How To Prevent Chronic Pain After A Joint Replacement Procedure

/ Thomas Cohn, MD

knee chronic painA joint replacement procedure can help you get back to moving without pain and significantly improve your quality of life, but these improvements won’t happen by accident. Joint replacement is a major trauma on your body, and if you don’t work hard to help your body heal following the operation, discomfort and even pain can linger. Nobody wants to undergo a joint replacement procedure only to be left with chronic pain, so you need to be proactive during your recovery.

Below, we take a closer look at how you can work to prevent chronic pain after a joint replacement procedure.

Preventing Pain After Joint Replacement Surgery

It doesn’t matter if you go to the best joint replacement surgeon in the world; if you expect to lay in bed for months and make a full recovery, odds are you’ll be left with discomfort or chronic pain. So what should you be doing during your recovery? While your specific course of treatment will be put in place by your treating surgeon, they will likely recommend some of the following techniques.

1. Early Movement – As we just mentioned above, you’re going to want to follow the care plan put in place by your treating physician, but many joint replacement procedures see the patient perform some early movement exercises. These will be nothing that your new joint can’t handle, but these exercises are imperative for improving your circulation and establishing comfortable range of motion. It may not be comfortable, but it’s going to be worth it. Early motion is essential for helping the new joint get used to normal movement patterns.

2. Physical Therapy – The single best thing that you can do to help your joint become stronger and more functional is to give it your all during your physical therapy sessions. If you don’t push yourself, your joint won’t become as strong as possible, and the same can be said if you stop your PT exercises early. Until you get full clearance to stop your exercises, make sure that you go to your in-person sessions and do all of your home-based routines.

3. Mind Your Restrictions – The first two points talk about pushing your body physically, but it’s also important to stay within your restrictions. If you step outside your restrictions or try to return to work or certain physical activities before enough healing has occurred, you’re opening yourself up a setback, and that can increase your likelihood of chronic pain. If you think you’re making great progress and you want to take on more of a physical challenge, make sure you get clearance from your physician.

4. Be Aware Of Signs Of Complications – Although infections are rare, they do occur, and that can greatly impact the stability and overall health of your new joint. Keep your incision site clean and change your dressings as recommended by your physician. If you notice discolored fluid, foul-smelling discharge or the incision site is hot, let your doctor know, because these are the early warning signs of an infection.

5. Focus On Your Diet And Sleep Health – Your diet will help you get the right nutrients to aid in recovery, and sleep is an important time for tissue healing. Be cognizant of the foods and liquids you are putting in your body, and strive to get healthy sleep each night. Falling asleep and staying asleep after a joint replacement procedure won’t always come easy, but if you develop healthy sleep habits and try to go to bed and wake up at the same time each day, you can help to create an ideal environment for healing and chronic pain prevention.

Keep these tips in mind, and if you want additional help fighting off chronic pain after an injury or surgery, reach out to Dr. Cohn and his team today at (952) 738-4580.

Showing Gratitude Can Help Manage Chronic Pain Symptoms

/ Thomas Cohn, MD

gratitudeIf we experience loss or sadness, oftentimes it leads us to channel our thoughts inward and to be thankful for the things we have. This feeling of gratitude can be an incredibly powerful sentiment, so much so that researchers want to see if expressing feelings of thankfulness could have an impact on our physical and mental health. Interestingly, showing gratitude helped improve a number of different life aspects that had a positive impact on pain. We take a closer look at this gratitude-based treatment below.

Gratitude Journaling And Chronic Pain

For the study, a group of researchers had 151 patients with arthritis test their theory on gratitude expression as a way to manage physical pain. Patients completed four once-weekly programs that included animated guides, audio-guided mindfulness exercises and self-directed gratitude journaling. Researchers hypothesized that focusing on some of the positive aspects of life and finding ways to write about individual thankfulness could help to reduce the fear of movement, pain self-efficacy and pain anxiety. Patients also completed pain-related questionnaires prior to and at the conclusion of the study

After completing the gratitude journaling program, researchers found that participants showed significant improvements in all three aspects. Researchers also said that they believe these three problems can feed off of one another. For example, fear of movement can create a decreased sense of pain self-efficacy, which in turn leads to more anxiety about pain. However, the same factors can show interconnected improvement through gratitude journaling. Focusing on the good in life can help keep you active, which can increase your pain self-efficacy and reduce your pain anxiety.

Another study involving chronic pain patients asked them to journal about their day, and these journal entries were specifically screened for language that indicated gratitude. When these journal entries were compared to pain scores for the day, researchers found that when daily gratitude was lower than average, patients reported more feelings of pain and fatigue. Conversely, when journal entries conveyed more gratitude than average, patients reported lower pain levels and improved sleep scores.

So while it’s easier said than done to focus on the things in life that you should be thankful for when you’re in the midst of a chronic pain flareup, gratitude journaling has its roots in mindfulness training. There are things in this world that are out of our control, and if we spend too much time focusing on these uncontrollable aspects, worry, doubt and anxiety can creep in, which only tend to worsen our pain condition. Reframing how we think towards controllable aspects of our life, or in the case of gratitude journaling, the things that we have that we are thankful for, we can regain some semblance of control over our chronic pain condition.

So if you journal, or if you have a chronic pain condition and you want to see if gratitude journaling has a positive affect on your health, we encourage you to pursue this incredibly low-cost treatment option. While writing out some of the things you are thankful for should by no means be your only form of treatment, it certainly appears that it can provide some benefits for the right patient.

Focus on the controllable and the positive things in life, and chronic pain may not seem as burdensome. To connect with someone who can help you manage all the physical, mental and emotional aspects of your chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

How To Maintain An Active Lifestyle Despite Chronic Pain

/ Thomas Cohn, MD

active chronic painChronic pain can make living an active life a little harder, but it’s certainly not impossible to stay active despite your chronic pain condition. In today’s blog, we share some tips for how you can work to maintain an active lifestyle even though you are managing a chronic pain condition.

Staying Active Despite Chronic Pain

It is important to remember that chronic pain is highly individualized, so it’s unlikely that all of these tips will work for every single patient hoping to stay active in spite of their chronic pain condition. That said, we’re confident that at least a couple of these tips can help you find it a little easier to stay active in the face of your pain condition. Here’s what we recommend.

1. Capitalize On The Good Days – Your pain and your mood can ebb and flow each day based on your symptoms, and you should never be ashamed to cancel plans or skip a workout if you’re dealing with a significant flareup. Conversely, you also want to pounce on an opportunity. If you’re having a good day, make the most of it. You don’t need to scale Mt. Everest or run a marathon simply because you are having a good day, but you should strive to be more active, because activity begets more activity. It may be easier to stack more good active days in a row if you take advantage of the time when your body can handle physical activity.

2. Know Your Limits – At the same time, it’s important to learn about your physical limits and to not overdo it during physical activity. If you’re taking on a new activity like hiking or cycling, don’t do too much at the beginning. Start slow and gradually build up your pace and your distance. Taking on too much physical activity can overstress your body and lead to injuries or worsening pain symptoms.

3. Utilize Ice And Heat – When you’ve returned home after your adventure, be sure to take care of your body with ice and heat. Ice packs can help to control swelling that may be more common in patients with certain chronic pain conditions, and hot packs or a warm bath can help to open up blood vessels and improve healthy blood flow throughout your body. See which methods help your body recover following periods of physical activity.

4. Strive For Healthy Sleep – Again, we know that it is easier said than done to tell a patient with a chronic pain condition that they could benefit from getting more quality sleep, but it really should become a point of emphasis if you want to pursue an active lifestyle. Restorative sleep ensures that we wake up ready to attack the day, and healthy sleep has been shown to help control pain sensitivity levels. Poor sleep can make us more sensitive to pain signals, which can only make it harder to get out and be active. Try to go to bed at the same time at night in a dark, distraction-free room, and you may find that you have more energy each morning.

5. Consistency Is Key – Finally, consistency is crucial when trying to maintain an active lifestyle with chronic pain. If you can gradually increase your activity levels and strive to always hit these goals each week, even in the face of chronic pain, it will be easier to always hit your activity targets and take on more physical tasks. It will take time and it won’t be easy, but forcing yourself to remain consistent in the short-term will make it easier to stay active in the long run.

If you focus on the above tips and connect with a pain specialist like Dr. Cohn for your individual pain care needs, we know that you can get back to living an active and independent lifestyle. For more information, or for help with your pain issue, give his office a call today at (952) 738-4580.

Brain Implants Are Helping To Decode Chronic Pain

/ Thomas Cohn, MD

brainChronic pain is one of the most common reasons why people visit a doctor’s office, but because of the highly individualized nature of chronic pain, figuring out a diagnosis and effective treatment plan isn’t always easy. It’s tough to really get inside the brain of a person who is battling a chronic pain condition, but that’s exactly what researchers tried to do with this most recent study.

To get a better understanding of chronic pain pathways, researchers implanted electrodes into the brains of four volunteers who were experiencing pain following an amputation (known as phantom limb pain). The participants went about their day as normal while the implants recorded activity in two specific brain regions where researchers believe pain responses occur – the anterior cingulate cortex and the orbitofrontal cortex. Patients were also asked to rate their pain levels on a standard scale several times a day over the course of six months, and when they would do this, they would also press a button that would cause the implants to record their brain signals for 30 seconds.

The captured information was then fed through a machine learning model that could find patterns in the data and predict each patient’s pain level based on the signals in their brain.

“From these models, we found that [electrical waves with] low frequencies in the orbitofrontal cortex corresponded with each of the patients’ subjective pain intensities, providing an objective measure of chronic pain,” said Prasad Shirvalker, a neurologist at the University of California, San Francisco and a co-author of the study, writes in the Conversation. “The larger the shift in low-frequency activity we measured, the more likely the patient was experiencing intense pain.”

Chronic Pain Brain Signals

Shirvalker went on to say that pain is highly individualized, but eventually they hope to decode unique pain signals to come up with patient-specific treatment plans.

“This is the first time ever chronic pain has been measured in the real world,” Shirvalkar tells the New York Times’ Priyanka Runwal. “Every patient actually had a different fingerprint for their pain.”

Researchers also wanted to better understand how the brain responded to painful stimuli, so they applied heat to each patient’s body to see how their brains reacted. They found that acute pain led to a more involved response from the anterior cingulate cortex. Because chronic pain involved a greater reaction from the orbitofrontal cortex, researchers say it’s the first time that there is direct evidence that chronic pain and acute pain involve different areas of the brain.

The data is extremely limited and was only collected on individuals who underwent amputation, but it is a step in the right direction for better understanding chronic pain and how our brains respond to these stimuli. Hopefully future research can continue to build on these findings and focus on more discoveries around the orbitofrontal cortex and its response to pain. The more we learn about how our brains react to chronic pain, the easier it will be to come up with targeted treatments.

In the meantime, if you need a more traditional approach to diagnosing and treating your chronic pain, reach out to Dr. Cohn and his team today at (952) 738-4580

Chronic Pain More Common Than Diabetes And Depression

/ Thomas Cohn, MD

diabetes chronic painNew data from the National Institutes of Health found that new cases of chronic pain are being reported at higher rates than diabetes, depression and high blood pressure.

The research, based on data from an annual survey form the Centers for Disease Control and Prevention, surveyed adults on how often they experienced pain in the previous three months. In the survey, chronic pain was defined as having pain on most days or every day over that three-month period. The results were then compared to the responses of more than 10,000 respondents in 2019 and 2020. Researchers then worked to determine the rate of new cases that developed over that period using a metric called person-years, which took into account the number of people in the study and the amount of time between survey responses.

An analysis of the data found that new chronic pain cases were developing at an alarming rate. Researchers found that there 52 new cases of chronic pain per 1,000 person-years, which outpaced the rate of new cases of high blood pressure (45 new cases per 1,000 person-years). The chronic pain rate was also far higher than the new case rate of depression and diabetes. The team also noted that of those without any pain in 2019, 6.3 percent reported new chronic pain in 2020.

“What we’re finding is, to nobody’s surprise, we have an astounding problem of pre-existing chronic pain in this country and a huge amount of people who are developing chronic pain as each year goes by,” said Dr. Sean Mackey, chief of pain medicine at Stanford University School of Medicine, who wasn’t involved in the research.

Concerning Data On Chronic Pain

High blood pressure is still more prevalent, but chronic pain is closing the gap as new cases outpace hypertension. Data shows that around 48 percent of adults had high blood pressure between 2017 and 2020, while 21 percent of the more than 10,000 surveyed adults reported chronic pain. That outpaces the 19 percent of U.S. adults with depression, and the rates of diabetes, heart disease and asthma, which all sit under 10 percent.

So while high blood pressure may still be a greater threat to the nation as a whole, the findings on chronic pain should be eye opening on a national level. It is great to see that this study is getting attention from large outlets like The New York Times, USA Today and NBC News, but covering the issue is only part of the puzzle. We also need to commit a lot more funding to treatment-focused studies. Understanding that chronic pain is a problem is helpful, but now that the national burden is under the spotlight, we need to put resources towards improving our understanding of how to best treat this highly individualized condition.

Another silver lining to take away from this study is the knowledge that if you are suffering from chronic pain, you certainly aren’t alone. More new cases are being diagnosed than many other serious conditions, and while that’s not great news in and of itself, it does mean that it should be easier to connect with others and with doctors who are familiar with your plight.

If you have questions about chronic pain or a condition that you’re battling, let us be a resource. Reach out to Dr. Cohn and his team today at (952) 738-4580.