Early Intervention May Help Treat Patients At High Risk For Chronic Pain

March 21, 2024 / Thomas Cohn, MD

As we’ve said on the blog in the past, early treatment is extremely helpful when it comes to effectively managing a pain condition, but a new study found that early identification of chronic pain risk can ensure those at the highest risk can effectively manage their pain issues.

In a recent study conducted at the Duke University Integrated Pain and Wellness Program, researchers found that a carefully worded two-question survey successfully identified patients who were most likely to develop chronic pain. These patients were then managed with a more detailed risk stratification and holistic services that contributed to better overall outcomes.

“Unlike traditional methods that reactively address chronic pain, this approach proactively provides resources to prevent the development of high-impact chronic pain, ensuring the right patient gets the right resources at the right time—before the problem escalates,” said Padma Gulur, professor in the anesthesiology and population health sciences department at Duke University School of Medicine, and senior author of the study published in the New England Journal of Medicine Catalyst.

Identifying Early Chronic Pain Risk

For the study, researchers provided patients in Duke’s pain and wellness program with a two-question survey that was created after reviewing numerous studies that identified factors lead to poor pain outcomes. The two questions were:

1. Have you ever felt your pain is terrible and it’s never going to get any better? (Y/N)

2. Have you ever used an illegal drug or prescription medication for non-medical reasons? (Y/N)

More than 13,500 – about 12% – responded yes to both questions and were then considered to be at high risk for poor pain outcomes. Respondents were grouped into high, medium and low risk categories, and those at the highest risk were treated with a more personalized treatment plan based on specific needs. Some common treatments for this group included pain management with the help of a pain specialist, referrals for social services and access to behavioral health, physical therapy and nutrition programs.

“The interventions were tailored to meet patients at their current state of pain management and to motivate them toward adopting a more holistic approach,” said Gulur. “The guiding principles emphasize that patients are doing as well as they can with the coping skills they have but, with the right support, they can do better.”

Of the 432 patients at the highest risk of poor pain outcomes who participated in the holistic treatment approach, more than half (51%, 224 patients) reduced their morphine dose within 30 days. That number rose to 299 patients at 60 days and 349 patients at 180 days. Moreover, the program’s treatments were more effective than those achieved through other management strategies.

“By demonstrating the effectiveness of early identification and intervention for patients at risk of poor pain outcomes, this research can inform the development of new therapies and treatment approaches focused on prevention,” Gulur said. “It could lead to improved health services by integrating similar proactive care models into broader health care settings, enhancing scientific understanding, and leading to better health care outcomes through more personalized and preemptive pain management strategies.”

If you answered yes to both of the above questions, or you are struggling to manage a chronic pain issue on your own, follow the lead of the patients in this study and connect with a pain management specialist. Chronic pain is incredibly complex, and you need to work with someone who understands how pain impacts you physically, mentally, emotionally and behaviorally. We take the time to get to know you and ensure your pain concerns are heard and addressed, no matter how long it takes.

For more information about who may be at risk for developing a chronic pain condition or to talk with a provider about a current issue that you’re dealing with, pick up the phone and call Dr. Cohn and his team today at (952) 738-4580.

Treating Chronic Pain Conditions In Young Adults

March 14, 2024 / Thomas Cohn, MD

Chronic pain is oftentimes assumed to be a condition that affects older populations, and while pain conditions are more likely to affect individuals over the age of 40, millions of young adults are also plagued by chronic pain. Because young adults are less likely to be affected by common drivers of chronic pain, like natural age-related degeneration and arthritis, and because of the inherent difficulty in treating pain disorders, it can be very hard for young adults with pain to get the help they need to overcome the condition.

We want to help you overcome these challenges and ensure you find the relief you seek and deserve.

Chronic Pain In Young Adults

As we talked about in the introduction, chronic pain can be caused by a number of different issues, and while arthritis and age-related degeneration are main factors, there are so many other components that can contribute to chronic pain conditions in young adults. Chronic pain can be the result of acute injury, nerve issues, and related health problems, and that doesn’t even factor in the mental components at play. As we’ve talked about on the blog in the past, stress, anxiety and depression can all lead to the onset of physical pain or worsen the symptoms associated with a chronic pain condition. A chronic pain condition is more likely to have physical and mental components in younger populations, and treatment needs to be based accordingly.

There’s no perfect playbook for treating a chronic pain condition, especially in young adults, but there are a few different approaches that may proven beneficial. Here are some of the ways we oftentimes work to help younger patients find relief from their chronic pain condition.

1. Pain Management Consult – For starters, it’s imperative that you truly understand what you’re dealing with, and the best way to get to the bottom of your pain condition is by connecting with a pain management specialist. They’ll be able to help you understand the root cause of your discomfort and develop an appropriate care plan. The first step in overcoming the problem is doing your best to fully understand what you’re up against.

2. Exercise/Activity – We’re not saying that you can always overcome chronic pain with exercise, but exercise can target some of the underlying causes of chronic pain. For example, if your pain is being caused by spinal instability or knee inflammation, exercise can help to target the supportive soft tissues in your spinal column or strengthen the knee joint so that it is less likely to inflame when stressed. Exercise and activity also helps to get your heart pumping, making it easier for oxygenated blood to reach areas in need.

3. Diet Improvements – You may also notice an improvement in symptoms by making some adjustments to your diet. We don’t want you to radically change your diet, as that can cause other issues for your body and your gut health, but slowly making some healthier choices can help you body get the nutrients it needs to support muscle function and development. Many junk foods and sodas are naturally pro-inflammatory, which can contribute to chronic pain symptoms. A poor diet can also lead to weight gain and more stress being applied to your joints, oftentimes intensifying chronic pain symptoms. We can help you find ways to tweak your diet so that your body has regular access to the nutrients it needs most.

4. Mindfulness – It’s also incredibly important that you work with your doctor to address the mental components of a pain issue. Chronic pain can leave you feeling isolated, which can be especially burdensome for younger adults. Find ways to reduce stress in your life and manage it when it arises. Exercise, deep breathing techniques and yoga can all help you improve your mindset and limit stress in your life, but find what works for you. Maybe you handle stress by reading a good book or doing some woodwork. Find a healthy outlet for stress and take care of your mental health amid your struggle with the physical discomfort of chronic pain.

5. Develop A Support Network – Know that you are not alone and that there are others out there who want to support you. Find a provider who empathizes with your situation and listens to your concerns, and keep connecting with people who are willing to support you. Friends and family can be great resources, but there are other places to turn as well. Online or in-person support groups will allow you to connect with people who better understand what you’re going through, which can really help you manage some of the unique aspects of chronic pain.

No matter your age, we want to help you overcome the pain issues you are facing. We welcome the unique challenge of treating younger adults with chronic pain, and we’ll work hard to find a solution for you. For more information, or to talk with a specialist about your chronic pain condition, reach out to Dr. Cohn and his team today at (952) 738-4580.

Older Adults, Doctors Differ Over Opioid Concerns For Chronic Pain Treatment

March 8, 2024 / Thomas Cohn, MD

A new study took a closer look at some of the concerns patients and providers have when it comes to older adults taking opioids for chronic pain, and the results show that the groups have some different underlying concerns about opioid use.

When patients were asked about the risks associated with long-term opioid use, older adults were more likely to express concerns about becoming addicted to the medication. When providers were asked the same question, their concerns centered around adverse events associated with how the medication may affect the individual, like a balance issue causing a devastating fall.

Plenty Of Similar Thoughts

Despite that main difference, providers and patients agreed on a number of different subjects in regards to opioid use for older adults with chronic pain. Areas of agreement include:

Conversations about “deprescribing” can be difficult and oftentimes unsuccessful.
Opioids as a treatment of last resort is OK.
The goal of pain therapy is to improve patients’ comfort and functional ability.
Trust is paramount in the doctor-patient relationship.

The new study decided to focus on older adults because they are the group with the greatest prevalence of prescription opioid use for chronic pain. Study researchers pointed to earlier data from 2019 that found that 15 percent of Americans age 65 and up had received an opioid prescription and 5 percent had been using the drugs chronically. While it’s encouraging that older adults are aware of some of the potential pitfalls of opioid use, they may be overlooking some of the more pressing concerns that are obvious to providers.

Doctors in the study went on to describe some other issues they regularly face that we’ve also seen first hand here in Minnesota and even in our office. One concern doctors regularly brought up were the challenges associated with deprescribing a patient. While patient reluctance was oftentimes an issue, other concerns also muddied the water. Doctors said that these conversations were often time-consuming and difficult to fit into the time allotted for the patient visit. Additionally, many patients had other pressing concerns during these appointments that took precedence over the prospect of weaning a patient off opioids. Finally, doctors also noted that in some situations there aren’t a lot of reliable alternatives for patients who are looking to move away form an opioid regimen, further complicating the matter.

It’s great that this study took a closer look at some of the opinions and attitudes on both sides of the equation when it comes to treating older adults with chronic pain with an opioid regimen. Hopefully these answers can guide future conversations and lead us to find new solutions to the challenges facing patients and providers battling the chronic pain crisis.

In the meantime, if you want a provider who will do everything in their power to listen to your concerns and help you find a solution to your chronic pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.

Healthy Eating Can Be Hard If You Have Chronic Pain

February 29, 2024 / Thomas Cohn, MD

New research published in Scientific Reports found that many patients with chronic pain expressed a desire to have healthier dietary habits, but following through on this desire can be difficult as a result of their pain condition.

Researchers took a deep look at some self-reported aspects of diet and nutrition among patients who were suffering from a chronic pain condition. They found that despite pursuing some common suboptimal habits like fast-food consumption and irregular mealtimes, many patients with chronic pain expressed a desire to live healthier. Researchers say the findings can help healthcare professionals and pain care specialists address nutritional challenges faced by patients with long-term pain.

Healthy Eating And Chronic Pain

For the study, researchers polled more than 2,100 individuals with a chronic pain condition about a variety of lifestyle factors and their pain levels. The average patient was just over 46 years old, and more than half were overweight or obese. More than half said they had been in pain for five or more years and reported high levels of pain intensity.

When comparing lifestyle factors, researchers found:

People who said they desired to eat healthier were more like to report a longer duration of pain.
A higher pain score was significantly associated with suboptimal eating habits (irregular meal times, unhealthy food choices, etc.).
People with the worst eating habits were the most likely to express a desire to eat healthier.

Looking at the totality of the study, it’s clear that there is a large portion of chronic pain sufferers who want to eat healthier but struggle to do so. And this is understandable, because chronic pain has a significant impact on a number of different aspects of your life. Chronic pain can be isolating and increase your risk of anxiety and depression, all of which can increase your risk of turning towards nutrient-poor and energy-rich food options. Doctors should be jumping at the opportunity to help patients improve their eating habits, because clearly the underlying motivation is there, they are just struggling with following through on these desires.

This is especially true when you consider just how much of an impact your diet can have on your chronic pain condition. A poor diet can lead to increased inflammation, increased oxidative stress, poorer gut health and alter your metabolism, all of which can make a chronic pain condition and its symptoms worse. Making some small positive changes can slowly help you become healthier and regain more control over your chronic pain condition.

We understand that changing your diet and eating healthier is not easy, especially when you’re battling a chronic pain condition, but that’s where we come in. We know that treating chronic pain needs to be a multi-faceted approach, and nutrition is just one key aspect that we’ll focus on during your journey to better health. Don’t just opt for a doctor who is going to write you a script and send you on your way. Work with a provider who takes a comprehensive approach to pain care, and we think you’ll be pleasantly surprised by the success of your treatment.

For more information, or for help with a chronic pain condition you’re experiencing, reach out to Dr. Cohn’s office today at (952) 738-4580.

Diversification Key To Effective Chronic Pain Management

February 22, 2024 / Thomas Cohn, MD

They say that you should be wary about putting all your eggs in one basket, and oftentimes that sentiment holds true when it comes to managing chronic pain. It’s wonderful that you are taking proactive steps to fight back against chronic pain, but rarely will you find that pursuing only one treatment method is the most effective. We almost always recommend a combination of treatments to our patients because we’ve found that common treatments are oftentimes complimentary of one another. In today’s blog, we explain why treatment diversification oftentimes yields the best results.

Pursuing Multiple Chronic Pain Treatments

Working to treat your chronic pain on multiple fronts oftentimes helps you win more small battles on a regular basis. One active treatment is great, but multiple treatments can build on one another, fueling even better results.

Let’s give an example of how multiple chronic pain treatments can build on one another. We typically say that exercise or physical therapy is one of the best treatments for chronic pain. Physical activity strengthens supportive structures and reduces the overall impact of stress on your body. When your body can better handle the stress you put on it, it’s less likely to succumb to a chronic pain flare up. Exercise also has a number of related benefits for our health, like improving circulation and regulating our gut health. If you’re only going to pursue one treatment for chronic pain, usually exercise or physical therapy is the best option.

However, you can enhance the benefits of your exercise program by pursuing some complementary treatment techniques. Here’s a look at some additional techniques and how they can make exercise more effective.

Sleep – Improving your sleep quality can help your muscles recover from the physical stress of the day and ensure your body can effectively remove waste products that are produced as a byproduct of exercise.

Diet – A healthy diet can give your body the nutrients it needs to fuel exercise and bodily functions like bone production or cell replication. Exercise can improve your circulation, and improved circulation makes it easier for your blood to deliver the nutrients from your diet to the areas that need it most.

Ice/Heat – The use of ice packs or heating pads can help to regulate the movement of fluid in your body as they have a physical impact on the size of your blood vessels. Effective icing or heating can help you manage inflammation that can occur as a result of physical activity, helping you recover faster so that you can pursue physical activity again in the neat future.

Anti-Inflammatory Medications – Similarly, anti-inflammatory medications and pain relievers can help quell discomfort that may be preventing you from exercising or prolonging your recovery period after exercise.

Hydration – Staying hydrated makes it easier for your muscles to work properly during exercise. Dehydrated muscles are more likely to cramp or spasm, so staying hydrated can help to prevent some potential physical issues during exercise.

As you can see, a number of additional chronic pain treatments can serve to make other treatments more effective, so don’t pigeonhole yourself when it comes to chronic pain management. If you want help developing the right complementary treatment plan for your needs, reach out to Dr. Cohn and his team today at (952) 738-4580.