Sex and Chronic Pain

June 30, 2014February 17, 2016 / Thomas Cohn, MD

Many patients who have chronic pain say they have no interest in sex, that sexual intercourse causes too much pain, or that they feel unattractive or undesirable because of the pain. It’s important to remember that emotional intimacy is as important as food and shelter for overall health. Sexuality is a normal part of living and is an important aspect of your identity. Chronic pain often invades the pleasures of life and destroys your sexuality.

Chronic pain affects the patient emotionally and physically. The psychological problems that chronic pain causes include:

Stress
Depression
Anxiety
Diminished self-esteem

If the brain cannot desire sex, the body certainly will not perform. The core problem may simply be the pain, but often it is much more complex. Receiving help requires the patient to identify that they are having sexual issues.

The most common direct causes of sexual problems include too much pain and medication side effects. Adjusting pain treatments may be the only necessary intervention. It also may be necessary to become more aggressive in the overall management and intervention for the painful condition. Many medications used in pain management (as well as medications for common problems) can cause sexual problems, including narcotics, anti-inflammatories and even antidepressants. A comprehensive strategy may be necessary and working with a pain physician may be the best approach.

Emotional Issues

Chronic pain often causes emotional problems, including stress, anxiety and depression. These problems all contribute to sexual difficulties. Until the psychological issues are being addressed successfully, it is often hard to control pain and have interest in sex. If simple medication management is not controlling emotional issues, professional help with a psychologist may be extremely beneficial.

Working with your partner is also necessary, especially when it comes to expressing your needs and concerns. Doctors cannot read your mind and if you do not tell them you are having problems, they will not be able to help you develop solutions. A comprehensive approach will often be necessary, since most problems involve a complex interaction between the emotional and physical causes. Working closely with your partner and professionals is often the solution. Most problems can be greatly improved with a little bit of support and creativity.

Pain Making it Hard To Sleep? We Can Help

June 25, 2014 / Thomas Cohn, MD

Pain often causes sleep problems. In patients with chronic pain, sleep problems occur in over 50 percent of patients. Problems with sleep can worsen pain and affect your whole life. Patients will often feel rundown, tired, depressed and very stressed. Relationships with your family, your spouse, and at work may be affected. Solving the issue if a complex process, and it won’t happen overnight.

4 Pain-Related Sleep Problems

Sleep problems can be divided into four categories:

Pain making it difficult to fall asleep
Chronic pain causing frequent awakening during the night
Pain may prevent restorative deep sleep
Waking up too early each morning because pain makes it impossible to fall back asleep

Each type of problem may need a different solution, and patients often experience more than one of the above conditions. The first step in treating the issue is by practicing good sleep hygiene. Activities that cause problems prior to sleeping include drinking caffeinated beverages and alcohol. Alcohol may initially cause tiredness but later in the night often disrupts sleep cycles.

Exercising late at night is another no-no. Exercise will help keep you awake, and napping during the day may also lead to decreased tiredness. The bedroom should be considered place only for sleeping and not for watching TV or doing work-related activities. The bedroom should be considered a calming and relaxing place.

Physician Treatment

When the simple things and conservative treatment does not help improve sleep, working with your physician for a more comprehensive treatment strategy is beneficial. A sleep study is often especially helpful in determining the issues that are preventing good sleep, and they can help formulate a plan to combat the problem. Multiple medications are available to help with sleep, but many can actually interfere with parts of this sleep cycle. Narcotic medications and older antidepressants may help with pain at night but often interfere with portions of the deep sleep cycle. Newer medications like Ambien and Lunesta are helpful in allowing the patient to fall asleep, but may not be helpful to keep a person asleep. Recently, melatonin at doses of 5-10 mg has been found to be helpful in maintaining good sleep cycles and reducing pain. Sleep studies can also be helpful to determine other medical problems that need to be treated to improve sleep.

Chronic pain often interferes with sleep, and poor sleep can lead to worsening pain. Improving sleep at night can often greatly improve the quality of life. Sleep problems can be simple, but often with chronic pain they are complex. A sleep study is sometimes needed to determine all problems associated with the lack of sleep. The solution to a good night sleep may require multiple changes and routines. The help of a pain specialist or a sleep expert may be necessary to find the right solution.

Dealing With Pain After A Car Accident

June 11, 2014June 23, 2014 / Thomas Cohn, MD

Trauma from motor vehicle accidents can cause significant ongoing injuries. Typically, lingering injuries that require medical care resulting from a car accident include:

Lower back injuries
Spine injuries
Headaches and neck injuries
Broken bones and and large lacerations
Whiplash injuries to the head and neck

Treatments For Car Accident Injuries

Treating acute pain is done symptomatically. Ice and heat for muscle strains in both the neck and the low back region is recommended. Immobilizing the neck with a brace for several days to rest the muscles may also be helpful. That said, wearing a neck or back brace for more than a week or two is not a good idea as the muscles need to move in order to heal correctly. Restoring normal movements is one of the main objectives in early treatment. In most cases, the muscles are only strained and not torn and will heal within a short period of time. Restoring movement and strength may require assistance and physical therapy. Chiropractic or massage treatments may also be helpful in the short term, but continued passive treatments are usually not helpful for larger issues.

If pain is a significant issue, over-the-counter medications are often very helpful. Initially, acetaminophen and nonsteroidal anti-inflammatory medications like Advil or Aleve may provide significant pain relief. If the nonprescription medications aren’t providing sufficient relief, it is time to see a physician. The physician may opt for a short course of narcotics along with regular physical therapy. With aggressive early treatment, most people will resolve their injuries within a month or two.

Continued Pain

If your pain has not resolved in two months, at that time, asking your doctor to be referred to a pain specialist would be beneficial. A pain specialist can perform a comprehensive evaluation and determine further tests and treatment that would help resolve your ongoing medical problems. Sometimes injuries such as whiplash cause microscopic damage to the spine and joints, and the use of injections along with other medications and physical therapy will allow for almost complete resolution of symptoms. There are many options in managing pain related to a motor vehicle accident, and depending on the unique characteristics of each person, a program can be found that meets any individual’s needs. A pain specialist is an expert in the complex problems that cause ongoing symptoms and is extremely knowledgeable about all the possible treatment options that will allow you to return to a full life.

Joining the Pain Care Team at Center for Diagnostic Imaging

June 9, 2014June 23, 2014 / Thomas Cohn, MD

Now that it’s official, I wanted to make an announcement that I have accepted a position with the Pain Care team at the Center for Diagnostic Imaging in St. Cloud. I am very excited about my new opportunity at CDI.

I decided to join CDI to take on a new challenge as part of their expanding CDI Pain Care program. Some of the services the program will be offering include:

Diagnostic and therapeutic injections

Medication management

Physical therapy

Behavioral health or surgical consults

Advanced imaging diagnostics

I am very grateful to have this wonderful opportunity at CDI, and I also want to say thanks to all my friends, colleagues, coworkers, and patients at MAPS Medical Pain Clinic. I learned a lot during my time at MAPS and met a bunch of wonderful people. I am blessed to have met all of you, and I wish you all the best going forward.

CDI has three offices in the greater St. Cloud area. I will be working out of the Sartell office. You can reach the office by calling 320-251-0609 or by visiting our website. We are open Mon-Fri 6:30am-10pm, and on Saturdays from 7am-3pm. Please call the office if you have any questions or would like to set up an appointment.

Sports and Pain Medication Abuse

May 27, 2014June 23, 2014 / Thomas Cohn, MD

The latest news out of the NFL is that the league is being sued for causing prescription pain medication abuse. A study done at Washington University revealed the severity of the problem. Researchers found:

52% of retired NFL players used prescription pain medications during their playing days.
Of those players, 71% misused the drugs, and 15% continue to misuse these medications.
63% of the retired players obtained the medications from non-medical sources including trainers and the Internet.
In general, the rate of prescription drug abuse for professional athletes was four times that of the general population.

The statistics on drug abuse among athletes points to the level of the problem in society. Performance as a professional athlete is a premium quality. Our society has been pushing athletes to perform at the highest level no matter the cost. Now, we are finally starting to uncover the stark reality of the cost. Abuse often becomes a lifelong problem. Pain and damage from athletics can definitely be a long-term struggle.

Abuse Treatments

Pain is a medical issue that has multiple treatments based on the pathology; only in the United States do people heavily rely on opioid medications. Addiction is a psychological and physical issue due to the brain and body’s dependence on these drugs. Addiction is extremely hard to treat, and is often a lifelong struggle.

The take home message is likely that as a nation, we need to become more realistic in the management of injuries, especially in sports. Ruining our life to just play a sport for a short time more is dangerous. Pain is a sign in an acute injury that there is ongoing damage. Masking the pain with an opioid leads to further injury and damage. The cycle keeps going and the athlete gets to the point where the injury is severe enough to never heal completely and the pain becomes lifelong experience.

Masking the pain with drugs and preventing normal healing is the wrong technique to use in sport injury management. The danger of addiction and lifelong pain is not an adequate reward for sports performance. NFL players or other athletes are not invincible. Chronic pain can lead to a miserable life, so seek professional services if you need help.