Chronic Pain In College Part 1 – Pain and Your Grades

November 23, 2015November 30, 2015 / Thomas Cohn, MD

(Below is Part 1 of a four-part series on chronic pain in high school and college. It was penned by a college student who has dealt with chronic pain throughout her academic career. The four-part series will cover four important aspects of college life – Academics, Dating, Employment and Social Life. Here’s Part 1 on how Chronic Pain can make studying for exams and getting good grades even more of a challenge.)

What can I say, chronic pain sucks sometimes. That said you can still live an “almost normal” life as a young adult with chronic pain. Personally, I’ve been dealing with chronic pain in my neck and back since 2008 when I had my first of four back surgeries to correct my severe scoliosis. Over the last almost eight years, I’ve grown into a young adult, and I am attending college to obtain an engineering degree while dealing with a plenitude of medical appointments in addition to trying to enjoy college and life in general. I intend on addressing the following topics of concern among young adults with pain—getting through school (high school, college, technical training, etc.), working and keeping a job, having a significant other, and day-to-day life enjoyment.

Chronic Pain and College Grades

Having any medical condition that can affect class attendance and performance can be difficult and daunting for many as they think about pursuing higher education. Throughout grade school, middle school, and high school your parents can work with the health office to create a 504 plan in order to address your needs. I found it helpful to have a second set of textbooks so I could keep a set in my locker and a set at home so I wouldn’t have to carry a heavy backpack. If your pain causes problems during exams you may want to look into extra time or extended breaks for exams to be added to your 504 plan. While many teachers at the high school level will allow you the time needed to finish an exam, if this could affect standardized tests such as ACT/SAT and others, you will need 504 documentation in order to apply for these accommodations on standardized tests.

If you are in the process of touring colleges or looking up universities and know you have chronic pain, look into the resources the school offers for “students with disabilities.” At my university, we have a “Services for Students with Disabilities Office” that helps everyone with anything from a temporarily broken arm, to ADHD and chronic pain. Personally, I’ve found the office very helpful in providing documentation to professors and needed accommodations.

Some helpful things to consider as you begin college while dealing with chronic pain include:

Getting notes from the professor or using a scribe to take notes for you in class.

Talking with your teacher at the beginning of the semester about the possibility of getting extra time for assignments & excused class absences in the event you have a pain flair.

Extra time or stretch breaks during classes and exams.

Desk/chair accommodations for classrooms (such as a standing desk or a more comfortable chair).

Book scanning services (to have a digital version of textbooks to reduce backpack weight).

Look into scholarships to purchase an iPad (light-weight computer alternative).

After looking into a combination of the above-mentioned accommodations, I find myself much more easily able to meet the academic demands at a top university. Being proactive about your chronic pain from the moment you step foot on campus will help prepare you for an inevitable flare up, will help professors learn of potential issues before a problem arises (this is key), and help prevent symptoms from worsening. It’s not easy, and you’ve got enough on your plate as a new college student, but it’s crucial to be proactive.

Part 2 can be viewed here.

Medical Marijuana: Why It’s Different

November 11, 2015May 10, 2016 / Thomas Cohn, MD

Recently, one of the two suppliers of medical marijuana to patients in Minnesota offered a tour of their facility to a small group of leading pain physicians. The business is fascinating and a completely different model from anywhere else in the country. In the rest of America, marijuana for medical purposes is not highly regulated, and is sold by minimally regulated distributors selling whatever types of marijuana they feel might be useful. Needless to say, it is basically the same marijuana that is being sold for recreational purposes to get high.

Minnesota has taken a very different approach to the legalization of marijuana. First, the legislature has recognized that there may be some legitimate medicinal value to marijuana, and that for certain conditions it may be helpful. The legislature also felt recreational marijuana had a spectrum of problems and wanted to avoid adding to the problems of abused substances. Therefore, in Minnesota, only medical marijuana is available, and it is tightly regulated.

There are only two producers of medical marijuana currently allowed in Minnesota. These producers can provide only to patients that have been certified with certain conditions approved to receive such medication. The patient receives extracts from the marijuana plant to ingest as a pill, concentrated liquid, or to inhale as a vapor. It is not available for smoking or as an additive in food. The formulation received by the patient is determined by a pharmacist, and adjusted as well as titrated to help with a patient’s particular symptoms. The pharmacist also will evaluate the effectiveness of the treatment every time the patient is seen, and information for the State is being kept on the treatment, its effectiveness, and what is being given to the patient.

Medical Vs. Recreational Marijuana in Minnesota

Medical marijuana is usually very different than the marijuana found on the street. For most medical conditions, the cannabinoids of interest are the “CBDs” and not THC, the part that gets one “high.” From research done around the world, plants with different amounts of CBD to THC are being grown to produce the desired amounts of these compounds to be used in the medications. Unfortunately at this time, isolating specific CBDs known to exist has not yet been the focus of manufacturing. The medications manufactured currently just have specific amounts and ratios of CBD and THC.

The producer that I visited was extremely interesting. The growing of the plants is very high tech. From the plants used to the growing conditions, all aspects are tightly controlled. After the plants are harvested, the components are isolated and carefully extracted and made into the medicines for each particular individual.

Not all patients who have been qualified by a physician will be accepted by the medical marijuana distributors. Further, since all medical marijuana is considered experimental, none of the cost of treatment is covered by insurance. Doctor visits regarding certification, follow up visits, and all drug and pharmacy costs are cash only and no credit cards are accepted. Medication costs are also fairly expensive since they are made at a custom pharmacy with strict quality controls for safety and purity.

Medical marijuana is truly a product currently for those who have failed conventional treatment. The treatment is only now for certain conditions. If qualified, it may or may not work for any individual. The cost is quite expensive, not supported by insurance, and is cash only. The benefit is medical marijuana is designed as another medication tool to help control symptoms of certain conditions. It is consistent and manufactured like most other drugs to be pure and safe. It is not designed for recreational use and getting high.

Intractable Pain and Medical Marijuana

November 9, 2015 / Thomas Cohn, MD

Medical marijuana for intractable pain is now on the agenda for Minnesota. The commissioner for the Department of Health is now evaluating whether to add intractable pain as a condition that will be included in its medical marijuana program. The commissioner received recommendations against adding pain from the medical advisory committee. There will be a public hearing this week and comments can be sent directly to the Department of Health, at health.cannabis@state.mn.us.

In Minnesota, intractable pain would most likely be handled differently than any other diagnosis for medical marijuana. Already, the medical panel has advised that it be restricted to people over the age of 21. Further, they want to make sure that anyone prescribed is not pregnant and that conventional treatments for pain have already failed.

What is Intractable Pain?

In Minnesota, intractable chronic pain is a legal definition set up by the legislature in the 1990’s. It means pain caused by some medical condition that is unresponsive to normal medical care including medication, physical therapy, and other management. If a patient has intractable pain, then they qualify for the use of opioid medication for management of symptoms. One other component of chronic intractable pain is that it must be certified by two different physicians. Unless new legislation is passed, chronic intractable pain would need to be certified by two physicians, not just one provider in order to qualify for the medical marijuana program.

Over the next month the Minnesota Health Commissioner is going to make a decision on adding intractable pain as a condition for medical marijuana, and it will affect both patients and healthcare providers. If you want to have input on the decision, now is the time. Past history has shown that the most vocal and persuasive voices will influence the decision on what diagnoses are on the list to receive medical marijuana. Mothers with children that had severe seizures were the main force that started the legalization in Minnesota. Patients and medical providers will be the force that determines if intractable pain is added to Minnesota’s list of conditions that are accepted for medical marijuana.

Cognitive Behavior Therapy Helps Those With Chronic Pain

November 3, 2015May 10, 2016 / Thomas Cohn, MD

Research out of Europe suggests that cognitive behavior therapy (CBT) could help control or reduce chronic pain by helping patients sleep better.

We’ve discussed the link between poor sleep and chronic pain on the blog before, and while we’ve shared some tips for falling asleep and staying asleep, we’ve never examined CBT’s role in the equation. According to the University of Warwick, cognitive behavioral therapy was found to be moderately or strongly effective in the majority of chronic pain patients who suffered from insomnia. Lead research Nicole Tang, PhD, from the University’s Psychology department, said CBT is better alternative that long-term drug treatment for insomnia.

“This study is particularly important because the use of drugs to treat insomnia is not recommended over a long period of time therefore the condition needs to be addressed using a non-pharmacological treatment,” said Dr. Tang. “We believe that our results will be of particular interest to primary care physicians and allied health professionals who are taking up an increasingly important role in preventing and managing long-term conditions.”

CBT and Chronic Pain

For their study, researchers conducted a meta-analysis of 72 studies involving more than 1,000 chronic pain sufferers with insomnia. Treatments varied in the individual studies, but the most popular intervention strategies were education about sleep hygiene, stimulus control, sleep restriction and cognitive therapy. They also analyzed how these approaches were delivered to the subjects. Finally, researchers looked at documented pain levels before and after intervention techniques were administered.

After conducting the meta-analysis, researchers uncovered:

CBT was associated with a decrease in insomnia and mild to moderate decreases in pain levels.

Improved sleep was associated with a decrease in depressive feelings.

Chronic pain sufferers who received CBT experienced improved sleep and had a wider positive impact on pain, fatigue and depression feelings.

Interestingly, intervention techniques were less effective if they were delivered electronically, either by phone or the internet.

“We found little evidence that using therapies delivered either by phone or computer benefited insomniacs. The jury is still out on the effectiveness of using automated sleep treatments. We found that, at the moment at least, delivering therapies personally had the most positive effect on sleeplessness,” Dr. Tang said.

Dr. Tang said they want to pursue further research to establish if CBT is feasible and cost effective for treating chronic pain in the long run.

Related source: Sleep Review Magazine

Could Cutting Sugar Curb Chronic Pain?

October 29, 2015 / Thomas Cohn, MD

Everyone knows that there’s a correlation between sugar intake and complications from diabetes, but excess sugar intake could also exacerbate symptoms caused by chronic pain.

For starters, there’s a known link between excess sugar and obesity, and extra weight can put added stress on your joints. If you’re dealing with chronic pain caused by inflammation, this extra stress can make movement extremely painful. But there’s more:

“While weight gain and teeth decay may be the most obvious consequences of excessive sugar consumption, there are many other ‘hidden’ effects of consuming too much of the sweet stuff,” according to Dana Dovey in a recent Medical Daily article.

Dovey said excess sugar can cause heart failure and heart disease, kidney disease, high blood pressure, erectile dysfunction and fatty liver disease. But she also details how extra sugar can make chronic pain worse.

The Brain and the Joints

Let’s start with the brain. According to a recent article published in Neuroscience, excess sugar levels can reduce a chemical called “brain-derived neurotropic factor.” When this occurs, normal cognitive tasks like learning, memory, reading and sleep all become more difficult, and we’ve already explained how inadequate sleep can make chronic pain even worse.

Chronic pain also negatively affects the joints. According to a study published in 2002, elevated levels of processed sugar can lead to excess inflammation in your joints. Inflammation is the main source of pain for most chronic pain sufferers. Arthritis is caused by chronic inflammation, which is why many arthritis sufferers are told by their doctors to limit their sugar intake.

You don’t need to quit sugar cold turkey, but be cognizant of how much sugar you’re putting in your body, and try to slowly curb it. Start with something simple, like sugary drinks. If you have a soda with lunch every day, try to cut down to one soda every other day, or swap out your sugary cereal for something healthier. Wean yourself away from sugar, and you’ll have a clearer mind and less pain in your joints.