Playing Through The Pain: A Doctor’s Prospective

/ Thomas Cohn, MD

Sports injury treatmentRecently, the Star Tribune published an article on professional athletes playing through pain. The article discussed whether the Vikings quarterback, Teddy Bridgewater, was not tough enough since he and the team elected not to play him against the Packers, four days after he suffered an ankle strain. The article also discussed how other athletes never missed a game due to injury. Furthermore, it basically said , if you are going to be a professional athlete, you need to play through pain.

Stupidity is playing while you are acutely injured to tell others you are tough. Pain is the way the body tells a person that they have an acute injury. Tissue damage stimulates the sensory fibers and initiates the body’s response to injury. Inflammation occurs, and then blood flow to the area increases in order too bring cells to clear the damage and initiate the healing process. Continuing to stress damaged tissue will usually only weaken the area or cause further injury. In an acute pain injury, protecting the region from further damage reduces the pain and allows quicker and more complete healing. The culture of toughness would be considered just stupidity from a medical viewpoint.

Professional athletes tend to have short careers in sports due to the fact that they tend to overstress areas of the body, causing permanent damage and reducing their abilities. Tiger Woods now is on the down side of his career due to back and leg injuries. Most football players do not play long into their 30’s due to injury. The NFL now has major lawsuits regarding concussion and head trauma. Many professional athletes have severely degenerated joints, back and neck issues from repetitive trauma, and now have chronic pain issues.

Acute pain is the signal from the body that there is tissue damage. Treating acute pain is doing the right stuff medically to allow the injury to properly heal. Chronic pain is not due to acute tissue damage and inflammation, but is an abnormal response to signals from previously healed damage. Rest is great for an acute injury but not for chronic pain. Activity can take your mind off the pain, release endorphins to act as natural pain relievers, and help build strength in affected areas. Activity in areas of chronic pain will decrease the pain in most cases. Working through chronic pain is tough, but it actually decreases pain signals and improves function.

Headaches, Nutrition, Neuroglycopenia and Children 

/ Thomas Cohn, MD

NeuroglycopeniaNeuroglycopenia is categorized as low blood glucose levels in the brain. Recently I was asked if children can have headaches due to inadequate nutrition and a neuroglycopenia. Children have a different susceptibility to low blood sugar than adults. Most people do not get low blood sugars if they have sufficient calorie intake. Many substances can be converted to glucose for the brain to maintain normal function, and that is a protective mechanism of the neurologic system. Low blood sugar levels in the brain can be manifested in a number of ways, including behavioral changes, headaches, and even seizures or loss of consciousness.

In a Google search on this topic, only one article was found; The Journal of Pediatrics in 1994 wrote that children can have behavioral changes related to low blood sugars and the possible affect on the brain. Low and high blood sugars due to nutrition in children probably occur regularly, and they can affect behavior and may be linked to headaches. Neuroglycopenia occurs when there is a severely low blood sugar level in the brain, and is generally linked to low blood glucose. Furthermore, this condition is linked mostly to diabetes and high insulin levels, and not to general nutrition.

Children can have headaches due to a number of reasons. Nutrition and sugar intake can definitely cause difficulties with headaches in some children. Headaches can be caused from problems such as poor vision, lack of sleep, psychological problems and stress. If headaches are frequent, then the child needs to be seen by a pediatrician, and possibly by a neurologist. Sudden severe new headaches need to be seen immediately at a hospital as an emergency.

Poor nutrition in children can lead to behavior problems, hyperactivity and headaches. The meal programs for breakfast and lunches in our schools partially grew out of awareness of the necessity of good nutrition in the ability of children to adequately learn. Severe low blood glucose in the brain, i.e. neuroglycopenia, is not necessary to be the cause of headaches. If the child is a diabetic, neuroglycopenia may be occurring and can cause headaches. Children without diabetes are unlikely to have nutritional issues so severe to cause low brain glucose and headaches. If a child is having headaches, the first stop is the child’s pediatrician.

Age and Professional Sports

/ Thomas Cohn, MD

Athletes and AgeThe prime of our lives is in our 20s. During the decade of time from age 20 to 30 years of age, our bodies and brains become fully mature. We are at our peak performance both physically and mentally. The body is the most flexible and heals quickly from minor trauma. Mentally, the brain becomes mature and can perform at a high level. For most sports, the best athletes are at their prime when the body reaches physical maturity. The length of time at a prime level is often about ten years. After that time, the body starts showing signs of wear and tear.

Professional athletes stress their bodies to the extreme on a daily basis to maximize training for their sport. Most are a bit sore every day from the hours of training and stressing of the muscles and joints. In general, the level of exercise completed is usually a bit beyond what the body was meant to endure. Structures of the body slowly start wearing out. Multiple injuries often start occurring, and it takes longer and longer for the person to return to full health.

The good news is that most of us our not professional athletes, so we are not dependent on an extreme level of activity for our livelihood. The bad news is we still are wearing out our bodies over time, but just not as fast as most athletes. Activity keeps us healthy as long as we do not overexert our bodies. Doing strength training keeps muscles strong and bones healthy. Aerobic conditioning is necessary to maintain good cardiovascular health. Being normal weight for our height keeps us from stressing the body structure as a whole. The average body starts to show signs of wear and tear in our 40s and 50s.

Historically, the body was designed to get us to about age fifty. In centuries past, before modern medicine and the industrial revolution, death often came by age fifty due to trauma, disease, or other natural causes. Now, we have learned to survive into our late seventies or eighties. As we grow older, age affects every organ including the muscles, tendons, joints and bones. The degeneration often causes aches and pains as we try to compensate for the changes that are occurring.

As I’ve said before, your body is like a car. A new car is beautiful and performs well with very little maintenance. As the car gets older, it takes more and more care to keep it running smoothly. If it is not maintained, it will likely fall apart. If we drive it hard and beat it up, it will fall apart sooner. If we baby it, it will become a precious antique. The body is not much different. We last longer and stay healthier if we take care of our body. Doing the work to keep healthy is beneficial to live a happy life.

Men and Women Similar When It Comes To Chronic Pain

/ Thomas Cohn, MD

Men and WomenAlthough there have been previous studies that suggest women have a higher pain tolerance than men, a new study out of the University of Malaga suggests that a person’s resiliency, not their sex, determines how well they handle chronic pain.

For their study, researchers analyzed numerous traits among 400 patients suffering from chronic spine pain (210 women and 190 men). What they found was that personal qualities, not genetic differences, was the best indicator of how a person dealt with chronic pain.

In essence, certain men and women have a very difficult time managing chronic symptoms, while others are able to work through the discomfort. The people who don’t let the pain bog them down are the same people you’d want on your basketball team when you’re down 10 points in the fourth quarter or if you need a big last week to meet your quarterly sales goals, because the research suggests that how a person handles adverse circumstances is the primary quality linked to an individual’s pain tolerance and how they adjust to chronic pain.

According to the researchers, the findings suggest more similarities than differences between men and women.

“More resilient individuals tend to accept their pain, that is, they tend to understand that their ailment is chronic and they stop focusing on trying to get the pain to disappear, to focus their energy on enhancing their quality of life, despite the pain, said Carmen Ramirez-Maestra, the study’s lead author. “In this regard, patients who are able to accept their pain feel less pain, they are more active on a daily basis and have a better mood.”

So remember, treating chronic pain is only half the battle. Dealing with, accepting, and not letting pain wear you down are other pieces to the pain puzzle.

Related source: Daily Digest News

Practicing What You Preach

/ Thomas Cohn, MD

Dr. CohnThere is an old adage that suggests a person should be wary to trust a skinny chef, and a similar principle can be applied to the medical world. Would you trust a doctor who is obese, waddles into the room, and smells of smoke to advise you on diet, exercise, and healthy living? Probably not, because they are not following their own advice.

At some level, the medical practitioner must be able to communicate and relate to their patients. Sometimes, it is their level of knowledge and experience that is obviously superior that helps invoke trust. At another level, sometimes it is the personal experience that may make an added difference.

As a Physical Medicine physician specializing in pain medicine, I have spent years studying and providing care to thousands of patients. I try to keep up with new research and treatments, reading journals and even attending conferences. During the course of countless evaluations, a doctor learns how to address a problem and that there may be many different treatment approaches to the same problem. One thing I didn’t expect to learn was that I would have to apply my knowledge to my own problems.

Back pain affects about 85% of the population at some point in their lives. My first bout occurred during my second year of medical school. I was lifting free weights with the bar at an awkward angle, and the next thing I knew my back had given out. Since I had no weakness, just pain, the physician treated it conservatively with ice, heat, physical therapy and anti-inflammatories. It took months to resolve, but as long as I was careful about using proper body mechanics when lifting, I was fine.

Years later, when I was in my late forties, I started noticing my back more regularly, and it occasionally flared with bouts of pain down my legs. This was when I underwent my first MRI – 25 years after my back was first injured. The scan showed a significant L5/S1 spondylolisthesis with narrowing where the nerve roots exit. A radiologist friend who read the scan asked me which colleague I planned to see for surgery. I tried injections, massage, exercise and anti-inflammatory medications to control pain at times, but they only stifled the pain, they didn’t resolve it. Aerobic conditioning was probably the most helpful, but I still dealt with pain from time to time.

Unfortunately, a couple of years ago it flared worse, brought on by no special aggravating factor. A new MRI showed severe narrowing where the nerves exit at the L5/S1 level. A couple of injections calmed my spine down, and I again was given a lesson in the importance of exercise. Regular exercise has been essential to control symptoms. If I do not exercise, my back begins to ache. Stretching and loosening up the back muscles is necessary multiple times a day, and anti-inflammatories help control stiffness. I also use a neuropathic medication to keep some of the sensitivity of the nerves down.

Despite back pain, life can still go on and be pretty normal. I do most everything I want to do, but running and jogging is off my list. I still exercise, but strengthening my core is not optional any longer. Core strengthening is definitely boring, but it helps immensely. I prefer aerobic activities like biking, using an elliptical or walking long distances. Long walks usually require stretching breaks, but as my dog gets her exercise, so do I.

So far, I have no absolute loss of muscle function in my legs and no trouble controlling my bladder or bowel related to my back. Still the most important aspect of treatment is taking care of myself and exercising. To get that done, I have to wake up very early each day and make it a priority. If a doctor does not take care of himself, it is not possible to take care of others. At this time, listening to my own advice of exercise, take your medications, don’t complain and stick with the routine are working for me. For me, I must practice what I preach.