The Only Advice You Need For Treating Chronic Pain

April 3, 2018 / Thomas Cohn, MD

Chronic pain comes in so many unique forms, and everyone experiences pain differently. Consequently, there is no one-size-fits-all solution to chronic pain. So as the title of this blog implies, how are we going to provide you with the only advice you need for treating chronic pain? Read on to find out.

Managing Chronic Pain

When it comes to managing carpal tunnel, lumbar spine pain or chronic migraines, there’s really only one piece of advice you should abide by when caring for your condition, and that’s this – Find what works for you, and stick to it.

As a medical professional, I always want to do my reading and examine the science behind pain management techniques. That’s why I’m hesitant to unconditionally provide support for things like medical marijuana and Kratom. There’s simply so much that we don’t know about individualizes strains and how they react to each person individually for most doctors to 100 percent support their use to treat pain.

That being said, we can 100 percent support a person who has found a relief through these methods. At the end of the day, our goal as pain specialists is to help you manage, reduce and ultimately eliminate your pain. If one of these solutions works for you, we’re going to be your biggest supporter, but that doesn’t mean we’ll blindly prescribe the same treatment for someone else dealing with a different pain problem. What works for one may cause a rash of problems in someone else. If there was a magic pill to treat pain, our job would be easy, but there’s not, so pain care requires a highly individualized approach.

Finding What Works

As I’ve mentioned on the blog before, I have struggled with my own pain problems throughout my life. I deal with regular occurrences of back pain, and it took me a while to find out what works to reduce flare ups and keep pain from controlling my life. It’s rarely easy, but that’s the challenge of pain care. I have to make time to get regular exercise, to eat healthy foods and to stretch before a partake in activity. It would be easier to stay on the couch or sleep in a little longer, but I know that doing so means a day with more pain. By finding what works and sticking to the plan, I’ve been able to take control of my back pain.

You can do the same. Whether that involves exercising in the evening, avoiding caffeinated beverages, a daily Kratom pill or acupuncture, when you find something that works, stick with it, but also build on it. If morning exercise helps, see how you body responds to morning exercise and another therapy technique. Keep trying new things until you’ve optimized a treatment plan that greatly reduces or eliminates your pain. Remember that it’s not going to be easy, but if you’re truly committed to finding a solution, you’ll make these treatments a priority.

If you need help developing a care plan or figuring out new treatment techniques to try, don’t hesitate to reach out to our clinic. Because at the end of the day, we want to find a solution that works for you.

Apitherapy – Why All Alternative Treatment Options Aren’t The Same

March 29, 2018 / Thomas Cohn, MD

If you’ve been following our blog for some time, you know that our goal is to help everyone find a solution to their pain problem. If you find something that works for you, then stick with it. That being said, not all alternative methods are created the same, and some can be downright dangerous.

That’s the lesson we learned when a 55-year-old woman recently died due to complications from apitherapy. For those of you who know your word origins, you might be able to figure out what apitherapy is – bee therapy. More specifically, apitherapy is known as live bee acupuncture.

Apitherapy Gone Wrong

We’re not saying the therapeutic technique is bonkers, because some people swear by it, and as is our motto, we want everyone to find a solution to their individual pain problem, so if it’s working for you, more power to you. That being said, even if it seems safe, it’s clear that we don’t know as much as we thought we did about the therapy technique.

According to the news reports, the 55-year-old woman had been undergoing apitherapy for more than two years without problems. However, during her most recent session, she developed a severe reaction and began wheezing, coughing, and suffering from shortness of breath. She eventually lost consciousness and was taken to an emergency facility. She died a couple weeks later of multiple organ failure. Medical researchers are saying it’s the first documented apitherapy death where the individual had previously been tolerant of the bee stings. Medical researchers who studied the woman’s case concluded that apitherapy is an “unsafe and unadvisable” treatment option.

Like a lot of things in this world, apitherapy has become more popular after being championed by an uninformed celebrity. In 2016, Gwyneth Paltrow touted the “thousands-of-years-old treatment” as something she tried for an old injury. Gerard Butler also said he received a bee sting injection in an attempt to calm inflammation from stunt work, but he ended up hospitalized after having a poor reaction to the injection. He said he felt like his heart might explode and it was as if he had ants crawling under his skin.

What Doctors Are Saying

The theory behind apitherapy is that bee stings cause inflammation, which in turns leads to an inflammatory response from your body. The hope is that the inflammatory response will address both the inflammation from the bee sting along with other local inflammation in the joints.

Doctors say patients considering the therapy should be fully informed of the dangers of apitherapy prior to treatment. They also recommend that measures be taken to identify if someone could have a bad reaction before receiving a full injection, and that practitioners should be trained in how to manage severe reactions and that they should have specific reaction medications on hand. There should also be a system where the patient can receive emergency response care in a quick manor if needed.

“The public need to be very aware of the unorthodox use of allergens such as bee venom,” said Amena Warner, Head of Clinical Services for Allergy UK. “This will come with risk and, in susceptible individuals, can lead to serious life threatening reactions.”

Opioids For Long-Term Pain Relief

March 12, 2018 / Thomas Cohn, MD

The latest copy of the Journal of the American Medical Association has a lead article on the use of opioids in the long-term management of low back pain. The article is a study of some 200 people who were managed either with opioid-type medications or without them. The conclusion was that there was no difference in level of function with the use of opioid medication.

There is a large problem with this study, since it does not distinguish between the wide variety of patients who have back pain. Back pain can be due to everything from spine problems to nerve damage and residual surgical issues. As it has been preached multiple times, opioids are only one tool in the treatment of back issues and there are often many different strategies to control pain.

Opioids and Back Pain

The reality of life is that many different things can cause pain, and treatment should be aimed at the cause of pain. Depending on what is causing the sensory complaints, management will vary based on the individual’s needs. A combination of strategies is often necessary to treat every different component contributing to a problem. Treatments may be simple, such as ongoing exercise, to complex, including injections and surgery. Sometimes simple strategies fail and the only medication that does help are opioids. Since these drugs have tremendous problems, they often are not a good solution especially for long-term use. Pain specialists often know a wide realm of treatment options and can help lead one to better choice or a combination of choices.

The biggest problem with the use of opioids is that they are cheap and they have been pushed in the United States as a great, inexpensive tool to manage any type of pain. It takes a lot of work to manage pain, and in this country many have opted out of the challenges. On top of the drug companies pushing these medications, often the insurance companies are equally complicit by not allowing treatments that may be more expensive. Everything from physical therapy, massage, chiropractors, acupuncture and even fitness centers with athletic trainers are often more beneficial than many medications and may well be cheaper. However, most insurance companies turn a blind eye towards alternative treatment strategies. Now that opioids are a problem, insurance companies still want to say no to alternatives to drugs, but are not willing to pay for the better alternatives.

Alternative Treatment Options

The important message from the study of opioids is that for most people there are better treatment strategies than these drugs for the management of pain in the long term. For short-term, these medications may be okay. For surgery and several days immediately afterward it may be reasonable to use them. After that time period, medications that are not addictive may be used with the strategy to return the body to normal functional patterns. The body needs to move and relearn normal movement and function. As the body moves and functions as it was originally designed, the body acts appropriately and does not generate pain sensory signals.

If you have a body that cannot move and function normally due to permanent changes, these may constantly send sensory signals that are interpreted as pain. Designing treatments that bring the body as close to normal motion and function as possible can reduce pain. This is difficult and requires significant effort; rarely is there a magic pill that performs this function. If one gets past the thought that life is pain free and then focuses on making life as close to ideal motion and function, then one can improve their quality of life.

The last take home message is that medicine needs to understand that some people honestly have tried everything available to treat their problems and nothing has worked. If they have worked with a legitimate pain expert, sometimes it is found that opioid medications are appropriate in the management of a problem long term. This should be considered a last option in most cases. Hopefully our culture will get a more realistic understanding of opioids in the management of pain and all those involved in treatment will support the use of reasonable alternative strategies. Initially it may not be cheaper, but a healthier society is likely the final outcome.

Chronic Pain Makes School Difficult For Children

March 8, 2018 / Thomas Cohn, MD

Although the findings may not be all that surprising, new research shows that children with chronic pain are significantly more likely to deal with life events that can contribute to poorer school performance.

According to the research, 81.5 percent of children with a history of chronic pain reported dealing with at least one adverse life event that could have impacted their school performance. Children with chronic pain were more likely to report:

Missing school due to not feeling well.
Missing school for medical treatment.
Having a difficult time paying attention in class.
Finding it hard to keep up with school activities.

Chronic Pain In School Children

As you can see, it’s clearly important for children, their parents and the education staff to develop a comprehensive care plan for dealing with chronic illnesses and flareups. These kids probably feel ostracized enough without having to feel like they’re falling behind on homework or with the curriculum. Here’s a look at some ways all of these groups can come together to ensure everyone is on the same page.

Children need to be proactive about getting homework and lesson plans from the classes they’ve missed.
Parents need to stress the importance of getting homework and ensure children aren’t missing assignments from missed classes.
Parents need to talk with school staff about the child’s potential health issues so it’s on their radar.
School staff need to realize that children aren’t using their chronic condition as a crutch or an excuse.
Parents and children should ensure they get a doctor’s note for medical appointments during class.
If homework extensions are needed, let the teacher know as far in advance as possible.
Consider supplemental education resources, like tutoring or extra credit.
If any party has concerns, they should be brought up sooner rather than later so there aren’t any misunderstandings.
Once you find a routine that works, do what you can to stay in that routine.

Chronic pain can be tough to deal with, but it’s even more difficult if you’re a kid in school trying to learn and make friends. If your child needs help with any aspect of their chronic pain care plan, reach out to Dr. Cohn’s office today.

Is Low Back Pain Inherited?

March 5, 2018 / Thomas Cohn, MD

A frequent question I receive from patients is whether low back pain is just your fate and if it’s inherited. This is an especially hard question to answer, but genetics may influence the fact that you develop problems with your back. There are many conditions that may cause low back pain, and some of them are linked to your genes and thus could be inherited.

Back pain that may have genetic causes include scoliosis, inflammatory arthritis, osteoporosis, spondylolisthesis, obesity and possibly even lumbar degenerative disc disease. Back pain in younger people tends to be more related to traumatic causes such as force exhibited on discs, joints and muscle sprains. In older adults, the lists of causes of back pain are often associated with lifestyle issues as well as genetic causes.

Inheriting Back Pain

There are certain causes we know that have definite genetic causes and have direct links to back problems. One of the most common is scoliosis. About 3 percent of the population has scoliosis, and in most cases it is usually a minimal curvature without any significant impact on the back mechanics, and therefore it does not cause pain. Most scoliosis is considered idiopathic, and that implies that we have no idea why it is present, but there is a family association of roughly 30 percent and thus there is likely some sort of genetic component. Another five percent of scoliosis is associated with a variety of neurologic and musculoskeletal disorders, like Marfan’s syndrome or muscular dystrophy, and these diseases are definitely related to genetic causes. A lot of these latter diseases are associated with significant curvatures of the spine and the structural abnormalities are painful.

Another category of genetic causes of back pain are related to certain inflammatory disease that are linked to arthritis. These are disease like rheumatoid arthritis, lupus, psoriasis, and ankylosing spondyloarthritis. All of those problems can cause a variety of structural changes to the spine, especially to the joints as well as to the discs and bones. These conditions can lead to structural and motion changes, whic could cause spinal narrowing and nerve irritation. The combination of physical changes in the spine often results in pain.

Degenerative Disc Disease and Osteoporosis

Research out of Kings College in London in 2012 identified a gene known as PARK2 that occurred in some 65-80% of those people whom have lumbar degenerative disc disease. As everyone ages, the discs do degenerate by losing hydration and shrinking in height. This may lead to some changes in movement patterns in the spine, and also lead to bony changes in joints and discs. Sometimes these changes can cause narrowing where the spinal cord is and where the nerves exit the spine. In some people these changes are painful, and in many they are not since the body can adapt to many things, especially if the change is very slow.

One common but often not recognized disorder that more commonly affects women is osteoporosis, which is commonly inherited. Thinning of the bones oftentimes occurs in the spine, which may cause the vertebral bodies to fracture and collapse downward. Sometimes these fractures are painful, and many times they are not, but the overall changes to the spine may lead to motion changes, muscle changes, and spinal narrowing, which may cause pain.

The overall answer to the question of whether your low back pain is due to genetics and is inherited is maybe. There are many things that can contribute to back pain and some of the most common issues are lifestyle related. A lack of exercise and obesity may be one of the most serious problems in our modern society. Many of us sit at desks all day long, eat too much food, and spend the evening in front of the television. Changing factors that one can control like the amount and type of exercise is often one of the most important strategies to treat back problems. One can not often change the inherited factors, but one often can change their impact by controlling your environment and lifestyle.