What’s New In Spinal Cord Stimulation?

spinal stimulationTreatment of chronic pain is often complicated and requires multiple strategies to solve the problem. Spinal cord stimulation is an advanced strategy in the United States, but in other parts of the world, it is often employed even prior to spine surgery. Over the last several years, there have been several new developments in the field, but whether they will help more than a few it remains to be seen.

Spinal Cord Stimulation For Pain

The science behind spinal cord stimulation goes back to 1984 when Medtronic designed the first unit. The original technology was adapted from heart pacemakers, and this concept remains about the same, except that we are pacing the nervous system instead of the heart. Over the last 30 years, research has improved in several areas including shrinking of electronic circuits as well as improved battery technology.

Besides these obvious areas, medical science has greatly advanced in understanding different components of the nervous system and diseases that may be contributing to pain. As technology has improved, the ability to electrically stimulate the nervous system has also changed. We know how to better find and block or modulate the abnormal signals causing pain. We can use multiple programs to change the pain signals and often find a variety of different things that all dampen pain, making it more manageable. Now that the batteries for these units are remotely rechargeable through the skin, the units are no longer limited by how long the battery would last.

Increased Effectiveness

Basic science has also contributed to increased effectiveness of spinal cord stimulation. We have a better understanding about how pain signals travel from the periphery of the body to the brain through the spinal cord. We now can direct signals to very specific regions of the cord to be more effective in controlling pain. For some very isolated pain situations, we can stimulate a specific nerve in the periphery of the body (known as peripheral nerve stimulation), or just as the nerve enters the spine (dorsal root ganglion stimulation). For some people, stimulating the spine at the thoracic T9 level at a high rate can not be felt, but it is effective to block pain signals. The last new pattern is known as burst stimulation, and that is using a special pattern of high frequency pulses to the spinal cord to block transmission of pain signals.

The new forms of spinal cord stimulation use a variety of electrical techniques to modify the ability of painful electrical signals to travel from the periphery to the brain. At this time, pain specialists cannot tell whether a certain type of electrical stimulation will be helpful unless a reversible trial is performed. If conservative treatment has failed to control pain, an interventional pain expert who has experience with spinal cord stimulation may be able to help determine whether this type of therapy is a reasonable option.

With the new types of stimulation available, if you are a candidate for implantable management options, this type of intervention is often an extremely successful treatment. In the right person, the success for pain control is about 70 percent, and failure is due to a variety of factors but especially due to patients disliking the electrical stimulation sensation.  As technology improves, hopefully this will be used earlier in the treatment of pain.

Food Choices For Pain and Weight Management

healthy diet food choicesEveryone is different, but improving your nutrition can drastically improve how well you feel. A good diet, exercise and adequate sleep all are parts of healthy living. Doing just one of the three things leads to mixed results. Living a balanced life can solve a lot of health problems, and is often very beneficial in treating pain. Unfortunately, doing the right things in life is not always easy. Most of these things take time and planning, and most are not fun.

Food and Pain

Different foods have different effects on the body. There are three basic food categories – proteins, carbohydrates, and fats. They all have different values to the body, and there are many ways to obtain these.

Proteins provide essential amino acids that are necessary for building various chemicals in the body including muscle, and can be a source of delayed onset energy.

Carbohydrates are used for energy, but also are in what we consider fiber.  It is important to remember that the quality of the food is often as important as the number of calories and how the body will use the food.

Fats are necessary also in small amounts for certain chemical processes in the body and can be stored for energy later.

Vegetables, fruits, whole grains, lean and vegetable type proteins, and healthy fats will provide quality energy during day while maintaining your health. Fast food provides limited short-term energy and often adds to the waistline due to the types of carbohydrates and fats.

Meal Planning and Pain Care

Starting your day with a good breakfast has been a nutritional rule for years. For most people, eating a breakfast with some complex carbohydrates like granola that is high in fiber and fruit, with a source of protein such as yogurt and nuts, provides energy throughout the morning, reducing fatigue and the desire to munch or eat things like donuts.  

Lunch provides the energy for the middle of the day. Some nutritionists say this should be the biggest meal of the day. Most of us do not have the time for this and is something that is eaten in a hurry. Maintaining a high fiber lunch with a protein source is a positive meal. A salad with a low fat piece of protein, like a chicken breast or tuna fish is an excellent meal to help control weight.

Many of us feel the need at times to snack. To help control this urge, drinking plenty of water is sometimes helpful. Nutritionally, one of the best snacks is nuts, especially almonds, walnuts, or other tree type nuts. These help reduce diabetic and cardiac risks, are high in protein, fairly low calories and will fill you up. The main thing to avoid  are sweets and high carbohydrates like potato chips or cookies. Popcorn that is not highly salted is also good due to high fiber content and low calorie amount.

Dinner is one of the hardest meals to do appropriately. It is important to learn balance and portion size. If you are trying to lose weight, eliminate simple carbohydrates like pasta and potatoes. Include salads, vegetables, and fruits to help to fill yourself up. Meat portion size should be about five ounces, and lean meats like chicken, fish and pork are the healthiest. Spaghetti squash can be used at times for a substitute for pasta in many dishes that have a meat sauce. Also, slow down your eating and drink plenty of fluids since both of these strategies help fill oneself up. Lastly, do not eat really late and then go directly to bed since this tends to allow the body to move the calories just eaten into fat for storage reasons. 

Dietary Health For Pain Sufferers

Eating a better diet often allows one to lose weight. Reducing the total calorie intake by reducing fatty foods and simple carbohydrates like bread, potatoes, and pasta, and also reducing sweets can go a long way to meeting a complex goal. The hardest thing is probably reducing the total amount of calories taken in during the day to maintain a balance with the activity level one is performing.

Most everyone will have an increasingly slower metabolism as we age, and to exercise enough to burn off all the calories we eat is often impossible. It takes a wise diet and exercise to lose weight. It is never easy, but the more one learns about eating healthy, the easier it becomes to lose weight. Discipline in diet is probably more important than any fad diet, and be sure to choose a diet that you can follow long-term.

An Update On The Daith Survey Study

daith surveyLast week, we announced that a colleague of ours was hoping to gather more information about the daith piercing and its role in migraine relief. We’re still hoping to collect more information, so if you have a daith piercing and you haven’t taken the quick five-minute survey yet, please do us a favor and find a few minutes to complete it.

So far more than 100 individuals have filled out the surveys, and the results have yielded some interesting findings. Although it’s still too early to really dig in and analyze the findings, the majority of individuals said the daith piercing helped to reduce their headache pain. The findings were also consistent for individuals with the worst types of headaches – migraines.

Daith Piercing Findings

So again, if you still haven’t taken the survey, you can click here and fill out the survey. Here are some more responses from the survey so far. The majority of people who underwent the daith piercing:

  • Were pleased they had the procedure.
  • Reported a consistent reduction in intensity and frequency of both mild and migraine headaches.
  • Reported a reduction in painkiller intake.
  • Reported an increased number of “better days.”

Additionally, some people experienced headache relief after the piercing was removed, which suggests that continued pressure on the vagus nerve may not be necessary for full relief.

So if you have a few minutes and want to help us gather more information on the subject, please consider clicking the above link to take the survey. If you’re still not sure about the daith piercing, feel free to check out some of our old blog posts on the topic, and if you have any questions or comments, leave them in the comments section below. Thanks again for helping us learn more about the daith piercing and pain pathways!

Dr. Cohn

The Uphill Battle Against Chronic Pain

Pain Pills insuranceOn Thursday May 4, 2017, a headline article in the Minneapolis StarTribune was on the effect of opioids on chronic pain. The article was written about a study at the Minneapolis VA hospital about not using opioids for patients with chronic pain. The study was done by Dr. Erin Krebs, an Internist who studied patients at the VA. The study involved two main groups of patients who all had back, hip or knee pain. One group received opioids and the other did not during a year of treatment, and both received extensive use of alternative pain management techniques.

The conclusion drawn by Dr. Krebs is that chronic pain patients do not need opioids since the non-opioid group did well with decreased pain intensity. Furthermore, Dr. Krebs, by her limited study, is implying opioids are ineffective to manage chronic pain and should not be used. This is a significant disservice to chronic pain patients and is an especially irritating claim being made by a physician who has practiced in pain management but only in an academic setting and is not even Board Certified in Pain Management.

Chronic Pain and Insurance Coverage

The first take home message for pain patients is that chronic pain is incredibly complex, opioids are only one medication management tool among many treatment options. This study is very limited, and the patient population does not truly reflect the complexity of many pain management practices with people who have multiple medical problems with multiple body locations of pain.

The patients in the study were given comprehensive and unlimited access to a number of treatments from physical therapy, psychological counseling, exercise, acupuncture, interventions and a variety of medications. In the “real” world, it often is extremely difficult to obtain insurance coverage on an ongoing basis for appropriate treatments including for anything that is not generic for medication, exercise programs, or psychological counseling (if a psychologist with interest in pain is even available).

Often the most appropriate management options for a patient are rejected by insurance companies, including a variety of interventional treatments, exercise programs, and non-narcotic medication. Proven interventions like spinal cord stimulation are rejected while the insurance companies have no problems with opioids. Patients who have failed all conventional treatments may benefit from a trial of options such as medical marijuana, and this is definitely excluded by insurance coverage.

The Complexity Of Chronic Pain

Chronic pain is not a single entity. It is a very complex outcome that is associated with multiple medical problems. Pain physicians and most doctors are not treating a single problem like osteoarthritis of the hips or knees – the main group of patients in this study by Dr. Krebs. Simple problems such as those in this study are often easily managed with a combination of conservative strategies and can oftentimes be treated quite well without opioids.

Now, most physicians are trying to avoid the use opioids for these issues when they can. Unfortunately, most physicians do not have enough training and experience in treating many of the problems that cause pain and up until recently, opioids were the easy solution to see a patient in a limited time and get them out of the office with a smile on their face. The solution to the opioid epidemic problem is much more complex then demonizing patients and a medication.

Most physicians are usually trying to do the right thing for their patients. Pain physicians are especially aware of the issues in treating these complex patients. First, coverage for alternative medical treatments for pain must be more easily approved, especially when recommended by a Board Certified specialist. Secondly, pain affects over 30 percent of the adult population and research into pain needs significant funding. Third, addiction to opioids is a separate issue beyond pain management, and needs to be treated in a different sphere, as only a small number of pain patients are addicted versus dependent on their medications. Lastly, there are multiple treatments for pain available, if alternative treatments were easily covered when recommended, less use of problematic drugs would surely occur.

If the media was more interested in telling the life of both legitimate pain patients and their treating pain physicians, a better understanding of how pain affects one’s life may occur. Too many people who have not been there are casting judgement on patients and physicians who are trying to treat a very complex problem. A third of the world population suffers from some sort of chronic pain, far exceeding the number who suffer any other medical problem, but there is hardly any money being spent on research and promoting safe management strategies. Moving forward will require less negative casting of the patients and physicians treating these problems and more investment into positive solutions.

Help Us Learn More About Daith Piercings

daith piercingThe internet is a wonderful thing. Not only has it made it easier for patients to find information, but it has also allowed doctors who would never otherwise meet to connect with one another. The latter recently happened with us.

As we’ve mentioned on the blog before, our posts on daith piercings have far and away been our most popular, which is interesting because the science behind why the piercing may help alleviate headache pain isn’t perfectly clear. However, we are working on changing that. Recently, we were contacted by Dr. Chris Blatchley from across the pond at the London Migraine Clinic. Dr. Blatchley has been helping patients find relief from migraine pain for years, and he has worked closely with a colleague who has performed more than 3,000 daith piercings. He stumbled upon our fascination with the piercing, and combined with his own experience, Dr. Blatchley has decided to try to compile some concrete evidence about why the piercing is effective for some patients.

Daith Piercing Study

To best do this, Dr. Blatchley put together a survey questionnaire on his website London-Migraine-Clinic.co.uk. On his website, he has a link to the survey which he hopes to use to gather responses from individuals who have undergone a daith piercing for pain relief. You can access the survey by clicking the link that will take you to his site, or you can go directly to the survey by clicking the link below.

Daith Piercing Questionnaire

The survey will only take a couple of minutes to complete, but we believe it will be a valuable tool for getting a collection of responses from individuals who have firsthand experience with the piercing and its effects. So please, if you’ve undergone the procedure, take a few minutes to complete the survey and share it with others who have received the piercing. The more we learn about pain pathways, the more pain we can take out of this world!


Dr. Thomas Cohn