Smoking Worsens Chronic Back Pain

February 22, 2016October 25, 2017 / Thomas Cohn, MD

New findings out of the Association of Academic Physiatrists Annual Meeting revealed another reason why you shouldn’t take up smoking if you want to have a healthy body. Researchers say smoking has been linked to worsening of degenerative disc disease in the cervical spine.

Degenerative disc disease is a natural process that occurs as we age, but that doesn’t mean everyone will suffer from painful symptoms. The condition occurs as the cervical discs between our vertebrae slowly break down over decades of use. If the condition worsens too much, the jelly-like central portion of the disc can rupture, causing pain and irritating local nerves. Living a healthy lifestyle can help prevent a speedy degeneration of your discs.

Smoking, on the other hand, has the opposite effect. Lead researcher Dr. Mitchel Leavitt said smoking can harm the small blood vessels in your back, which can make it difficult for oxygenated blood to flow in your back, exacerbating degenerative disc disease.

“Smoking is not healthy for a person’s intervertebral discs given the risk of developing microvascular disease – a disease of the small blood vessels – due to nicotine abuse,” Dr. Leavitt said. “Intervertebral discs receive their nourishment from the microvasculature that line the endplates on either side of each disc; when these blood vessels are damaged, the discs do not receive nourishment and this may speed up the degenerative process.”

Chronic Back Pain and Smoking

To understand how smoking contributed to chronic back pain, researchers evaluated CT scans of 182 patients who did not necessarily have back pain. 34 percent of individuals identified as smokers, and five cervical discs were given a grade on a 0-3 point scale with a 3 score denoting severe disc height loss. A five-disc total score between 0-15 was assigned to each individual.

After looking at the available data, researchers found that on average, smokers scored 1-point higher on the degeneration scale compared to non-smokers.

“This is another example of the detrimental effects of smoking. Tobacco abuse is associated with a variety of diseases and death, and there are lifestyle factors associated with chronic neck pain,” said Dr. Leavitt. “Pain and spine clinics are filled with patients who suffer chronic neck and back pain, and this study provides the physician with more ammunition to use when educating them about their need to quit smoking.”

So if you want to give your lower back the best chance to avoid chronic pain from degenerative discs, give up your smoking habit.

Cyrotherapy for Chronic Pain

February 17, 2016October 25, 2017 / Thomas Cohn, MD

Cyrotherapy is a relatively new approach to treating some types of chronic pain. The therapy involves short-term exposure to very cold temperatures. It works because the skin reacts to the cold temperatures and sends messages to the brain that work as a stimulant to normal bodily functions. This exposure also helps trigger the release of anti-inflammatory molecules and endorphins.

In fact, the therapy is already being used by a particular subset of people who deal with pain on a frequent basis – professional athletes. These athletes use cyrotherapy for a number of reasons, including to:

Reduce pain
Improve recovery time
Improve therapy results

Researchers hope that through more study, we can expand this therapy to chronic pain sufferers.

Cyrotherapy Risks

In any treatment where you’re working with elevated or decreased temperatures, there will be risks involved. Some potential risks of cyrotherapy include:

Nerve damage
Tissue damage
Burning sensation on skin

Medical data shows that roughly 1,500-2,000 injuries happen each year due to cyrotherapy, but the majority of the injuries are due to inexperience or overexposure. It’s also worth noting that a woman died last year after using a cyrotherapy chamber without supervision, adding to the idea that it should only be pursued with the assistance of a well-trained specialist.

Recently, the University of Texas was awarded a 4-year grant to study and improve cyrotherapy techniques. Their goal is to learn exactly how blood flow is affected by cyrotherapy, and they want to introduce antioxidants and substances into the bloodstream to block certain nerve responses. In essence, they want to better learn how to manipulate pain responses during cyrotherapy, which could be a breakthrough for chronic pain sufferers.

We plan on keeping an eye on the University of Texas as well other research facilities who are attempting to build on this therapeutic program. People have been icing injuries and using cold packs for hundreds of years, hopefully we can continue to build on that premise.

How To Properly Dispose of Pain Pills and Opioids

February 8, 2016October 25, 2017 / Thomas Cohn, MD

Opioid abuse has become a huge problem in the United States. After many minor procedures and trauma people are prescribed pain medication. Oftentimes people have leftover pills that end up sitting around the home. This is one source of pills that may be misused or abused by others, or the patient themselves and can lead to addiction. No one usually wants to waste their medicine, but with the abuse potential and danger of these opioids, disposal then becomes an issue.

Leftover pain medications that are opioids need to be handled properly. When storing them at home, due to the street value and abusive potential, they should be kept hidden and locked away securely. One does not want these medications to ever be lost or stolen. Furthermore, easy access may allow another household member or friend the ability to take the opioids and use or abuse them. Your safety and others is dependent on keeping all your medications secure and used only according to the directions of the prescriber.

Proper Disposal

Disposal of medications has become a major problem. Most drugs, no matter the category, are considered hazardous substances. Drugs can be toxic to other people, animals and the environment. Studies of wastewater have often showed traces of a wide variety of substances from birth control hormones, to antidepressants and narcotics. The most common recommendation for drug disposal has been to flush them down the toilet. Unfortunately this has led to the spread of many compounds into the water system and the environment. A better solution for personal disposal is to crush and mix the pills with dirt or cat litter making the drug unusable and disposing with the trash.

Currently, the best option for disposal is burning the medication in a commercial incinerator. This actually destroys and fairly safely vaporizes most medications. Minnesota does have a program coordinated by local law enforcement offices to take unused prescription medications, and these are sent for hazardous waste incineration. Unfortunately this is not the most convenient system for a lot of people. Physician offices usually do not have the ability to do this but often they can add prescription medications to other drugs and materials that are sent out as hazardous waste on a very limited basis. Pharmacies and drugstores do not generally have the ability to accept returned medications.

Hopefully in the near future, Minnesota will develop a system to encourage medication return to pharmacies for disposal in a secure and proper way. A wide spread system of pharmacy return and transfer for incineration would be ideal. For this to occur, Minnesota would need to change its law and assist with the coordination of collection and proper disposal. This would be a major step forward in reducing medication available for abuse and it would lessen the toxic effects on the environment.

The Importance of An Anti-Inflammatory Diet, Part 2

February 4, 2016 / Thomas Cohn, MD

Earlier this week, we posted a blog titled “The Importance of An Anti-Inflammatory Diet, Part 1.” In the post, we discuss five tips for keeping chronic pain at bay through a healthy diet. Here’s Part 2, which includes five more tips.

Tip 6: Try adding onions to more dishes – Onions are packed with beneficial antioxidants. These may help reduce inflammation, lower bad cholesterol and reduce heart risks. Use more onions in your food preparation from sauces to salads and on things like sandwiches.

Tip 7: Watch out for some plants that may have the reverse effect of increasing inflammation – The most notable would be potatoes and corn since they are high in starches. Others are more controversial in effects, but are most likely beneficial. These include tomatoes, peppers and eggplant. All the latter are found significantly in the Mediterranean diet and are likely to have benefits from a number of compounds they contain that are antioxidants.

Tip 8: Fiber is your friend – Fiber lowers C-reactive protein levels and is a marker of inflammation that can be detected in the bloodstream. Fiber also fills up a person, and makes one feel full during a meal. This also helps in the overall digestive process and improves gastric motility, decreasing constipation. Fresh vegetables, some fruit, and unprocessed grains are good sources. Eat popcorn without extra salt and butter for snacks as an additional bonus.

Tip 9: Avoid processed foods, like white bread or rice, chips, cookies, and many prepackaged foods – These often are high in sugar, preservatives and salt and all are linked to being unhealthy. Many of these things tend to promote inflammation. Salt also promotes unnecessary fluid retention and high blood pressure and is found in large amounts in processed food.

Tip 10: Do everything with a degree of moderation – When you eat a meal, use a smaller plate, this will encourage one to eat less. There is no need to stuff oneself and constantly be eating. The brain needs time to receive the signals that you are full, so eat less and slow down. Eat more fresh food and prepare it yourself. Adding in a small amount of wine is a good treat and many wines contain resveratrol, another anti-inflammatory compound. Coffee has also been shown to be healthy with a number of anti-inflammatory and antioxidant compounds, so you can still enjoy your morning.

Changing your diet, eating less, eating more fresh fruit and vegetables, cooking your own food and improving your lifestyle can improve pain levels. Unfortunately, it does take a fair amount of dedication to change. However, if you keep doing things the same way all the time, the same results are going to occur. Consider the benefits of change to decrease pain and inflammation. For many chronic pain conditions there is no magical solution and changing your lifestyle is necessary to obtain the desired results.

Minnesota Doctors Not Sold on Marijuana

January 18, 2016 / Thomas Cohn, MD

The Minnesota medical community is, according to January 12, 2016 article in the Star Tribune, not sold on medical marijuana. In reality, this is not very surprising. There are probably many reasons, but the most obvious reason is the idea that medical professionals like to base all their care on a scientific basis. From taking a history, to performing an exam and determining the tests and treatment, medicine is more of a science and depends on evidence for diagnosis and treatment of problems. If there is not evidence to support a treatment, medical professionals are trained to be skeptical of its use and purpose. Currently, medical marijuana definitely falls into this category.

Most important to the debate on medical marijuana is that there is very limited scientific research supporting many of the claims of usefulness. The research with regards to the management of most medical problems is related to a few small studies, and there are hardly any definitive studies that show significant positive value, and the study designs are often not blinded/controlled with any large number of participants. For pain management there is mostly incidental case report-type studies without mentioning which specific cannaboids are effective. Since cannabis plants contain over 100 different cannaboids and other compounds, using so many chemicals at once in a relative uncontrolled mixture is not a scientific approach to treatment. In a way it is like throwing a grenade at a problem and hoping everything does not blow up in your face.

Fixing The Marijuana Issues

The proponents of medical marijuana often bring to the table multiple examples of the wonderful help that various individuals have experienced with its use. However these are individual cases, and not necessarily what will occur with every individual. When a new drug is brought to market, we all want to have extensive testing performed to make sure it is safe, to ensure it performs correctly and that the same effect will occur each time it is taken. With medical marijuana we do not know most of these things. We have no idea what exactly is in the extracts, and we have no studies on how animals or humans will react to the compounds over time. Any other drug besides marijuana with this lack of scientific research would never even be considered to be used widely as an intervention. It is not surprising most medical professionals have a huge degree of skepticism about certifying patients to use medical marijuana and endorsing treatment.

In pain management there are many treatments available that have been shown to be reasonably effective. A pain management expert often can help a person through the maze of management options and help find an effective plan. There are a portion of patients with extremely complex problems without great solutions to control symptoms at this time. Failure of standard treatments may be a reason to want to try medical marijuana. Those who do go this route need to know at this time it should be considered truly an experimental treatment, and that the short and long term side effects and problems are not really known. There are a huge number cannaboids contained in medical marijuana, and while some may be helpful, others can be harmful. It may be a significant risk to use these compounds and until they are better studied and understood, and it is unlikely that the medical field will endorse such treatment without serious reservation.