Chronic Pain: The Benefits of Exercise

January 8, 2015March 18, 2016 / Thomas Cohn, MD

Chronic pain is tough to deal with, and oftentimes it can seem like and endless cycle of pain, medications, and failed treatments. Since your chronic pain can be caused by hundreds of different issues, pinpointing the problem is key, and what works for some may not work for others. But one thing that most pain management specialists agree on is that exercise is beneficial for treating chronic pain.

Now you might be saying, “How is running going to make my chronic back pain any better? Staying still is pailful, moving is only going to make it worse!” We’re not saying you need to get off the couch and run 10 miles, but moderate exercise has been shown to lessen chronic pain symptoms. Just check out this study. As individuals exercised, their pain tolerance increased. While they still felt similar amounts of pain, their ability to cope with it improved.

Another reason exercise is beneficial is because it kickstarts your body’s release of endorphins. These endorphins help decrease discomfort during a workout, and their effects can linger after your exercise is complete. This process is known as “exercise-induced hypoalgesia.”

Regular Exercise

As I mentioned in my post “Practicing What You Preach,” I suffer from spondylolisthesis that affects the nerves in my back. I suffer back pain from time to time, but I know the best way to control it. Time and time again the best way to keep back pain from slowing me down is to incorporate aerobic exercises into my daily routine. It’s gotten to the point where my back aches if I don’t find time to exercise.

Stretching and exercise can alleviate chronic pain problems, so it’s important to find a workout that works for you. I can no longer run or jog, but I’ve found that long walks or a half hour on the elliptical works wonders. I pair the workout with anti-inflammatories, but I know there is no magic pill that will cure my pain without me putting in effort. Just like diet pills, you can’t lose weight simply by popping a pill, you need to pair it with nutrition and exercise.

There are a lot of reasons to avoid exercise, especially if you have chronic pain; you’re in too much pain, you don’t know what exercises to do, you don’t have the right equipment or you simply find it easier to stay seated. If you are truly interested in alleviating chronic pain, it starts with taking care of your body. Modern medicine is great, but it’s only one prong of the multifaceted approach. You can’t always cure chronic pain, but with exercise, you can help control it.

Control Chronic Pain With Healthy New Year’s Resolutions

January 2, 2015 / Thomas Cohn, MD

Every New Year’s Day, many of us make resolutions of what we like to change in our lives. When making New Year’s resolutions, we should work on changing things that would improve our lives. If we are like 40% of Americans who have pain, then there are many things in our lives we can do improve our quality of life.

The first resolution is that you can “manage” your pain and move forward in life. Pain has physical and psychological components, and we can control the cognitive, interpretative parts. When pain becomes chronic, there are normal sensory signals going to the brain that are being perceived as pain. The pain does not change, and you feel it regardless if you are moving or if you are doing nothing. Stop doing nothing, move forward, and get busy. If you are busy, you will not have time to worry about the pain, and you will feel better.

The second resolution is part of the first; get regular exercise. Start slowly and work up to a significant level. Two things must be done, stretching and strengthening, and aerobic conditioning. To tolerate more activity, having adequate muscle strength is essential. Core muscle strength is necessary. These are the muscles of the trunk including your abdomen, along the spine, and those about the pelvis and hips. These are muscles that we normally do not specifically work on and most everyone needs guided training to get started. With strengthening, stretching the muscles daily keeps them from becoming too tight and allows them to maintain normal function. Cardiac health is also necessary. This is done through traditional exercises, like walking, running or biking, in order to increase the heart rate. Aerobic exercise helps burn more calories and control weight.

The third resolution is to lose weight and get close to your ideal body weight. Excess weight stresses the body, especially the muscles and joints. Fat also has been shown to produce compounds that cause inflammation, and those who have pain already do not need to promote more pain within their bodies. If we eat healthier, we tend to feel better and have more energy. Mentally, being close to ideal body weight also promotes a better self image. We can control what we eat, and if we eat healthier, there are many rewards.

It is a new year. Step forward and start taking control of your life. Choose wisely and start doing the things that will improve the quality of your life. Stop making excuses for your behavior and change the bad and reward yourself for the right stuff. Start tracking your diet and exercise, and stick to the plan. Use a fitness tracker and pay attention to diet. If you need help, work with your health care providers. Start now and make positive changes in your life.

The Prevalence of Pediatric Chronic Pain

December 29, 2014January 18, 2016 / Thomas Cohn, MD

Pediatric chronic pain is a growing problem in the United States. According to recent statistics, 1 in 5 children between the ages of 7 and 18 report that they have weekly headaches, and nearly 1 in 10 experience regular abdominal pain. Additionally, 14 percent say they frequently deal with back pain, and four percent are plagued by musculoskeletal pain.

The biggest concern, however, may be that more children are experiencing chronic pain on a regular basis. According to research published in the journal Pediatrics, the number of children admitted to the hospital due to chronic pain rose from 143 in 2004, to 1,188 in 2010 – an increase of 831 percent. With a growing need for pediatric pain treatment, it’s no wonder that more than 30 hospitals nationwide have opened pediatric pain centers of the past few years. These centers provide children with:

Specialized care

Acupuncture sessions

Unique exercise facilities

Sleep specialists

Extensive outpatient therapy treatment

“Kids may be having more pain than in previous generations, but physicians are also more attentive to it and doing more about it,” said Dr. Navil Sethna, clinical director of the rehabilitation center at the Mayo Family Pediatric Pain Rehabilitation Center, one of the top pediatric pain centers in America. Clinics like the Mayo Family Center focus on treating difficult chronic conditions, like fibromyalgia, frequent migraines or ailments resulting from a virus or other injury.

Dr. Lonnie Zektzer, director of the children’s pain and comfort care program at Mattel Children’s Hospital ULCA, said he’s referred children to the Mayo Family Center, and those types of clinics are growing in demand.

“Such programs are becoming more of a trend because they’re so badly needed.”

Pain Management vs. Pain Cure

For many of these facilities, curing the pain is the ultimate goal, but that’s not always possible. Instead, these clinics focus on helping children manage their pain and strengthen their bodies so they experience a gradual reduction in pain over time.

“We teach them how to handle any pain that comes from getting jostled in a hallway or gym class,” said Jenna Duckworth, an occupational therapist who works at the Mayo Family Pediatric Rehabilitation Center.

Judy Gaughan, a nurse and clinical coordinator at the same facility echoed Duckworth’s sentiments, saying, “The treatment goal is to maintain and regain function, not a complete alleviation of pain.”

The center notes that nearly 90 percent of children who finish their program still experience pain symptoms, but the majority report a gradual reduction over several months as they return to normal life.

A 2012 study also shows that the center is improving chronic conditions in children without heavy reliance on painkillers. Nearly all of the 56 children admitted to the program during its first year were taking fewer prescription pain medications 10 months after discharge, the children on meds were usually on a non-addictive preventative drug, and 30 percent weren’t on pain meds at all.

Related source: Boston Globe

Chronic Pain in the Military

December 10, 2014January 18, 2016 / Thomas Cohn, MD

A recent study published in JAMA Internal Medicine suggests that chronic pain in active and former military members is a significant problem.

The study surveyed 2,597 soldiers who served in either Iraq or Afghanistan in 2011 in order to understand how chronic pain affects their everyday lives. According to the survey results:

45.4 percent reported suffering combat injuries.

44 percent reported experiencing chronic pain.

48.3 percent reported pain lasting at least a year.

55.6 percent said they suffer from “constant” pain.

51.2 percent said their pain was moderate to severe.

Those tasked with helping military members reintegrate back into society after a deployment know the management of physical and emotional pain is crucial. The study also attempted to uncover how military members use opioids to aid in pain management.

“I had conducted a similar study at [the] CDC because we felt that it was important to understand [the] use of opioids to get a greater context for misuse and abuse,” said lead author Dr. Robin L. Toblin, a clinical research psychologist at the Walter Reed Army Institute. “When I began my current position, we sought to look at the same constructs within a military population, who seemed to be that much more likely to be in pain due to the combat deployments over the last decade.”

Dr. Toblin noted that providing opioid therapy and management to combat veterans is key. Opioids can certainly ease pain after a combat injury, but problems can arise if veterans try to self-medicate or are uninformed about proper dosages. According to Dr. Toblin, 15.1 percent of soldiers say they have received opioid-based therapy to control their chronic pain.

“[Based on these findings], we hope that the military services will be more aware of the unmet needs for the assessment, management and treatment of pain and will broaden the services and availability of those services for servicemembers,” Dr. Toblin said.

The findings have touched off some debate over whether military members should be taking opioids. Obviously we want returning service members to be pain free, while others claim the drugs could affect their physical and mental performance. In the end, I think it really comes down to taking a strong, hands-on approach to ensure our veterans and returning servicemembers get the care they deserve and a treatment strategy that suits their individual situation.

Is The Web A Useful Resource for Medical Information?

December 8, 2014 / Thomas Cohn, MD

The web can be a very good place for information, but one has to be careful at which places they look for info. There are many commercial based sites that try to sell products based on your search criteria. Other sites are the equivalent of an infomercial for a medical practice or institution, while some may simply be a personal blog. Various organizations also sponsor sites, and some are very good, while others are pushing their philosophy toward a certain problem as the only true solution. The best sites seem to try to explain the science behind a problem and explain the variety of solutions available.

The sites that I have found the best are sponsored by the government or large medical organizations. For instance, the Mayo Clinic has a huge amount of information on a variety of topics. They write informational pages on various topics, like medical problems, the typical history, diagnostic studies that may be needed and treatment options. Other good places to look for factual information include insurance companies, health organizations, medical groups, and large universities. Many of these places have fact sheets available on topics of interest that are good reference material. The U.S. government also sponsors information, often from the National Institutes of Health, on a variety of issues.

Then there’s the gray area source of Wikipedia. Generally this source can is an excellent place for information and entries are written by top notch experts on a disease, however, it can be also written by someone who actually has no medical background and just decided to write an article for the site. The information found on this site should be verified with other sites and not be taken as a sole source of data.

The Internet and Chronic Pain

The internet can provide an excellent resource of information for the self motivated person. I have found it useful for baseline information about various pain conditions. I also use it as a resource for patients who want more information on certain topics, like exercises for low back pain. Youtube also has videos that demonstrate a variety of things from exercises to surgical procedures.

Cellphones have brought the internet to the palm of the hand. For a quick definition or piece of information it can be wonderful. Medical providers can find a variety of references for free that help make diagnoses, identify medications and there uses, and for dosing information. That said, reliable and free information in app form is hard to find. iPhone apps are a huge business, but I’ve found no beneficial free exercise apps for patients with chronic pain. There are some inexpensive apps for exercise, but read the reviews first to see if they are going to be helpful for your situation.

The internet is like the Wild West from long ago. There are many very good sites and areas to find educational information about a variety of conditions. The better sites are free and often sponsored by large medical institutions, such as the Mayo Clinic, Johns Hopkins University, other not-for-profit organizations or the U.S. government. Some doctors are also prolific writers and work at trying to educate their patients through the web. Unfortunately, in the pain world, there are also some terrible sites that are forums to gripe about a condition, and the doctors who “know nothing.” The internet can often be a very good starting place for information. It is also a good place to develop questions such that you can have a good discussion with your doctor about what to do next in your management.