Loneliness and Chronic Pain

loneliness painChronic pain is difficult to manage for a variety of reasons, and pain is only part of the problem. Chronic pain disrupts your social life, and it can leave you feeling isolated or with feelings of loneliness. Maintaining a healthy mindset and combating these feelings of isolation are key in treating the whole issue of chronic pain. Today, we share some ways to avoid feeling alone if you’re dealing with a chronic condition.

Preventing Isolation With Chronic Pain

Here are some things you can do if you’re feeling like your chronic pain condition is making it difficult to connect with the outside world:

1. Join A Support Group – The key to avoiding feelings of isolation when battling a chronic pain condition is to remember that you are not alone. At times it may seem like you are alone, but there are so many others dealing with the same condition. Ask your doctor if they know of any support groups for people living with your condition, or perform a simple online search. Odds are a support group is only a couple clicks away!

2. Lean On Close Friends – Not everyone is going to understand what you’re going through, and that’s fine. However, odds are you have a couple friends that are sympathetic and understand what you’re going through. Make plans to connect with these people, even if it’s just once or twice a month for coffee. Pain can sometimes interrupt these plans, but your close friends will understand and adapt, and making plans gives you something to look forward to instead of just dwelling on your pain condition.

3. Exercise – Exercise releases endorphins in your brain that can enhance your mood, and it also gives you a sense of accomplishment. Pain can make exercise difficult, but odds are you can find a few exercises that you can perform without pain getting in the way. Exercise also helps to combat chronic pain, so aside from helping put you in a positive frame of mind, it’s also helping you fight against chronic pain.

4. Talk About Your Emotions – Don’t bottle up your emotions. It’s helpful to talk about your feelings and vent about your frustrations when it comes to chronic pain. If you don’t want to talk to your friends or family about your feelings, bring them up to a doctor, your support group or a therapist. It’s important to remember that these feelings are normal, but hiding them or trying to mask them can actually make them worse. You’ll also feel more connected with others if you open up to them about what you’re going through.

For more tips on combating feelings of loneliness or isolation, reach out to Dr. Cohn and his team today.

Exercises For Sciatica Relief

Sciatica is a painful condition that occurs when your sciatic nerve becomes damaged or compressed. Your sciatic nerve runs down your leg, and when it becomes compressed, symptoms can range from mild discomfort to major pain.

Sciatica is a condition that we see pretty regularly in our office, so when our colleagues at Pain Management & Injury Relief reached out to us about sharing an infographic they created that focuses on sciatica treatment, we thought it would be a great addition to our blog. A stretching routine combined with regular exercise is one of the best ways to control and combat sciatic nerve pain, so if you are dealing with shooting or tingling pain in your legs, check out the infographic below.

Also, for more information on treating sciatica pain or other chronic conditions, be sure to swing on over to PainInjuryRelief.com

Find Sciatica Relief with These Simple, Effective Stretches

Concerning Behaviors Associated With Pain Pill Abuse

painkiller abuse signsOpioid management is probably the most charged topic that we talk about frequently on our blog. Many of our patients and readers take some type of opioid medication to help manage their pain, and they get nervous or angry when they hear big government talk about restricting opioid access due to an increase in overdoses. The majority of people take their pain pills responsibly, and they are concerned that the minority who are abusing pills will make it impossible for them to get the opioids they depend on.

Opioids certainly have value in a pain management program, but we also don’t believe they should be the only treatment option that is being tried. And if you are going to take opioids, you need to be sure you use them responsibly and they aren’t abused by others in your home. One way in which doctors and family members can help stop painkiller abuse is by looking for certain concerning behaviors that are often associated with opioid abuse. We take a closer look at some of those behaviors in today’s blog.

Behaviors Associated With Pain Pill Abuse

Here are some of the behaviors that doctors and family members can look for that may suggest a person is dealing with a substance abuse or pain management problem:

  • Missing appointments.
  • Taking their pills for something other than pain.
  • Using more medication than prescribed, or asking for a refill before the prescription end date.
  • Repeated inquiries to get an increased pill dosage.
  • Being aggressive or hostile to healthcare staff or family members.
  • Taking medication in combination with alcohol or other drugs.
  • Lack of participation in other treatment modalities.
  • Bouncing around from doctor to doctor or clinic to clinic.

If someone you now is demonstrating a few or all of these behaviors, reach out for support. Contact Dr. Cohn or reach out to your specialist to learn ways to talk to your loved one about painkiller abuse and how to get them the help and support they need. It’s never an easy conversation, but it’s one that needs to happen.

The consequences of painkiller abuse can be deadly, so don’t sit back and do nothing. Contact a healthcare provider or addiction services center to ask about the next steps in the process. We’ve also compiled a few links that you can check out if you suspect that a friend or family member is abusing pain pills. Please don’t hesitate to reach out if you have any questions.

What’s New With Complex Regional Pain Syndrome?

crps painComplex regional pain syndrome is often seen as a weird and devastating problem. One of the biggest issues is the lack of identifying it as an issue and beginning the right type of pain management. Fortunately, in my practice, we are known for being able to deal with it and often find good solutions to manage it. Treatments can range from simple to complex. In the educated pain community, a better understanding is occurring. Unfortunately, it seems that some pain doctors are not furthering their education when it comes to CRPS.

Improving Treatment of CRPS

The good news is that we are starting to get a better with diagnosis and treatment of CRPS. The prognosis in general is that the symptoms in most people will resolve within a year; this occurs in 75 percent of people. The understanding of CRPS is better nowadays, and it does not just occur spontaneously. It is not an entity without a cause. It occurs in context with some sort of injury.

Usually it occurs in either the arm or leg, and it is often related to either surgerical trauma or actual physical trauma. Examples include an arm with multiple fractures or a hand injury coupled with carpal tunnel syndrome. In the leg it is often associated with multiple fractures or an ongoing sprain in the foot and ankle. It is also more common in people who already have a sensitized nervous system, such as someone with a neck or low back problem, a diabetic, or someone with fibromyalgia. The research is also showing that there may be a genetic component (there may be 80 or more genes that are involved) and some people may be prone to this occurring, but there is no test yet available.

The answer to why a person has uncontrolled pain is that there are too many sensory “pain” type signals going to the brain for too long of a time period. With most injuries, healing rapidly occurs, especially when treated promptly. Injuries to the foot and hand are more complex since there are multiple tendons, ligaments, bones and nerves present and many of these can be damaged. The medical community often does a great job of fixing the obviously fractured bones, however, if the trauma is with sufficient force to fracture a bone then it can damage surrounding things like tendons, ligaments and nerves.

These “soft tissue” structures are much harder to see and to determine if they are damaged. Repairing them also may be hard and sometimes things like damaged nerves are not really possible to surgically treat. All these structures in the hands and feet must work in a very complex manner; one part not moving correctly often will send messages back to the brain that all is not well. These continuous error messages to the brain start becoming amplified and a short circuit occurs telling the pain signals that there is a problem in the area and something needs to be done to stop the problem. The amplified pain signals is what we perceive in CRPS.

The Goals Of Treatment

The goal of CRPS treatment, if identified early, is to find and fix the issues present. As a medical provider, the goal of understanding CRPS is not that the patient is crazy, it is that something is wrong and what can we do to fix and address the problem. To control the pain, a patient with signs of CRPS must first determine what are all the issues that may be contributing to the problem. A comprehensive evaluation is necessary and all the patient’s medical history can be extremely important. Everything from concurrent medical problems to psychological issues can contribute to the problem.

More frustrating may be that not all of the medical problems contributing to the CRPS may be treatable. Sometimes the fracture damage of an arm or leg cannot be fully corrected. Damaged ligaments, bone misalignment and nerve injury are not able to return to normal function. The signals that tell our brain that something is wrong cannot be turned off since there is no mechanism to shut them down completely. This is especially true in severe trauma or where there are secondary conditions reinforcing the signals like spine problems or diabetes. For the physician, the first mission is to find out what are the problems causing the abnormal signals and correct them. A team approach is often the best since it may take an expert in pain to identify all the problemed areas and the expertise of a variety of specialists to intervene if a fix is available. As noted above, 75 percent of the people will experience symptom relief within in a year, meaning successful management strategies can be implemented.

Identifying CRPS early within the first few weeks to months leads to the best treatment. If pain after an injury does occur, is severe and continues past normal healing time, seek the help of a good pain physician. The mark of good pain physician is one who frequently sees and treats complex problems. Many pain physicians confine their practices to the simple straightforward pain problems; these tougher issues need the physicians that know medical and interventional treatment options and are active in ongoing evaluation and management including high levels of intervention. Physicians who do mostly medical or interventional managements and not both are unlikely to have a full knowledge of the complex issues contributing to CRPS. Understanding and communicating with the patient is essential. Find a good physician that does understand CRPS and the strategies to have the best chance at finding pain relief.

Multifaceted Approach To Treatment

Not all CRPS cases can be easily resolved. Obviously, not all injuries can be corrected and when there are multiple problems contributing to CRPS, it may be an ongoing issue. The treatment plan often needs to include physical therapy to improve functional problems associated with the body parts involved. With any significant injury, it often takes a lot of exercise for a long period of time to restore function, and it may involve complex strategies to retrain the body. The efforts with physical therapy need to be continued on your own, and stopping the exercises does not work for recovery.

Psychology is another important aspect to manage and improve when it comes to CRPS treatment. The pain is not imagined, and psychologists can help the patient understand how the brain decides to perceive the pain signals and how patients interpret them. The brain can only do a couple of things at one time and psychologists often can help train the brain not to pay attention to these pain signals. Recognizing the associated cognitive issues like the perception of pain and that depression is not a sign of being weak leads to more successful outcomes.

CRPS is a complex phenomenon and involves understanding of all parts of the syndrome. There are now a variety of medications used for treatment. Common medications include those that affect nerve signaling like Gabapentin and Lyrica. Some depression medications also decrease nerve signaling. Cymbalta does this well, and older medications like amytriptyline and nortriptyline can also be very helpful, and they may also help with related sleep problems. Newer medications that have found to be helpful range from those used to treat osteoporesis like Boniva (or many of the other drugs in this category know as biphosphonates), to Botox, Viagra, and odd blood pressure medications like clonidine. Ketamine, an anesthetic, is used occasionally but is difficult to safely administer, works for a limited amount of time, may have significant side affects, is costly and often insurance does not cover its use.

Spinal Cord Stimulators For CRPS

For the most refractory cases of CRPS, implantable devices are one of the best and most cost effective treatments. These devices are primarily spinal cord stimulators (SCS) but sometimes may include intrathecal pumps to deliver medication directly to the spine. A good pain physician will be able to coordinate and make sure all the conservative medical issues are addressed prior to working with implantable devices.

If this is the first suggestion without working with a team to address all the other issues, be careful with proceeding forward. SCS systems are wonderful treatments, but there is a lot of marketing being done toward physicians with these devices so an experienced implanter is needed since treatment with these systems may need to be aimed at multiple targets. There are systems that can be used just for a specific target known as DRG spinal cord stimulators and they are good when there is absolutely no other problem contributing to a foot or ankle CRPS that is not fixable (they are not used for hand and arm CRPS).

Multiple companies make SCS units. It is debatable who has the best unit, but other factors like manufacturer support and MRI scan safety also need to be considered. Properly placed, a SCS’s effectiveness can usually be determined after a trial period of about 5-7 days. Improved function, improved ability to stand, walk, do activities, and sleep are the goals associated with a SCS. If nothing is working, implantable pain pumps are reasonable. These do have risks but they can greatly improve the patient’s quality of life. A variety of medications can be delivered to the spine and the best medication may not be an opioid, but Ziconitide, which is a snail toxin.

CRPS is a complex issue, in reality it may affect the whole body due to the impact of the pain. It takes a team to treat and help the patient through this medical problem. A good pain physician will help one navigate the treatment path of CRPS. It is a very tough medical problem, and its not only in your brain. Treatment needs to be an interaction with your provider who fully understands and helps with coordinating and providing care for all the issues. CRPS does feel like a scary medical problem, but good pain physicians can lead one to a successful outcome.

Chronic Pain and Your Credit Score – An Interesting Link

chronic pain creditChronic pain has many obvious drawbacks, but it also has many hidden consequences. We know that chronic pain can be costly to treat, but new research suggests that it can have a severe impact on your buying power or your ability to secure credit.

According to a new study published in the National Pain Report, a survey of 840 chronic pain sufferers found that a whopping 63 percent were unable to secure credit. As you might have guessed, this has far-reaching consequences for pain sufferers.

Chronic Pain and Your Credit

Researchers said that there were a number of different reasons why chronic pain sufferers had difficulty securing credit. Some of the most common challenges individuals with chronic pain run into credit-wise include:

  • Difficulty obtaining credit because chronic pain makes it hard or impossible for them to maintain employment.
  • High interest on credit cards or loans that they are able to secure.
  • Difficulty getting a cell phone contract.
  • Inability to get approved for a home loan or apartment rental.
  • Inability to secure utilities, like electricity, propane or gas.
  • Difficulty getting automobile or life insurance, and when they do, rates are often very high.

“The inability to secure credit brings a long list of challenges, particularly for those who also suffer with medical conditions, like pain,” said Jim Shanahan, President and CEO of Prepaidian, Inc, a company who specializes in Prepaid debit cards that are intended to provide buying power for people who are unable to secure credit. “You may be unable to get a checking account, or pay exorbitant fees on those accounts, in addition to trying to manage medical bills.”

How To Improve Your Credit While Dealing With Chronic Pain

Improving your credit score while you deal with chronic pain isn’t always easy, but there are things you can do to improve it bit by bit. For example, always try to make your payments on time, even if it’s just the minimum amount. Paying on time helps to improve your credit score. Secondly, don’t be in a rush to close your accounts. Closing accounts, even ones you don’t use, negatively impacts your credit score because it limits your buying power. If you absolutely have to close out an account, see if you can increase your line of credit on a different account. Even if you don’t plan to spend that much, your credit score improves when you have more potential buying power at your disposal.

Secondly, try to settle up past due accounts. Odds are if you’re willing to pay at least a portion of the bill, the credit card company will be willing to erase the debt, because getting some money is better than getting nothing. You can call in and see if they’ll waive late fees or some interest charges, because it never hurts to ask, and if waiving a fee gets the credit card company their money, oftentimes they’ll be willing to compromise. It never hurts to ask.

Lastly, if medical bills from chronic pain are stacking up, try to get on a payment plan with your health center or insurance company. Making regular payments and working towards a zero balance will do wonders for your credit score. Explain your situation, and people may be more willing to help.