely be part of a comprehensive treatment plan, but they are not a great stand alone option. Doctors know that opioids alone will not address the underlying issue causing the chronic pain condition, so if they are going to prescribe them, they will be used in conjunction with other treatments like physical therapy, exercise or other active treatments. Making it harder for patients to have access to the medications that can make physical therapy more bearable or simply manage cancer-related pain isn’t the answer.

Lawmakers should seriously consider visiting a pain clinic or a cancer ward before they blindly vote to increase the price of opioids for those with a legitimate prescription in Minnesota. The overwhelming majority of patients use these medications responsibly and have a medically necessary reason for seeking them out. These price hikes will be deferred to them and may make it much harder for them to care for their pain condition. They may have to ration their pills outside of their doctor’s orders to cut down on other necessary expenses just to be able to afford their medications. This bill isn’t the answer, and it will put a bigger financial strain on many chronic pain sufferers across Minnesota.

We’ll keep an eye on the bill when it comes up for a vote, but hopefully Minnesotans aren’t further financially burdened by this potential price hike.

Four Things Your Chronic Pain Specialist Wants From You

/ Thomas Cohn, MD

doctor listeningWe have a pretty good idea of what patients are looking for in a pain management specialist. You want someone who is a good listener, someone who gives you their complete attention and someone who is willing to try different techniques if the first treatment doesn’t solve your chronic pain. But in order for chronic pain treatment to have the best chance at being successful, it’s not just about finding the right provider. The patient plays a key role as well.

Because of this, doctors are also hopeful that patients will have certain qualities throughout their time working with the physician. In today’s blog, we take a look at four things that your chronic pain specialist wants from you.

What Your Doc Wants From You

We know what you’re looking for in a physician, but here’s a look at four qualities we hope to find in a patient who has come to our office looking for help with a chronic pain condition.

1. Effective Communicator – We love it when patients can be clear and concise about the issues they are facing. Be vividly descriptive about your condition. Don’t just tell us that you have lower back pain, show us where it’s located, describe what your pain feels like (shooting, dull, pins-and-needle-like, etc.) and tell us what activities make pain worse or better. The more we know about your pain, the easier it will be to develop an individualized treatment plan for you.

2. Strong Work Ethic – One of the least favorite patients of any chronic pain specialist is the one who only wants to pursue passive treatments. They want to rest or take a pill and magically find relief. As we’ve said on this blog time and time again, rest and pain medications can absolutely be an integral part of a pain management plan, but they aren’t good standalone options. We want someone who is going to really throw themselves into a physical therapy program or commit to lifestyle changes to address their pain condition, even if they won’t be easy.

3. Don’t Give Up Easily – Winning out over your chronic pain condition isn’t going to be easy, but we’re in it for the long haul, and we hope you will be too. We may have to change strategies, try different approaches or see each other a few times over the course of many months. It’s going to be worth it in the end, but when it comes to chronic pain, there’s rarely an easy and straightforward solution, so we want patients that don’t give up when things get tough.

4. Rule Follower – Finally, the ideal patient will be a good listener and great follower of directions. If we tell you to do some moderate intensity exercises a few times a week, or we advise against certain activities, we expect you to follow through on your end because this is all part of your treatment plan. If you only attend some of your physical therapy sessions or you don’t work to improve your sleeping habits like advised, don’t be surprised if symptoms linger. We can’t be with you 24/7, so we need to have confidence that you’ll follow our advice when you’re not at the clinic.

If you have all of these qualities, or if you’re just struggling to get control over your chronic pain condition, we hope you’ll reach out to Dr. Cohn for assistance. Give our team a call today at (952) 738-4580.