Spine Surgery and Work Ethic Fueled Tiger Woods’ Masters Win

/ Thomas Cohn, MD

tiger woodsTiger Woods coming back to win a major tournament in golf after multiple spinal surgeries appears to be a sports miracle. Most physicians wrote Tiger off once he developed low back problems. Performing at the level of a professional athlete with any physical dysfunction, especially with lumbar disc problems, is extremely difficult.

To compete at the highest level of any sport usually requires excellent physical and mental fitness. Anything that is less than perfect usually generates only average results and not the level necessary to be at the top of a sport, especially in golf, where even tiny issues with your swing can cause the ball to end up far away from your intended target. Aside from the physical aspects, there are also significant mental components, and one must not have any distractions like pain.

Tiger’s Journey

News reports with regards to Tiger Woods have clarified his struggle over the last several years. Tiger has had a single L5-S1 disc problem for several years. This is the bottom disc in the lower back and often takes the most force from activities. It is also the disc that most likely will go bad over time and degenerate or have a disc protrusion. For the last several years, Tiger has struggled with treatment, doing extensive conservative options to no avail. Additionally, he has had multiple surgical decompression operations with removal of parts of the herniated disc. Despite all the work, he still had pain and difficulties related to the L5-S1 disc. Ongoing symptoms impaired his ability to mentally and physically play golf.

The last option for Woods was for a lumbar fusion at L5-S1. He underwent that surgery with an extensive anterior interbody fusion type intervention. After removing the offending disc, the L5-S1 disc space was restored with a spacer device and packed with bone so the L5 vertebral body becomes fused to the sacrum. Once healed, the hard work of rehabilitation began with extensive strengthening and conditioning. Fortunately, everything went well and his strength as well as his coordination returned. The fusion healed and his pain improved.

So far for Tiger Woods, everything has gone well after his surgery. Unfortunately, this probably isn’t the last we’ve heard about his spine. The lumbar spine is incredibly well balanced, and every single level is important to control motion properly. Golf requires a lot of twisting of the back with some bending. These motions put an extreme amount of force through all of the segments in the lumbar spine. Now that one segment does not move in the normal way, forces that once went through the bottom level now are transitioned to the next level, as well as the forces that naturally occur at the L4/5 level.

This level will likely have a degree of premature degeneration and could easily start causing problems within a few years. Having good body mechanics, range of motion and strength is key to a good outcome. Tiger has spent a year rehabilitating his back and strengthening it in order to play golf. If he is lucky, the stress of golf will not cause further back problems. Avoiding overstressing a surgically repaired area is often key to avoiding re-injuring, but Tiger will be testing that theory every time he tees it up from here on out.

Get Your Vitamins and Minerals From Food, Not Supplements

/ Thomas Cohn, MD

supplementsMany people ask about taking dietary supplements, vitamins, minerals, and various natural compounds to improve their pain and their life. These are not officially regulated as far as how well they work. They are regulated only to the level that they cannot be toxic when ingested and they have become a billion dollar business.

Are They Effective?

Recently, a large study was done with regards to multiple dietary supplements, with an extra emphasis on medications with claims of helping with heart disease and natural degeneration caused by aging. Simply put, nothing had any positive impact on health for any of the compounds being pushed. The study was published in JAMA in January 2019 and looked at many different compounds. Included were ginkgo balboa, coenzyme Q10, coral calcium, and many others. These are all found in the vitamin and supplement aisle of many stores. None of these promoted items had any impact on cardiac health, dementia, cognition or any general component of health. Basically, none of these vitamins, compounds or minerals made a difference.

The answer of what really works is eating healthy. All these various compound are found in our fresh foods. Eating fresh food provides nutrients in a way through the gut that the appropriate vitamins and minerals are absorbed correctly and can be used by the body. In pill form or other concentrate, the body often will not be able to utilize the compound successfully. Many times the form of the compound in a pill is not absorbed or is destroyed by the body’s digestive processes. When we eat our food, our digestive system can find the nutrients and make sure they travel to the correct areas of the body. All the studies show that nutrients that come from eating a good diet are helpful, and adding a variety of supplements shows no benefit.  

The best suggestion based on all these medical studies is save the money spent on supplements and spend the money on eating a healthy diet with fresh fruit and vegetables and low fat protein. Highly processed foods with high carbohydrate loads often do not have a high nutritional value. Develop a diet that comes from the outer aisles of the grocery where the fresh foods are found. None of the claims for supplements have really be proven, so save your money for now.

Chronic Pain and Its Impact On The Workforce

/ Thomas Cohn, MD

back pain workMany people have a vested interest in helping to solve the problem of chronic pain, and a new study suggests that you can add employers to the list.

According to a new study published in Integrated Benefits Institute, more than one-third of US workers take prescription pain medications. Interestingly, those workers who take prescription medications take significantly more sick days than those who don’t, and those who have problems with those medications take even more sick days. The study found:

  • Compared to those who don’t take prescription pills at all, painkiller users took an average of twice as many sick days.
  • Problematic painkiller users took more than three times the number of sick days on average as a healthy adult.
  • Prescription pain medications were associated with approximately 261 lost workdays per 1,000 workers per month.

For the study, researchers looked at the amount of time lost at work connected with prescription pain relievers when viewed in the contest of other substance use disorders in the American workforce.

“The high rates of prescription pain medicines among employees indicates a much larger issue for employers than lost productivity,” says IBI researcher Erin Peterson, MPH, the report’s first author. “The significant number of sick day absences by employees who use pain relievers without problems likely doesn’t represent the full impact. As most people abusing opioids started with prescribed medications, this is a very large number of people at risk for developing problematic behaviors associated with pain relievers.”

Chronic Pain and Lost Days of Work

If you suffer from chronic pain, regardless of whether or not you take opioids to help with discomfort, you know firsthand how difficult it can be to get out of bed on some mornings, let alone get through the work day. That’s one of the reasons why it’s so important to work with a pain specialist to get control of your issue or help to minimize the days when pain becomes overbearing. It’s not always going to be easy, but if you truly want to do whatever you can to get your pain under control, it’s worth it.

Dr. Cohn and his team have helped numerous workers get a handle on their pain and thrive in the workplace, and he can do the same for you. To set up an appointment so he can get to the bottom of your pain and chart a course for recovery, click here or give his office a call today. It’s never too late to take back control of your life from chronic pain.

Opioids, Medical Marijuana and Chronic Pain

/ Thomas Cohn, MD

marijuana pillsWhen it comes to managing chronic pain, we’re always looking for new and better ways to help patients control their discomfort. If you’re a regular follower of our blog, you probably know that we’ve written a number of blogs on opioids and medical marijuana, but a recent study decided to take a look at what happened when these two treatment plans were used simultaneously. You might be surprised at the findings.

According to research presented at the 2019 American Pain Society Scientific Meeting, individuals with chronic pain who used both prescription opioids and recreational marijuana showed higher levels of mental health and substance abuse problems than those who use opioids alone. Now, the study makes a big distinction noting that patients were using marijuana recreationally and not medicinally, but it still shines a light on how problems can occur when people try to supplement their opioids with other substances.

Study Results

Those weren’t the only findings that were of concern according to researchers. The team said that anxiety and depression scores were also significantly higher for patients who used both opioids and recreational marijuana, as were measurements of opioid dependence severity and alcohol and cocaine involvement. Researchers also noted that there was no difference in pain severity or pain disability between the group of individuals just using opioids and those using opioids and recreational marijuana.

“The things psychologists would be most worried about were worse, but the thing patients were using the cannabis to hopefully help with — namely pain — was no different,” said Andrew Rogers, University of Houston, who worked on the study. “Co-use of substances generally leads to worse outcomes. As you pour on more substances to regulate anxiety and depression, symptoms can go up.”

Abhiram Bhashyam, MD, MPP, of Massachusetts General Hospital in Boston, who was not involved with the study, said the findings provide even more evidence that patients shouldn’t assume that recreational marijuana will help with the effects of their chronic pain if they are already on opioids.

“This study provides further evidence that cannabis may not be an effective substitute or alternative to opioids for pain management,” said Dr. Bhashyam. “Studies like these are important for clinicians as patients increasingly ask about opioid-cannabis co-use for managing their pain. We lack robust evidence to provide appropriate guidance due to a paucity of research on this topic at present.”

Both opioids and medical marijuana can be helpful if you’re dealing with chronic pain, but it’s important to realize that there’s a significant difference between regulated medical marijuana and recreational marijuana, so don’t assume that what you pick up on the street will be beneficial in combination with opioids for your pain. As this study suggests, it doesn’t appear to help and it can certainly make some problems worse. If you’re considering medical marijuana or another treatment plan for your pain, consult with a physical medicine specialist first to ensure you’re making the right choice for your individualized condition.

The Importance Of A Support System When You Have Chronic Pain

/ Thomas Cohn, MD

support systemWhether you’re off pursuing your dreams of being a musician in New York City or trying out for the varsity basketball team, everybody wants to have a strong support system that they can turn to in a time of need. Another group of people who need a strong support system in their life are those individuals with chronic pain, but those with a chronic condition know that a good support system can be hard to find. Today, we share some tips for finding and building a strong support system if you have chronic pain.

Chronic Pain Support System

All of the following tips may not apply to your situation, but we’re confident at least some of them will. Here’s how you can build and learn to rely on a support system if you’re dealing with a chronic illness.

1. Find A Few Close Friends – You probably have one or two really close friends or family members that you can rely on when things get tough, and it’s important to lean on them when you need help. Just because you have a large family or a large network of friends doesn’t mean they are all going to be sympathetic to your cause and be reliable in your time of need. Recognize that not everyone is going to be part of your support system, so focus on the really reliable members of your support system instead of trying to involve a larger network of people.

2. Online Support – The rise of the internet has made it much easier for people to connect with other individuals who are going through the same thing. You can find highly specialized support groups that can allow you to talk to people who know what you’re dealing with. Try a simple google search and see what groups are out there. Find one or two that seem supportive and consider joining.

3. Share Your Experiences – A number of people find it helpful to share their stories with others. Whether you’re talking to your best friend on the phone or writing out your daily struggle on an online forum, it can be extremely helpful to talk about your experiences. Find a place where you can vent or be vulnerable, and let your story be heard.

4. Support Yourself – It’s also important to remember that you are the most important member of your support group, and you need to take care of yourself. You need to be getting regular exercise, eating a healthy diet and partaking in activities that contribute to a healthy physical and emotional well-being. If you have self-destructive tendencies, your support group may fall apart because others may think “Why should I care about them if they don’t seem to care about themselves?” Be your biggest supporter.

5. Professional Help – Finally, don’t be afraid to reach out to a professional for help. Whether you need a chronic pain specialist to help you get a grip on your condition, or you want to talk to a mental health counselor about your feelings and your concerns, please reach out for help. We want to be part of your support team, but we can’t get you help unless you connect with our office. Let us help you.

For more tips on building and maintaining a healthy support system if you have chronic pain, reach out to Dr. Cohn’s office today.