Manipulating Statistics About Chronic Pain

June 27, 2016 / Thomas Cohn, MD

A newspaper headline read this week, “1 in 3 Medicare Patients took Opioids” in the last year. Is that as big a deal as the headline made it out to be? Probably not. If one starts to think about the article and read the whole story, it becomes ridiculous. The study being cited actually reports that 1 in 3 Medicare recipients overall received at least one prescription for an opioid medication in the last year. The article and the study indicated this was a major problem.

Some facts should be thought about when analyzing such a study. First, one in three people suffers from chronic pain. Further, chronic pain tends to be more common in the elderly and disabled, the very population that has Medicare. One prescription within a year’s time is probably not significant. Many people have significant medical procedures within one year, including dental procedures, numerous outpatient surgeries, or even painful diagnostic studies. Others have injuries that may be extremely painful for several days. The common thread is that all these things are appropriate for short-term opioid use to control pain. Obtaining one prescription within a year for a third of all Medicare patients would probably be very normal.

Interpreting The Stats

The focus of the study and the article is to emphasize how bad and problematic are opioids. If one stops and thinks for a second, making that conclusion on the basis of “1 in 3 Medicare patients have received a prescription for opioids in one year” is terrible. Acute pain is exactly what opioids are best used to treat, especially for just a few days. It would not be surprising to find out that 1 in 3 Medicare patients had a significant medical procedure for which an opioid was prescribed.

A more devastating fact should be that 1 in 3 people suffer from chronic pain. The causes of pain are extremely varied. The headlines of the paper are all about addiction. There are very few about how widespread pain is a problem. The big alarm is about death related to drug abuse. Addicts are obtaining billions of dollars for further treatment and research from the government. There are no headlines about how people struggle day to day with dealing with pain and still trying to continue with life.

Addiction to opioids and the increases in deaths is a problem. The solution in reality is probably to treat the true problem, which is the pain. Better pain medications that are not addictive definitely are needed. Research in the basic science of pain and how to prevent it is needed even more.

What Patients Are Saying About Daith Piercings

June 17, 2016 / Thomas Cohn, MD

Our post on Daith piercings has been by far our most popular blog post, and it’s clear many people are fed up with their chronic migraines. We’ve never touted the Daith piercing as a surefire fix to migraine pain, we’ve only stated that it’s a relatively cheap alternative option for individuals who are fed up with failed treatments. Some people took issue with the fact that the piercing isn’t backed by clinical science, and while it draws on some of the same pain pathways as acupuncture, we made it clear that there was no hard science behind the pain management technique.

Well, our readers have taken to the comment section of the original post, and many have shared their first-hand experience with the piercing. Again, it may not be for everybody, but here’s what patients who have had the piercing are saying about it.

I’ll provide more anecdotal, non-scientific “evidence.” Mine cost $25 each. BEST money ever spent. Ever. Chronic migraine sufferer for over 20 years. This has been the only thing that has consistently worked. Now I can deal with the sinus/hormone headaches and not have them compounding and piggybacking each other. Given a choice between a piercing I could remove or narcotics, it would be a piercing every single time. My piercer is great, though. I don’t know that I would have trusted any one else to do it- unless she gave the ok.

I just had my daith piercing done a week ago in hopes of helping with my chronic migraines. So far I’ve had two migraines since, so I don’t think it is helping, but I believe mine are largely hormone related so I don’t know that a piercing would be able to help. Just wanted to say that I still think it’s a cute piercing and will keep it regardless AND the pain really wasn’t that bad. I went to a local tattoo shop with a great reputation and the pain was no worse than my other cartilage piercing that I had had done before. It hurt worse putting the actual earring in, but overall really not a bad pain level. Good luck!

I have suffered from migraines for the past several years. I would get one and it would last for several days, then 1 day off, then back to migraines. I was desperate and had heard of the daith piercing. I did not put much stock into it. Again, I was desperate, so I got it done. I was a little painful (pain is subjective). My piercer said that he was not a doctor and could not cure migraines, but just about everyone that he had done, had good results. I wasn’t expecting a miracle. Even if it just cut down on the frequency, that would have been fine. It has been 2 months and I have not had a single migraine. I stopped taking my preventative when I got the piercing to see if it would work. This doesn’t work for everyone, but it worked for me. Even if my migraines come back, I had a few months pain free and that is so worth it.

I suffered from migraines and headaches. I gotten the daith piercing and it helped a lot I don’t get them any more. My tattoo artist is also a piercer and done it for me. The only thing that really hurt was the clamp cause where it’s in the ear it’s a hard place to get too and you’ll feel some pressure for a couple days but it’s worth it in the end.

I’ve had migraines for 44 years. Mostly left sided. Many times in cycles of 2-3 weeks of either waking up with one, or going to bed with one. Nausea, noise, light sensitivity… the whole bit. I can’t take most migraine meds because of a heart issue. Not much to help with them, pretty much most meds might as well be candy. Went in for the piercing during the third day of a migraine. Yes, it hurt for a brief moment, but compared to weeks of headaches, it was NOTHING!!! As soon as the piercing went in, the intense pain behind my eye and the nausea were gone! And the next morning, absolutely no headache and no ‘headache hangover’ as after most migraines. So far, so good. If it doesn’t work, I have not lost much, and will take it out. If it continues to work….GREAT! Many people seem to want many scientific studies done on this, but, I believe for the most part, most studies are funded by pharmaceutical companies, and what company that makes lots of money on migraine meds, would want to study something that could cut down on their business?!?! Just my opinion, but drugs aren’t always the answer to fix things, like some doctors believe. If you truly suffer with debilitating migraines, then you are always looking for a way to make the pain stop. What do you have to lose?

Hi, I had suffered with migraines for 35 years. I used to get around 3 a week but my tablets did work if I took them in time or didn’t wake up with the migraine. I was told to get the piercing on the side I have the most frequent migraines which is my left side. I had the piercing 3 months ago and have had no left sided migraines since, just 2 on my right side buy I can cope with only 2 migraines in 3 months. The piercing does hurt when you have it done but for me, well worth it.

I have been a migraine sufferer since I was a young girl and now I am 57 yrs. old, I have tried it all, Botox worked the best but still had many Migraines and insurance eventually stopped paying, I recently had the daith or rook piercing done, the next day I had the worst migraine but since then I am in shock how, (So Far) it is working for me, I sure hope it continues, its been about 8 weeks, I NEVER go that long without a migraine, so hoping it continues!

I had nearly daily migraines. Imitrex made me too groggy but Excedrine Migraine deadened the pain enough to “function”. Avoiding triggers wasn’t always an option since I had barometric migraines (trigger: weather changes). It was only a week ago I got a Daith Piercing….I have not had any headache all week…a record for the last several years. I feel better so I’ve gotten better sleep than I remember for ages.

So as you can see, it’s certainly helped some patients. For more information, or to read more comments from readers, check out the original post!

There Are No Magic Pills For Chronic Pain

June 10, 2016 / Thomas Cohn, MD

As we’ve said in a bunch of previous blogs, there’s no “magic pill” to cure all your symptoms associated with chronic pain. It takes hard work on the patient’s end and a medical team dedicated to finding the right solution. It’s not going to be easy, but it will be worth it.

Recently, I read a story about one family’s plight with chronic pain and felt compelled to share it. Originally posted in the New York Post, Michelle Makin pens a piece about how one family has battled through the troubles associated with chronic pain, learning the lesson we preach – that’s there’s no magic pill, but solutions are in reach.

A Daughter’s Battle Against Chronic Pain

As Veronica marks her 16th birthday this month, we are sharing an update in hopes of de-stigmatizing and demystifying life with chronic pain, fatigue and other undiagnosed chronic illnesses.

It’s been a year since Veronica lay bedridden, unable to breathe normally, felled by a mysterious combination of neurological and physiological complications that dozens of doctors couldn’t quite pinpoint. We thought we had a definitive answer when she was diagnosed with Tourette syndrome last July. But it turned out to be the tip of a medical iceberg.

Though her alarming bout with ‘‘air hunger” dissipated and she willed herself back to school part-time, she could still barely make it through each day. Despite normal blood tests, her exhaustion, brain fog, migraines and weight loss made it nearly impossible to function.

If you’ve suffered from chronic illness, you know the social ostracism that comes with it. ‘‘It’s all in your head,” ‘‘Stop being so dramatic” and ‘‘You don’t look sick” are some common responses from armchair doctors.

For teens, the isolation is wrenching. Veronica lost almost all of her ‘‘friends” last summer — too shallow or self-absorbed to care or comprehend her condition. Depression set in. We were losing her to an abyss of hopelessness.

Then came the Mayo Clinic. The renowned Rochester, Minn., practice runs a Pediatric Pain Rehabilitation Center for adolescents and young adults with chronic illnesses. It’s basically a three-week boot camp to equip young patients and their families with skills to get their lives back through cognitive-behavioral therapy, physical therapy, occupational therapy and recreational therapy.

We learned that Veronica’s basket of seemingly random co-morbidities is common among those diagnosed with dysautonomia, postural orthostatic tachycardia syndrome, hypermobility and pain-amplification syndrome. Her brain and body are wired differently; the triggers are unpredictable. We learned that the ‘‘what” of Veronica’s symptoms didn’t matter as much as the ‘‘how” to help her cope day to day.

There are no magic pills. It’s a tough-love crash course in hard work, personal responsibility and mind over matter. I’m not exaggerating when I say some patients enter the program in wheelchairs or on crutches — and leave on their own two feet with the ability to walk or even run after months or years of inactivity. The goal isn’t to eliminate pain or cure sickness, but to restore functionality.

For Veronica, exposure to and bonding with other teens saddled with similar conditions — and in some cases, much worse — was life-changing. It’s one thing to be told by a specialist ‘‘you’re not alone.” It’s another to join a family of survivors riding the chronic-illness roller coaster together.

Since completing PPRC last fall, Veronica has had more good days than bad. She didn’t let her migraines, second shoulder surgery for subluxation, severe joint pain or OCD stop her from finishing her sophomore year of high school. She has remained close to several of her fellow PPRC grads and made new friends at home.

She received a lot of help along the way. A caring counselor helped her become an athletic trainer at her school, which enabled her to rebuild her social life.

Mental-health professionals successfully treated her OCD and depression using a combination of medication and exposure therapy — an agonizing but effective treatment that required her to confront her fears. Gifted physical therapists continue to treat her joint pain and train her to manage it.

One of the most intriguing aspects of PPRC is the mandate to stop dwelling on symptoms. Talking and thinking about pain or fatigue all the time reinforces the neural pathways for pain and fatigue.

Instead, we focus on the small triumphs each day. We measure life, to borrow blogger Christine Miserandino’s famous analogy, by the spoonful: getting up on time, being able to walk on the treadmill for 10 minutes, completing simple chores, eating well, having a good laugh, breathing free and easy.

So, how’s Veronica doing? The short answer is that she’s doing — and that’s a gift we never take for granted. Happy birthday, my sweet 16 badass. Per aspera ad astra.

Some Opioids May Actually Hinder Healing

June 6, 2016 / Thomas Cohn, MD

A recent study on rats has brought to light another problem with using opioids for pain treatment. In the study, rats had an experimental trauma to the sciatic nerve causing leg and foot pain.

One group was given opioids to control pain while recovering from the injury, while the control group was not given any medicine and allowed to heal on their own. The opioid treatment group took at least 16 weeks to heal, while the other group healed in eight weeks, and the control group actually reported more complete healing. The opioid group showed signs of prolonged inflammation throughout the treatment period. The untreated group did not have signs of ongoing inflammation. Now as a reminder, this study was in rats, not in humans.

The significance of the above study is that the use of opioids in humans does have many negative effects. We know that these medications cause problems from cognition to constipation, depression, and many other medical issues. The current leading concern is addiction. Now if the above research holds true in humans, or has even a partial effect in humans, using opioids for pain may be inhibiting recovery from injury and prolonging pain and inflammation.

Having The Reverse Effect

The goal of most physicians when treating pain is to promote recovery from difficulties that may be causing damage to the body. Pain physicians promote multiple strategies to treat painful conditions. Medications are one strategy. More effective treatments often involve physical therapy in order to promote healing and more natural restoration of function. It takes strength and endurance to function normally. Return to normal function after injury takes a lot of work, there is not a magical pill to reverse pain.

As time goes on, the more we learn about medications, the more we realize that every substance that we put in our bodies has the potential to create more problems. Most medications prescribed by physicians are relatively safe, but they can all cause problems. If we want to do the best thing for our bodies, we need to often go back to the basics. The body needs the right exercise, food, nutrition, and rest. Treat the body right and it will not be angry and painful. Doctors can only help a person so much, the rest is up to the patient to take care of themselves.

Applying Pain Lessons To Our Every Day Life

June 1, 2016 / Thomas Cohn, MD

I try to skim the medical news every couple of days to see what’s making waves in the field of pain management. Most of what I see has to do with a variety of topics related to musculoskeletal medicine and pain.

A lot of articles I see have limited value to my current practice, but some topics have interest because there is science that may be important if it is applied in a more broad way. Other things are interesting because they are rooted in obvious facts.

Last week, the Star Tribune had an item on cancer prevention. JAMA Oncology had an article that 63 percent of men’s cancer and 41 percent of women’s cancer was preventable. The interesting thing was that if we just lived a healthy lifestyle, a lot of cancers would not occur. The obvious is the simple stuff, like not smoking and wearing sunscreen. The other aspects are a bit tougher, like eating healthier foods, not being obese, exercising, and sleeping adequately. It is a potent reminder of how we live life significantly impacts our overall health. The best way to cure cancer is to prevent cancer in the first place.

Another article in the paper was on baby powder causing cancer. The most common cancer was ovarian, but lung cancer may also be linked. The connection to cancer is that baby powder is a very fine particulate. It is also very similar to asbestos. If these fine particles get inside the body, they can cause immune reactions and stimulate abnormal tissue growth as well as cancer. So a supposedly harmless substance we use can cause deadly problems.

Take Away Points

There is a message here from these news pieces about cancer that applies to all of us. The first is that if we work at keeping ourselves healthy, we will have less illness and medical problems. Secondly, keeping compounds that naturally do not belong in our bodies out helps prevent cancer.

Applying this logic to pain management is natural. Let’s first look at the ideology of keeping ourselves healthy to prevent chronic pain. Exercises including stretching, strengthening and aerobically conditioning the body all help prevent pain. I used to be able to do parts of a program sporadically and function fairly well. As I have aged, consistency with a well-rounded program of exercise has been essential, as skipping days does not work well for me. Getting enough quality sleep is a problem; I have not yet focused on how I will try to improve my sleep. Eating healthy has been issue, but I am slowly changing my diet, lowering my carbohydrate intake, and concentrating on protein, vegetables, fruit and some cheese. I am trying to find a diet plan that makes sense and is sustainable.

The second point of focus is not adding things into my body that may not be healthy. That means keeping my medicine intake to what is necessary to prevent illness, such as taking cholesterol medicine (I have a familial variety of high cholesterol), and asthma medicine when needed. I keep away from addictive medicines. Overall, the most important aspect of health and pain control comes down to eating right, exercise, and good sleep. There is very little magic and a lot of personal work put in on my end, and my body thanks me for it.