Let’s Talk About Chronic Pain and Suicide

chronic pain suicideNew research presented at PAINWeek 2017 in Las Vegas suggested that individuals with chronic pain are twice as likely to attempt suicide than those without chronic pain.

For their study, researchers asked more than 1,500 chronic pain sufferers to fill out a questionnaire on their pain and their mental mindset. What they found was that individuals with chronic pain were twice as likely to attempt suicide than individuals without chronic pain, and that 32 percent of chronic pain sufferers reported “suicide ideation in some degree.”

According to researchers, chronic pain (as opposed to acute pain) may share some neural networks with mental health disorders like depression, which can contribute to self-harm tendencies.

“This shared neurobiology may explain why cognitive behavioral interventions can be effective in chronic pain patients,” said Dr. Joseph Pergolizzi, who suggested that patients with chronic pain should be evaluated for other helpful treatments, like cognitive behavioral therapy or mental health counseling. They recommended that mental health assessments during the diagnosis and treatment of chronic pain could be clinically important for reducing the risk of suicide or self-harm in this patient population.

Getting The Help You Need

As someone who is prone to chronic back pain from an injury I suffered back in college, I know how frustrating chronic pain management can be. It can take forever to find a solution that works, and there’s no guarantee that it will work the next day. You’re fighting an uphill battle, but it’s important that you try to stay positive. Remember that you can only control what you can control. You can’t always control your pain, but you can:

  • Get regular exercise
  • Eat a healthy diet
  • Partake in physical therapy
  • Seek a second opinion
  • Get involved a chronic pain group
  • Try new treatment alternatives
  • Share your experiences with others online
  • Take time to focus on your mental and physical health

Pain may play a role in your life, but you should never feel like it is controlling your life. If you’ve found that it’s harder to get out of bed or you just haven’t been the same lately, reach out to a Pain Management specialist. We can take another look at your pain and figure out the best way to help you manage it. We can also set you up with wonderful programs to ensure that your mental health remains positive while you’re tackling your chronic pain issue.

Nobody knows exactly what you’re going through, but that doesn’t mean we’re not willing to learn or to help. Please, if you’re struggling with chronic pain or depression, make a call to our office or to a pain specialist in your area. We’ll do everything in our power to help reduce you pain levels and find something that works for you. We can’t promise solutions, but we can promise that we will try our hardest to find a treatment option that makes your day a little brighter. Contact us today.

The Truth About Chronic Pain

When it comes to chronic pain, one thing is clear – You are not alone. In fact, chronic pain affects roughly one in three people in the world. Whether it’s a sore back, neck pain or complex regional pain syndrome, we all deal with different kinds of pain. But just because our pain is different, doesn’t mean we’re not all going through something similar.

To help illustrate this point, we turn to our friends at WallMassagers.com. They specialize in pain management tools and they’ve created this wonderful infographic to help explain just how widespread chronic pain is in the United States. Check out the infographic below!

chronic pain infographic

A Doctor Who Understands Your Pain

spine pain cohnI have been known to preach a little about the work it takes to control pain. It is not about taking a pill or just going to therapy and it will all be better. I often offer advice and I rarely cut people a lot of slack. I also do not like opioid medications, but that is for obvious reasons related to effectiveness and addiction. But most people wonder if I actually understand pain. The answer is yes, I deal with my own issues daily, but my patients are not paying to listen to me complain. The reality is I had to learn what works for me to manage my issues.

My Pain Story

My story started in medical school. Keeping in shape was important just to have the energy to spend countless hours in class and studying. At one point, a housemate convinced me to try weightlifting. The second time I tried I had the weights in the wrong position, lost my balance, and took out my back. I probably herniated a disc in my lower back, but there were no scans available then. I did therapy and over months it became manageable most of the time, not slowing me down if I was generally careful and not doing stupid things.

In my mid forties, 20 years later, my back started to become more noticeable. I had regular low back pain, and it started to frequently radiate down the leg. I gave up on running since that set it off, and just tried to keep in reasonable shape. This worked until I was in my late forties, and then finally I had a MRI scan that showed a significant slippage at the bottom of the spine, a disc that was pretty much shot and a lot of narrowing where the nerves exit the spine. The radiologist that read the scan had only one question for me, and that when was I thinking about having surgery. Surgery had not crossed my mind since my issue was pain. I decided to follow the advice I had given others; If there was no weakness and no loss of bowel or bladder control, surgery was not the answer.  

Conservative management was my goal. I had a couple of lumbar epidurals that brought down the worst pain and I did a few physical therapy sessions and they gave me a ton of exercises. The exercises were repetitive, and they seemed to be focused on the same muscles, doing all of them took about 40 minutes and they were boring. As the pain improved, I gave up on the program. Within 18 months the pain was again bad and I had another epidural, but I thought I needed to condense the exercise program. I narrowed it down to a set of core exercises that were all different parts of my core muscles, and I added a stretching regimen. Core work was about 10-20 minutes depending on what I did, and stretching was only about 5-10 minutes at the most.

My kids were hockey players, and my daughter had scoliosis and had exercises and a balance board. When I tried the balance stuff, I was terrible and it proved to me I needed to work more on core. I also felt since I was getting old, general strengthening would be a good thing to add to my workouts to reduce muscle loss. Lastly, I needed to also throw in general aerobic conditioning to maintain cardiac health.

Finding What Works For Me

The workout for the last few years has been pretty consistent. I start every day pretty early to get it done. After I climb out of bed, I stretch for a couple of minutes, and my dog gets a belly rub while I loosen up my back. After that comes core work that includes planks on a balance board, sit-ups, leg lifts and upper body/core with rubber tubing. I use a universal gym machine for additional strengthening and a roman chair device for abdominal work and pull-ups. Cardiac/aerobic workouts rotate between an elliptical, bike and rowing machine doing intervals. The rowing machine is the most recent addition. It supposedly works 85 percent of all your muscles, and it really seems to loosen things up and get the body moving well without stressing things out. During the summer I get outdoors and bicycle. Since I have a big dog, she gets twice a day walks daily year around.

As with everyone, as we get older, we all start to gain weight. I like to eat, and often enjoy snacking on junk food. Eventually my wife convinced me that I needed to change my habits. I had to stop eating as much carbohydrates, eat more vegetables and protein, and get rid of sugary drinks and snacks. I am no where near the weight I was in college, but I think I probably have more upper body muscle and some extra gut, but I have lost a few pounds.

For most people with back pain, sleep is a huge problem. Like many, I never feel well rested. I used to be a stomach sleeper, but with my back, extension is the worst position and that is absolutely out.  Side or back sleeping is feasible. Multiple pillows are my best friends keeping my knees bent while on the back, between the legs while on the side, and adjusted under my neck to keep that in a neutral position. A good memory foam pad adds to the comfort level to help relieve pressure points. I am not a deep sleeper, and after four hours stiffness often wakes me up. Instead of fighting it, I get up and stretch for just a few seconds, and then go back to bed and I can sleep for several more hours. For me, sleeping over 7.5 hours just hurts my back, so I get moving after that amount of time. To fall asleep, I do not do work right before bed, I do some reading and try to clear my mind of anything serious.

Like everyone else who has back pain, I have to take care of my back. It is not easy to do, but it is a priority to stay healthy.  It would probably help me if I could figure out how to get more sleep at night since some experts say this is good for general health. Maybe I should try to meditate, but this would also take time, and I am not yet into that either. I may spend to much time exercising, but a large part of it is walking my dog, and someone has to do it. Eating a more healthy diet has reduced my weight slightly. To lose more weight, another major change and reduction in calorie intake would be necessary and no fun. Life is a matter of balancing multiple options. If you have pain, one of the best treatment options is a comprehensive exercise program. There will never be a magic solution for pain, it will always require lifestyle choices.

Does Anyone Understand My Pain?

understand chronic painMost people who have chronic pain, no matter what the source, believe they are alone in the world and that no one has similar problems and no one in medicine can appreciate the problems they suffer. However, as I have often said, about 30 percent of the population in the world has problems of some type with pain. It is the same in the United States as it is in the undeveloped world in Africa or in the industrial world of Europe or Japan. If so many people have pain, a lot of people have similar types of problems and there are likely medical professionals that do understand pain problems. There are many types of medical professionals that see pain patients, including Chiropractors, Physical Therapists and Psychologists, to all kinds of physicians including Physiatrists to surgeons.

Who Should I See For My Pain?

The best person for one to see is someone who may understand whatever problems are causing pain. If the problem is simple, it may not matter who you see because many professionals understand and are trained on that care. The more complex the problem, the harder it becomes to find professionals who care and understand the issues and have the expertise to coordinate management. My personal bias for the complex patient is to find a pain clinic that is led by a specialist in Physical Medicine and Rehabilitation – a Physiatrist. These are the physicians that have been crossed trained across multiple specialties including internal medicine, rheumatology (arthritis), neurology and orthopedics among many disciplines. Most of these doctors are good at coordinating a team effort to help patients. As with any doctor or specialist, 90 percent of them will do a good job and 10 percent will be outstanding.

Finding an outstanding doctor is always difficult. Sometimes it is a gift of a good personality, others listen well, and some just have so much experience that they can help those who want help and are willing to work toward a solution. Every patient has a different need and many patients will define good doctors and professionals in their own ways. Some doctors just understand things better because they have been through the problems personally.

My Personal Experience

To tell the truth, when I was in my medical training, the experience I had treating pain patients was one of my least favorite areas. I always was looking for other things to treat, including pediatrics, spinal cord injuries, electrodiagnostics and inpatient rehabilitation. As I entered private practice 30 years ago, I did inpatient rehabilitation of devastating problems like stroke and spinal cord injury, and outpatient care of every type of medical problem that could cause pain. After about five years I was doing more outpatient than inpatient, and eventually I transitioned to all outpatient practice. Most of my patients had medical problems or injuries that somehow caused pain. Either I needed to get good with diagnosis and treatment or else find something else to do, so I worked at getting good at that special area.

Unfortunately as I became older, I not only became wiser, but also had back pain problems from an injury to my lumbar spine as a medical student when I tried weightlifting. I also saw close people around me have issues with pain, from my wife to all my children at times. Some of the problems have been easy to help manage, some I struggle with daily and are heartbreaking even for me. The most important thing about the overall experience is that it develops a level of empathy and knowledge that it takes a ton of work on both the patient’s part and the treating physician to provide good care and help with a management plan. Furthermore, for many people pain never goes away, but is something that gets managed. It is physical and it is mental, in your brain and it affects the perception of life. It can be time consuming, tiring and often it seems depressing. Despite all the problems, the reward is moving forward and seeing the world change.

If you have pain, you are part of a third of the world population who does have pain. There are many people out in this world that can help guide you through the maze of pain management. Finding the right person for you may take time. There are multiple choices and multiple providers that may help. Yes, some people are better than others, and some will be more helpful, and lastly you may not like some of the people who may actually have the best answers. Life is tough, but it will be a team effort to move forward, and the most important person to move forward is you.

Not Every Pain Study Should Be Taken As The Truth

radiofrequency lesioning spineYears 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.