Chronic Pain in the Summer

/ Thomas Cohn, MD

The summer is here and it’s time to be outdoors. Summer heat and the change of seasons can have a variable effect on pain, as medical conditions react differently to weather changes. Most pain conditions often do better during the summer, since the warmth allows muscles and joints to move more comfortably. Summer also allows for more time to use the outdoors as a place to exercise.

The warmth of summer is often a blessing for those with painful conditions. Muscles in the warmth often do not tighten up, and thus hurt less. Joints are less stiff since they are not cold. Now is the time to get some exercise. Start exercising slowly, warm up and stretch your muscles as you get going. Remember, if you have not been exercising, do not over do it initially. Walking is good exercise, and gradually increase your pace, distance and time as you build up strength. Go for 30 minutes a day and meet the American Heart Association goals for cardiac conditioning. If walking is too slow, bicycling is another low impact activity that can easily get the heart moving. Exercise stimulates the body’s endorphins, improves the brain function and decreases pain. Get a fitness tracker and monitor whether you are meeting your goals.

Pain in the Summer

Pace, Hydration and Sun Protection

Once the weather turns nice, many of us forget common sense. We need to pace our selves especially with activities that we have not done or which are repetitive. Spending a weekend doing extensive landscaping is likely to cause injury. Heavy lifting and highly repetitive jobs or sports may damage the back or muscles, tendons and ligaments. Be reasonable and break up the tasks that need to be done to prevent problems.

The summer is a great time to be outdoors. However, do not forget to hydrate and protect against the sun. Dehydration is easy if it is hot and humid outside. Drink plenty of water, and if you are sweating excessively, drink liquids that replace nutrients. Avoid drinking alcohol when its hot outside since this tends to lead to dehydration. Remember the sunscreen when outdoors, as new studies show men ignore using sunscreen and have a higher incidence of skin cancer.

Summer is a good time to have some fun. Relax, exercise and enjoy the outdoors. There are many benefits of being outside and taking advantage of the good weather. Use a little common sense and your pain may greatly improve.

Chronic Nerve Pain Can Impact Mood and Motivation

/ Thomas Cohn, MD

Chronic Pain BrainChronic nerve pain doesn’t just make it painful to go through your daily routine, it may actually make it psychologically harder for your brain to get motivated to complete certain tasks, according to California researchers.

Researchers at UC-Irving and UCLA say their findings suggest that brain inflammation caused by chronic nerve pain can have significant psychological effects. In a lab study, researchers uncovered that rodents with brain inflammation exhibited “accelerated growth and activation” of immune cells known as microglia. These microglia cells cause chemical signals that restrict the release of dopamine, a chemical that helps control our brain’s reward and pleasure centers.

New Approaches To Chronic Pain Care

What’s more, the researchers may have uncovered new evidence in the battle to control and conquer chronic pain. Researchers found that certain opioids designed to spur the release of morphine may actually be ineffective in certain cases. One such case occurred with these rats. In rodents with brain inflammation, these opioids did not stimulate dopamine release as designed.

Instead, when the same rodents were treated with an opioid designed to inhibit the release of the microglial cells, dopamine levels returned to normal.

“For over 20 years, scientists have been trying to unlock the mechanisms at work that connect opioid use, pain relief, depression and addiction,” said Catherine Cahill, an associate professor of anesthesiology & perioperative care at UCI. “Our findings represent a paradigm shift which has broad implications that are not restricted to the problem of pain and may translate to other disorders.”

Cahill and her team hope to recreate the study in humans in order to combat mood swings, depressive attitudes and behavioral disorders.

“We have a drug compound that has the potential to normalize reward-like behavior,” she said, “and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuity found in rodents occurs in chronic pain patients.”

The First Phase of Legal Marijuana

/ Thomas Cohn, MD

Medical MarijuanaThe start of legalizing medical marijuana in Minnesota began last Monday. The initial step for patients is to be certified that one has a condition approved for treatment by this medication. Pain is not a condition approved for marijuana in Minnesota. Once certified as having an appropriate condition, the process in Minnesota applying for the medication can begin, and then obtaining the approved medication can occur. One can assume, the medical marijuana oils obtained in Minnesota, will be far different from recreational use marijuana.

In June, 2015, the lead National Geographic article is titled “Weed, The New Science of Marijuana”. It is an excellent review of the knowledge and science of cannabis. The use of marijuana dates back to at least to 3000 B.C.E., but did not become demonized until 1970 when it became a Schedule 1 drug, meaning it had no valid medical purpose. The truth about marijuana is much more complex. The study of marijuana really began only in the early 1960’s compared to the early 1800’s when opium and cocaine became known. Those drugs, which were once taboo, led us to the discovery of morphine and coco leaves. Will marijuana follow a similar path?

The Science Behind Marijuana

In 1963, a young organic chemist by the name of Raphael Mechoulam began experimenting with the compounds in marijuana. After isolating a number of compounds, Mechoulam tested the compounds on monkeys. Only one compound produced a significant effect. As Mechoulam wrote, “normally the rhesus monkey is quite an aggressive individual,” but when injected with this compound, the monkeys became quite calm.

Flash forward a few years, and Mechoulam’s research is helping 20,000 patients get treatment in his home country of Israel for a variety of conditions, including Crohn’s Disease, glaucoma, Tourette’s Syndrome and asthma. Mechoulman says he doesn’t believe the substance should be legalized for recreational use, but he hopes the stigma of studying the compounds for medical research fades now that more people seeing the medical benefits it possesses.

“We have just scratched the surface,” he says, “and I greatly regret that I don’t have another lifetime to devote to this field, for we may well discover that cannabinoids are involved in some way in all human diseases.”

In fact, researchers are using marijuana to combat cancers as we speak. Research in Spain found that some rats with brain tumors were cured of their condition after being injected with THC. The results are quite encouraging, but as biochemist Manuel Guzmán noted, “the problem is, mice are not humans. We do not know if this can be extrapolated to humans at all.”

Think about that for a second. We may have found another potential ally in the war on cancer, but there’s still so much hate for the drug that it’s impeding medical progress. We need to study these compounds in order to provide the best care possible for our patients.

Related source: National Geographic

Regular Exercise Isn’t Easy, But It’s Worth It

/ Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

Regular Exercise

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.

How Exercise Affects Your Brain

/ Thomas Cohn, MD

A recent article in the Chicago Tribune by Julie Deardorff gives a person another reason to exercise. Physical fitness has a crucial role in how the brain develops and functions. From infancy to old age, exercise is linked to positive changes in the brain.

Brain ExercieStarting in infancy, movement is necessary for proper development. In children, exercise has been shown to improve attention and focus, as well as developing coordination and ability to perform complex motions. In the elderly, new work is showing the benefit of physical exercise in staving off dementia.

Brain Benefits

Physical exercise has a broad range of benefits for the brain. These effects are true across our whole life span. Higher cognitive functions of attention, memory and multi-tasking are improved by exercise. In the 1990’s, the protein brain-derived neurotropic factor (BDNF) was found. This protein supports the growth of brain cells. Exercise triggers the production of BDNF.

Now we know exercise is good for all aspects of the body, and doctors and health associations are taking note. The American Heart Association has promoted exercise for the improving your heart health. Pain physicians have promoted exercise to reduce pain by elevating endogenous opioids in the body. All physicians promote exercise to help in healing injuries, as exercise is critical to keep us healthy in mind and body. There is no perfect pill that will alleviate your ailments; sometimes the best course of action is to get off the couch and go for a run.