Baby it’s Cold Outside: Chronic Pain and the Cold

/ Thomas Cohn, MD

Many people who suffer from pain feel worse when it is cold outside. Those who have joint problems like osteoarthritis and rheumatoid arthritis, fibromyalgia, nerve damage and muscle disease have more pain when the temperature drops. If we have been told to use ice to prevent injuries from hurting, many ask why they feel worse when cold weather settles in. The reason for feeling pain is the same reason we actually use ice packs to prevent pain. Cold can slow the transmission of the nerves. Placing ice on an injury keeps inflammation down and reduces the ability to transmit pain signals.

Chronic conditions that cause pain often become worse with the cold. When the body is cold, muscles, tendons, ligaments and joints do not move as well as when they are warm. Joints become stiff from the joint fluid not flowing as smoothly.

Chronic Pain Cold

In the cold, muscles, ligaments and tendons are also stiff. The body is not much different than many other materials when exposed to cold. Materials like plastic become brittle when exposed to cold and become more pliable when warm. The body is not much different. When cold, many structures become stiff and do not move as well. As the structures in the body are warmed up, they move better and smoother. If a structure is not moving well, it is likely we feel it and sense the abnormality of movement. Most people feel the change in sensation of movement as discomfort, stiffness, aches or pain.

Frozen Nerves

Cold can also stimulate nerves. Some pain fibers respond specifically to the cold and send signals of pain when they sense it. Furthermore, a large portion of the nervous system functions to inhibit abnormal signals. Cold slows nerve transmission in general and thus slows the body’s ability to inhibit signals. The body’s ability to control pain signals are also impaired and slowed by cold.

Winter is here, and the weather is unlikely to get much better for several months. When it is cold outside, it is important to keep your body warm to reduce pain. Warmth allows the body to function more normally. Normal body temperature allows the fabric of the body to move smoothly. Keeping the body close to normal temperature allows its structure to function the best with the least amount of pain.

In the News: Torture and Pain

/ Thomas Cohn, MD

There has been extensive debate in political circles about whether torture of prisoners should be allowed and the ethics behind using torture to obtain confessions. The pain of the interrogation process is said to force the prisoner to give out reasonable, actionable information. Furthermore, the “horrible” acts of these prisoners justify the means to obtain the information. We also know that this type of pain is temporary.

In the United States, about 40% of the population suffers from chronic pain. On a daily basis, many people live with trying to manage their pain. The hope is that pain does not interfere in their activity and they can continue to enjoy life. For many, pain is torture, and the problem haunts every aspect of their lives. It often is a 24-hour problem, affecting daytime activities and interrupting nighttime sleep. Medicine does not have an answer or cure for many things that cause ongoing pain. No one wishes pain on another, and we all want to develop a better treatment so others do not have to suffer.

Pain and Torture

The Correlation Between Chronic Pain and Torture

So if pain is something that we do not wish on anyone, how can we as a society ever say it is okay? If we believe that it is not okay to inflict pain on others willfully, than torturing another is clearly wrong. The end does not justify the means. Those in power who feel torture and inflicting pain on others is worthwhile seem to lack a moral compass. A society that tries to improve the world cannot move forward by inflicting physical pain on others. Watching anyone who has chronic pain try to meet the challenges of life on a daily basis, it is clear that causing more pain is not okay. It is heartbreaking to tell someone that there is not a cure for their pain, and it is immoral to purposefully inflict unnecessary pain on anyone for political reasons.

Those in power in our country need to remember that we are a nation of freedom. We are a nation that has become the power and the standard of law by respecting the rights of the individual. Many in our country have suffered from the problems of life in other countries and have come to this country due to the higher standards we place on the importance of life.

From those who suffer from pain every day, to those whose mission in life is to treat the problems that cause pain in life, causing pain by inflicting harm on political or war prisoner is not okay. There is no such thing as justified torture, no such thing as enhanced interrogations being morally acceptable. 40% of the population deals with pain on a daily basis. We are always trying to find solutions for the problem. It is not right for our government to be actively trying to cause intense physical pain on individuals in our captivity. We need to be spending our efforts in helping those in our country to live better lives.

5 Tips For Dealing With Chronic Pain During The Holidays

/ Thomas Cohn, MD

Chronic Pain HolidaysChronic pain is never fun to deal with, but it can be especially difficult to manage during the holidays. Your diet, sleep schedule and travel plans can get your body out of whack, so today I’m sharing some tips to help you control your chronic pain during the holidays.

1. Travel Tips – If you’re dealing with chronic back or neck pain, being crammed on a plane or in a car for hours on end can be painful. That said, there’s still some ways to make yourself more comfort while traveling. If you’re traveling on a plane, see if you can get an aisle seat. That way you can stand up and stretch if needed without waking up any sleeping patrons in your aisle. If you’re in a car, leave earlier so you have time to stop at a rest stop and move around if your joints start to get stiff.

2. Eat Right – The holidays are a time when our waistbands can expand to Santa’s size, so be cognizant of what you eat. Eating junk food can aid to your chronic pain, make you more lethargic, and as a result, keep you from exercising, which is beneficial in chronic pain management. If you have to travel, pack a healthy option so you’re not gorging on fast food during your travels.

3. Keep Exercising – As I’ve said in earlier posts, regular exercise is crucial in controlling and preventing chronic pain symptoms. Getting your regular workout in during the holidays is no easy task, but don’t use the company party or a family visit as a reason to skip your exercise. Wake up early or carve out some time – even if it’s only 15 minutes – to exercise. Getting out of a routine makes it easier to stay out of your exercise routine, so don’t let the holidays slow you down.

4. Medication Management – Most people who take medications to help with their chronic pain have a pretty set schedule for managing their meds, but as this post suggests, the holidays can throw your routine out of whack. Double check to make sure you have all your medications for a long stay, but also be aware of where you store them so young nieces and nephews can’t accidentally access your medications. If you’re going to run out of a prescription while out of town, contact your doctor before you leave instead of having to jump through hoops from afar.

5. Rest Up – Sleep is a restorative process where your mind and body relax and rejuvenate, so try not to skimp on sleep this holiday season. It may be easier said than done, but it’s important nonetheless. That means no staying up in the wee hours of the night trying to catch Santa Claus!

Follow these tips to have a pain free (or at least a little less painful) holiday break! If you have any tips on how you manage chronic pain during the holidays, please share in the comments section.

Nutrition, Diet and Pain

/ Thomas Cohn, MD

DietPain is a complex experience with multiple components, including those from the physical interpretation of sensory signals to the brains perceptions of the signals. Sensory signals are transmitted electrically and chemically throughout the body. The chemical nature of the body is significantly affected by our activities, including exercise, nutrition and diet. What we put into our bodies affects how we feel, including our perception of pain. Diet and nutrition can certainly impact pain.

In the most basic sense, obesity and being overweight can contribute to pain. Recent studies have shown that the extra fat of obesity is pro-inflammatory, causing the body to feel more pain. Extra weight also mechanically stresses all components of the body. The extra forces placed across them stresses the joints. The muscles, ligaments and tendons are forced to use extra power to move normal amounts. Often people in pain find that eating is one of few pleasurable activities, and then they eat more and move less.

Inflammatory Foods

Food can be broken down into two general categories: pro-inflammatory and anti-inflammatory groups. The pro-inflammatory foods and nutrients have the effect of promoting inflammation in the body directly or by how they are metabolized and broken down. The anti-inflammatory foods do the opposite and reduce inflammation in the body either directly or indirectly. Not surprisingly, eating a healthy diet tends to be high in anti-inflammatory compounds. Diets rich in pro-inflammatory compounds tend to be rich in things that are considered not so healthy.

Diets that are pro-inflammatory are very common in our culture. The foods typically have a high glycemic load, raise blood sugars, contain “empty” calories, are highly processed and contain red meat, fat and oils that are not healthy. The American diet is rich in refined grains, sweets, and sugar. Pasta, white rice, bread and potatoes are all mostly carbohydrates and just add to our glycemic load and produce inflammation. Topping it off, many processed foods contain sugar or corn syrup, which are just empty calories. Animal fat (and human fat) are high in omega-6 essential fatty acids, and these are broken down into pro-inflammatory compounds including arachidonic acid thromboxane and leukotrienes. Vegetable oils including sunflower, peanut and corn oil also are high in omega-6 fatty acid and tend to be pro-inflammatory.

Diets that tend to be healthier are rich in compounds that are anti-inflammatory in nature. Foods that are high in omega-3 fatty acids, anti-oxidants and phytochemicals are anti-inflammatory. These include a variety of fruits and vegetables, spices and cold water fish. Omega-3 fatty acids are found in walnuts, flaxseeds, chia seeds, olive and canola oils and are anti-inflammatory. Healthy fish to eat include tuna, herring, salmon, cod and bluefish. Beans and lentils also provide high quality protein without bad fats. Some intake of omega-6 is necessary in the body, but controlling the amount and thus the amount of fatty red meat is essential.

Diets that have more fresh vegetables and fruits also tend to provide good sources for vitamins and minerals that act as antioxidants. Compounds that are antioxidants rid the body of free radicals that can lead to inflammation and breakdown of many structures like vessels and joints in the body. Vegetables and fruits also provide the body with phytochemicals, nutrients that protect cells, fight bacteria and help regulate the body’s hormones. Many spices and herbs also provide essential antioxidants and phytochemicals, and some even tend to mimic the actions of compounds like Ibuprofen.

Improving diet and nutrition can be a healthier way to control pain. What we eat can have a direct effect on our pain in many different ways. The typical American diet is rich in the compounds that promote obesity and inflammation. A dietitian can be extremely helpful in changing a person’s intake to change your health. It will take a bit of work, but eating better will help you lose weight and may decrease pain and inflammation in the body.

Chronic Pain in the Military

/ Thomas Cohn, MD

Army painA recent study published in JAMA Internal Medicine suggests that chronic pain in active and former military members is a significant problem.

The study surveyed 2,597 soldiers who served in either Iraq or Afghanistan in 2011 in order to understand how chronic pain affects their everyday lives. According to the survey results:

  • 45.4 percent reported suffering combat injuries.
  • 44 percent reported experiencing chronic pain.
  • 48.3 percent reported pain lasting at least a year.
  • 55.6 percent said they suffer from “constant” pain.
  • 51.2 percent said their pain was moderate to severe.

Those tasked with helping military members reintegrate back into society after a deployment know the management of physical and emotional pain is crucial. The study also attempted to uncover how military members use opioids to aid in pain management.

“I had conducted a similar study at [the] CDC because we felt that it was important to understand [the] use of opioids to get a greater context for misuse and abuse,” said lead author Dr. Robin L. Toblin, a clinical research psychologist at the Walter Reed Army Institute. “When I began my current position, we sought to look at the same constructs within a military population, who seemed to be that much more likely to be in pain due to the combat deployments over the last decade.”

Dr. Toblin noted that providing opioid therapy and management to combat veterans is key. Opioids can certainly ease pain after a combat injury, but problems can arise if veterans try to self-medicate or are uninformed about proper dosages. According to Dr. Toblin, 15.1 percent of soldiers say they have received opioid-based therapy to control their chronic pain.

“[Based on these findings], we hope that the military services will be more aware of the unmet needs for the assessment, management and treatment of pain and will broaden the services and availability of those services for servicemembers,” Dr. Toblin said.

The findings have touched off some debate over whether military members should be taking opioids. Obviously we want returning service members to be pain free, while others claim the drugs could affect their physical and mental performance. In the end, I think it really comes down to taking a strong, hands-on approach to ensure our veterans and returning servicemembers get the care they deserve and a treatment strategy that suits their individual situation.