Yoga Has Benefits Similar To PT For Low Back Pain

/ Thomas Cohn, MD

Yoga Chronic Back PainNew research suggests that yoga can be as beneficial as physical therapy in reducing chronic low back pain, according to a study out of Boston.

Both yoga and physical therapy have similar mechanisms in that they work to increase our range of motion and strengthen areas of our bodies that may not always get worked, but this study wanted to see if yoga could potentially be a substitute for targeted PT for chronic low back pain.

“We know that yoga is effective, we know that PT is effective, but we don’t know their comparative effectiveness,” said Robert Saper, director of integrative medicine at Boston Medical Center. “To get a complementary health practice into mainstream health care, I would say that (at minimum) it has to be as effective as the conventional therapy, and perhaps offer other benefits, like cost-effectiveness.”

How Effective Is Yoga For Back Pain?

Due to its obvious cost-effectiveness, researchers wanted to learn just how effective yoga was at treating chronic low back pain compared to physical therapy. They started by getting 320 patients in the Boston area who suffered from chronic low back pain with no obvious anatomic cause. The average pain score from their pain was a 7 out of 10, and nearly 75 percent reported taking pain medications for their discomfort.

Patients were then split into one of three groups:

  • Yoga
  • Physical Therapy
  • Education

The yoga group attended a 75-minute yoga session each week and were given tools to perform some yoga exercises on their own in their home throughout the week. The PT group consisted of 15, hour-long sessions of individualized physical therapy, while the education group received a comprehensive book on back pain. The yoga and PT sessions lasted for 12 weeks, then patients were tracked for a year, with random sessions assigned throughout the year.

At the end of the study, researchers noted that individuals in the yoga and PT groups reported similar levels of function, and both scores were higher than the education group. Individuals in the yoga group also reported high levels of satisfaction with their pain and their progress. Yoga also proved to be a pretty safe option, with only a few patients reporting flare ups of pain during or after a yoga session.

Saper concluded that while the findings were interesting, patients received a highly targeted form of yoga, and individuals with chronic low back pain may not see similar results if they just head to the yoga studio down the street. He hopes to conduct more studies down the road to better understand the best yoga techniques for handling spine pain.

Proper Opioid and Painkiller Disposal

/ Thomas Cohn, MD

Opioid Pill Disposal MinnesoraWith the increasing problems with drug abuse plaguing our society, there often is a question with regards to disposal of unused medications. The old training used to be to crush it up and throw it down the toilet. However, this is not a very environmentally friendly method of disposal. Tests performed at water treatment facilities often test positive for compounds like Prozac, an antidepressant. Fish are currently showing up with human hormones from ingesting residuals from birth control pills to testosterone. Clearly there are better solutions.

Recently, several different solutions have been proposed. A common suggestion has been to crush the pills and mix them with used coffee grounds and then throw them in the trash. Most likely, this is not much better than flushing them down the toilet. If the trash is incinerated, that would destroy the medications safely, but most trash is still placed in landfills, and again may end up in the environment.

Another solution offered by some pharmacies involves a special bag provided by the pharmacy with a chemical agent that neutralizes the drugs when they are placed inside the bag, making them unusable. The drugs then can be thrown away in the trash, or in some places returned to the pharmacy for disposal. There is a push on the state level to make it legal for pharmacies to take back unused drugs and then they can send them to an incinerator to be fully destroyed. High temperature burning leaves no significant chemical residual that may be harmful.

Police Intervention

One of the best solutions currently available is returning them to drug take back boxes that many police departments use. My local police department has a disposal box that is in the lobby, and is can be used 24 hours a day, 7 days a week. The police will then make sure the medications are sent for safe disposal at an appropriate incinerator.

The most important thing to be aware of is that unused medications sitting around the home are a significant safety hazard. They can be abused, misused, or even accidentally taken, which can lead to overdose and death. Proper disposal is essential. Currently, the best solutions are to use police disposal boxes, neutralizing pouches, or to return them to a pharmacy. Avoid flushing them down the toilet when possible.

Sometime in the future, hopefully some genius will figure out how to safely recycle medications. This would not be an easy task. Each individual medication would need to be separated, and then chemically reprocessed and purified to the same standard as the original production. Whether this would be cost effective, no one currently knows. In the meantime, old and unused medications need to be safely disposed on a timely basis since these are dangerous and toxic compounds.

Fentanyl – The Newest Deadly Drug

/ Thomas Cohn, MD

Fentanyl chronic painThe death toll from opioid overdoses keeps rising across the country, and the new culprit turning up everywhere is fentanyl. Authorities are suggesting that Prince died of Percocet laced with fentanyl. More and more street drugs are being laced with fentanyl to increase the high. It started with heroin and now many of the street drugs are being laced with this compound. Sometimes it is normal fentanyl, but other times it is a “designer” type of fentanyl that are created to be even stronger and more potent than regular fentanyl.

Drugs on the street have obvious danger, and what is in them is usually unknown. Drug addicts seek out potent opioids for the high that they will get. Typically the high started with plain prescription opioids, often given for relatively minor injuries. For those who are prone to addiction, the legal prescription starts the path toward severe problems with abuse. Initially, it is doctor shopping and doing what ever is necessary to convince a physician to prescribe. Since pain was considered the fifth vital sign and was heavily promoted, obtaining medications for vague pains used to be easy. With increased awareness of opioid abuse, the tide has turned and it is now much more difficult to legally obtain the medications. Most doctors have become scared to prescribe, and those who do by necessity oftentimes check the state Pharmacy Board for reported fills of a prescription by the patient, and they drug test the patients on their own.

Addicts are now turning to the street to obtain their opioid fix since the legal prescriptions are harder to obtain. The most common cheap drug is heroin. However this drug has a definite bad reputation, and prescription drugs have been the preferred safer option for many addicts. Even heroin is now being laced with fentanyl to make the drug stronger. The street drugs are often marketed as the same as those obtained by prescription. Some are actually the drug, such as hydrocodone or oxycodone. Now however they often are being laced with fentanyl to improve the high generated from the drug. Fentanyl is 100 times stronger than oxycodone, hydrocodone or morphine. It’s dosed in micrograms normally for medical uses. Lacing another medication with fentanyl is very tricky since it is easy to add a trace too much. The consequence of too much fentanyl is a significant overdose. Too much fentanyl hits the respiratory centers of the brain hard, preventing breathing. Reversal agents must be given in multiple doses immediately if a patient has any chance of surviving an overdose.

New Fentanyl Problems

The latest drug to be added or laced to street drugs is carfentanil. It is 10,000 times more potent than morphine. Therefore just a trace of this drug mixed with another opioid would obviously give an extreme high, but also would likely kill a person if not treated almost immediately. This drug is now turning up in Ohio and along the East coast, and has been seen in Europe. It was initially used apparently as an elephant tranquilizer. To reverse this drug it often takes a half dozen or more shots of Narcan, the reversal agent for opioids. The rash of deaths linked to drug overdoses is often linked to this compound. Unfortunately it is also attracting addicts to areas where overdoses are occurring, since they know they might be able to find their ultimate high.

Unfortunately, as we become more aware of the latest problems with fentanyl, newer designer formulations are being made that are equally as strong or stronger. A brief search shows about a half dozen types of fentanyl possibly being made and all are deadly. These days, any street drug can be laced with a deadly compound, if you are an addict, death could be easily around the corner. Opioids are dangerous drugs, if addicted, seek appropriate medical treatment.

Chronic pain is a difficult problem. Clearly, opioids are dangerous drugs and are not the preferred treatment. There are multiple treatments available for pain. If your pain is not well managed, find a good pain specialist who will work with you to find alternative management options. Once pain becomes chronic it is extremely complex, and not able to be cured or fully treated. It often needs to be managed such that it is not the focus of life. It is not a perfect solution, but it can be made manageable.

5 Pill-Less Treatment Options For Chronic Pain

/ Thomas Cohn, MD

Opioids and other pain medications can certainly help people cope with problems associated with chronic pain, but it should not be your only method of treating your pain. Pain pills are a passive treatment option that can be successful in controlling pain in the short term, but they lose their effectiveness and leave patients at risk for dependence and abuse in the long term. Today, we take a look at five pill-less treatment options for chronic pain that can be used on their own or in conjunction with other strategies to help keep your pain away.

Treating Pain Without Pills

We’ll offer a short blurb on five pill-less treatment strategies below. Click on the link in each article to learn more about each treatment option.

1. Exercise – Exercise is one of the best treatment options for chronic pain. It helps get healthy oxygenated blood flowing to painful areas of our body, helps us keep off excess weight, and it helps off push away the stress in our daily lives. Even if it’s low-intensity workouts, regular exercise is one of the best things you can do for your body, especially if you have chronic pain.

2. Yoga, Tai Chi or Meditation – These techniques also help get blood flowing and strengthen areas of our bodies that are in pain, but they also are great for the mind. Most people don’t recognize just how mentally and emotionally draining physical chronic pain is, but these treatments can help you keep your mind healthy while you’re battling your physical pain. If you have a healthy mindset, you’ll find that the physical pain is often less debilitating.

3. Massage Therapy or Acupuncture – These two techniques are similar in that they focus on the pain pathways in our body. These techniques haven’t been emphatically proven to be effective, but some people have found relief with these options. They should be used in conjunction with other strategies because they too are passive techniques, but both massage therapy and acupuncture have been shown to be successful for some patients with chronic pain.

4. Physical Therapy – Sometimes our chronic pain is caused by an easily identifiable problem, like a pinched nerve or bulging disc. When the pain pathways can be clearly identified, physical therapy to strengthen the areas or free damaged nerves can be a great option. Ask your doctor about what stretches you can do as part of your physical therapy, or better yet, see if they’ll refer you to a physical therapist that can assist you in person.

5. Daith Piercing – If your chronic pain is in the form of constant headaches or migraines, the daith piercing may help provide relief if other options have continually failed. Our blog on daith piercings has been far and away our most popular blog, and while there is no direct evidence that the piercing can provide full relief, numerous commenters have tried the technique and noticed a reduction in headache symptom and prevalence.

Lessons From Prince On Chronic Pain

/ Thomas Cohn, MD

The death of Prince shocked the nation, a great artist lost to early, and his death has since been linked to opioids. Many celebrities have struggled with drug and alcohol addiction, but this story seems different. Prince did have a problem it appears with opioid addiction, as he died from an overdose most likely of fentanyl mixed in with oxycodone. He knew he had a problem, but for some reason he was slow to seek treatment, and help was just hours to late. The reason why this celebrity death is different is that Prince had chronic pain, and opioids were being used to help control symptoms.

Chronic pain is estimated to affect about 30 percent of the population in the United States as well as throughout the world. As a musician, Prince had apparently developed several injuries related to his work. He definitely had hip arthritis with deterioration of at least one of his joints. He may also have had other injuries, possibly pain related to repetitive stress on joints from hours of practice and playing multiple instruments. According to some reports, Prince would have definitely benefited from hip surgery and possibly a replacement. However he was a Jehovah’s Witness and this surgery was against his beliefs. Instead of taking care of it surgically, he chose other strategies.

Pain and the Pressure To Perform

Prince, like every other professional, felt the obligation to always be up and performing. Everyone wants to hide their suffering from others, and many people will go to any end to be able to look their best. For performers like Prince, either he showed up and gave a great show or he would probably no longer have a career. As far as his health, he made it a secondary priority. Chronic pain does not discriminate, and crosses all social, cultural and economic groups. No one gets special privileges, only you may be able to afford more treatments. Celebrities are also not immune from overdose, addiction, and certainly not death.

Chronic pain in Prince’s case was a result of hip joint destruction. As with all painful conditions, there are multiple ways to treat it.  The best way when it has become severe, and when the circumstances are similar to his, is surgical replacement. This usually solves the problem and mostly eliminates the pain while restoring near normal function. Unfortunately, personal religious convictions limited this option. Other good treatments would have been:

  • Exercise
  • Anti-inflammatory medication
  • Possible cognitive/behavioral therapies

Long-term opioids are not a good choice. The worst choice was self-medicating with opioids obtained illegally, since there is no way to know what they might contain. Chronic pain is not a sexy disease, and no one wants to be the poster child for such a disease. Maybe Prince will be the poster person. Unfortunately, he be a sobering reminder about the drawbacks of self-medication.

Chronic pain is extremely common, if you have pain, first start working with a primary care physician. If it is not responding to straight forward management, get a pain management specialist on the team to help find better solutions. Pain has many solutions, opioids are only one of many tools, and usually it is not one of the better ones, and it is generally extremely poor for long-term use. If medications are part of pain treatment, then one provider and one pharmacy is needed, and street drugs are off limits. Further, the primary prescriber needs to be screening all patients for abuse since it is difficult to determine who will be an abuser of medications. Lastly, if one does become addicted to medication, then it is time to get over embarrassment and get treatment so you do not end up overdosing.

Chronic pain is a difficult problem, it occurs in a third of the population in general. If you have pain, get good advice and obtain knowledgeable medical treatment.