Preventing Chronic Pain When Shoveling

/ Thomas Cohn, MD

Chronic Pain ShovelingA big snowstorm is coming our way, and odds are you’re going to need to bust out the shovel or snowblower when it’s all said and done. Moving all that snow is never easy, but it can be an even bigger headache if you’re also dealing with chronic pain. Today, we’re going to share a few tips for how to effectively move snow without triggering a chronic pain flareup.

Chronic Pain and Shoveling

Keep these tips in mind the next time you have to head out and shovel snow:

  • Warm up your body before you head outside. Do 5-10 minutes of light stretching exercises to ensure your muscles are warm before heading outside.
  • Grab a friend. The more people helping to move snow, the quicker the job will get done.
  • Take frequent breaks. Don’t try to get everything done in one session, because if you overwork your muscles, you’re more likely to trigger a chronic pain flareup.
  • Practice proper lifting techniques. Try to push the snow off your driveway instead of lifting and throwing it, as that can lead to back problems. When bending, bend at the knees, not the waist.
  • Stay warm. Cold weather can trigger inflammation in our joints. Put on enough layers so that you’ll stay warm when shoveling, and head inside to heat up if you start to get cold.
  • Take an anti-inflammatory medication like ibuprofen prior to heading outside to shovel to help keep inflammation at bay.
  • Invest in a snowblower. They can be pretty pricey, but if they help prevent painful flareups, they are well worth the investment.
  • Talk to your doctor. If you are dealing with a specific chronic pain condition, talk to your doctor to see if they have any other specific tips for preventing chronic pain flareups while you’re removing snow from your driveway and sidewalks.

Stay safe this weekend, and follow these tips before you head outside to shovel!

Understanding Nonspecific Low Back Pain

/ Thomas Cohn, MD

nonspecific back painA recent reading in a new issue of one of the many medical journals that showed up at my home was an article on the management and treatment of low back pain for general practitioners. Usually I hope to pick up an interesting piece of knowledge to add to my treatment regimen, but unfortunately this article was a major disappointment. The focus of this article was on “nonspecific” low back pain. For a person with low back pain, this is the category of everyone who does not need surgery right away since they do not have a huge disc herniation.

Low Back Pain

Low back pain does have many specific causes and detailing the problem leads the practitioner to treatments that may be more effective. It is very important to understand that there are many structures in the low back region that can cause pain. Oftentimes multiple structures may be causing problems and treatment may need to include a number of different things. Solving only one of five problems leaves four issues that may be equal or worse and provide no relief for a patient.

To successfully treat low back pain, a practitioner must fully understand all the structures in the body and how they can contribute to pain. There multiple body parts involved including joints, nerves, discs, muscles, ligaments, bursas, and various organs in the lower abdomen and pelvis that all can contribute to pain sensations. On top of all the stuff in the direct area, the brain also can be an important factor since it is necessary to interpret the sensory signals and their meaning. If there are numerous sensory signals, the brain can short circuit on them and overly amplify the quality of pain. At this point, central sensitization occurs and normal sensory signals in the body can become interpreted as pain; the equivalent of a short circuit is present in the nervous system.

When low back pain is not easily fixed with time, simple medication and exercise, then getting higher level expertise with an expert in Physical Medicine doctor is helpful. Pain experts come in all varieties, but you should stick to those who have the broadest knowledge, since they will be more likely to be able to determine what is actually the problem and develop potential solutions. Many people claim to treat back problems, but only those who take the time to look into your history, to fully look at what has been done as far as diagnostic studies, and to conduct a physical exam will be successful.

The Pain Management Approach

Pain that has not been solved quickly is often a complex problem. Before I see a patient, I try to review their medical history and what has been done for diagnosis and treatment. A patient’s history and story about their problems often is the most important key to understanding what to do for a person. After hearing what the patient thinks is the problem, then a physical exam can often lead to a series of diagnoses. Most of the time, a person can tell me some odd information that is the absolute clue to helping a person with their pain problem. Tailoring the right treatment to a person is where experience is extremely helpful and what determines a successful management strategy. Many people are afraid that they are wasting the doctor’s time. Rarely if ever is a patient wasting my time, especially if they want to get better and are willing to try various treatments.

The human body is a wonderfully complex machine, and answering the question of what is wrong is very hard. Since in the low back, many things can be wrong, simple answers are rare. As people get older, everything in our bodies does deteriorate and degenerate. Some things in the body can be repaired, but many things like the discs and joints in the body show normal degeneration, sometimes by the age 30 or 40. Currently we have no way to reverse aging, and treatment of pain requires managing of symptoms. There often is no way to “fix” the problem, but we can find strategies to manage the symptoms better.

Pain Management Needs To Be A Complimentary Approach

/ Thomas Cohn, MD

Complementary medicineA recent publication in Mayo Clinic Proceedings explored the benefits of complementary therapy in the greater picture of pain management. This is a subject we’ve preached on the blog time and time again; There is no magic pill for chronic pain, and you need to put in the effort to have the best results. Oftentimes this comes in the form of other activities in conjunction with the standard care of rest, rehab, physical therapy, etc. Some of these complementary methods include:

“Medications may not completely relieve chronic pain or can produce unwanted side effects, including the potential for addiction. Thus, many people may turn to complementary health approaches to help manage their pain,” said Richard L. Nahin, PhD, MPH, lead epidemiologist at the National Center for Complementary and Integrative Health.

Complementary Medicine Benefits

Without going into too much detail, the article looked at a number of complementary approaches to common chronic ailments. What they found was that acupuncture and yoga were beneficial for individuals with back pain, acupuncture and tai chi had benefits for knee osteoarthritis, and massage therapy was proven useful for individuals with cervical spine and neck pain. Considering that more than 120 million Americans deal with some sort of chronic pain, these complementary approaches have the potential to positively affect millions of people.

This beneficial link is important because unfortunately many people have to pay out of pocket for some of these treatment techniques. In fact, national data suggests that people pay more than $8.5 billion annually for out of pocket complementary treatments for back pain alone. Now that there’s a link between these approaches and chronic pain improvement, there may soon be a push to make some of these options at least partially covered by insurance. It may require insurance companies to spend a little more in the short-term, but if it helps people recover faster and more fully, it could greatly reduce expenses in the long run.

We need to continue investing money into chronic pain research to find the best methods to treat pain, reduce costs and help patients.

PTSD An Approved Condition For Medical Marijuana In Minnesota

/ Thomas Cohn, MD

PTSD medical marijuanaThe Minnesota Department of Health added post-traumatic stress disorder as a qualifying condition under the state’s medical marijuana program on Thursday.

“PTSD presented the strongest case for potential benefits and a … lack of treatment alternatives,” said MDH Commissioner Dr. Ed Ehlinger.

PTSD comes in many forms, and there’s no one-size-fits-all treatment for individuals who are dealing with the psychological condition. Medical marijuana will not work for everyone, but like we mentioned in our post on Daith piercings for migraines, medical marijuana will provide another potential low-cost treatment option. Medical marijuana is by no means cheap, but trying the initial treatment is much less costly then certain therapy sessions or countless doctor visits, so it opens a new door for individuals with PTSD.

Coming In 2017

Although PTSD has been added to the list of approved conditions for medical marijuana in the state, it was not granted immediate approval. PTSD won’t be considered an active condition until August 1, 2017. However, this doesn’t mean that it will be easy to get clearance from a doctor for PTSD. Military veterans will need to get a doctor’s diagnosis and approval in order to be eligible, but that recommendation cannot come from any Veterans Affairs hospital because marijuana is considered illegal under federal guidelines. They will need to get approval from another physician, and oftentimes it’s difficult to get a new physician to declare you eligible for the medical marijuana program, as doctors are leery of patients jumping from doctor to doctor to try and find a doctor that will grant them approval.

PTSD was the only condition added to the list of approved conditions on Thursday, as Ehlinger and the Minnesota Department of Health shot down proposals for other conditions like arthritis and depression.

Preventing Back Pain During Thanksgiving Travel

/ Thomas Cohn, MD

Thanksgiving is nearly here, and if you’re like most people there’s a good chance you’ll be spending some time tomorrow or this weekend in the car. Traveling to see family and friends can be an enjoyable experience, but not if the ride is plagued by spine pain.

Thankfully, there are a number of things you can do to help prevent painful flareups during the long road trip. For tips and tricks to beat back pain in the car, we turn to our friends at the Back Clinics of Canada, who designed this lovely infographic about spine pain and road trips. Their site is filled with helpful information about preventing and treating back pain, so when you’re done reading the infographic, be sure to head over to their website to learn more about keeping your back pain free. Check out the infographic below, and we hope you have a wonderful Thanksgiving!