study

Yoga And Acupuncture May Ease Chronic Pain Symptoms

/ Thomas Cohn, MD

Yoga Chronic Pain MinnesotaNew research published in the journal Mayo Clinic Proceedings suggests that activities like yoga, Tai Chi and other complementary health approaches may help alleviate discomfort associated with some types of chronic pain.

Lead author Richard L. Nahin, Ph.D., of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH), suggested that activity options like Tai Chi and yoga may help prevent symptoms from chronic pain, especially when paired with other treatment options like regular exercise, a healthy diet and certain pain medications.

“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects,” said Nahin. “As a result, many people may turn to non-drug approaches to help manage their pain.”

Chronic Pain, Yoga and Tai Chi

For their study, researchers identified 150 randomized, controlled U.S. clinical trials conducted over the past 50 years that examined non-drug approaches to chronic pain. Specifically, the research targeted five common sources of pain, which were:

The treatment techniques analyzed were considered effective if patients reported that it led to improvements in pain severity and pain-related disability/function. After looking at the data, researchers found that both yoga and acupuncture were safe and effective for chronic back pain, while Tai Chi and acupuncture may be most beneficial for patients with osteoarthritis of the knee. Massage therapy was also somewhat beneficial for patients suffering from neck pain when it was managed with one-hour sessions 2-3 times per week.

“These data can equip providers and patients with the information they need to have informed conversations regarding nondrug approaches for treatment of specific pain conditions,” said David Shurtleff, Ph.D., deputy director of NCCIH. “It’s important that continued research explores how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”

At the end of the day, the study paints an interesting picture at some non-drug techniques that can be used in conjunction with other lifestyle interventions to provide relief. Simply getting massages or doing some yoga isn’t going to fully rid you of your pain, but it can play an important role in a total pain management plan. There is no magic pill to cure many of the above conditions, but with a multifaceted approach that involves treatment with a physical medicine pain specialist, relief can be found.

The Link Between Anxiety and Chronic Pain

/ Thomas Cohn, MD

Anxiety and chronic pain minnesotaResearchers say the expression of a single peptide has been linked to both anxiety disorders and chronic pain, suggesting that we may be on the verge of a breakthrough for treating patients with both conditions.

Currently far too many patients are being prescribed a combination of drugs to treat both their anxiety and chronic pain condition, which researchers say can be dangerous. Instead, researchers say the discovery of the expression of pituitary adenylate cyclase activating polypeptide, or PACAP for short, could change the way we simultaneously treat the two conditions.

“Chronic pain and anxiety-related disorders frequently go hand-in-hand,” said Dr. Victor May, a professor of neurological sciences at the University of Vermont and study author.

Chronic Pain and Anxiety Disorders

For the study, researchers used mice to determine where the pathways for stress and pain intercept. By applying what the team called a “PACAP receptor antagonist,” researchers were able to successfully reduce both stress and pain in the rodents.

“By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders,” said May, who plans to next develop small molecule compounds that can antagonize PACAP actions. “This would be a completely different approach to using benzodiazepine and opioids — it’s another tool in the arsenal to battle chronic pain and stress-related behavioral disorders.”

The findings are intriguing because the US Food and Drug Administration recently issued a strong warning against mixing opioid painkillers and benzodiazepines, which is a current standard treatment for patients with chronic pain and anxiety. You can read more about the study here.

Chronic Pain and Depression

/ Thomas Cohn, MD

Chronic Pain DepressionThe majority of people will deal with chronic or nagging pain at some point in their life, and new estimates suggest that 1 in 10 adults will be diagnosed with chronic pain every year. Even though these numbers are really high, as a society, we’re not doing a very good job of solving the problem of chronic pain.

Even when chronic pain is managed and controlled, it can lead to other issues. When you’re constantly dealing with physical pain, it can be mentally and emotionally exhausting, and the same can be said in the inverse. If you aren’t in the right mindset, it can be difficult to stay active and really work towards preventing chronic pain.

Recently, a new study decided to take a closer look at the connection between chronic pain and mental health – more specifically, depression and chronic pain. For their study, researchers out of the University of Edinburgh in the United Kingdom examined physical and mental health assessments of more than 100,000 individuals.

Depression and Pain

After looking at the findings, researchers uncovered:

  • People who have partners with depression were more likely to experience chronic pain.
  • A person whose spouse was depressed had an 18.7 percent increased risk of suffering from chronic pain.
  • Also of note, having a parent with chronic pain increased a person’s likelihood of developing chronic pain by 38.4 percent.

“We hope our research will encourage people to think about the relationship between chronic pain and depression and whether physical and mental illnesses are as separate as some believe,” researchers wrote.

At the end of the day, this research shines a little more light on another potential avenue for chronic pain management. Sometimes we need to go beyond the root source of the pain and look at environmental and other contributing factors. If we can improve our mental health and the mental mindset of those around us, we might be able to reduce the number of people who have to battle chronic pain on a daily basis.

Smoking Worsens Chronic Back Pain

/ Thomas Cohn, MD

Smoking Back Pain chronicNew 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.

How To Properly Dispose of Pain Pills and Opioids

/ Thomas Cohn, MD

Pain Pill Disposal MinnesotaOpioid 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.