Consider Chronic Pain When Voting on Tuesday

November 7, 2016 / Thomas Cohn, MD

It is not glamorous, but voting is essential. One of the most important issues to medical practitioners is the need to maintain access to healthcare. The United States is one of the wealthiest nations in the world, but we also have one of the most expensive systems with some of the poorest outcomes. The tough decisions that would make healthcare more affordable are often blocked for ridiculous reasons, especially those protecting big business and privacy. Currently, like it or not, the biggest issue is the Affordable Care Act (ACA), known as Obamacare. Voting is critical if you want to maintain access to healthcare.

Many of those who have pain have chronic conditions, or have had injuries to the back or neck. Prior to the ACA, health insurance companies could deny care to those with a previous injury or chronic condition, or could just make insurance costs so high that it was not a feasible expense. Despite its recent problems, more people do have health insurance and costs are more affordable for those who do have chronic conditions. Without the ACA, in the past myself, and two of my kids would likely have been unable to be insured, do chronic health issues or back problems. If you have never had a health problem, insurance is easily obtainable. Now, the law requires everyone have insurance, spreading the risk pool across a wide spectrum and reducing costs. Throwing out the ACA and the guaranteed ability to be insured at a reasonable cost is not an option in life for most patients with chronic pain.

Healthcare Costs in America

The cost of the healthcare is an issue in this country. The problem is our elected representatives have no onus to develop sensible healthcare changes in our country. The first thing that is necessary is that insurance companies should be allowed to work across state lines to broaden their base of clients and lower their overall risk profile. They also should be considered basically minimal profit, such that the cost reflects the product, not the profit to investors. Second is to move to a better level of control of the drug/pharmaceutical industry. The fact that the government does not place any control on these companies have led to the outrageous charges for medications. If one buys the same drug in Mexico, India, or Canada, the cost often is 10 percent of what is paid in the United States.

Data is the best way to improve our healthcare system. The best way to improve our system is actually quite simple; every person must have a unique medical identification code, and every medical record is kept electronically in the same way in one single system. If anyone sees a doctor, every other doctor who treats that person can see what has been done and will not need to duplicate tests or services. Statistics then can be data mined for any condition and treatment and soon it would become clear to see what works and what doesn’t work for any management option. The cost should plummet once we stop repeating tests and start seeing what really works for management of various problems.

Going backwards and throwing out the ACA is not viable option for anyone who needs to see a physician regularly or who has had a chronic medical issue. Vote for those who recognize the need to maintain the ability to obtain insurance. Also, vote for those who will stand up for changes to big businesses like the insurance and pharmaceutical industry. Lastly, get over the fear of the government having access to your personal health data, if they know everything about you financially since you pay taxes, what is the difference if they are actually trying to improve your health and make the system less costly? The United States ranks about number 40 in the world for the quality of healthcare, behind many third world countries. It is time people step up an vote for leaders who will improve the quality of our lives, not the politicians’ own pocket books.

Fitness Trackers and Weight Loss

November 4, 2016November 4, 2016 / Thomas Cohn, MD

Fitness trackers like the Fitbit have been part of the health craze for several years now. Two claims are common for these devices:

That they will improve fitness levels, and;
Help people lose weight.

Recent studies have shown that these devices may improve the number of steps taken but fall short on helping patients lose weight or improve health. The study was performed at Duke-NUS Singapore Medical School. In general, knowing how many steps one takes has not translated to improved overall health.

Fitness Tracker Study

The study involved 800 adults, divided into four groups, and the interventions with the trackers lasted for six months. The goal was to boost activity to 50,000 to 70,000 steps a week. Three groups received trackers, and incentives to use the trackers varied and one group was a control group without the trackers. The control group was just given information on the benefit of exercise. The study lasted six months, and the groups given the trackers were successful at boosting their physical activity and maintained their activity the best at one year out. However, 90 percent of those with a tracker stopped using them by a year after the conclusion of the study. The most telling outcome was increased activity did not cause any improvements in blood pressure or weight loss.

The reality is that improved cardiovascular health and weight loss is more complex than just increasing the number of steps taken. Cardiovascular health has several components, to lower blood pressure one must have a degree of higher intensity aerobic conditioning. The heart rate must get to a high level to be effective at possibly lowering your blood pressure. Weight loss is extremely complex, and goes well beyond exercise. Fitness trackers like the Fitbit are best to be considered motivational devices. Everyone has a different reason for exercising. Some people are self motivated and just exercise because they want to and may have personal goals to achieve. Some people like to go to health clubs and find exercising a social pursuit. Others exercise for health reasons, such as controlling cardiac disease or diabetes. A fitness tracker allows some to maintain personal goals. Checking the amount of steps may keep a person going to meet their goals. However if your goal is better cardiovascular fitness or weight loss, it will take more than just walking a certain number of steps. If weight loss is a concern or cardiovascular fitness is your need, working with a physician or other professional may be beneficial for more guidance.

Chronic Pain Reaches The World Series

October 26, 2016February 7, 2023 / Thomas Cohn, MD

The World Series is under way, and after a Game 1 victory the Cleveland Indians are only three wins away from capturing their first championship since 1948. Their manager, Terry Francona, already has two World Series rings from his time in Boston, and while another championship would be ideal, he’s already winning another big battle in his life – his battle with chronic pain.

Francona played eight seasons in the majors before eventually transitioning to a coaching role, but his years in the big leagues took a significant toll on his body. He eventually needed a couple knee replacement operations, and complications left him in severe pain with blood clots and staph infections. He was in a great deal of chronic pain, and he eventually turned to opioids to help manage the pain. Unfortunately, like many others, what started as a technique to manage pain transitioned into a habit and later abuse.

Opening Up About Life On Painkillers

Francona opened up about his battle with painkiller abuse in a book by Dan Shaughnessy titled, “Francona: The Red Sox Years.” He said his descent into pain pills began after some complications from knee surgery.

“I think I probably should have died with all that happened,” said Francona, referencing an extended hospitalization in 2002 when he almost needed to have his leg amputated. “There were a couple of nights in the hospital where I was thinking, I can’t take this anymore. The nurses would come running in because I’d stop breathing. I was in bad shape. There were people around who did not think I was going to make it. I know I came real close to losing the leg.”

He turned to painkillers like oxycodone and Percocet to ease his discomfort as he recovered.

“I lived on it at that time,” Francona recalled in Shaugnessy’s book. “When I left the hospital, I was on heavy-duty drugs, and it was tough.”

He eventually recovered from the problemed surgery, but he still kept taking pain pills, and eventually started hoarding them because they were easier to obtain in the clubhouse. That was until one day when his daughter found a bottle at home with more than 100 Percocet pills, and she eventually convinced her father to seek professional help and to enter a confidential drug treatment program managed by Major League Baseball. That same year, after the Red Sox collapsed in the weeks leading up to the playoffs, the Boston Globe published a piece saying that “team sources expressed concern that Francona’s performance may have been affected by his use of pain medication.”

Francona was not hired back after his contract expired that year, but he’s found a home with the Indians and appears to have put his days of painkiller abuse behind him. He mentioned that he still takes a blood thinning medication, but he’s taken to other options, like exercises and compression sleeves, to improve his blood circulation so he’s not relying solely on pills.

Francona is a shining example of how easily someone can get sucked into the world of painkiller abuse, and it’s fantastic that he’s been able to get professional help and more forward with a healthier lifestyle. Win or lose in this World Series, he’s won his battle with painkiller abuse.

Tai Chi Beneficial For Chronic Neck Pain

October 18, 2016 / Thomas Cohn, MD

Last week we shared a story on how yoga may be helpful for individuals with low back pain. Today, we’re learning of new research out of Harvard that suggests another form of low-intensity exercise may be beneficial for people with chronic neck pain.

To better understand the benefits of the ancient martial arts technique, researchers gathered a group of 114 individuals who were at least 18 years old and who suffered from nonspecific chronic neck pain for at least three months. Half of the group was asked to participate in regular Tai Chi classes for a period of 12 weeks, while the other half acted as the control group.

It may not sound shocking that individuals in the Tai Chi group had better outcomes than individuals who did nothing to improve their condition, but that’s what researchers discovered.

“The study showed that 12 weeks of Tai Chi was more effective than no treatment to improve pain, disability, quality of life and postural control in persons with chronic neck pain,” said Peter M Wayne, assistant professor at Harvard Medical School in the US.

Something Better Than Nothing

The news about Tai Chi having benefits for neck pain isn’t revolutionary, but it speaks to the larger point we try to express to our patients – that you need to put in the work if you want to take control of your pain. Your pain isn’t going to resolve simply by sitting down and popping a pill, you’re going to need to take an active role in pain management.

The researchers went on to say that Tai Chi was no better or worse for chronic neck pain than targeted neck exercises, but it again stresses the importance of strengthening your body to fight back against pain. As we’ve said before, there is no magic pill for chronic pain, and that holds true here. Even low intensity workouts can have amazing physical and psychological benefits. Don’t just hope your neck pain resolves, attack it head on.

Pain Care – When Correlation Doesn’t Equal Causation

October 13, 2016 / Thomas Cohn, MD

It seems that there are new articles being published almost every day on the dangers of opioid pain medications. Unfortunately a lot of the studies are not very enlightening. Worse yet, some are just sensational, dumb correlations without causation.

For instance, saying obesity is correlated to eating is a great example of poor research. If you eat, of course could run the risk of being obese, but if you do not eat you could die, so obviously these findings are not very meaningful.

The latest was an article stating that a third of all adults in the United States in the last year received a prescription of opioid medication, and this is larger than the number of people who smoke cigarettes. The reason this is absolutely meaningless is this number has no real meaning. If you add up all the prescriptions for opioids written in one year and divide by the adult population, this is very likely.

Another interpretation would be that 1 in 3 people had a serious medical issue in the last year and were prescribed pain medication. Most people who have been in the hospital or emergency room for a surgery or injury may get a short-term prescription for pain medications. This is one of the very legitimate uses of these drugs, and should not be demonized. Treating acute pain aggressively at the outset has been shown to reduce the incidence of chronic pain problems. Several days of pain medications after a surgery or serious injury is appropriate but it should not be an ongoing use once the acute episode has healed.

Making Bad Connections

A third of the world population also suffers from chronic pain. A small percentage of those people are helped only by opioid medication and use these appropriately to maintain function and ability. There are many who use these medications extremely sparingly and thus continue to be highly productive in society since then they can control their symptoms. These people are dependent on these medications, they are not addicted, and oftentimes other conservative treatments have failed them. If there were better legal treatments available, many of these people would never use opioids.

Taking a prescription pain medication for a legitimate medical problem is not a significant issue or statistic. Smoking cigarettes for most is a daily addiction, affecting 25 percent of adults. It is voluntary, it causes multiple health problems, and has a huge cost to society. Comparing pain medication use to smoking is a useless correlation with no meaning.