Dopamine May Be Key To Unlocking Chronic Pain

May 11, 2015 / Thomas Cohn, MD

Medical researchers at the University of Texas say dopamine – the mechanism in your brain responsible for movement, memory and reward – could provide the key to unlocking the problem of chronic pain.

Dopamine is vital for several different brain functions, but its contributions to the problem of chronic pain are not well known. To better understand dopamine’s role in chronic pain transmission, researchers began studying its effect in mice. Researchers noted that removing a specific collection of neurons -known as A11 – helped diminish the perception of chronic pain. The cluster of A11 neurons contained high levels of dopamine.

“These findings demonstrate a novel role for how dopamine contributes to maintaining chronic pain states,” said associate professor Dr. Ted Price.

How it Works

When a person gets injured, neurons inside the body send pain signals to the brain. In someone with chronic pain, these neurons send pain signals to the brain even when an injury isn’t present. A physical medicine pain specialist’s job is to determine what is causing these neurons to fire, and how to stop them from incorrectly firing.

The A11 cluster might be causing some of these neurons to fire. In fact, when removed, mice were still able to feel acute pain (an actual physical injury), but they exhibited a lesser response to chronic pain.

“We used a toxin that affected A11 neurons, and that’s when we found that acute pain signals were still normal, but chronic pain was absent,” said Dr. Price. “This may open up new opportunities to target medicines that could reverse chronic pain,” said Dr. Price.

Dr. Price and colleagues want to continue studying dopamine receptors in relation to chronic pain perception.

“In future studies, we would like to gain a better understanding of how stress interacts with A11. And we’d like to know more about the interaction between molecular mechanisms that promote chronic pain and dopamine.”

Finding Compassion in Medicine

May 4, 2015May 4, 2015 / Thomas Cohn, MD

Medicine has become a tough endeavor recently, as the physician is routinely under many pressures. Institutions and employers want as many patients seen as possible in an effort to increase their bottom line, while staff to assist the physician are often kept at a minimum to keep costs low. Tests and procedures should not be ordered or they need to be ordered more frequently, depending on who is paying the bill, and of course the physician should know which is the pertinent case. The physician also is getting paid too much and does not work enough hours. The physician also should do administrative work, read more current journals, and be responsible for quality improvement projects for the practice. They also must attend continuing education courses and constantly recertify their qualifications. The demands are endless.

As for the patient, they only want a good physician that can solve their problems quickly. Now that medicine has become more of a business, finding a good and caring physician is even harder. Physicians often feel they need to be done seeing a patient as quickly as possible. This is just the opposite of the needs of the patient. Many physicians have just given up with the pressures of the business, and have become mediocre at all aspects of medicine.

Striking a Compassion Balance

Finding the physician who has found the balance in medicine and who has the desire to provide high quality care is difficult. There is no magical way to find those special physicians, and word of mouth is often still the best method. There are rating services, but unfortunately most physicians try to hide from them and may not be very well represented. Furthermore, many of the best physicians let their skill be their only voice, and the best physicians often feel no need to advertise, as their work should speak for themselves.

In any profession, 90% of the practitioners are good, and 10% are exceptional. In medicine, this also holds true. The best physicians find a way to balance all the needs of the changes in the business of providing care. The most telling sign is that the patient always comes first. The physician will know his patients and their history, and will be willing to develop a joint treatment plan. They are up-to-date on research, and can explain complex medical problems without being flustered. Often they are experienced and can figure out what is wrong and what needs to be done quickly.

Medicine has become increasingly complex for both the patient and physician. Finding good medical care is difficult. Word of mouth, and sometimes the Internet can help find the better caregivers. Even good physicians are hampered by their surroundings and the business aspects of their offices. Every visit may not run smoothly, but having a physician that really knows how to help you is worth some inconveniences. Look for a physician who is mature, board certified in his specialty, and is prepared whenever they see you.

The 5 Most Abused Prescription Drugs

April 29, 2015 / Thomas Cohn, MD

When taken in the correct dosage, prescription drugs can work wonders for people suffering from chronic pain. That said, medications can have a fairly strong effect on the body, and a person can develop a dependency if they aren’t careful. Below, we take a look at five of the most abused prescription drugs.

5. Syrups containing codeine and hydrocodone

Prescription cough syrups containing codeine and hyrdocodone are the first drugs to make the list, specifically because of their popularity among the young adult community. In larger doses, these types of syrups create a euphoric and pleasant feeling inside the body. These syrups aren’t typically abused to the point of fatal overdose, but they are often taken in combination with other drugs, like acetaminophen or guaifenesin, which can do serious damage to your body. Because it’s rather easy to obtain cough syrup, it’s easy to see how these drugs can be repeatedly abused.

4. Adderall

Adderral is becoming more popular on college campuses, as it has been touted for it’s ability to help the subject concentrate. College kids cramming for tests and pulling all nighters pop these pills like candy, especially since it’s relatively easy to fake an attention deficit disorder. The user feels energized, enthused, stimulated and euphoric after ingesting Adderral. Young adults and students can get addicted to those feelings, and they may continue to search for that high long after they’ve graduated.

3. Xanax

Xanax, a form of benzodiazepine, is a very common drug for self medicating users who are trying to relieve stress or anxiety. A physician may prescribe Xanax for panic attacks, insomnia and anxiety, as it offers a deep relaxation and lowers inhibitions. Users report a relaxed, zoned-out and dream-like state when under the influence of a heavy dose of Xanax. Withdrawals after dependence can lead to even greater panic attacks and anxiety, so it’s easy to see how someone can become addicted.

2. Opana oxymorphone

This drug is becoming more popular as drug manufacturers are beginning to fight back against Oxycodone abuse. It is likely that oxymorphone will become the next most popular drug for prescription pill abusers. The euphoric feelings offered by oxymorphone are almost unmatched, as some say it exceeds the sensation offered by oxycodone and heorin.

1. Oxycodone

Oxycodone, also referred to as Percocet with acetaminophen, comes in at the top spot on this list. The pill has probably done more harm than any other pill on this list over the last twenty years. The pill is typically prescribed to patients with chronic pain, cancer or disabilities, and it is said to provide a blissful, heavenly euphoria. It can certainly help people who live in constant pain, but it’s usually sought after by people who simply want to abuse the drug. Manufacturers are working on developing different types of drug formulas to make it harder for users to abuse the drug, but due to the nature of its intended effects, it will continue to be a sought after drug by abusers.

5 Famous People Who Battle Chronic Pain

April 27, 2015 / Thomas Cohn, MD

More than 40 percent of the population suffers from some type of chronic pain, so it’s no surprise that some big names deal with pain. Today, we show you that you’re not alone in combating chronic pain. Here’s a look at five celebrities who are continually battling chronic pain.

1. George Clooney – The famous actor nearly called it a career back in 2005 after he suffered an extremely painful back injury while filming the movie Syriana. Clooney struck his head during a particularly action packed scene, and he suffered a torn dora – the area around the spine that holds in spinal fluid. Before several surgeries were able to correct the issue, Clooney told reporters that he thought about ending his acting career once and for all.

2. Jillian Michaels – Micheals, best known for her role as a trainer on The Biggest Loser, deals with endometriosis and Polycystic Ovary Syndrome on a regular basis. The conditions cause debilitating abdominal pain and can cause complications during pregnancy. Michaels eats healthy meals and exercises regularly to help keep her symptoms at bay, but she has decided to adopt in lieu of pursuing a painful and potentially dangerous pregnancy.

3. Montel Williams – Williams had been misdiagnosed as having chronic pain for 10 years before he was correctly diagnosed with multiple sclerosis back in 1999. The talk show host said he viewed the diagnosis as a “call to action,” and he went public with his diagnosis in an effort to raise public awareness as well as funding for a cure. He runs the Montel Williams Foundation, which raises money for MS research, and he noted that he exercises for 75 minutes a day to keep symptoms from flaring.

4. Sinead O’Connor – Mrs. O’Connor had to step away from her music career in 2003 to deal with her painful Fibromyalgia. She returned to her career two years later, noting “Fibromyalgia is not curable. But it’s manageable. You get to know your patterns and limits, so you can work and plan around it.”

5. Kathleen Turner – The two-time Golden Globe award winning actress has battled with rheumatoid arthritis for over 20 years. The condition attacks the body’s soft tissue and joints. Just like the above celebrities, Turner said the diagnosis gave her a fresh perspective on life, saying “Suddenly all that stuff about having good looks and being sexy took secondary position to being able to walk without pain.” She now speaks out about the condition with hopes of raising awareness and finding a cure, and she earned a lifetime achievement award from the Massachusetts Arthritis Foundation for her efforts.

Related source: Prevention.com

Another NASCAR Driver Dealing With Problematic Pain

April 22, 2015 / Thomas Cohn, MD

Denny Hamlin is the latest NASCAR driver to have his season impacted by debilitating pain, as he needed to withdraw from Sunday’s race at Bristol Motor Speedway with neck pain.

Hamlin told reporters that he pulled something in his neck during the 12th lap, and he didn’t feel want to compete if he thought he was a danger to others.

“I can’t move my head or neck like I need to, and I’m not doing this team any justice if I go out there like this,” Hamlin said after withdrawing from the race. “I have no idea what happened. I think it’s just a pull, something where you jerk your head around and you feel a pain. Almost like you slept on it wrong.”

It’s surprising that the injury occurred so early in the race. We’ve shared ideas for avoiding pain and injuries while driving in the past, but NASCAR drivers don’t typically have the luxury of getting out of their car and stretching to break up the drive.

Despite pulling out of Sunday’s race, Hamlin said he plans to compete in three races this week, which seems a little aggressive for a driver who only completed 22 of 500 laps last week. He added that he’s received treatment early this week, and he’s excited to compete this week at a track 20 miles from where he grew up.

“After treatment this week, I feel close to 100 percent, and I’m confident that I’ll be good to go this weekend in Richmond,” Hamlin said. “It’s a great track for our team, and one that means a lot to me personally. Hopefully we can go out there and compete for the win.”

Another NASCAR Injury

Hamlin’s neck pain is the one of the first NASCAR injuries we’ve heard about this year, but last season the injury news centered around Jeff Gordon, who claimed that chronic back pain could force him into retirement. Over the course of his career, Gordon has undergone professional treatment, strengthening exercises and received anti-inflammatory medications and cortisone injections to manage his back pain.

Although he hasn’t publicly stated that it’s due in part to his back, Gordon has already announced that this season would be his last full-time season in the Sprint Cup Series.

I’ll keep tabs on Gordon and Hamlin as the NASCAR season progresses, but under the playoff structure, Hamlin has already qualified for the Chase for the Sprint Cup championship, so it wouldn’t be surprising if he missed some races to ensure he enters the Chase as healthy as possible.