Fibromyalgia: Symptoms & Pain Management Options

August 26, 2013September 27, 2016 / Thomas Cohn, MD

Fibromyalgia is a disorder characterized by diffuse musculoskeletal pain throughout the whole body. It is often accompanied by sleep issues, jaw pain, headaches, stomach problems, and depression. There is no special test, blood work, nerve or muscle test, or X-ray that confirms the diagnosis. Rather, diagnosis of Fibromyalgia is based on a patient’s history, medical exam, and the exclusion of other diseases that may cause similar problems.

Symptoms of Fibromyalgia

There are 2 core symptoms of fibromyalgia:

Diffuse muscle pain
Fatigue

With diffuse muscle pain even a light touch of the skin produces pain. Typical locations of muscle pain include all four extremities, head and trunk. Muscle pain often interferes with sleep, and contributes to fatigue and depression. This constellation of problems is thought to be driven by an over-active nervous system, which is hypersensitive to sensory inputs.

Treatment Options

Treatment of fibromyalgia is aimed at minimizing symptoms and maximizing function. People with fibromyalgia often greatly diminish activity and withdraw from normal interactions. A comprehensive strategy that teaches a person to understand the physical and mental aspects of the disease is often helpful. A multidisciplinary team that includes medical management, lifestyle, psychology, and physical therapy is one of the most effective strategies. Physical Medicine based pain clinics often coordinate such programs.

Medication Management

Medication management of fibromyalgia is aimed at modifying symptoms. There are 3 drugs now approved specifically for fibromyalgia. All these medications are considered neuropathics. They reduce the sensitivity of the nervous system so that stimuli are not perceived as intensely. Analgesics can be helpful when used judiciously, especially acetaminophen, anti-inflammatories, and occasionally tramadol. Symptom treatment for depression, and sleep management is also extremely important.

Fibromyalgia is a disorder that affects the whole body and every aspect of daily function. At this time, there is not a known cause and no definitive cure. Management of symptoms is the key to treatment. An experienced pain physician with a multidisciplinary team will often lead to the most beneficial personalized treatment strategy.

Does Laughter Really Help Relieve Pain?

August 12, 2013September 27, 2016 / Thomas Cohn, MD

There’s an old saying that laughter is the best medicine. While most would admit that laughter is good for your emotional health, can it really reduce pain on a physical level?

In short, yes. Laughing can help fight both mental and physical pain.

Physical Benefits of Laughter

There are many ways that the physical act of laughing can decrease pain and improve your overall health. Here are a few examples:

Increased Endorphins. When you laugh, your oxygen intake increases. This invigorates your organs and releases endorphins in your brain.
Decrease Stress. Laughing helps circulation and results in more relaxed muscles. This can undercut tension caused by stress.
Natural Pain Killers. Laughing helps the body create its own natural painkillers.

Additionally, laughter has been found to increase blood flow, lower blood pressure, and boost the immune system.

Laughter & Brain Signals

Laughter is the opposite of being sad and depressed. Too much sadness stimulates areas of the brain that are next to the centers that translate pain signals in the brain. The centers that are involved in depression can “talk” to and stimulate the pain centers. Emotional pain can make physical pain even worse. Therefore, you need to laugh and spend time relaxing and enjoying life.

When you are in pain it’s often difficult to find the funny things in life and laugh. The old saying that laughter is the best medicine may just help. It increases the body’s own pain fighting hormones, and decreases the activity areas of emotional pain. Laughter distracts the brain from bad signals and focuses on the enjoyable ones.

Top 4 Causes of Back Pain

July 10, 2013October 30, 2015 / Thomas Cohn, MD

The human spine consists of roughly 30 bones, known as vertebrae that are stacked on top of each other. In between each of these vertebrae are discs – bits of cartilage that prevent the bones from rubbing against one another. When something disrupts the organization of the spine, it often results in back pain.

Many people suffer from back pain, but it’s often difficult to pinpoint what exactly is causing the pain. Here are four of the most common causes of back pain:

Injuries to the muscles, and ligaments. This can include injuries from sports, car accidents, or simple slip and fall accidents. Jarring your back in an unnatural way can result in move the vertebrae or discs out of their place, resulting in chronic back pain.
Herniated Disc. This is also known as a slipped disc. It happens when a spinal disc expands and presses against the nerves in the spinal column.
Degenerative Changes. Over time all areas of the body gradually break down. The spine is no exception. As a person ages their bones generally weaken, and the spinal discs can weaken or shrink (causing vertebrae to rub against each other).
Pinched Nerve. When discs bulge or shift, they can press against or pinch nerves, resulting in sometimes extreme pain.

You don’t have to live out your life just dealing with back pain. There are numerous treatment options available that can help you get back on the road to a pain free life.

How the Body Feels Pain

July 8, 2013September 27, 2016 / Thomas Cohn, MD

Pain is a complex issue. Acute pain is usually related to one of the following:

Tissue damage
Perceived damage
Injury

Chronic pain can be associated with chronic damage or a short circuit in the transmission of pain signals. Treatment of pain depends on the cause. In acute pain, if you treat the cause the pain will normally go away. However when pain becomes chronic, treatment often does not take away all the symptoms.

Pain Signals & Sensory Stimuli

Chronic pain is generally defined as pain lasting longer than 3 to 6 months. Often, it outlasts the initial injury. In some ways it becomes independent of the initial stimulus or cause. Damage may be ongoing, and there may be a chronic inflammatory response, all causing ongoing sensory stimuli, which are subsequently linked in the spine and brain, to the perception of pain. Often, non-painful sensory signals then become linked to nerves that previously transmitted pain signals. Normal signals then become perceived as pain.

All sensory signals are processed in the brain at some level. The brain has an incredible ability to determine the importance of each signal and then form a response. Depending on the circumstance, the brain can ignore the same signal that would be horrific pain. For example, we all have heard about soldiers in war who have been shot, but continue fighting with no loss of focus. Therefore, the real key player in all responses to pain signals is the brain and its interpretation of the signals.

Blocking Pain Signals

The key to treatment of pain then is altering the brain’s ability or desire to interpret sensory signals as pain. Blocking signals can be done anywhere along the path from the sensory receptor including:

The peripheral nerve to the spinal cord
Along the spinal cord pathways
In the brain itself

Although pain can be treated in multiple ways, all treatments try to prevent transmission and interpretation of sensory signals that are perceived as pain. There is no magic bullet and no one treatment alone that will work for everyone.

The simple reason why there are so many treatments for pain is that there are so many ways to alter signals that are perceived as pain. Medications have been designed to affect sensory impulses at a variety of locations from the skin and periphery to the spine and brain. Furthermore, there are a variety of techniques from proper movement, to acupuncture, to psychological training that can effectively treat pain.

How to Choose a Good Pain Doctor

June 17, 2013September 27, 2016 / Thomas Cohn, MD

Choosing a good doctor is always a challenge. There are many options to consider, including:

Insurance Requirements
Where you Live
The Degree of Specialization of the Physician you’re looking for

The best pain doctors will be those who have a broad range of experience, and a broad range of ability to evaluate and treat a variety of problems.

The Definition of Pain

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is how the body interprets certain sensory signals in the nervous system, which includes how the brain processes the signals and determines how to react to them. Pain sounds simple, but becomes extremely complex due to many causes and interactions.

Qualities of a Great Pain Doctor

A good pain doctor needs to have many qualities in order to successfully manage what can be an extremely complex problem. Pain often comes from multiple sensory sources, and finding each sensory source is a challenge. The start to finding the source is listening to the patient, the story, and where and what is happening. The story is often critical, and a good doctor will be able to recognize what story matches various internal problems. An experienced doctor can match a story very quickly to the pain problem.

In addition to listening to the patient’s story, a doctor may also need to perform other tests in order to grasp the full scope of your pain, such as:

Analysis of a patient’s movements
Checking motion in various body parts
Examining the neurologic and musculoskeletal system
Scans and X-rays

The best doctors have done this many times, and can put complex information together rapidly to determine a treatment plan.

Finally, all the good pain doctors should at least be fully licensed, and have subspecialty boards in Pain Medicine. Backgrounds in Physical Medicine and Rehabilitation are also a huge plus. Expect a good physician to be familiar with your history and examination, and have a comprehensive treatment plan, and be willing to address a number of complex issues contributing to your unique problem.