A Closer Look At Acute And Chronic Pain

October 7, 2019 / Thomas Cohn, MD

Chronic pain is usually different from acute pain. Acute pain is considered to be directly related to stimulation of sensory receptors for noxious stimuli located throughout the body. It is often related to direct damage or trauma to the body. It also is the normal physiologic response to the various types of sensory receptors that is perceived as noxious or painful. Acute pain is relatively short lasting and is a direct response to direct stimulation of sensory receptors with lengths from seconds to usually less than several months. Chronic pain however is long in duration, lasting over three months and becomes independent of direct stimulation of sensory receptors for acute stimuli.

Chronic and Acute Pain

Chronic pain most often is characteristically different from acute pain. It often involves the nervous system changing on a peripheral and central basis such that sensory signals are perceived differently. In the limbs or other areas, sensory receptors become increasingly able to respond to any stimuli and then sending a signal out into the central nervous system. The nervous system essentially becomes primed for responding to sensory inputs and blasts out a powerful danger signal out of proportion to the intensity of the event. A small touch on the arm could feel like being hit by a sledgehammer.

Chronic pain is divided medically into three types;

Nociceptive
Neuropathic
Central sensitization

It can also be a combination of these. As pain becomes more chronic, the central nervous system becomes more involved and pain has more centralized components. The secondary outcomes of chronic pain over time also become prominent with increased healthcare utilization and often decreased quality of life.

There are multiple correlations in a person’s life that are associated with chronic pain. Common attributes include being female, early life trauma, family history of pain and mood disorders, genetics, sleep disturbances and mood disorders. Certain types of pain that more commonly become chronic include headaches, low back pain and fibromyalgia/diffuse myofascial pain, while the psychological factors of anxiety, depression, catastrophizing, and PTSD are linked to developing chronic pain.

Well-managed and aggressively treated chronic pain comprehensively reduces the incident of chronic pain, but as pain continues ongoing aggressive management can impact the intensity of long-term issues. It is important to treat all aspects of a painful condition. Often there are multiple factors stimulating pain and all the physical problems need to be addressed from muscles, nerves, tendons, ligaments, joints, bones and any other system involved as well as the psychological impacts.

Comprehensive management of symptoms is one of the keys to successful outcomes. Using traditional medical strategies including medications and physical therapy in conjunction with techniques like acupuncture, meditation and improving sleep hygiene may all be necessary in managing pain. Aggressive management of acute pain, especially traumatic or post-surgical, helps reduce the incident of the development of chronic symptoms.

Acute pain is a common arena for most regular physicians. Comprehensive initial management of acute painful conditions reduces the development of more chronic problems. If the pain is showing tendencies toward becoming chronic, involvement of a pain specialist can reduce the impact of the long-term symptoms.

Five Non-Opioid Options For Chronic Pain Relief

September 19, 2019 / Thomas Cohn, MD

Chronic pain is one of the most complex health conditions to treat because it is so unique to the individual. What works for one person isn’t guaranteed to work for another, and sometimes many different treatment options are required in combination with one another in order to provide relief.

In our experience, painkillers and opioids can be effective for the right patient when used in combination with other treatment options, but they aren’t a good primary source of treatment. What we mean by that is we’ve never seen a patient get better solely by taking an opioid. They may be helpful in conjunction with dietary changes and other interventions, but they aren’t a great stand-alone option because they don’t address the root problem. Because of this, we want to share five chronic pain treatment options that can treat the root cause of pain and help you find relief. Below, we share five non-opioid treatment options that may be effective for your chronic pain condition.

Treating Chronic Pain Without Meds

This is a general guide of some treatment options we’ve found effective for some common types of chronic pain. For individualized care and a treatment plan tailored to your specific condition, please reach out to our office.

1. Exercise – Exercise is one of the most basic treatment options for some types of chronic pain. Exercise pushes healthy blood through your body, which can help structures function properly, and it works to strengthen supportive muscle groups. If back pain is causing discomfort, some low-stress exercises like swimming, walking or yoga may be just what you need to calm spinal nerve compression or strengthen key muscle groups that can contribute to pain.

2. Physical Therapy – A close cousin of exercise is physical therapy. PT is great for a number of different patients, but it’s especially helpful for those chronic pain patients who are battling arthritis or joint issues. Physical therapy helps you reestablish mobility and range of motion in the joint, and it can help prevent the further progression of arthritis, keeping you more mobile. Physical therapy works by targeting specific areas with certain exercises, stretches and movements.

3. Tens Unit – We’ve talked about TENS units on the blog in the past, but they can be just what the doctor ordered for the right patient. TENS stands for transcutaneous electrical nerve stimulation, and it is a small device that transmits electrical signals to drown out pain signals. Many of them are widely used among patients who suffer chronic headaches or migraines. You can learn more about different units and their uses in the above link.

4. Spinal Cord Stimulation – Spinal cord stimulation is another topic we’ve talked about in the past. They work similar to a TENS unit in that they provide electrical stimulation to drown out painful nerve signals, but these can be implanted inside the patient and controlled by a device to provide different types of stimulation as pain develops. New technology means these devices can even be recharged while still in the body. Again, you can learn more about this option in our expanded post in the above link.

5. Nerve Blocks – Finally, Dr. Cohn’s offers nerve blocks and corticosteroid injections for patients who are dealing with certain chronic pain conditions. For chronic muscles spasms or irritated spinal nerves, a calming injection can provide relief and allow patients the ability to pursue other active treatments, like PT or exercise. They aren’t always a very good stand-alone long-term solution, but they can be paired with other techniques to provide symptom relief.

What Patients Wish They Would Have Known Earlier About Their Chronic Pain

September 5, 2019 / Thomas Cohn, MD

Everybody can look back at some aspects of their life and say “I wish I knew then what I know now.” The same can be said for anyone who is dealing with chronic pain or who has progressed through a pain management plan. Oftentimes life would have been so much easier if we just would have known a few things back then. That sentiment is the focus of today’s blog. We’re going to share some things that many patients with chronic pain wish they would have known earlier in the process, and hopefully they can help you come to an understanding earlier than you may have on your own.

If Only I Would Have Known Sooner

Here’s a look at some sentiments a lot of patients wish they would have come to grips with sooner. We understand these may not apply to every single situation, but at least a few points should apply to your pain problem.

1. Pain is not just physical – One of the biggest misconceptions about your chronic pain is that it’s only a physical issue. Pain has a way of impacting us physically, mentally and emotionally, and it can exhaust all aspects of our life. You can’t just focus on the physical aspect of your health, because ignoring your emotional and mental health will wear you down and leave you feeling worse off. Treating pain needs to be a multi-faceted approach that focuses on your total wellness. If you’re feeling anxious, tired or mentally or emotionally fatigued, bring this up to your care physician because taking care of these areas of your life will help your physical pain as well.

2. Pain isn’t always curable, but it is treatable – What we mean by this is that although we do everything in our power to completely rid you of your pain, there’s no guarantee that you will be completely pain free when all is said and done. That being said, we are extremely confident that we will be able to help decrease your symptoms or help you get a better handle of your pain condition, no matter what you’re dealing with. We’ve never met a patient that we’ve felt that we couldn’t at least make life a little better for. But it’s important to manage your expectations. Assume that things will get better, but understand you might not be back to a completely pain-free way of living.

3. It’s going to take work – As we’ve said on the blog in the past, there is no magic bill to treat chronic pain. Painkillers can help mask pain, but they won’t treat the underlying problem. Most pain conditions best respond to physical therapy, controlled exercise, weight management and other healthy lifestyle choices. This takes concentrated effort, but it’s worth it. If you just hope time heals all wounds, you may be surprised at how little progress you see.

4. Control what you can control – A final aspect we want to share is that you need to focus only on what you can control. You can’t control how your pain responds to treatment, but you can control the effort you put in to treatment. You can’t control your good and bad days, but you can control your attitude and mindset, even if it’s not always easy. Know that some things are out of your control, and that’s ok. If you focus on what you can control, you’re going to be in a better mental space, and it often leads to better physical outcomes.

What Science Says About CBD Oil For Chronic Pain

August 5, 2019 / Thomas Cohn, MD

cbd oil Cannabidiol, commonly referred to as CBD, is a compound found in the cannabis plant that many people swear by for its benefits when it comes to pain management, anxiety, stress or other health issues. We want you to find relief with whatever works, but what does science say about CBD’s effectiveness for pain management? Let’s take a look.

CBD and Pain Relief

If you’re like me, you can’t go a couple blocks it seems without seeing another business offering CBD products. Pizza places, movie stores, bakeries and wellness shops are all places where we’ve seen CBD being offered, but just how effective is it for your health condition? Scientifically, the jury is still out, but researchers are cautiously optimistic.

One of the reasons why we don’t have a lot of scientific data on CBD’s effectiveness for different pain conditions is because up until December 2018, cannabidiol was classified as a Schedule I substance. Now that it has been removed from that list, we’re quickly working to figure out its medical capabilities. Early studies have come to mixed conclusions, with some saying that the right combination of CBD products can help calm symptoms, while others say there exists a lack of good evidence that CBD can help with chronic neuropathic pain.

With that said, many researchers are still hopeful about CBD and it’s health uses in the future. The previous studies have had many limitations, so their conclusions may not be as accurate as we’d like. For example, many of these studies looked at the short-term impact of CBD in patients with a number of different pain conditions. Pain is the most unique health condition in the world, and everyone’s pain is unique to them.

We very well may eventually learn that CBD can help treat symptoms of certain types of arthritis or nerve pain, but it takes time to isolate all the variables and make these breakthroughs. In fact, a study published this year in the journal Pain found that CBD interacts with serotonin receptors in animals, which are believed to play a role in pain, depression and anxiety. By building on these studies, we may be able to come to stronger conclusions and better help patients in the not so distant future.

So as it currently stands, the jury is still out on the effectiveness of CBD oil for a variety of pain conditions. But as we said above, if you’re dealing with a pain condition, we want you to be able to find relief one way or the other. Some people find relief with diet and exercise, others with physical therapy, and others with CBD. What we will say is that while CBD may help your pain condition, it shouldn’t be your only form of treatment. Substances like CBD are a passive treatment, and they need to be combined with active treatments like stretching or exercise therapy to really help the underlying problem. Here’s hoping we learn more about CBD so we can best help our patients.

Chronic Pain Patients Struggling To Find Primary Care Services

July 15, 2019 / Thomas Cohn, MD

A new study published in JAMA Network Open found that chronic pain sufferers have a harder time finding primary health care because they have an active prescription for opioids.

According to the study, 40 percent of the nearly 200 primary care clinics contacted as part of study said they would not accept a new patient who takes Percocet daily for chronic pain as a result of a past injury, no matter what type of health insurance they had. An additional 17 percent of clinics said they would want more information about the patient before deciding if they would take them on, with two-thirds of this subset saying the patient would be required to come into a preliminary appointment before a decision could be made. Despite these findings, all of the clinics said they were currently accepting new patients.

The findings suggest patients with a history of chronic pain could face health care access problems.

“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees’, being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” said study lead researcher Pooja Lagisetty, M.D., M.Sc. “However, there have been no studies to quantify the extent of the problem. These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician.”

Slippery Slope

Dr. Lagisetty said for patients with chronic pain conditions, getting access to primary care goes beyond just checkups and preventative care. Having a regular physician could allow them to receive other pain-relieving treatments, and in some cases, work with the new provider to gradually and safely taper off their use of opioids. Primary care providers can also help recognize the signs of opioid use disorders or addictions, so not accepting patients simply because they are trying to manage their pain only works to further the crisis.

“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” said Dr. Lagisetty. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”

It’s easy to accept the healthy young adult at your clinic, and it can be harder to take on the patient managing multiple health conditions, but both should be guaranteed access to primary care providers. We need more doctors who are willing to take on the harder patient.