Could Non-Invasive Brain Procedure Help Solve Chronic Pain?

/ Thomas Cohn, MD

ultrasound brainResearchers out of Virginia Tech are exploring the possibility of using targeted soundwaves to put an end to chronic pain sensations.

According to the research published in the journal PAIN on Feb. 5, researchers believe that low-intensity soundwaves aimed at a place deep in the brain called the insula could positively impact the perception of pain as well as some of the bodily effects of chronic pain, like heart rate variability.

““This is a proof-of-principle study,” said study lead author Wynn Legon, an assistant professor at the Fralin Biolmedical Research Institute at Virginia Tech. “Can we get the focused ultrasound energy to that part of the brain and does it do anything? Does it change the body’s reaction to a painful stimulus to reduce your perception of pain?”

Harnessing Ultrasound Technology

Ultrasound technology is commonly associated with the ability to view a baby inside a mother’s womb, but it has plenty of other helpful medical uses. High intensity ultrasound can ablate tissues, while low intensity soundwaves can alter electrical activity within a nerve. The latter was the idea behind Legon’s latest study.

For the study involving 23 patients, researchers applied heat to the back of their hands to induce discomfort. At the same time, a wearable headpiece delivered focused ultrasound waves to a specific spot in their brain that was guided by magnetic resonance imaging. Participants were asked to rate their pain perception during each application from zero to nine. At the same time, researchers monitored a person’s heart and heart rate variability, which can help to interpret the body’s reaction to painful stimulus.

When the soundwaves were administered, participants reported an average reduction in pain of three-fourths of a point.

“That might seem like a small amount, but once you get to a full point, it verges on being clinically meaningful,” said Legon. “It could make a significant difference in quality of life, or being able to manage chronic pain with over-the-counter medicines instead of prescription opioids.”

The study also found that the ultrasound application reduced the measured physical responses to the stress of pain – heart rate and heart rate variability.

“Your heart is not a metronome. The time between your heart beats is irregular, and that’s a good thing,” Legon said. “Increasing the body’s ability to deal with and respond to pain may be an important means of reducing disease burden.”

Although the research is in its infancy, it presents a new angle for tackling the issue of chronic pain. Hopefully future studies will find similar results, as a non-invasive and non-addictive treatment is the ideal answer to the problem of chronic pain.

For now, if you’re looking for a more traditional way to overcome your chronic pain condition, sync up with Dr. Cohn and his team. For more information, or for help with a specific chronic pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

Do Redheads Experience Pain Differently Than Others?

/ Thomas Cohn, MD

redhead painRed is the rarest of natural hair colors, accounting for less than two percent of the world’s total population. Aside from sticking out in a crowd, redheads also oftentimes have a heightened skin sensitivity to light, but do they also process pain differently?

A few different studies have explored the idea that redheads experience pain differently than others, and we take a closer look at those studies in today’s blog.

Redheads And Pain

Red hair is caused by a genetic mutation in the gene MC1R. This gene leads to the production of a brown-black melanin pigment called eumelanin, and the more eumelanin created by this gene, the darker and blacker your hair. Because of this genetic mutation, redheads cannot produce eumelanin, which results in the dominant pigment being the red-toned pheomelanin. These pigments don’t just impact a person’s hair – they also play a role in eye color and skin tone, which is why redheads also tend to have blue or green eyes and fairer skin tone. But could this genetic mutation also impact how redheads process pain?

The theory isn’t without some merit, as the MC1R gene is also responsible for the midbrain function that regulates our pain response. A few different studies have sought to see if redheads to experience pain differently than those with other colored hair, but the research has produced some mixed results.

First, there was a study involving female redheads conducted by researchers at the University of Louisville in 2004. In that study, researchers found that redheads required nearly 20 percent more inhaled anesthesia for sedation compared to women with darker hair. They also found that lidocaine injections were less effective in redheads, perhaps suggesting that they experience a greater pain tolerance to local anesthetics than darker haired individuals.

A study conducted a year earlier found different results. In that study conducted by a team of researchers at McGill University in Montreal, they found that female redheads required less morphine to dull pain than non-redheads. Additionally, redhead women needed less of a particular opioid for labor-pain than women with darker hair.

So what does all of that say about redheads and pain? Although the research is limited, it’s possible that redheads are both more tolerant to local anesthetics but more sensitive to painkillers like opioids. Either way, there is no significant evidence that suggests that redheads are worse off with a chronic pain condition than anyone else with different colored hair.

At the end of the day, we want to help you overcome your pain condition no matter your hair color or any other unrelated factor. We just want to help you find a solution to your new or chronic pain issue. For more information on how we work to help you achieve this relief, or to talk with a specialist about your individual pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

How To Overcome The Invisible Battles Of Chronic Pain

/ Thomas Cohn, MD

invisible injuriesIf you slip and fall on the ice and break your ankle, it’s pretty obvious that you are working to overcome an injury when your friends and coworkers see you hobbling around on a cast or crutches the next day. We tend to have a lot more empathy for those dealing with obvious and visible injuries than for those who consistently fight “invisible” battles against conditions like chronic pain, fibromyalgia or migraines.

But why are we so less empathetic to those fighting invisible battles, and what can you do to win these battles if you’re constantly dealing with the fallout of an invisible condition? We answer those questions and more in today’s blog.

Why Invisible Battles Can Be So Hard To Fight

A chronic pain condition can be hard enough to overcome without all the other problems it can beckon as a result of being an invisible battle. Here’s a look at some of the reasons why winning these invisible battle can be extra challenging:

1. Unpredictability – If you break your ankle, you know you’re going to be in a cast for a while before gradually putting more pressure on the foot as you work back towards a return to normal activities. It’s pretty easy to chart your expected treatment and recovery plan for that type of injury. The same cannot be said for a condition like chronic pain, which is oftentimes unpredictable and difficult to treat. There’s no standard playbook for treating chronic pain, and the condition can flare up at a moment’s notice, and this unpredictable nature can be another added stress.

2. Lack Of Empathy From Others – We touched on this in the intro, but many patients find that they don’t receive the same amount of empathy from others as a result of the invisible nature of their condition. It can be easy to empathize with an obvious physical injury, but it’s not always easy to empathize with someone who looks completely fine on the outside, even if they are dealing with a major issue on the inside.

3. Impact On Relationships – Invisible injuries can also put a strain on your interpersonal relationships. The unpredictable nature of your condition can lead to cancelled plans and isolation, stressing your relationships with others.

4. Takes A Toll On Your Mental Health – Studies have found that patients with a chronic pain condition are more likely to also deal with mental health issues like depression or anxiety. These mental health issues can have real-world implications for your physical health as well, especially if they make it hard to live an active and social life.

Winning Invisible Battles

It’s easy to see why these invisible battles can be extra burdensome, but how can we break through and start winning these battles? While every patient and condition is different, some of the more common treatments and lifestyle changes that can prove helpful include:

Of course, one of the best ways to overcome your individual chronic pain challenge is by connecting with an interventional pain management specialist who can take a closer look at your pain problem in person and develop a personalized treatment program. Your specialist can develop a treatment plan catered to your specific needs and adjust things as needed after you make progress or notice a setback. It won’t always be easy, but it can be one of the most effective ways to start winning more of these invisible battles.

For more information about chronic pain problems, or to connect with a pain management specialist in the greater Twin Cities area, reach out to Dr. Cohn and his team today at (952) 738-4580.

Chronic Pain’s Impact On Your Heart

/ Thomas Cohn, MD

heart chronic pain

It should come as no surprise that a chronic pain condition can have repercussions for other areas of your body, but it can also cause problems for a very vital part of your body – your heart. In today’s blog, we take a closer look at how an unmanaged pain condition can make life more difficult for your heart.

Chronic Pain And Your Heart

When you’re dealing with pain signals, the area of your brain called the amygdala is more active. When your amygdala is active, it triggers something known as the hypothalamic-pituitary-adrenocortical axis (HPA axis for short). Your HPA axis releases a number of hormones throughout your body, like adrenaline, cortisol and noradenraline. Your body knows how to respond to the presence of these hormones, but problems develop when your body is exposed to an unrelenting release of these hormones as a result of your chronic pain. Essentially, chronic pain causes your amygdala and HPA axis to go into overdrive, leading to excess hormone production which can be harmful to certain bodily systems, inducing your heart. Research has found that hyperamygdalar activity has been linked to an increased risk or arterial (heart) inflammation.

There is also an established connection between pain and your heart rate. Research has found that heart rate variability can occur as a response to painful stimuli, and over time an extended period of time, this can increase your risk of heart arrhythmia. Working to calm your pain condition can also help to normalize your heart rate and take stress off the vital organ.

Chronic pain has also been linked to issues with blood pressure, which too impacts your heart health. Acute pain has been linked to a short-term increase in blood pressure, but chronic pain sensations can affect your body’s ability to regulate its blood pressure. Chronic pain can impair your cardiovascular and analgesia systems, which can increase your risk of long-term elevated blood pressure, which only stresses your heart further.

Finally, chronic pain has been connected to an increased risk of a myocardial infarction, or heart attack. Not only are you at a greater risk of heart attack if you have an elevated heart rate and blood pressure, but certain medications used to mange your chronic pain may too increase your risk of a heart attack. One study followed 17,614 people who were using pain relievers for at least three months to treat their chronic pain condition. When compared to a control group, researchers found that the patients taking long-term pain relievers were 20 percent more likely to suffer a heart attack (and 30 percent more likely to suffer a stroke).

And while we’re still learning more about the connection between chronic pain and your heart health, it’s clear that unmanaged chronic pain can have a significant impact on your overall heart health. Fortunately, treating the underlying chronic pain condition can also help to improve your heart health, which is just another reason why you shouldn’t just succumb to a life with chronic pain.

If you want to take care of your heart health, strive to take more control over your chronic pain condition this year. For professional help achieving this, reach out to Dr. Cohn and his team today at (952) 738-4580.

Medical Cannabis For Chronic Pain Could Increase Heart Arrhythmia Risk

/ Thomas Cohn, MD

medical marijuana programNew research out of Denmark suggests that medical marijuana use for chronic pain issues may significantly increase a person’s risk for de novo arrhythmia compared to patients who pursue other treatments for their pain.

While the absolute risk of developing heart arrhythmia while taking medical cannabis for a chronic pain condition is still relatively low (0.4%), the fact that is raises your risk at all could be a cause for concern for many patients, especially those with a history of heart issues.

“Short-term risk of arrhythmia was significantly elevated in patients prescribed medical cannabis compared with matched control patients, but the absolute risk increase was modest at 0.4% in the first 180 days,” said Anders Holt, MD, cardiologist at Copenhagen University Hospital – Herlev and Gentofte in Denmark, in an interview with Healio.

Medical Cannabis And Heart Issues

For their research, Holt and colleagues used nationwide registers to identify 5,391 patients with chronic pain who began using medical cannabis between 2018 and 2021 as part of their treatment plan. This group was then age- and sex-matched 1:5 to 26,941 control patients with a chronic pain diagnosis that were pursuing another pain medication treatment other than medical cannabis.

For the patients that used medical cannabis:

  • 24% used CBD
  • 29% used combination CBD/THC
  • 47% used THC alone

For patients pursuing other treatments, the most common medications were NSAIDs, anti-epileptic drugs and opioids.

Researchers reported that medical cannabis use was associated with a 180-day absolute risk for new-onset arrhythmia of 0.8%, whereas non-use was linked to a 180-day absolute risk for new-onset arrhythmia of 0.4%, meaning patients who pursued medical cannabis were twice as likely as their counterparts to develop a new heart arrhythmia. Researchers said the increased arrhythmia risk was similar regardless of the type of medical cannabis they pursued.

“Both CBD and THC have an effect on the CB1R receptor, which theoretically could lead to CV [cardiovascular] side effects,” said Holt. “Previously, side effects have been mostly suspected to be related to THC since the psychoactive properties of cannabis arise from this cannabinoid. Findings from this study suggest that both THC and CBD may play a role in the risk of CV side effects.”

The team did note that they observed no significant association between medical cannabis use for chronic pain and risk for acute coronary syndrome

“This study adds important and much-needed data on CV side effects related to medical cannabis; however, clinicians should consider the observational nature of these findings which limits their impact and applicability for clinical recommendations before changing any practice,” Holt concluded. “Considering all available data on medical cannabis treatment for chronic pain, I believe that it should probably be reserved for chronic pain conditions where the effect is supported by sufficient evidence, eg, neuropathic chronic pain. Considering data from this study, some improved monitoring of CV symptoms immediately following initiation could be beneficial, especially in patients with known cardiometabolic disease or history of cancer.”

Dr. Holt’s takeaway point here is key. Given the nature of the study results, physicians should thoroughly review a patient’s heart history before recommending medical cannabis as a treatment option, and heart monitoring could be beneficial for chronic pain patients who are beginning a medical cannabis regimen. Medical cannabis has been shown to be an effective tool in managing symptoms for many types of chronic pain patients, but it’s not without its own risks. Patients would benefit from an open and honest dialogue with their doctor about their heart health prior to beginning a medical cannabis regimen as part of treatment for their chronic pain condition.

For more information about medical cannabis or chronic pain treatment, reach out to Dr. Cohn and his team today at (952) 738-4580.