Combat Chronic Pain By Improving Your “Zest” For Life

February 10, 2021 / Thomas Cohn, MD

zest A new study focusing on the psychology of chronic pain recently revealed that intentionally training certain character strengths could possibly help patients reduce or overcome their chronic pain condition.

The desire to learn more about this possible connection was driven by the idea that chronic pain can suck the joy and satisfaction out of many of life’s pursuits. Researchers posited that if chronic pain can influence our quality of life and some of our daily character traits, the reverse may also be true, in that focusing on developing character traits that define us could in fact help a person gain more control over their chronic pain.

While that may sound a bit far fetched, when you break it down with some examples, the theory seems to hold some water. For example, someone who heavily relies on humor or a very honest person may be better able to deal with the totality of their chronic pain condition than someone without those personality traits because of the psychology that drives these character traits.

Which Character Traits Help With Chronic Pain Control?

To get a better understanding of which character traits may have more influence on a person’s ability to control their chronic pain condition, researchers asked 491 chronic pain patients to complete a survey about their pain severity, how it impacts their physical function and their self-efficacy (their ability to engage in normal daily activities despite pain). Additionally, patients were asked to complete a self-assessment of their character strengths, which included 24 different character strengths as defined by a previous study. Those 24 different character strengths were:

Creativity
Curiosity
Judgment
Love of learning
Perspective
Bravery
Perseverance
Honest
Zest
Love
Kindness
Social Intelligence
Teamwork
Fairness
Leadership
Forgiveness
Humility
Prudence
Self-regulation
Appreciation
Gratitude
Hope
Humor
Spirituality

Interestingly, some character traits were associated with greater pain self-efficacy in the face of higher pain severity and functional loss than others. The three best traits for chronic pain self-efficacy were:

Zest
Perseverance
Hope

While the three lowest were:

Appreciation
Creativity
Leadership

So, on that note, researchers pondered if working to improve one’s “zest” could in turn help them better manage their chronic pain condition. Zest, as the researchers write, “is characterized by a sense of vitality and ‘aliveness’ in their own individual lives, as well as having the ability to invigorate and energize the people around them.”

During a two-week intervention, 81 participants were asked to either work on cultivating their zest for life or another neutral condition and given instructions on how they could improve these characteristics. Both groups had similar pain levels at the beginning of the two weeks, and both groups reported less pain and functional improvement by the end of the study. However, only the patients in the zest group reported an increase in pain self-efficacy.

While the research is small and limited, it certainly is interesting. If you’re working to combat a chronic pain condition, follow the traditional methods but also work on improving your zest for life. It’s easier said than done, but by trying to become more enthusiastic for life and using your energy to the fullest degree, you may notice an improvement in your self-efficacy as it relates to your pain condition!

For more information, or for help with your chronic pain condition, reach out to Dr. Cohn’s office today.

Not Every Pain Study Should Be Taken As The Truth

August 21, 2017 / Thomas Cohn, MD

Years ago when first entering into the world of medicine, I thought that if a study appeared in a leading scientific journal then it would have to have been a good scientific study. As an undergraduate and in my medical student years I was never really taught how to read a paper and analyze it for its quality. Over the years more articles stopped making sense, and as one would delve into the details, it often became clear that many studies that were published were just bad research.

Often if one knew something about the subject being studied, either the conclusions were obvious or they were not clearly defined such that the answer found may not really have a true correlation to the problem. Good medical studies are often very hard to perform. If you are not very careful, the answer will be junk, even if it is published in a good medical journal. Recently, this has occurred in a major medical journal.

Insurance Sponsored Studies

A recent study in the Journal of the American Medical Association (JAMA) was published with the finding that radiofrequency lesioning does not work in the lumbar region. Unfortunately, this again was a seriously flawed study and on top of everything from a research perspective, it was an insurance sponsored product. The pain societies across the world have been surprised and highly critical of the poor quality of the research and conclusions drawn in this paper.

If one has done their research, they would see that there are multiple excellent studies supporting the use of radiofrequency techniques for some specific uses. This technique has been around since the 1970’s and good equipment and understanding was established in the 1990’s. The technique is very successful for removing a nerve pathway for sensation feedback from facet joints. The science has been proven in detailed and has benefited thousands of pain sufferers. It is a common treatment for facet pain in both the neck and lumbar region and is highly successful when diagnostic blocks done first are indicative of pain relief.

This type of intervention has also been used for a number of other things including knee joint problems, sacro-iliac joint pain, and a variety of peripheral nerve problems and lumbar disc issues. All the other areas treated have had less success due to complex nerve locations. Lumping all radiofrequency treatments together and saying that they do not work is a true disservice to medicine and the patients. Further, since the JAMA is a highly regarded journal, the editors should have more closely scrutinized the study for its validity. Understanding the anatomy in the body also makes a huge difference; nerve location for most areas of the body can be highly variable from person to person and therefore it may be difficult to be successful in severing a nerve with limited ability to visualize its location.

Pain is a very complex sensation in the human body. The overall perception of the stimuli is based on the interpretation of signals in the brain. The brain may actually be receiving signals from multiple structures but interpreting them all as similar and from one location. Eliminating one piece of the signal may be sufficient to solve a pain problem. If the signals are coming from multiple locations, eliminating just one part of the signal may not change the brain’s perception of pain. The joints along the spine have very well defined sensory nerves and feedback; If the pain is from this structure it can be clearly determined and successfully treated. The discs and sacro-iliac joints have poorly defined sensory feedback, trying to eliminate the signals from these regions is still a matter of study. If the editor of JAMA used some critical thinking, the poor quality of the study would have been easily seen and the disservice of its publication could have been avoided.

Radiofrequency management of pain can be highly successful. It is definitely a science with some very technical variables that impact its success. To use this as a tool in pain management, understanding its science, capabilities, risks and benefits is necessary. It is well proven to work in certain situations. A good clinician can maximize radiofrequency effectiveness for a variety of problems but it does have limits. It is not experimental but it does have its inherent challenges in its ability to safely remove enough nerves to relieve pain. If you have pain, a good board certified pain physician can often help a patient find strategies that may lead to more successful management of your symptoms.

The Link Between Chronic Pain and Ringing Ears

September 28, 2015 / Thomas Cohn, MD

Ringing ears and constant pain in your back may not seem like they are correlated, but new research suggests the link might be closer than we initially expected.

In a recent clinical review, both chronic pain and ringing in the ears (tinnitus) are categorized by changes in two regions of the brain. The regions responsible for these conditions – the nucleus accumbens and the ventromedial prefrontal cortex – are both located in the front of the brain. These systems act as stimulus “gatekeepers,” according to researchers, and when systems go awry, ringing ears and chronic pain can set in.

“It’s a very clever system,” said Josef Rauschecker, a professor of physiology and biophysics at Georgetown University and lead author of the review.

Rauschecker likened the flood of signals your brain receives on a regular basis to living near a train track. When you first move in, the noise from the train might drive you crazy, but after a while, your brain unconsciously begins to dismiss the noise. Eventually, it ignores the noise altogether.

But with chronic pain and tinnitus, there’s something wrong with the part of your brain that inherently ignores this background noise.

“If you step back, you can see the similarity [between the two conditions],” Rauschecker said. “In both tinnitus and chronic pain, the body sends signals to the brain that really don’t mean anything, but these signals are not filtered out, as they normally would be.”

Confirmed Through MRI

For their study, researchers examined structural MRI results of patients with chronic pain and tinnitus. Structural MRIs showed that people with those conditions had a smaller ventromedial prefrontal cortex, while a function MRI scan showed that these people exhibited increased activity in the nucleus accumbens.

Both of these regions regulate emotions and executive function, which is categorized as the thinking that control other types of thinking, like planning and then executing a task. When combined, they formulate a central gatekeeping system that allows our bodies to interpret signals and react accordingly. But when they are damaged, the brain can interpret certain signals as chronic pain, tinnitus or another condition.

“It’s an interesting idea based on solid facts, and it opens up the possibility for new treatments and prevention tools,” Rauschecker concluded.

Could Dad Be To Blame For Chronic Pain Woes?

August 31, 2015 / Thomas Cohn, MD

A study out of Japan suggests that how parents bond with their children during adolescence could impact the child’s likelihood of developing chronic pain later in life.

Furthermore, the study suggests that children who had a poor bond with their father were the only group to show a significant increase in chronic pain likelihood.

The goal of the study was to better understand chronic pain as a complex biopsychosocial condition and how outside psychosocial factors like pain, pain-related fear, self-efficacy, anxiety, depression and psychological distress feed into that perception of pain.

For their study, researchers polled nearly 800 adults about their relationship with their parents and their overall health. Participants completed the Parental Bonding Instrument, a self-administered questionnaire that assessed perceived parental bonding, as well as a health assessment. The PBI test asked respondents several questions about their relationship with their parents growing up, including questions about the perceived level of bonding, over/underparenting, affection and discipline as well as control and understanding. Participants took the survey twice, once while contemplating their relationship with their father and the next while answering questions about their mother.

After comparing the PBI results with the results from the health exam, researchers uncovered:

Compared to the optimal bonding group, the odds ratio for having chronic pain was much higher in the affectionless control group for paternal bonding and for maternal bonding.

When adjusting for other factors, significance remained only for parental bonding.

“The fact that fathers have been shown to be much more likely to use physical punishment and abuse than mothers in several epidemiological studies may also be related to these findings,” the study authors wrote. “Clearly, further studies are needed to elucidate the mechanism(s) whereby parental care affects the development of chronic pain in a gender-dependent fashion.”

Researchers concluded by saying that mass-education on parenting behaviors for optimal bonding may be one of the most promising chronic pain prevention techniques that few are pursuing.

Insomniacs More Prone to Chronic Pain

May 14, 2015 / Thomas Cohn, MD

Findings out of the Norwegian Institute of Public Health suggest that people who have trouble sleeping are more likely to have an increased sensitivity to pain.

Although the study didn’t show a cause-and-effect relationship, researchers said insomniacs were more likely to be sensitive to pain. For the study, researchers asked more than 10,000 adults to dip their hands in cold water for 1 minute and 46 seconds. If they felt the cold water was causing too much pain, participants could remove their hands from the water prior to the completion of the timer.

After their reading was recorded, researchers asked participants a bunch of questions about their sleeping habits, including how long they typically sleep, how long it takes them to fall asleep, and if they suffer from insomnia. Researchers also asked questions about related issues that can make it hard to fall asleep, like anxiety, stress and depression.

Study Results

After looking at the findings, researchers uncovered:

Nearly 1/3 of participants were able to keep their hands in the water for the entire test.

42 percent of people with insomnia pulled their hands out of the water early.

31 percent of people without the sleep disorder pulled their hands out of the water early.

Participants with frequent insomnia were more likely to remove their hands from the water than people who have insomnia once a month.

People with insomnia and chronic pain were twice as likely to have a reduced pain tolerance than participants without those conditions.

“While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain,” researchers wrote, “it is not clear exactly why this is the case.”

Dr. Cohn Comments

Although the findings are interesting, they are hardly revolutionary. In fact, it’s more of a chicken-and-the-egg type argument. People who have chronic pain are more likely to be plagued by nagging pain, which can make it difficult to fall asleep and stay asleep, and if you don’t get a full night’s sleep, your body can fully recover from the activities of the day, contributing to more pain. So what came first, the chronic pain or the insomnia?

Related source: Health.com