The Gender Gap In Chronic Pain Care

March 10, 2023 / Thomas Cohn, MD

The wage gap difference between men and women tends to get the most attention when comparing sexes, but it’s certainly not the only realm where men and women are treated differently. Men and women are also unfortunately treated differently when it comes to chronic pain management. We do our best to really listen to each of our patients and provide them with the right individual treatment plan, but that’s not the reality that many other chronic pain patients face.

That difference in pain care between sexes was made evident in a recent study published in November 2022 called the Gender Pain Gap Index Report. The study was conducted by the manufacturers of the painkiller Nurofen, and it surveyed more than 5,000 men and women about their experiences and perceptions of pain. Here’s a closer look at some of the findings from the report:

50 percent of women reported a lack of support from their general practitioner when asking for help with pain. Only 36 percent of men responded similarly.

56 percent of women said they felt ignored or believed they were being dismissed as “emotional.” 49 percent of men felt the same.

63 percent of women said they felt men’s pain is taken more seriously due to “gender discrimination by healthcare professionals.” Only 39 percent of men said that they believed that a gender pain gap existed.

74 percent of women regularly chose self-care over seeing a healthcare provider. 60 percent of men said the same.

It’s truly unfortunate that so many women feel that they are not getting the care they hoped to receive from their healthcare provider, and it’s even more disheartening to hear that many feel that their concerns were ignored because of their sex. Every patient deserves to be listened to and to be treated by a physician who is going to go the extra mile for them.

We try to do that for every patient, and we know that it’s not easy. Sometimes that involves switching treatments because the first route was ineffective, while other times it means saying longer with a patient in the exam room to really get to the bottom of their symptoms and try to understand what they are going through physically, mentally and emotionally to treat all aspects of pain. Again, it’s rarely easy, but it’s worth it because we know firsthand how debilitating chronic pain can be and how amazing it can be to reclaim your independence from your condition.

If you want to connect with a physician that will make you feel heard, reach out to Dr. Cohn and his team at (952) 738-4520.

How Untreated Chronic Pain Can Increase Your Dementia Risk

February 23, 2023 / Thomas Cohn, MD

New research published this week found that untreated chronic pain can increase a person’s risk of cognitive decline and dementia, and that risk increases based on the number of areas in the body suffering from chronic pain.

The findings, published this week in the journal Proceedings of the National Academy of Sciences, found that chronic pain had an interesting effect on a person’s hippocampus, the area of the brain that is associated with learning and memory. Researchers compared the size of the hippocampus in patients with chronic pain to the size of the hippocampus in aging individuals without chronic pain. When comparing these models, researchers found that chronic pain may artificially age the hippocampus. When compared to a healthy 60-year-old patient, researchers found:

Patients with one chronic pain site had a hippocampus that had aged by an additional year.
Patients with two chronic pain sites had a hippocampus that had aged by roughly two additional years.
Patients with five or more chronic pain sites had a hippocampus that had aged by up to an additional eight years.

“In other words, the hippocampal (grey matter volume) in a 60-year-old individual with (chronic pain) at two body sites was similar to the volume of (pain free) controls aged 62-year-old,” wrote corresponding author Tu Yiheng and his colleagues.

So while you may only be 60 years old, if you are suffering from chronic pain in five or more locations in your body, your hippocampus may have experienced aging similar to that of a 68-year-old. Aging is a common underlying factor in dementia onset, and if your brain is artificially aged due to chronic pain, you may be more likely to experience dementia or cognitive decline.

Prevent Dementia By Treating Chronic Pain

While the findings may be a little concerning for patients dealing with chronic pain, fortunately we can try to reduce our dementia risk by really working to control and treat our chronic pain condition. This is certainly easier said than done, but if you develop a plan and work closely with a pain management specialist like Dr. Cohn, not only can you lead a more comfortable life free of chronic pain, but you can keep your brain healthy as you age.

Treating chronic pain is highly individualized, but may patients find that a combination of the following techniques can help them gain more control over their chronic pain condition:

Exercise
Posture Improvements
Dietary Changes
Physical Therapy
Stress Relief
Sleep Quality Improvements
Cognitive Behavioral Therapy
Deep Breathing Techniques

As you can see, all of the above techniques are active treatments that focus on improving one or more aspects of your health. Pain medications can certainly play a role in chronic pain management, but the above techniques are better at targeting the underlying pain cause and providing long-term relief.

Of course, working with a pain management specialist can help you find the right combination of treatments for your specific needs. If you want help identifying a pain treatment plan that’s right for you, or you just want to talk to a pain management provider about your symptoms, reach out to Dr. Cohn and his team today at (952) 738-4580.

Opioids – Damned If You Do, Damned If You Don’t

February 2, 2023 / Thomas Cohn, MD

If you’re a regular reader of our blog, you know our views on opioids for pain management. Used correctly, opioids can be a wonderful compliment to a chronic pain management program, but their use can also cause some health issues even when carefully taken. According to a new study, not only can starting an opioid regimen be potentially hazardous to your health, so too can stopping opioid use. This doesn’t mean that you should plan to take opioids indefinitely, but it speaks to the importance of working with a pain management provider when starting and stopping an opioid regimen.

According to a recent study published in the journal PLOS Medicine, stopping a prescription opioid regimen can actually increase a person’s risk of overdose death. Opioid-related overdoses are a major concern here and in Canada where the study was conducted, and researchers wanted to learn more about the potential impact of discontinuing an opioid treatment plan. You might inherently believe that your risk of overdose falls to zero if you stop taking opioids, and in a perfect world, you’d be right. However, not everyone who stops taking opioids can do so easily, and therein lies the risk of eventual overdose.

Safely Stopping Opioid Use

For the study, researchers reviewed the medical records of more than 14,000 patients in British Columbia who had been on opioid therapy for at least 90 days. After reviewing the records, researchers found that discontinuing opioid therapy for chronic pain was associated with an increased overdose risk for people without an opioid use disorder (OUD). An inverse effect was seen in patients who tapered off of opioid use, as their overall risk of overdose decreased. Researchers concluded that abrupt opioid stoppage could be dangerous, and that patients should work with a provider to taper off of medications so as not to increase their risk of overdose as they seek to end an opioid regimen.

While there were some limitations in the study, including whether or not associated overdoses occurred with prescription medications or those obtained illegally, the general message holds true in that it is extremely important that you work with a physician when working to stop an opioid treatment plan. We understand that you are aware of some of the potential issues associated with opioid use, and we commend you on wanting to curb or eliminate your reliance on these medications. However, there is a right way to go about cutting prescription medications out of your system. Sometimes slow and steady wins the race, and cutting opioids cold turkey could have some unintended withdrawal effects.

If your current medication plan isn’t getting you where you want to be, talk to a doctor about safely adjusting your medication program. We want to help you find the right solution, but finding the right treatment is only part of the battle. You also need to approach the treatment in the right manner, otherwise you may face some unexpected obstacles.

For more information, or for help with a chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

More Patients Swapping Out Opioids For Medical Marijuana To Manage Pain

January 12, 2023 / Thomas Cohn, MD

New research has found that nearly one-third of patients with chronic pain report using medical cannabis to manage their pain, with more than half of them decreasing their reliance on other pain medications, like opioids, in the process.

“That patients report substituting cannabis for pain medicines so much really underscores the need for research on the benefits and risks of using cannabis for chronic pain,” said lead author Mark C. Bicket, MD, PhD, assistant professor, Department of Anesthesiology, and director, Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, in an interview with Medscape Medical News.

Medical Cannabis Use

For the study, researchers surveyed 1,724 Americans over the age of 18 with chronic noncancer pain living in areas where medical cannabis was available. Participants were asked about their use of three different types of pain management:

Medical marijuana
Pharmacologic treatments like opioids, non-opioid analgesics and over-the-counter medications
Non-pharmacologic treatments like physical therapy, cognitive behavioral therapy or mindfulness

After looking at the survey results, researchers found that 25.9 percent of respondents reported using medical cannabis within the last year, and 23.2 percent reported using it within the past 30 days. More than half of patients who said they used medical cannabis said this also led to a decrease in prescription opioid use, prescription non-opioids and over-the-counter medications. “Almost no one” said that medical cannabis led to a higher use of these medications, said Dr. Bicket.

Medical cannabis use also impacted other treatments as well, for the good and the bad. 38.7 percent of people said that cannabis use led to decreased physical therapy sessions, 19.1 percent said it led to lower use of meditation, and 26 percent said it led to less CBT. Conversely, 5.9 percent of patients said cannabis use led to more physical therapy, 23.7 percent said it led to more meditation therapy, and 17.1 percent said it led to more CBT, so cannabis use clearly had a more widespread variance on other therapies than it did on pharmacological treatments, which saw a very obvious decreased correlation.

While Bicket was pleased with the findings, he noted that the current environment – where cannabis use is medically approved on some state levels but illegal on the federal level – makes it harder to accurately study the best ways to implement cannabis use for a patient population.

“We really don’t have a good sense of the relative risks and benefits that could come from cannabis as a treatment for chronic pain,” said Bicket. “As a physician, it’s difficult to have discussions with patients because I’m not able to understand the products they’re using based on this regulatory environment we have.”

Bicket seems to have the same gripes about the current medical marijuana climate that we have about chronic pain care in general. For one reason or another, we’re not able to easily study the best ways to treat chronic pain or harness the power of certain treatments like medical marijuana. Hopefully the landscape changes in the near future so that patients can have better access to the right treatments for their individual needs.

Will My Chronic Pain Get Worse Over Time?

November 3, 2022 / Thomas Cohn, MD

A chronic pain condition can make life uncomfortable, and oftentimes it leaves patients wondering if things will ever get better. A recent study out of Europe found that patients who had chronic pain in their forties were more likely to have chronic pain and other health issues later in life, which leads many to assume that chronic pain conditions will get worse over time.

But is that the truth? Are you really stuck with pain for the rest of your life, or is there something you can do about it? Below we explain why your chronic pain doesn’t have to get worse as time goes on.

Will My Pain Condition Improve?

As we’ve said numerous times on this blog, the following is just general advice. Chronic pain is both complex and highly individualized, so we can’t sit here and say that your condition will certainly get better or get worse depending on the treatment route you pursue. That being said, many patients don’t realize how much control they have when it comes to managing their chronic pain condition on a long-term basis. While chronic pain can oftentimes feel out of control, there are steps you can take each day to help you find more control over your condition down the road.

So we’ll start by saying that chronic pain is typically a health issue that will continue to worsen as you get older if you do nothing to treat the problem. While sometimes rest or activity avoidance can help you overcome small issues like a muscle strain or a headache, you’re not going to be able to do nothing and watch your chronic pain condition disappear. Chronic pain suggests that there is an underlying issue, and if you keep doing the same things that led to your condition in the first place, things won’t get better, and oftentimes they will only get worse.

That said, the opposite is also typically true, and that’s wonderful news for chronic pain sufferers. Targeted active treatments can oftentimes alleviate symptoms, calm inflammation, slow natural degeneration and improve your overall physical function. It’s not always easy, and you’re not always going to enjoy doing your physical therapy exercises or watching what foods and drinks you put in your body, but it’s these little daily wins that will make you stronger in the long run.

Another way to greatly improve your likelihood of overcoming your chronic pain condition is to connect with a specialist who can give you the individualized attention and advice that you’d benefit from. Chronic pain can be a very isolating health condition, and that can lead a person to withdraw from their friends, family and even their healthcare professionals. You need to know that you are not a burden and there are plenty of people out there who want to see you overcome your chronic pain issue. We rely on professionals for a number of different aspects of life, whether that’s to change a faulty piston on our vehicle or to install a new garage door, so don’t feel like you need to take on your complex medical challenges by yourself. Connect with a specialist and let them put their expertise to work for you.

And finally, many patients find it helpful if they acknowledge the fact that recovery is going to take some work. You’re not going to be able to take a magic pill or lay in bed for two weeks and all of a sudden you’re feel better. You’re going to have to put in the work with active interventions, like daily exercise, regular physical therapy, posture improvements, weight loss and more. As we mentioned above, it won’t always be fun, but working towards these goals is way more fun than living each day with chronic pain.

Know that your pain doesn’t have to remain consistent or worsen as you get older. You have a say in your chronic pain story, and we’re here to help in any way we can. For more information, or to get started on your journey to become free from chronic pain, reach out to Dr. Cohn and his team today at (952) 738-4580.