Two Reasons Why Smoking And Chronic Pain Don’t Mix

smoking chronic painAs someone who has dealt with both acute and chronic back pain, I understand why patients want to control certain aspects of their life. Chronic pain can lead to anxiety and stress, and oftentimes patients just want 5-10 minutes where they can turn their brains away from their pain and feel a little relief.

Unfortunately, some people turn to cigarettes for this relief, and while it may offer you short-term relief, it’s making it hard for you to achieve long-term relief from your chronic pain.

Smoking has been linked to cancer, but today we’re going to focus on its impact on your chronic pain. I understand where the smoker’s head is at, but here are two reasons why smoking is seriously jeopardizing your likelihood of ever solving your chronic pain problem.

Why Smoking Worsens Your Chronic Pain

Smoking does a number of different things to your body, but one specific side effect of smoking is the impairment of oxygen-rich blood to your bones and soft tissues. Think of it like watering your garden during a week-long drought. If you water your garden once during the middle of the week, the plants will get some nutrition, but they will also suffer because they need more water. If you watered your garden 3-4 times throughout the week, your plants would never be without nutrition and thus could grow and prosper.

The same thing happens when you smoke. Some oxygenated blood reaches the lower back, but more would help your body heal faster. Giving up smoking will ensure that more healthy blood reaches areas of pain, decreasing your likelihood of a flare up.

Along a similar vein, the second reason why smoking makes it harder to recover from a chronic pain situation is because smoking has been linked to fatigue and slower healing rates. Exercise is a great way to combat chronic pain, but if you are tired or unable to exercise for longer periods due to your smoking habits, your chronic pain is more likely to linger. Similarly, blood vessel restriction means that your body can’t always get the nutrients to heal as quickly. Chronic pain can easily become cyclical if smoking slows your body’s ability to heal, or if it contributes to the onset of other painful conditions, like arthritis or degenerative disc disease.

It’s easier said than done, but if you can kick the habit for a healthier one, odds are you’ll be amazed at the health improvements you’ll see. We understand the desire to find some control in what seems like an uncontrollable situation, but turning to cigarettes only makes the problem worse.

Does Anyone Understand My Pain?

understand chronic painMost people who have chronic pain, no matter what the source, believe they are alone in the world and that no one has similar problems and no one in medicine can appreciate the problems they suffer. However, as I have often said, about 30 percent of the population in the world has problems of some type with pain. It is the same in the United States as it is in the undeveloped world in Africa or in the industrial world of Europe or Japan. If so many people have pain, a lot of people have similar types of problems and there are likely medical professionals that do understand pain problems. There are many types of medical professionals that see pain patients, including Chiropractors, Physical Therapists and Psychologists, to all kinds of physicians including Physiatrists to surgeons.

Who Should I See For My Pain?

The best person for one to see is someone who may understand whatever problems are causing pain. If the problem is simple, it may not matter who you see because many professionals understand and are trained on that care. The more complex the problem, the harder it becomes to find professionals who care and understand the issues and have the expertise to coordinate management. My personal bias for the complex patient is to find a pain clinic that is led by a specialist in Physical Medicine and Rehabilitation – a Physiatrist. These are the physicians that have been crossed trained across multiple specialties including internal medicine, rheumatology (arthritis), neurology and orthopedics among many disciplines. Most of these doctors are good at coordinating a team effort to help patients. As with any doctor or specialist, 90 percent of them will do a good job and 10 percent will be outstanding.

Finding an outstanding doctor is always difficult. Sometimes it is a gift of a good personality, others listen well, and some just have so much experience that they can help those who want help and are willing to work toward a solution. Every patient has a different need and many patients will define good doctors and professionals in their own ways. Some doctors just understand things better because they have been through the problems personally.

My Personal Experience

To tell the truth, when I was in my medical training, the experience I had treating pain patients was one of my least favorite areas. I always was looking for other things to treat, including pediatrics, spinal cord injuries, electrodiagnostics and inpatient rehabilitation. As I entered private practice 30 years ago, I did inpatient rehabilitation of devastating problems like stroke and spinal cord injury, and outpatient care of every type of medical problem that could cause pain. After about five years I was doing more outpatient than inpatient, and eventually I transitioned to all outpatient practice. Most of my patients had medical problems or injuries that somehow caused pain. Either I needed to get good with diagnosis and treatment or else find something else to do, so I worked at getting good at that special area.

Unfortunately as I became older, I not only became wiser, but also had back pain problems from an injury to my lumbar spine as a medical student when I tried weightlifting. I also saw close people around me have issues with pain, from my wife to all my children at times. Some of the problems have been easy to help manage, some I struggle with daily and are heartbreaking even for me. The most important thing about the overall experience is that it develops a level of empathy and knowledge that it takes a ton of work on both the patient’s part and the treating physician to provide good care and help with a management plan. Furthermore, for many people pain never goes away, but is something that gets managed. It is physical and it is mental, in your brain and it affects the perception of life. It can be time consuming, tiring and often it seems depressing. Despite all the problems, the reward is moving forward and seeing the world change.

If you have pain, you are part of a third of the world population who does have pain. There are many people out in this world that can help guide you through the maze of pain management. Finding the right person for you may take time. There are multiple choices and multiple providers that may help. Yes, some people are better than others, and some will be more helpful, and lastly you may not like some of the people who may actually have the best answers. Life is tough, but it will be a team effort to move forward, and the most important person to move forward is you.

Updating The Daith Piercing Survey

migraine surveyWe wanted to give you another quick update on the Daith piercing survey that a colleague of mine is running in order to help us better understand how the Daith piercing may help individuals with chronic headaches. This update won’t have a lot of information, but that’s a good thing. Medical journals are pretty picky when it comes to publishing studies that have already been published in another source, so in order to ensure the findings get shared in a major medical journal, this update can only speak in generalities.

Daith Piercing Update

That being said, this update is also encouraging. Over 1,000 people have taken part in the survey so far, and you still have time to do so if you haven’t taken it yet. You can participate in the survey by following this link and answering the questions on that page.

The results show very promising results when it comes to successful management of certain headaches with the Daith piercing. To be safe, that’s all we can really say right now, but we still need your help. My colleague Dr. Chris Blatchley, who is running the study, has created a second version of the Daith piercing survey to address some areas that he felt the first version did not adequately cover. If you are willing, please click here to take the second version of the survey. Regardless of whether you completed version one or not, it would be wonderful if you could take a couple of minutes to fill out the new version of the survey. The first version of the survey is no longer available, to the two links we’ve posted in this blog will take you to the same place.

Thank you so much for taking the time to help us get a better understanding of the Daith piercing and how it may be able to help certain patients. We promise to keep you updated about future studies, this study’s results, as well as when and where the full data analysis will be published. Thank you for your continued support, and please reach out to Dr. Blatchley if you have any questions. You can visit his website by clicking here.

Thanks!

Dr. Cohn

Not Every Pain Study Should Be Taken As The Truth

radiofrequency lesioning spineYears ago when first entering into the world of medicine, I thought that if a study appeared in a leading scientific journal then it would have to have been a good scientific study. As an undergraduate and in my medical student years I was never really taught how to read a paper and analyze it for its quality. Over the years more articles stopped making sense, and as one would delve into the details, it often became clear that many studies that were published were just bad research.

Often if one knew something about the subject being studied, either the conclusions were obvious or they were not clearly defined such that the answer found may not really have a true correlation to the problem. Good medical studies are often very hard to perform. If you are not very careful, the answer will be junk, even if it is published in a good medical journal. Recently, this has occurred in a major medical journal.

Insurance Sponsored Studies

A recent study in the Journal of the American Medical Association (JAMA) was published with the finding that radiofrequency lesioning does not work in the lumbar region. Unfortunately, this again was a seriously flawed study and on top of everything from a research perspective, it was an insurance sponsored product. The pain societies across the world have been surprised and highly critical of the poor quality of the research and conclusions drawn in this paper.

If one has done their research, they would see that there are multiple excellent studies supporting the use of radiofrequency techniques for some specific uses. This technique has been around since the 1970’s and good equipment and understanding was established in the 1990’s. The technique is very successful for removing a nerve pathway for sensation feedback from facet joints. The science has been proven in detailed and has benefited thousands of pain sufferers. It is a common treatment for facet pain in both the neck and lumbar region and is highly successful when diagnostic blocks done first are indicative of pain relief.

This type of intervention has also been used for a number of other things including knee joint problems, sacro-iliac joint pain, and a variety of peripheral nerve problems and lumbar disc issues. All the other areas treated have had less success due to complex nerve locations. Lumping all radiofrequency treatments together and saying that they do not work is a true disservice to medicine and the patients. Further, since the JAMA is a highly regarded journal, the editors should have more closely scrutinized the study for its validity. Understanding the anatomy in the body also makes a huge difference; nerve location for most areas of the body can be highly variable from person to person and therefore it may be difficult to be successful in severing a nerve with limited ability to visualize its location.

Pain is a very complex sensation in the human body. The overall perception of the stimuli is based on the interpretation of signals in the brain. The brain may actually be receiving signals from multiple structures but interpreting them all as similar and from one location. Eliminating one piece of the signal may be sufficient to solve a pain problem. If the signals are coming from multiple locations, eliminating just one part of the signal may not change the brain’s perception of pain. The joints along the spine have very well defined sensory nerves and feedback; If the pain is from this structure it can be clearly determined and successfully treated. The discs and sacro-iliac joints have poorly defined sensory feedback, trying to eliminate the signals from these regions is still a matter of study. If the editor of JAMA used some critical thinking, the poor quality of the study would have been easily seen and the disservice of its publication could have been avoided.

Radiofrequency management of pain can be highly successful. It is definitely a science with some very technical variables that impact its success. To use this as a tool in pain management, understanding its science, capabilities, risks and benefits is necessary. It is well proven to work in certain situations. A good clinician can maximize radiofrequency effectiveness for a variety of problems but it does have limits. It is not experimental but it does have its inherent challenges in its ability to safely remove enough nerves to relieve pain. If you have pain, a good board certified pain physician can often help a patient find strategies that may lead to more successful management of your symptoms.

Chronic Pain After Surgery

chronic pain cpspIn the vast majority of cases, a surgical procedure helps to eliminate or reduce pain in the targeted area. However, in rare cases, complications or unforeseen circumstances can result in the onset of what’s known as chronic postsurgical pain.

Today, we’re going to take a closer look at CPSP, and how it is prevented and treated.

Treating Chronic Pain After Surgery

Medical experts define chronic postsurgical pain as pain that persists for at least two months after surgery and is not attributable to a preexisting condition. Oftentimes CPSP is considered neuropathic in nature, and patients describe the pain as shooting, burning, tingling or electrical in nature. Some procedures that have a higher rate of CPSP after surgery include:

  • Amputation
  • Coronary artery bypass surgery
  • Thoracotomy
  • Spine surgery
  • Breast surgery
  • Hip surgery
  • Hysterectomy
  • Inguinal hernia repair
  • Cesarean section

Doctors believe that CPSP develops because stress from the operation, inflammation or nerve damage results in neuronal hypersensitivity that results in the expression of chronic pain flare ups long after the surgical site has healed.

Risks and Prevention

There are a number of factors that increase a person’s risk of developing chronic postsurgical pain after an operation. Those factors include undergoing repeat surgeries, lengthy surgeries, open procedures instead of minimally invasive surgeries, and undergoing an operation in a previously injured area. On the doctor’s end, a surgeon can increase a person’s risk of developing CPSP if there is intraoperative nerve damage, which is more likely to occur in difficult operations, surgeries involving severe trauma, or surgeries near the spinal cord and central nervous system.

The main way surgical teams prevent CPSP is through surgical techniques and improved operative practices. If possible, the surgeon will opt for a laparoscopic procedure in lieu of an open procedure, because minimally invasive options have a decreased likelihood of CPSP. Another thing surgical teams will do is carefully administer analgesic agents with different mechanisms of actions during the pre-, intra- and post-operative periods. These approaches reduce peripheral and central sensitization and are associated with enhanced efficacy and fewer adverse reactions.

Should you develop CPSP after an operation, reach out to a chronic pain doctor in your area to see what solutions are available to you.