Pain Care: The Benefits of Pain Management

July 9, 2014February 17, 2016 / Thomas Cohn, MD

Pain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition. As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Medical Marijuana For Chronic Pain in Minnesota

July 2, 2014 / Thomas Cohn, MD

Minnesota has taken a conservative approach to the use of marijuana for medical purposes. Only a little quality research has been done with regards to the use of marijuana for pain. Most of these studies have been done for patients with cancer or eye problems, and current research is focused on seizures.

The reason why marijuana research is moving slowly is because there are all over 100 compounds that may be an active in cannabis. Most medical professionals would like to know both the positive and negative aspects of any intervention. Since there is no significant marijuana research available, it is hard for medical professionals to recommend the use of this compound.

Marijuana in Minnesota

Minnesota’s new marijuana laws allow the use of marijuana for only limited medical diagnoses. At this time, chronic pain is not included in the list of treatment recommendations. Chronic pain is extremely complex, and has multiple causes in most people. A single compound like marijuana is unlikely to be helpful and every person. Determining which group of patients would be helped by such a compound will be difficult due to the variety of conditions that cause pain.

Most physicians in Minnesota will not be prescribing medical marijuana. If you have chronic pain, do not expect a physician to write you a prescription for marijuana, especially since it isn’t approved for recreational use in Minnesota or even nationally. Furthermore, the drug enforcement administration (DEA) can stop a physician from being able to prescribe any medications if they prescribe to known drug abusers. The use of marijuana is not considered a legal medication, and physicians can lose their license if they prescribe to a patient who abuses marijuana.

Alleviating Symptoms

Pain symptoms in some patients may seem to improve with the use of marijuana. There are many compounds in marijuana that may help control a variety of symptoms including anxiety and pain. Most physicians who are prescribing control medications such as narcotics will do a urine drug screen to determine whether street drugs are being used by the patient. Most physicians have a zero tolerance rule for the use of street drugs since they could lose their license if they prescribe to an abuser. If you use marijuana, do not expect to be prescribed narcotic medication. Most pain physicians will work with you to control your symptoms with other treatments that are very effective in managing your problems.

In the distant future, when we know which compounds in marijuana are effective, we may be able to develop more comprehensive treatment plans for patients with chronic pain. Until that time, hopefully the change in laws will promote good research with regards to the active compounds that will be effective in managing pain. More tools to treat pain will always be helpful. Unfortunately, research takes time and these new compounds may take up to 10 years or longer to develop.

Sex and Chronic Pain

June 30, 2014February 17, 2016 / Thomas Cohn, MD

Many patients who have chronic pain say they have no interest in sex, that sexual intercourse causes too much pain, or that they feel unattractive or undesirable because of the pain. It’s important to remember that emotional intimacy is as important as food and shelter for overall health. Sexuality is a normal part of living and is an important aspect of your identity. Chronic pain often invades the pleasures of life and destroys your sexuality.

Chronic pain affects the patient emotionally and physically. The psychological problems that chronic pain causes include:

Stress
Depression
Anxiety
Diminished self-esteem

If the brain cannot desire sex, the body certainly will not perform. The core problem may simply be the pain, but often it is much more complex. Receiving help requires the patient to identify that they are having sexual issues.

The most common direct causes of sexual problems include too much pain and medication side effects. Adjusting pain treatments may be the only necessary intervention. It also may be necessary to become more aggressive in the overall management and intervention for the painful condition. Many medications used in pain management (as well as medications for common problems) can cause sexual problems, including narcotics, anti-inflammatories and even antidepressants. A comprehensive strategy may be necessary and working with a pain physician may be the best approach.

Emotional Issues

Chronic pain often causes emotional problems, including stress, anxiety and depression. These problems all contribute to sexual difficulties. Until the psychological issues are being addressed successfully, it is often hard to control pain and have interest in sex. If simple medication management is not controlling emotional issues, professional help with a psychologist may be extremely beneficial.

Working with your partner is also necessary, especially when it comes to expressing your needs and concerns. Doctors cannot read your mind and if you do not tell them you are having problems, they will not be able to help you develop solutions. A comprehensive approach will often be necessary, since most problems involve a complex interaction between the emotional and physical causes. Working closely with your partner and professionals is often the solution. Most problems can be greatly improved with a little bit of support and creativity.

Pain Making it Hard To Sleep? We Can Help

June 25, 2014 / Thomas Cohn, MD

Pain often causes sleep problems. In patients with chronic pain, sleep problems occur in over 50 percent of patients. Problems with sleep can worsen pain and affect your whole life. Patients will often feel rundown, tired, depressed and very stressed. Relationships with your family, your spouse, and at work may be affected. Solving the issue if a complex process, and it won’t happen overnight.

4 Pain-Related Sleep Problems

Sleep problems can be divided into four categories:

Pain making it difficult to fall asleep
Chronic pain causing frequent awakening during the night
Pain may prevent restorative deep sleep
Waking up too early each morning because pain makes it impossible to fall back asleep

Each type of problem may need a different solution, and patients often experience more than one of the above conditions. The first step in treating the issue is by practicing good sleep hygiene. Activities that cause problems prior to sleeping include drinking caffeinated beverages and alcohol. Alcohol may initially cause tiredness but later in the night often disrupts sleep cycles.

Exercising late at night is another no-no. Exercise will help keep you awake, and napping during the day may also lead to decreased tiredness. The bedroom should be considered place only for sleeping and not for watching TV or doing work-related activities. The bedroom should be considered a calming and relaxing place.

Physician Treatment

When the simple things and conservative treatment does not help improve sleep, working with your physician for a more comprehensive treatment strategy is beneficial. A sleep study is often especially helpful in determining the issues that are preventing good sleep, and they can help formulate a plan to combat the problem. Multiple medications are available to help with sleep, but many can actually interfere with parts of this sleep cycle. Narcotic medications and older antidepressants may help with pain at night but often interfere with portions of the deep sleep cycle. Newer medications like Ambien and Lunesta are helpful in allowing the patient to fall asleep, but may not be helpful to keep a person asleep. Recently, melatonin at doses of 5-10 mg has been found to be helpful in maintaining good sleep cycles and reducing pain. Sleep studies can also be helpful to determine other medical problems that need to be treated to improve sleep.

Chronic pain often interferes with sleep, and poor sleep can lead to worsening pain. Improving sleep at night can often greatly improve the quality of life. Sleep problems can be simple, but often with chronic pain they are complex. A sleep study is sometimes needed to determine all problems associated with the lack of sleep. The solution to a good night sleep may require multiple changes and routines. The help of a pain specialist or a sleep expert may be necessary to find the right solution.

Therapeutic Pillows and Mattresses For Pain

June 16, 2014June 23, 2014 / Thomas Cohn, MD

Patients often ask me if they should buy a new pillow or mattress to help alleviate their chronic pain. The answered is complex. If your pillow or mattress is worn out, it may need replacing. Many pillows only will last one or two years. Mattresses on the other hand can last 10 or more years depending on the design. Pillows are often not too expensive, while mattresses can be quite costly. Unfortunately, the ideal mattress or pillow will always be a personal choice based on what is comfortable for the individual. There is very little medical research identifying the best pillow or mattress.

The Perfect Pillow

Comfortable pillows are very much a personal preference. Finding the perfect pillow depends on what position you usually sleep in. Some people sleep on their back, while others are more comfortable on their side or stomach. Find a pillow that gives your head support in a neutral position without bending your neck while you sleep.

What’s inside the pillow is also important. Some people prefer feathers, artificial down, or memory foam. The contour of the pillow may or may not be comfortable for each person. Most people need to try a variety of pillows to find their ideal design and comfort.

Magnificent Mattress

A good mattress provides support for the body in a natural position. Ideally, support should be evenly distributed along the whole body in whatever position a person is laying. A traditional mattress often does not supply even support to the body. Extra pillows often can help improve a person’s position in bed. If you lay on your back, a pillow under the knees flattens the spine and may increase the comfort in the low back. People who lay on their side, should try a pillow in between the knees for comfort. A mattress topper made of memory foam may also be helpful to improve comfort and prevent the need to replace a mattress.

The choices for new mattresses are complex. Some people like to have a firm mattress while others prefer a soft mattress. Some mattresses bend to raise the head or the legs. The more features a mattress has, the more expensive it will be. Mattresses that include a memory foam top layer help conform to the body and maintain a neutral position. An adjustable air mattress allows a person to determine the right firmness that is best for their sleep. A bed that changes position may allow adjustments for the best sleep position for the individual. Finding the right bed with the right features at the right cost is always a personal choice, and unfortunately, there is not a medically perfect bed, mattress or pillow.