Pain Catastrophizing and Chronic Pain Care

Pain CatastrophizingWhen it comes to managing chronic pain, it’s imperative to take as much care of your mental health as it is your physical health. Ignoring your mental health can lead to more negative attitudes towards your pain, which can lead to even more problems according to a new study.

A new report out of the Stanford University School of Medicine suggests that individuals who negatively fixate on their symptoms have been found to report greater pain intensity and are more likely to be prescribed opioids. Interestingly, the association was much higher in females than it was in men.

“When it comes to opioid prescriptions, pain catastrophizing has a greater effect on the likelihood for having a prescription in women than it does in men,” said medical student and lead researcher Yasamin Sharifzadeh.

Pain Catastrophizing

According to researchers, “pain catastrophizing” is defined as the cascade of negative thoughts and emotions in response to actual or anticipated pain. When you begin to let these negative thoughts continue to build and take hold over your pain, it can actually amplify the pain process and lead to greater pain and increased disability. Previous studies have shown that pain catastrophizing has been linked to increased pain sensations, but this is the first study to find a correlation between it and an increased likelihood of being prescribed opioids.

For their research, Sharifzadeh and her team analyzed clinical data from more than 1,800 patients with chronic pain. After analyzing the data and parsing out the results between genders, researchers came to an interesting conclusion.

“In men, it is pain intensity that dictates whether or not they are prescribed opioids,” Sharifzadeh said. “However, in women, there is a more nuanced issue where relatively low levels of both pain catastrophizing and pain intensity are associated with opioid prescription. Pain catastrophizing and pain intensity are working together in determining if a woman has an opioid prescription.”

This is especially problematic when you consider that women are more likely to suffer from chronic pain, be prescribed pain relievers and given higher doses for longer periods than men, according to the Centers for Disease Control and Prevention. However, by recognizing this correlation, doctors can help to mitigate this risk.

“If physicians are aware of these gender-specific differences, they can tailor their treatment,” Sharifzadeh said. “When treating chronic pain patients — especially women — they should analyze pain in its psychological aspect as well as its physical aspect.”

If you feel like your mental health is fighting a losing battle with chronic pain, reach out to your doctor. Contact Dr. Cohn today.

Early Findings From The Daith Piercing Study

daith piercingAs we mentioned a couple of weeks ago, a colleague of mine decided that he wanted to conduct some research on the daith piercing among individuals who have sought out the piercing for migraine relief.

As someone who has written numerous blogs on the subject, I wanted to help spread the word about the study, and of course I am interested in the results. So if you have a daith piercing and you haven’t take the survey yet, please click here to take it!

Daith Piercing Survey

Although the study is still in the collection phase, Dr. Chris Blatchley of the London Migraine Clinic was kind enough to share some of the early findings from the survey. We thought it would be interesting to share some of those findings with you before the results are really broken down and trends are discovered. So below, you’ll see some findings from the early batch of responses to the daith study.

  • The vast majority of respondents have had the piercing for 18 months or fewer. This is likely due to the fact that the daith piercing has only recently gained popularity in the pain care/migraine community.
  • Of the 50 or so respondents who have had migraines for over 10 years and had the daith piercing for over one year, 38 percent reported having migraines most days and only two percent said they had gone a month with one or fewer migraines. Since getting the piercing, only six percent report migraines on most days, and a whopping 69% say their migraines have been reduced to one or fewer a month.
  • The general consensus is that the majority of individuals who underwent the daith piercing procedure for migraine relief showed marked improvement in all modalities, although it is worth nothing that for a small percentage of individuals, their migraines got worse after the piercing.

These early results are interesting, and although this is only a surface level interpretation, we’re intrigued by the results. There are some obvious limitations in that the survey relies not only on self-reporting, but also self-reporting pain levels from years ago. However, the survey is certainly a huge step in the right direction for understanding pain pathways and harnessing the power of the daith piercing for the right patient.

One final thing we hope to glean from the study is a better understanding of the placebo effect on patients who undergo the procedure. Is their pain truly being resolved because it is helping stop the transmission of pain signals, or are people experiencing better results simply because they expect to? It’s a fascinating angle, but when you consider that the placebo effect has not been shown to be as effective in other medical interventions, it certainly seems like there is a credible link between the piercing and migraine relief in some individuals!

We’ll keep tabs on the survey as it continues, and be sure to take the survey if you haven’t yet!

Vitamin D’s Role In Controlling Chronic Pain

vitamin d painWhen it comes to controlling chronic pain, we all know how important it is to get a restful night’s sleep, but that’s easier said than done when you’re in regular pain. However, new research suggests that adding something to the mix may help control pain and provide you with a better night’s sleep.

According to research published in the Journal of Endocrinology increasing the levels of Vitamin D in the body can help manage chronic pain conditions, including arthritis. The correlation between the sun vitamin and pain control is no secret, as previous research has suggested that the vitamin can help inhibit the body’s inflammatory response, which sometimes triggers pain sensations. Other research has shown that Vitamin D deficiency has been linked to sleep disorders, so correcting the problem may lead to a better night’s sleep, and in turn, less pain.

New Findings on Vitamin D

The newest findings regarding Vitamin D are that when used in conjunction with a good night’s sleep, it can actually make other treatment methods more effective. This means that patients who increase their levels of Vitamin D and who partake in physical therapy for their chronic pain condition may notice more pain relief than individuals who only partake in physical therapy.

“We can hypothesize that suitable vitamin D supplementation combined with sleep hygiene may optimize the therapeutic management of pain-related diseases, such as fibromyalgia,” said Dr. Monica Levy Andersen, who led the review.

They concluded that pain management specialists and primary care physicians should consider asking patients about their Vitamin D intake or begin monitoring it in order to see if increasing intake on a daily basis helps to mitigate symptoms from certain pain conditions. Now, it’s important to remember that simply taking a Vitamin D supplement isn’t going to take your pain from a level 8 to a level 2, but there’s a chance that when paired with other treatment options that it could help take your symptoms down a level or two. It’s certainly something worth exploring.

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.