Could This Be The Next Big Thing In Pain Management?

June 10, 2019June 10, 2019 / Thomas Cohn, MD

Last Sunday in the science section of the newspaper there was an article about research on a new pain drug. The scientists behind the drug are convinced they have the next great drug. The skeptic in me hopes but doubts it. The reason the news has not made the traditional rounds in in all the reputable medical sites that spread news of discoveries. Furthermore, the work to date is only in animals and there has not been definite evidence this will transfer to humans.

The article discusses the work of Dr. Bruce Hammock, an entomologist at University of California-Davis. In the 1970’s he was working on an enzyme that converted a corn ear-worm to an insect. Removing the enzyme essentially killed the insect before it converted to the moth and was able to breed. Overall this was not found to be a cost effective strategy for this insect to be controlled. Since that part of his work did not pan out, he started looking for how the enzyme or related enzymes might occur in other species. especially humans.

Eventually Dr. Hammock found these compounds in humans and they supposedly reduce pain. Of note, he does not specify what these compounds are, but only says they are chemically broken down rapidly in the body naturally. He then found a way to keep them from being broken down in the body as quickly. Dr. Hammock believes this compound can somehow help relieve pain.

Believe It When We See It

The reason to be skeptic is that naturally this compound that reduces the intensity of pain is very transient in the body by the description given. This makes me believe it is likely easily broken down by chemicals in the body and is in a very limited location. This type of compound is very hard to deliver conveniently (like a pill) into the body and be absorbed. It is also likely to be easily broken down no matter what one does. Lastly, the chemical sounds like it may be something that exists in the nervous system, and thus isolated by something like the blood-brain barrier.

The researchers behind this new novel compound are just looking at starting human trials. So far there has been little funding toward the research from what has been said in the regular press. Further, as noted earlier there is no information in the extensive research pain literature on the animal-level studies discussing this compound. If the research was really promising, more money would be involved without question since pain treatment is a billion dollar industry with huge potentials.

The bottom line is that there is research going on in the field of pain medicine trying to develop new treatments and medications. However, whether any of the current research will lead to new drugs is difficult to guess. A lot of treatments have been proposed but most die as they are tested. Human studies usually take between five and 10 years to complete. Only time will tell if this research will ever lead to a new drug that is useful to treat pain.

Work Can Be Exercise

June 3, 2019 / Thomas Cohn, MD

Adding an exercise to a busy person’s life is sometimes difficult. Many people claim that their daily activities give them enough exercise to stay healthy, and in some cases this may be true. Physicians are beginning to recognize that what we do as part of our regular routines may count as exercise. For meeting the goal of aerobic conditioning, the movement we do routinely is helpful.

Aerobic conditioning is one component of exercise. Any activity that increases the heart rate and increases the body’s use of energy is good. A term given to this is “non-exercise activity thermogenesis,” or NEAT. It is also the exertion of daily living for many people. People who are up on their feet and walking all day are performing exercise. Among the professions that are known to have high levels of activities include waitresses, preschool teachers, maintenance workers, and mail carriers that have walking routes. Monitoring step counts on these people, they often have well over 10,000 daily steps.

Daily Activities and Physical Fitness

Regular activities of daily living can also be helpful in aerobic conditioning. During the summer, cutting the lawn and performing yard work keeps many busy for hours on end and adds 5,000-10,000 steps to a day’s routine. Doing household chores such as cleaning, laundry, vacuuming and doing dishes all require standing and motion. When shopping, park a little further away from the nearest door and walk the extra distance. To make it worthwhile, track how much you actually do with a fitness tracker. Good fitness bands that track heart rate and steps are now less than $100, and almost every smart phone has a built-in step counter that can be activated.

If you have chronic pain, aerobic conditioning is just one aspect of needed exercise. Conditioning maintains cardiac health, improves endurance and the ability to perform activity, and increases the body’s own painkilling compounds known as endorphins. However, most with chronic pain need to do more than just conditioning and need to also do routine stretching and strengthening. Physical fitness for everyone requires the combination of the above three routines. “NEAT” is a great way to meet the conditioning component of fitness. Developing a routine to meet stretching and strengthening goals to maintain function and decrease pain can be the focus of time spent exercising beyond aerobic activities.

Preventing Back Pain During Summer Projects

May 23, 2019 / Thomas Cohn, MD

Memorial Day and the unofficial start of summer is almost here, and that means many Minnesotans will soon be outside doing yard work and other physical activities. Staying active in the summer can help us cross items off our to-do list, but it can also lead to an uptick of back injuries. Below, we share some tips for helping to prevent back injuries during spring and summer projects.

Protecting Your Back This Summer

Here are some tips to keep in mind to help protect your back and prevent spine injuries during the warm summer months.

1. Bending and Twisting With Yard Work – The summer time means it’s yard work season, and that can take a physical toll on your body. Use tandem lifts when moving heavy equipment, use knee pads if you’re going to be on the ground planting the garden or pulling weeds, and don’t be afraid to break up the yard work over the course of a couple days. Overstressing your back is one of the easiest ways to injure it.

2. Ladder and Height Safety – If you need to get up on a ladder to clean the gutters, make sure the ladder is stabilized properly or you have someone to secure it. Every year we see patients who have hurt their spines because of a fall from a height, so be smart about getting up on the ladder this summer. For even greater heights, use safety harnesses.

3. Hydrate – Spinal muscle injuries and spasms are more likely to occur if you are dehydrated, so if you’re going to be working out in the sun for a while, be sure that you bring water and stay hydrated.

4. Stretch – Before diving into any projects, even if it’s just mowing the lawn or trimming the hedges, take a couple minutes to stretch. Stretching will help your spinal muscles prepare for the physical activity that lies ahead, which can help prevent sprains and strains.

5. Rest – Rome wasn’t built in a day, and you shouldn’t expect to get all of your home projects done in a day. Take your time and listen to your body. If something starts to hurt, take a break. If it continues to hurt, set up a consultation with a spine specialist.

6. Stop Small Pains – Finally, don’t try to push through pain in order to get your project done. It’s better to see a pain specialist and treat your bulging disc instead of trying to push through the pain and suffering a full blown disc herniation. Stop lesser injuries before they snowball by proactively treating them.

For more tips on how to protect your back this summer, or to talk with a pain specialist about discomfort you’re having, reach out to Dr. Cohn’s office today.

The Link Between Gout and Chronic Pain

May 14, 2019 / Thomas Cohn, MD

gout According to new research published in Clinical Rheumatology, individuals who suffer from gout may be twice as likely to suffer from chronic pain. Researchers say that there appears to be a correlation between the inflammatory arthritis condition and certain chronic pain conditions.

Gout is an inflammatory arthritis condition that develops when a person has high levels of uric acid in their bloodstream. This acid can eventually crystallize in the joint and cause tenderness, swelling and pain with movement. Most commonly, the joint that is affected is the big toe joint in one or both of your feet. Gout can also affect your feet, ankles, knees and hands, with flareups typically lasting a couple days to a week.

For the study, researchers examined more than one million health claims through the United States Medicare system. After combing through the data, researchers uncovered that in patients with newly developed chronic pain, they were twice as likely to also have gout compared to the average. Another model found that the risk of developing chronic pain was higher than average for individuals with gout compared to those who did not have the inflammatory condition. This led researchers to conclude that preventing the onset of gout can also help to ward off chronic pain.

“Efforts must be made to optimize gout control, so that chronic pain can be avoided as a long-term sequel of gout and when present, treated early and appropriately,” the authors wrote.

Preventing Gout

The good news is that the strategies for preventing the onset of gout are very similar to how you can help to ward off chronic pain. Gout is closely tied to our diet and exercise habits. Research shows that diets with excess red meat and alcohol lead to an increased risk of gout, and so too does a sedentary lifestyle. So if you want to prevent gout, you need to be cognizant of the foods you’re eating, cut back on alcohol and make sure to get regular exercise.

You’ll also want to increase your water intake, as that will keep your blood flowing properly and help you work the acid out through your urine. Water is preferred to caffeinated beverages which can work to dehydrate you and trigger a gout attack.

If you have gout, be sure that you’re treating it proactively, and make smart lifestyle choices to also help reduce your risk of other forms of chronic pain. Dr. Cohn and his team are always here to help if you have questions or concerns. For gout or chronic pain issues, reach out to his clinic today.

Inversion Tables and Low Back Pain

May 8, 2019 / Thomas Cohn, MD

I am often asked about various techniques to help with low back pain. The questions usually are about physical therapy or a home exercise program, and back braces and equipment for independent exercise are common areas of interest. In general, being consistent with a comprehensive exercise program with stretching, strengthening and aerobic conditioning is the most important. How to do your exercises is highly variable, so find what works best for you.

Stretching exercises for the low back require no special equipment. A well-rounded program can be learned from a physical therapist, and it is also easy to find basic exercises on the internet. The simplest is just bend over, keep the knee straight and touch your toes. This can also be done sitting on the ground and bending forward. This stretches the back and the hips. The counter stretch is doing pelvic tilt exercises. Balanced stretching makes sure opposing muscles do not become too tight. More advanced stretching can be done with formal activities like yoga. For those who like group activities, yoga as well as Tai Chi are excellent in working on gentle motion and stretching. Foam rollers are not recommended for the low back area.

What About Inversion Tables?

Another common question asked is whether an inversion table would be helpful. The answer is not straightforward. First, you must not have eye problems, uncontrolled blood pressure, or possible problems with brain swelling. If you have lower leg problems or foot or ankle issues, inversion tables would be difficult to use. The purpose of an inversion table is to use gravity and the weight of the body for traction to the low back region. Anchoring the ankles and being upside down can produce this effect.

The first attempt at this was the use of inversion boots; these were metal sleeves with hooks fastened to them and one would hang from a bar hoping that the bar or boots would not fail. One person I knew was an ironworker who strapped on his boots and hung from the steel girders or beams in buildings he was constructing – not especially advised. This evolved to the inversion tables, a device that hooks in your ankles while standing on a platform of a table that can pivot the body position. Most tables allow one to rotate to a variety of angles including all the way inverted. Complete inversion is not needed to be effective, but try to be at least 60 degrees angled.

If you are going to buy an inversion table, it is important to invest in a very sturdy one that can support your weight easily and has a large base that it is stable as you change positions. Whether this will help your back is unknown. The best way for it to help is to do the inversion and immediately lie down in bed afterwards so gravity and standing does not reverse the effect of the upside down position. This requires having the equipment bedside.

The last question I often receive with regards to low back pain is about wearing a back brace. In general they are not recommended. The appropriate time to wear these is only associated with stabilizing the back after surgery to allow good healing. Using a back brace to control pain and prevent movement is typically a poor strategy. Wearing a back brace does not control movement and pain well. The down side is it allows the muscles to become weak and tight since they are not working in their normal manner. Further, back braces do not help prevent back injuries when working. The better treatment for painful low backs is exercise and a healthy diet.