Chronic Pain Makes It Hard To Fall And Stay Asleep

/ Thomas Cohn, MD

Chronic pain makes it hard for patients to fall and stay asleep, and studies show pain sufferers are getting almost an hour less of sleep each night because of their discomfort.

According to the “2015 Sleep in America” poll conducted by the National Sleep Foundation, chronic pain plays a big role in how much and the quality of sleep people get. According to the study:

  • Chronic pain caused 57 percent of Americans a “significant loss of sleep.”
  • People with chronic pain said they got 42 fewer minutes of sleep than they needed each night.
  • People with chronic pain were more likely to blame their difficulty on other sleeping factors, like noise, light, temperature and mattress problems.

The biggest issue facing people with chronic pain was that it’s a cyclical battle. Pain makes it harder to fall and stay of sleep, and lack of sleep exacerbates chronic pain symptoms.

Chronic Pain Sleep

Tips For Falling Asleep With Chronic Pain

Falling asleep with chronic pain is no easy task, but there are some steps you can take to improve your chances of falling and staying asleep. Here are some steps to consider:

  • Stick to a Routine – Going to bed at 8:30 one night, 10:00 the next night and 11:45 on the weekend is a good way to throw your sleep rhythm out of whack. We know you might stay up later on the weekend, by strive for consistency during the work week.
  • Remove Distractions – The bedroom should be a place for sleeping, not a place you go to watch Netflix and read your Kindle for an hour before bed. Do those activities in another room so your body gets used to falling asleep faster when you’re in bed.
  • Keep it Dark – Similar to the above point, iPads, Kindles and televisions are bright objects that signal to your brain that you’re not yet ready to fall asleep for the night. Remove those electronics, close shades and turn off all lights, because it’s easier to stay asleep and fall back asleep in a dark environment.

Chronic Pain Is All About Being Resilient

/ Thomas Cohn, MD

Resilience is defined as the ability to weather adverse events and circumstances. When one has pain, resilience is the ability to cope with the pain and move forward in a positive direction. There are people who have chronic pain and who thrive in their lives. Others spend their time concentrating on every aspect of their pain and how their lives have changed and is controlled by the pain. The ability to be resilient is a skill, and an ability to deal with stress. Those who learn the skill of resilience can better survive the tough challenges life throws at them.

Resilient

The people I see on a daily basis have a varying degree of resilience. The most difficult people to treat are those with little resilience and ability to cope. The people who seem to do the best are those who have a high degree of resilience. Resilience takes some physical skills and a lot of mental capacity. Developing the mental ability may be natural, but is a topic many benefit from and can be taught often by psychologists.

New Research on Resilience

The newest research on resilience focuses on mindfulness. This is an area of psychology that has a person become aware of how they are responding to various situations and trains them refocus on appropriate responses and helpful approaches to problems. It also tries to diminish the emotional and irrational thoughts on a subject and replace them with practical solutions to a problem. In a way, focus on what you can change, and avoid becoming bogged down by your emotions.

A recently article in Time magazine listed ten expert tips for resilience. They are interesting guides in life and if put to use, may help improve the ability to handle stress and pain. Below are listed the tips from the Time article.

  • Develop a core set of beliefs that nothing can shake.
  • Try to find meaning in whatever stressful or traumatic thing has happened.
  • Try to maintain a positive outlook.
  • Take cues from someone who is especially resilient.
  • Don’t run from things that scare you: face them.
  • Be quick to reach out for support when things go haywire.
  • Learn new things as often as you can.
  • Find an exercise regimen you’ll stick to.
  • Don’t beat yourself up or dwell on the past.
  • Recognize what makes you uniquely strong and own it

Take these tips to heart, and you’ll notice that you’ll be better prepared to handle chronic pain.

Minnesota on the Eve of Medical Marijuana

/ Thomas Cohn, MD

Medical Marijuana in MinnesotaRecently there have been excellent reviews on the state of the science of medical marijuana. Minnesota is about to start its program, but only a handful of people have been approved for the program and there are not many providers interested in participating. So why is medical marijuana off to such a slow start in Minnesota?

Medical cannabis is a complex subject, after attending many lectures on the subject, and reviewing significant amounts of literature, the one main conclusion is that the science behind cannabinoids is only in its infancy. For the average reader, the Time Magazine May 14, 2015 and the National Geographic July, 2015 issues have good information. At a higher level for medical science, the June 23/30, 2015 issue of the Journal of the American Medical Association has more data.

US Lags Behind

The United States has not been a leader in the study of marijuana. Since marijuana has been labeled a Schedule 1 compound by the DEA, its scientific analysis in the U.S. has been extremely limited. Some of the best research initially has come out of Israel where many of the cannabinoid compounds have been isolated, and in Spain where some of the cancer research and other studies have been done. The most recent issue of JAMA has reviewed a large number of medical studies with regards to a variety of conditions. For the scientist, it is clear there is a significant shortage of information supporting claims of effectiveness of the compounds for most conditions. Most information is based on a very limited numbers of study participants. Comparing the information to almost all other drugs on the market, these studies would barely qualify for drug approval.

The quality of studies for marijuana and chronic pain has been especially limited. The studies researched include neuropathic pain and cancer pain. Most of the studies just looked at a numeric pain scale to measure success and did not quantify any other objective measure like functional ability. The outcome was a modest improvement in reported pain level, but deeper evaluation did not show any changes in quality of life measures when compared to placebo or standard treatments.

After reading multiple articles on cannabinoids and pain, one clear message is present. First, there are a number of different cannabinoid compounds, probably well over a hundred. Second, the chemistry is poorly understood and the effectiveness to treat a variety of medical conditions is limited. Medicine has become a very science driven field. Physicians are constantly under fire to provide care that is safe and effective. The current status for medical marijuana is truly still in the research phase. We won’t be able to fully embrace medical marijuana as a viable option until we know more about all of its compounds.

Pain Doctors Looking To The Painless For Possible Solutions

/ Thomas Cohn, MD

Pierce BrosnanIf you’re a James Bond fan, you may remember the 1999 film, The World is Not Enough. The movie’s villain is a Russian terrorist named Renard who suffers from a rather unique condition. During an encounter with British agent 009, Renard gets shot in the head. However, like most bad guys in the movies, the oft-would-be kill shot doesn’t end up being a fatal blow. Renard’s doctor saves his life, but he is unable to remove the bullet, as doing so would kill the man. Eventually, the bullet will claim Renard’s life, but until that time, its presence in his medala oblong gata renders him almost senseless, dulling his ability to smell, taste and even feel pain.

Although the events leading up to Renard’s condition are unique, the inability to feel pain is not. Many people are unable to sense pain, which may sound appealing, but it can actually be very dangerous. After all, pain is one of the quickest ways our body tells us that something is wrong.

Inability to Feel Pain

The inability to feel pain is known in the medical community as congential insensitivity to pain. It is part of a larger set of disorders known as hereditary sensory and autonomic neuropathy.

As we mentioned above, it may sound cool to feel “invincible,” but it can leave you open to injury. For example, let’s say you have the condition and you set your hand on a hot stove. You’ll still suffer the burns, but you won’t realize you’re being burned. See how this could be an issue?

Interestingly, it’s the pain-free that the pain community are turning to to address the problem of chronic pain. Researchers at Cambridge University have recently pinpointed the exact gene responsible for the pain-free condition, and they’re trying to replicate its expression to help find new pain management avenues.

According to researchers, knowing the underlying mechanisms of pain sensations are critical to controlling and reducing pain, especially because some current methods are ineffective or addictive.

“We are very hopeful that this new gene could be an excellent candidate for drug development, particularly given recent successes with drugs targeting chromatin regulators in human disease,” said Dr. Ya-Chun Chen, the study’s first author.

Obviously the treatment strategy is in the beginning stages, but it’s encouraging for the future of pain management. The key here will be to find a delicate balance between helping people achieve chronic pain relief without dulling the senses so much that the individual is in danger.

Related Source: Medical Daily

Talking Therapy May Help Ease Chronic Pain

/ Thomas Cohn, MD

Talking therapy, where patients focus on easing psychological stress to make it easier to complete physiological activities, may be another avenue for chronic pain sufferers.

The therapy – also referred to as Contextual Cognitive Behavioral Therapy or CCBT – works by helping people overcome stress that can exacerbate chronic pain symptoms. For example, some people with chronic pain may become stress/fear avoidant, meaning they’ll avoid certain activities simply because they fear the potential outcome. Not only can limited activities make a chronic pain condition worse, but it can also make it harder for the patient to fully overcome the condition.

“We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments,” said Dr. Stephen Simpson, director of research and programs at Arthritis Research UK. “This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”

Talking Study

For their study, researchers recruited 89 patients with chronic back pain and split them into two groups. The first group received just physiotherapy, while the second group received CCBT and physiotherapy. After completing their assigned therapy, researchers noted that physiotherapy was more successful if patients also received CCBT. Additionally, patients who received both therapies said they believed CCBT helped them be successful in physiotherapy.

“Our study found that CCBT is acceptable to patients,” said Tamar Pincus, a professor at Royal Holloway University of London. “Interestingly many patients who took part, as well as several of the clinicians involved — both psychologists and physiotherapists — thought the best treatment was a combination of both physiotherapy and CCBT.”

Researchers concluded that physiological treatment is just as important as physical treatment when dealing with chronic pain, as mental therapy can improve patient conditions and reduce treatment costs.

Related source: UPI.com