Smoking Increases Risk of Chronic Back Pain

December 2, 2014 / Thomas Cohn, MD

A new study conducted at Northwestern University found further evidence that smokers are at an increased risk for developing chronic back pain.

While medical experts have known for a while that smoking increases a person’s risk of chronic back pain, this study examines why that’s the case. Researchers were keen to learn more about the link between back pain and smoking as back pain affects more than 80 percent of the population at some point in their life. According to the folks at the American Chiropractic Association, back pain is the number one reason for missed work and the second most common reason for doctor’s visits.

Smoking Study

For their study, researchers examined 160 individuals who had developed subacute back pain, which is defined as back pain lasting between 1-3 months. In addition, researchers analyzed 32 participants with chronic back pain – back pain for more than five years – and 35 people with no symptoms of back pain. Patients were asked to complete a health and wellness questionnaire once a year for a period of five years, and they also underwent MRI brain scans to analyze brain activity in the nucleus accumbens and the medial prefrontal cortex. These areas play a role in a person’s addictive behavior and motivated learning.

Without getting too technical, researchers say there is a crucial connection between these two areas of the brain. The stronger the connection between the too, the less resilient a person is to chronic pain. According to researchers, smokers had a stronger connection between these two areas of the brain compared to non-smokers, meaning smokers were more likely to develop chronic pain. In fact, researchers suggest that a smoker is three times more likely to develop chronic back pain than a non-smoker.

But there is good news. Dr. Bogdan Petre said the connection between the nucleus accumbens and the medial prefrontal cortex can be decreased by kicking the habit.

“We saw a dramatic drop in this circuit’s activity in smokers who – of their own will – quit smoking during the study,” said Petre. “So when they stopped smoking, their vulnerability to chronic pain also decreased.”

Petre concluded that his team’s findings are only further evidence that smokers are putting themselves at risk for chronic back pain.

“We conclude that smoking increases risk of transitioning to chronic back pain, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning.”

Doctor Ratings and the Importance of Communication

November 24, 2014 / Thomas Cohn, MD

Everyone wishes to have the best doctor available. In Minnesota there are multiple rating services available that score doctors, however, which rating systems are the best? Some services rate doctors on their compliance to medical guidelines such as those established for asthma and diabetes. Other services monitor the cost of a physician’s per patient billing to the insurance company, while others are patient reviews. The real question is, what will make you happy with your choice of physician?

Important qualities in a doctor includes their knowledge, skill, understanding of a patient’s condition and their communication skills. Almost every physician will have a good basic set of knowledge about any medical condition that they treat. In any profession, from car mechanics to teachers, 90 percent of the practitioners are good and 10 percent are exceptional and have a special talent in that field. Skill level is similar; most physicians have good techniques, but some just know the small things that make all the difference when doing any procedure, and are just better than others.

Understanding a patient’s condition is somewhat complex. First, a doctor must be prepared. This includes reviewing a patient’s medical record and knowing their history. This is ongoing, and the doc should know this information at each visit. Medical records are helpful, but personal notes may be needed in addition to fill gaps. Experience is also important, as is continuing to grow in their skill by attending conferences and seminars on a regular basis.

Doctor-Patient Communication

Communication between the doctor and patient is critical in quality of care. Most important is that communication is not one directional. To treat a patient, a doctor needs to know what is wrong, what are the symptoms, and what is actually working correctly. Since doctors often have limited time with each patient, they will need to guide the conversation to obtain the relevant information. Being honest is also extremely important. There are often multiple sources to confirm data, and if the information provided is not truthful, a doctor will likely be guarded in their care. Patients also need to ask questions about their condition and be open about their recovery.

Ratings of doctors are of limited value. The final rating that matters is how well you communicate with your doctor and whether or not you trust his ability and knowledge. Sometimes, you can find the right physician without any trouble. Other times, word of mouth and information from friends who know the practitioner is critical. Ratings on the web may be inaccurate or forums for the unhappy patient. No physician will be perfect, but finding the right physician may be a matter of how well both you and the physician communicate with each other.

How Obesity Makes Pain Problems Worse

November 17, 2014 / Thomas Cohn, MD

More information is now becoming available about how obesity can contribute to pain problems, sometimes in unexpected ways. Obesity is a known factor for osteoarthritis of the knees, and increased weight leads to mechanical stress on the knees, causing premature deterioration. Another factor is problems directly related to adipose tissue, fat, and products this tissue produces. Fat produces compounds that influence inflammation. These compounds can make weight bearing and deterioration worse.

Recent studies have shown that weight and thus mechanical stress is a main cause of knee degeneration. The majority of the patients that have knee degeneration are significantly obese. Other factors for knee arthritis often include multiple injuries and repetitive trauma from activities like sports or running. Running can be especially damaging with the impact on hard surface. That said, conversely, losing weight can actually relieve symptoms in patients with knee osteoarthritis. Managing knee pain is closely associated with managing your weight.

Hand Pain and Obesity

Unlike knee arthritis, hand arthritis is not typically related to mechanical stress of weight. Studies have found in these cases, the chemical factors related to inflammatory compounds have significant impact on these joints. The relationship between inflammatory compounds and hand joint deterioration have confirmed that hand arthritis is more common in the obese. Research has now begun to identify the chemical compounds that are increased in obese individuals with arthritis to determine how their presence can best be deterred.

Obesity causes mechanical stress and now we know fat releases chemicals that cause inflammation and pain. Reducing weight does decrease mechanical stress on joints. It may also decrease the amount of available inflammatory compounds that also cause damage to joints. Pain has many causes, but since individuals can have significant control over their own weight, managing it is one of the best ways to decrease your likelihood of developing arthritis in your joints.

Men and Women Similar When It Comes To Chronic Pain

September 25, 2014 / Thomas Cohn, MD

Although there have been previous studies that suggest women have a higher pain tolerance than men, a new study out of the University of Malaga suggests that a person’s resiliency, not their sex, determines how well they handle chronic pain.

For their study, researchers analyzed numerous traits among 400 patients suffering from chronic spine pain (210 women and 190 men). What they found was that personal qualities, not genetic differences, was the best indicator of how a person dealt with chronic pain.

In essence, certain men and women have a very difficult time managing chronic symptoms, while others are able to work through the discomfort. The people who don’t let the pain bog them down are the same people you’d want on your basketball team when you’re down 10 points in the fourth quarter or if you need a big last week to meet your quarterly sales goals, because the research suggests that how a person handles adverse circumstances is the primary quality linked to an individual’s pain tolerance and how they adjust to chronic pain.

According to the researchers, the findings suggest more similarities than differences between men and women.

“More resilient individuals tend to accept their pain, that is, they tend to understand that their ailment is chronic and they stop focusing on trying to get the pain to disappear, to focus their energy on enhancing their quality of life, despite the pain, said Carmen Ramirez-Maestra, the study’s lead author. “In this regard, patients who are able to accept their pain feel less pain, they are more active on a daily basis and have a better mood.”

So remember, treating chronic pain is only half the battle. Dealing with, accepting, and not letting pain wear you down are other pieces to the pain puzzle.

Related source: Daily Digest News

Examining Germs, Bacteria and the Hand-Washing Debate

September 3, 2014 / Thomas Cohn, MD

The prevention of the spread of disease is important. Lately in the news there have been stories saying we should stop shaking hands to prevent disease. For doctors, wearing ties is out, and coats is of serious question. Sterile technique for any procedure is a major ritual. In reality, are we going a bit crazy with our fear of germs? The answer is probably yes, but we do need to use some common sense.

Our bodies depend on bacteria to maintain our health. The mouth and colon are filled with bacteria that digest our food and are essential to us getting the right nutrition. The skin has bacteria all over it, which prevents the wrong bacteria from taking hold. We use yeast to create food and drink for us daily.

There are microorganisms that help us live, and others that make us sick. If we live in a germ-free bubble, the body never learns to distinguish good and bad, and the immune system in our bodies becomes unable to fight the correct germs. The best example is our ability to fight the flu virus. Children are much more prone to get sick from the flu every year since they have not had exposure to these viruses and the body has no antibodies to fight the virus. Older adults have developed antibodies to many strains of the flu and often do not get sick from the various strains spreading every year.

Hand Washing and Bacteria

Healthy people will have a variety of germs on their hands. Touching another person or shaking their hand should not be an issue. As a physician, washing hands between patients is logical, especially if treating sick people who may have contagious problems. Treating healthy people with pain problems, or many other problems like high blood pressure or high cholesterol, should not be an issue of spreading disease.

In the past, physicians that touched their patients – categorized as hands-on doctors – were found to be the best liked and most successful healers. For a physician, washing hands in-between patients makes sense to prevent the accidental spread of unknown infections. Shaking a patient’s hand and touching a patient allows one to establish a good relationship and do a good exam. The body can handle normal germs in the environment and our immune system is geared with this ability. Recognizing the conditions when contamination can occur and preventing those issues is the important message. If you are healthy, the body should be able to control most common germs and it is okay to shake a person’s hand and not panic.