Working Through Chronic Pain

May 18, 2015 / Thomas Cohn, MD

Living with chronic pain isn’t easy. Some people are awarded full or partial disability, but for many people, those benefits eventually run out or their claim is denied altogether. Because of this, many people are forced to work, even with debilitating chronic pain. Today, we share some tips for getting through the work day with chronic pain.

1. Move Around

You might think you’re making your pain problem worse by moving around, but staying sedentary for long periods can actually trigger chronic pain. For example, if you’re dealing with chronic back pain, staying seated in one position can actually put more strain on your back. Moving around helps build muscle and helps regulate blood flow to affected areas. Try to get up and walk around for five minutes every hour. This doesn’t necessarily mean you need to take a break every 60 minutes – just find an excuse to walk around. Deliver those memos to accounting by hand or walk around while you’re talking on the phone.

2. Don’t Overdo It

While you want to move around, you don’t want to overdo it at work. It may sound obvious, but a lot of workers want to prove to themselves and their coworkers that their pain condition won’t hold them back at work. Lifting heavy boxes or equipment can exacerbate a previous pain condition. Talk to your boss about your condition so there are no surprises when you return to work. If you can’t preform all the typical duties, talk with your boss or your coworkers about other ways you can contribute. For example, instead of loading boxes onto the truck every Friday, maybe you can compile the weekly productivity reports. Being open and honest about your limitations means there will be no confusion about your job duties.

3. Tell Your Boss

As we mentioned above, it’s important to talk to your work superiors about any limitations you might have because of your chronic pain. Lying or trying to hide your pain can be extremely problematic. First, it can affect your disability benefits. If you tell your insurance company that your injury is preventing you from completing all your tasks, but you attempt to push through the pain and complete them anyway, your insurance can deny your claim. On the other hand, if you don’t open up about your condition to your boss, he or she might not be as open to hearing why you didn’t finish a certain task.

4. Adjust Your Schedule

This one again goes hand in hand with the above point. If possible, try to adjust your schedule to accommodate your pain. For example, if you are supposed to take water therapy classes to alleviate your back pain, and the classes are only offered at 8am on weekdays, but you normally work 8am-5pm, ask your boss if you can work from 9am-6pm on Tuesdays and Thursdays so you can get to your treatment. If you can’t adjust your work schedule, do your best to adjust your personal schedule so you can best manage your pain condition.

Insomniacs More Prone to Chronic Pain

May 14, 2015 / Thomas Cohn, MD

Findings out of the Norwegian Institute of Public Health suggest that people who have trouble sleeping are more likely to have an increased sensitivity to pain.

Although the study didn’t show a cause-and-effect relationship, researchers said insomniacs were more likely to be sensitive to pain. For the study, researchers asked more than 10,000 adults to dip their hands in cold water for 1 minute and 46 seconds. If they felt the cold water was causing too much pain, participants could remove their hands from the water prior to the completion of the timer.

After their reading was recorded, researchers asked participants a bunch of questions about their sleeping habits, including how long they typically sleep, how long it takes them to fall asleep, and if they suffer from insomnia. Researchers also asked questions about related issues that can make it hard to fall asleep, like anxiety, stress and depression.

Study Results

After looking at the findings, researchers uncovered:

Nearly 1/3 of participants were able to keep their hands in the water for the entire test.

42 percent of people with insomnia pulled their hands out of the water early.

31 percent of people without the sleep disorder pulled their hands out of the water early.

Participants with frequent insomnia were more likely to remove their hands from the water than people who have insomnia once a month.

People with insomnia and chronic pain were twice as likely to have a reduced pain tolerance than participants without those conditions.

“While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain,” researchers wrote, “it is not clear exactly why this is the case.”

Dr. Cohn Comments

Although the findings are interesting, they are hardly revolutionary. In fact, it’s more of a chicken-and-the-egg type argument. People who have chronic pain are more likely to be plagued by nagging pain, which can make it difficult to fall asleep and stay asleep, and if you don’t get a full night’s sleep, your body can fully recover from the activities of the day, contributing to more pain. So what came first, the chronic pain or the insomnia?

Related source: Health.com

Finding Compassion in Medicine

May 4, 2015May 4, 2015 / Thomas Cohn, MD

Medicine has become a tough endeavor recently, as the physician is routinely under many pressures. Institutions and employers want as many patients seen as possible in an effort to increase their bottom line, while staff to assist the physician are often kept at a minimum to keep costs low. Tests and procedures should not be ordered or they need to be ordered more frequently, depending on who is paying the bill, and of course the physician should know which is the pertinent case. The physician also is getting paid too much and does not work enough hours. The physician also should do administrative work, read more current journals, and be responsible for quality improvement projects for the practice. They also must attend continuing education courses and constantly recertify their qualifications. The demands are endless.

As for the patient, they only want a good physician that can solve their problems quickly. Now that medicine has become more of a business, finding a good and caring physician is even harder. Physicians often feel they need to be done seeing a patient as quickly as possible. This is just the opposite of the needs of the patient. Many physicians have just given up with the pressures of the business, and have become mediocre at all aspects of medicine.

Striking a Compassion Balance

Finding the physician who has found the balance in medicine and who has the desire to provide high quality care is difficult. There is no magical way to find those special physicians, and word of mouth is often still the best method. There are rating services, but unfortunately most physicians try to hide from them and may not be very well represented. Furthermore, many of the best physicians let their skill be their only voice, and the best physicians often feel no need to advertise, as their work should speak for themselves.

In any profession, 90% of the practitioners are good, and 10% are exceptional. In medicine, this also holds true. The best physicians find a way to balance all the needs of the changes in the business of providing care. The most telling sign is that the patient always comes first. The physician will know his patients and their history, and will be willing to develop a joint treatment plan. They are up-to-date on research, and can explain complex medical problems without being flustered. Often they are experienced and can figure out what is wrong and what needs to be done quickly.

Medicine has become increasingly complex for both the patient and physician. Finding good medical care is difficult. Word of mouth, and sometimes the Internet can help find the better caregivers. Even good physicians are hampered by their surroundings and the business aspects of their offices. Every visit may not run smoothly, but having a physician that really knows how to help you is worth some inconveniences. Look for a physician who is mature, board certified in his specialty, and is prepared whenever they see you.

1 in 4 Misuses Chronic Pain Meds

April 15, 2015 / Thomas Cohn, MD

New research published in the journal PAIN suggests that approximately 20 to 30 percent of opioids prescribed for chronic pain are misused. Additionally, the current rate of opioids addiction hovers around 10 percent.

“On average, misuse was documented in approximately one out of four or five patients and addiction in approximately one out of ten or eleven patients,” who were prescribed pain pills as part of their treatment for chronic pain, said Dr. Kevin E. Vowles and colleagues. They added that the new findings provide “updated and expanded” estimates of the opioid problem in America.

Increased Prescriptions, Increased Addictions

To see how increased opioid prescriptions have fueled pain pill addictions, researchers analyzed 38 reports to measure three separate opioid-related problems:

Misuse
Abuse
Addiction

Researchers examined documented cases of dependence, withdrawal and overdose to come to their conclusion. Opioid misuse was classified as “using opioids contrary to instructions, regardless of harmful or adverse effects.” After adjusting for variables, researchers concluded that between 21 and 29 percent of people who are prescribed opioids misuse them.

“If it is accurate that approximately one in four patients on opioids display patterns of opioid misuse, but not addiction, then perhaps more efficient targeting of treatment resources would be of benefit,” said Dr. Vowles.

As for opioid abuse, which is classified as continued opioid use with actual or potential harmful effects, researchers suggested that about 8 to 12 percent of patients abuse their medications.

Dr. Vowles and colleagues concluded by saying that physicians should seriously evaluate if a patient is a good candidate for an opioid prescription, as the dangers seem to be outweighing the benefits.

“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”

Related source: Medical News Today

What Pain Professionals Are Saying About Marijuana

March 23, 2015 / Thomas Cohn, MD

Marijuana is a controversial topic in society. Some people want it legalized while others demonize the compound. The reality in the medical field is somewhat in the middle. The first thing that needs to be understood is that in most circumstances, medical experts are primarily interested in all the compounds in marijuana except for THC. That means most medical professionals are interested in what cannabinoids or cannabidiols (CBD) compounds are present and what medical purpose they serve. The major compound that is present in almost all available marijuana is THC, which also happens to be the compound responsible for the high one receives from marijuana.

For pain professionals, there is good understanding of the action and effects of THC. Most strains available in states that have legal marijuana, including strains that are “medicinal” in use have high amounts of THC, 10% or greater in amount, and virtually no other cannabidiols, or less than 2%. In the years of the hippie generation, the 1960’s and 1970’s, THC to CBD ratio was 1:1, and averaged 1-2%, while the really good stuff was just around 5%. Now available in legalized states, most available strains are minimum of 10% with up to 30% THC.

Medically, the best comparison of legal marijuana at this time, is to alcohol. The risk of dependence to THC is about 9%, including when using once a week (in reality this is a very strong way to become dependent), compared to alcohol which is 15%. Regular use, once a week, is known to increase depression, suicide, impulsivity, schizophrenia and psychosis, especially if use is started under the age of 20. It also leads to an 8-point loss of IQ in the young. Further, smoking does cause problems with the lungs. Recommending regular marijuana is no different for medical professionals to recommending drinking alcohol. The risks and associated problems are clearly out numbering benefits.

Need To Understand More

What we know about cannabidiols is just the beginning. In marijuana, we know there are over 100 different types. Our experience so far has found that they have some properties that may be helpful in about 30% of patients with neuropathic pain associated with MS and HIV. In low back pain, we’ve learned:

It has helped in anxiety but not with pain.

More people respond to acetaminophen then marijuana.

The future of cannabidiols is interesting for pain. It is unlikely that many professionals would be enthused to prescribe a substance that has the risk profile of THC. Once we can find the particular cannabidiols that have medical uses, it is likely that we will try to study them fully and make them commercially available for specific conditions. Cannabidiols may be helpful in the future, but we still don’t know enough right now to safely prescribe marijuana for a wide range of conditions.