pain

Can Genetic Switches Turn Off Pain?

/ Thomas Cohn, MD

twinsA recent article published in Forbes this month describes research in England that found a connection between DNA and perceived pain levels.

The Study

The study tested perceptions of pain across 1,000 identical twins. Researchers attached a heat source to each twin’s arm and began to increase the heat, telling each participant to press a button when the heat became too much to handle.

The results of the study showed that many of the twins did not have identical perceptions of pain.  Researchers then took blood samples from a select group of twins in which the differences in pain perception were highest. From these blood samples, researchers found several segments of DNA that appeared to be different between the twins.

As most studies go, this is interesting but it’s a relatively weak finding, all things considered.  Pain is far more complex than this study makes it out to be. As a result, this study really does not show anything useful.

Pain Perception is based on Emotional Experiences

Pain is an emotional response to perceived sensory changes.  Identical twins have the same genetic make-up, but they do not have the same life or emotional experiences and therefore will likely have different perceptions of pain.  Analyzing the differences in genetics between two twins and postulating that these contribute to differences in perceived pain is highly unlikely.  The most likely explanation of the difference in pain perception is the difference in life experiences.  There clearly was no control of these variables and this is well known to have a significant effect in pain perception.

Unfortunately, this is only an interesting side light of a story on pain.  When the most important variables that impact pain perception have no control, no conclusion can possibly be accurate beyond the wildest of guesses for the results.  Bottom line, this makes for an interesting story and nothing more.

Common Causes of Pelvic Pain

/ Thomas Cohn, MD

pelvic painPelvic pain can occur in both men and women. It can be caused by a variety of conditions. Some of the more common causes of pelvic pain include:

  • Bladder infections such as interstitial cystitis
  • Hernias
  • Kidney stones
  • Bowel issues
  • Endometrial issues, and ovarian cysts (in women)

Treatment is based on the cause, and these pains usually resolve once the acute condition resolves.  Read on the learn more about these specific conditions that can result in pelvic pain.

Endometriosis and Fibroids

Chronic pelvic pain in women is often related to several problems related to the unique pelvic anatomy.   Endometriosis and fibroids are uterine tissue that forms outside the normal uterine location.  Its growth is stimulated by the normal hormonal cycles.  The tissue eventually causes scar tissue in the pelvic region and the scarring can cause diffuse pelvic pain.  Surgery is often used to help resolve some of the problems related to this condition.  Physical therapy and neuropathic medications can be helpful for long-term management.

Chronic Interstitial Cystitis

Chronic interstitial cystitis is an issue seen mainly in women with irritability of the bladder.  The lining in the bladder becomes scarred, has pinpoint bleeding, and then becomes shrunken and stiff.  Frequent urination (up to 60 or more times a day) and constant pelvic pain are common with chronic interstitial cystitis.  Bladder distention is sometimes helpful and sometimes medication is instilled into the bladder.  Bladder stimulators sometimes are implanted to help control symptoms.

Hernias

Hernias more commonly appear in men than in women.  The muscle wall in the groin region weakens and abdominal contents push out of the area.  Surgical repair is the treatment of choice, however there are nerves in the region that in 2% of the population can become entrapped in scar tissue and be painful.  Physical therapy to release scarring, medications, and sometimes steroid injections are used to relieve symptoms.

How to Prepare for a CT Scan

/ Thomas Cohn, MD

ct scanA CT scan is a medical imaging tool widely used by medical professionals to gain better insight into afflicted areas of the body.  In this article, we’ll explain what a CT scan is, how it works, and how to best prepare for one.

For more information, read our blog on when CT scans, MRIs, and x-rays are useful in treating pain.

What is a CT Scan?

Computerized Tomography (CT) scans are a series of x-ray views taken of a body part at different angles. Computer processing of the views is used to create a cross-sectional picture of the scanned body part.  A number of “slices” (x-ray images) are taken, and the computer combines the images to create a 3-dimensional view of the region examined.  When the test was first introduced, the brain was the most common area examined by CT scan. Now, CT scans are used to examine many areas of the body.

When are CT Scans Helpful?

CT scans are x-ray images of a body region.  Therefore, radiation exposure does occur during these studies.  They are very fast to obtain and often provide very detailed information.  CT scans are often used when detailed information is needed rapidly to make a diagnosis and initiate treatment.  This makes them useful in acute illness, trauma, and brain injury where data needs to be collected fast and treatment cannot be delayed.  MRI scans may provide more detailed information, but can take a long time to obtain.  CT scans are also used in people who have metal implants in their bodies like pacemakers that can not placed in strong magnetic fields.

The risk of CT scans is similar to the risk associated with x-ray radiation.  This is generally a small risk if exposure is limited.  Frequent or multiple x-rays and CT scans can be a concern due to radiation and cancer.  Scans also should not be done during pregnancy due to possible radiation damage to the fetus.

How to Prepare for a CT Scan

Preparing for a CT scan depends on the area being scanned.  Since they are used in cases of trauma, often no special preparation is necessary.  Sometimes, a special contrast is needed to increase visualization of an area.  It may be swallowed, or injected in a vein or body cavity.  The scanning process is fast, and the scanner is fairly open, so claustrophobia is generally not an issue.  Most people will be required to wear a hospital gown for the scan so that clothing does not interfere with the imaging.

After the scan, a radiologist will interpret the results and report their findings to the doctor who ordered the scan (your physician).  Combining the results of the scan with clinical information (including patient history and physical examination) is critical.  Since the picture is only one part of the story, all the information needs to be combined to give an adequate explanation of the condition and the treatments that will work.

Can Pain be all in your Head?

/ Thomas Cohn, MD

pain in the headMany patients wonder if their pain is all imagined and in their head.  Pain is a very complex problem.  Often the source is hard to determine and treatment is not totally effective.  The definition of pain also gives us a clue of the complexity.  The IASP, an international medical group that studies pain, defines pain as:

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Emotions are from the brain – therefore pain can be “all in your head” at times.

The Brain & Pain

The brain is the master of all sensory signals.  The role of the brain is to receive, interpret, and then provide a response to signals received.  Some sensory signals are from pain fibers in the periphery of the body, they travel to the brain, and the signals are then decoded in several different regions of the brain.  Acute pain sensory signals are often interpreted correctly and the body and brain can handle an appropriate response.  The body handles chronic pain signals differently.

There are multiple areas in the brain that respond to pain sensory signals.  When pain is chronic, there is an actual increase in pain sensory signals going to the brain and an increase in brain sensitivity to these signals.  Furthermore, areas of the brain that are near pain responders become stimulated, including emotional areas of the brain responsible for depression.  A short circuit occurs and emotions are often perceived as pain.  Treatment of pain that is it stimulated by emotions (such as depression) centers on successful treatment of the depression.

A Short Circuit in the Brain

There are also a few central pain syndrome triggered by damage to the spine or brain causing the brain to perceive pain, sometimes whole body pain, when there is no other injury.  The pain is very real, but the source is basically a short circuit in the wiring to the brain or within the brain.  Treatment of these problems is extremely difficult. Minimal pain medications help and central neuropathic medications like drugs for seizures are often the most helpful.

When pain is all “in the head,” there is likely an emotional component to the pain signals.  Chronic pain often stimulates this problem.  Treatments of the emotional components of pain are often as important or more important than medications for the pain itself.  Pain is complex, and treating all components is necessary, and since pain entails emotions, these must be treated equally.