Psychological Interventions Could Help Chronic Pain Patients

May 22, 2018 / Thomas Cohn, MD

New research published in JAMA Internal Medicine found that patients with noncancer chronic pain can benefit from psychological interventions, which can help to reduce perceived pain levels.

Dr. Bahar Niknejad and colleagues at the Department of Medicine at Eastern Virginia Medical School conducted a systematic review and meta-analysis of the effectiveness of psychological therapies for noncancerous chronic pain. The main factor they wanted to analyze was psychological therapy’s role in managing pain intensity, but they also examined how it influenced pain interference, depressive symptoms, anxiety, negative thoughts, self-efficacy for pain management, physical function and overall health.

The meta-analysis looked at 22 studies involving more than 2,600 individuals, and after looking at the data, researchers concluded that psychological therapies were associated with small decreases in pain intensity, pain interference, depressive symptoms, anxiety and negative thoughts, while there were small increases for self-efficacy, physical function and overall health.

“Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophizing beliefs and improving pain self-efficacy for managing pain,” the authors reported. “These results were strongest when delivered using group-based approaches. Research is needed to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects among older adults with chronic pain.”

Types of Psychological Treatments To Chronic Pain

Psychological treatments of chronic pain center around the idea that if we understand our pain and why it’s happening, then we can learn to control or better cope with flare ups. Knowing this, here’s a look at some of the more popular psychological treatments for chronic pain:

Patient education about the condition.
Biofeedback (A technique where patients learn to interpret feedback regarding certain physiological functions).
Relaxation Training.
Operant Conditioning.
Cognitive-Based Approaches.
Acceptance-Based Approaches.
Expectation Management.
Emotional Stress Management.

By helping the patient find new psychological strategies to control or better cope with their pain, people often feel more in control of their symptoms, which in turn can decrease the perception of pain. If you are suffering from chronic pain, talk to your doctor about psychological approaches to best manage your condition. Reach out to Dr. Cohn for more information.

Chronic Pain Makes School Difficult For Children

March 8, 2018 / Thomas Cohn, MD

Although the findings may not be all that surprising, new research shows that children with chronic pain are significantly more likely to deal with life events that can contribute to poorer school performance.

According to the research, 81.5 percent of children with a history of chronic pain reported dealing with at least one adverse life event that could have impacted their school performance. Children with chronic pain were more likely to report:

Missing school due to not feeling well.
Missing school for medical treatment.
Having a difficult time paying attention in class.
Finding it hard to keep up with school activities.

Chronic Pain In School Children

As you can see, it’s clearly important for children, their parents and the education staff to develop a comprehensive care plan for dealing with chronic illnesses and flareups. These kids probably feel ostracized enough without having to feel like they’re falling behind on homework or with the curriculum. Here’s a look at some ways all of these groups can come together to ensure everyone is on the same page.

Children need to be proactive about getting homework and lesson plans from the classes they’ve missed.
Parents need to stress the importance of getting homework and ensure children aren’t missing assignments from missed classes.
Parents need to talk with school staff about the child’s potential health issues so it’s on their radar.
School staff need to realize that children aren’t using their chronic condition as a crutch or an excuse.
Parents and children should ensure they get a doctor’s note for medical appointments during class.
If homework extensions are needed, let the teacher know as far in advance as possible.
Consider supplemental education resources, like tutoring or extra credit.
If any party has concerns, they should be brought up sooner rather than later so there aren’t any misunderstandings.
Once you find a routine that works, do what you can to stay in that routine.

Chronic pain can be tough to deal with, but it’s even more difficult if you’re a kid in school trying to learn and make friends. If your child needs help with any aspect of their chronic pain care plan, reach out to Dr. Cohn’s office today.

Penny-A-Pill Plan Proposed To Prevent Opioid Abuse

February 22, 2018 / Thomas Cohn, MD

Minnesota Governor Mark Dayton has proposed a “penny-a-pill” program in which drug companies would have to pay the state an extra penny for every pill prescribed in the state. The money raised from this tax would go towards an opioid stewardship program that provides opioid prevention, treatment and recovery services.

Gov. Dayton said the program may be able to generate $20 million a year.

“You can call it whatever you want,” Dayton said. “It means that they’re going to pay for the product they’re producing, which is causing this epidemic.”

According to data, there were 395 opioid overdose deaths in Minnesota in 2016. That number represents an 18 percent increase from the previous year, and 194 of the 395 deaths were linked to prescription opioids. The CDC also notes that there are 47 opioid scripts written for every 100 Minnesotans.

One Of Many Changes

The penny-a-pill program is just one of a number of changes aimed at reducing the number of opioid overdoses and deaths here in Minnesota. Two months ago, the state announced new guidelines that affect how area physicians write prescriptions for painkillers. The new guidelines suggest that physicians should:

Prescribe the lowest effective dose and duration of opioids when used for acute pain.
Monitor the patients closely, including prescribing opioids in multiples of seven days.
Avoid initiating chronic opioid therapy, make it so long term prescriptions would include face-to-face visits with the provider at least every three months.

Additionally, Minnesota wants to renew the focus on educating physicians, patients and their families on the potential dangers of opioids, as well as how to spot the signs of a problem.

“One opioid prescription can start the downward spiral in the right person,” said Dr. Rahul Koranne, Chief Medical Officer for the Minnesota Hospital Association.

Minnesota is actually one of the better states in the US when it comes to regulating prescription opiods. The state prescribes the fifth fewest opioids in the nation, which speaks volumes considering there are 47 scripts written per 100 Minnesotans.

Do you think the penny-a-pill program is a good idea? Leave your thoughts in the comments section below.

Chronic Pain and Your Credit Score – An Interesting Link

December 4, 2017 / Thomas Cohn, MD

Chronic pain has many obvious drawbacks, but it also has many hidden consequences. We know that chronic pain can be costly to treat, but new research suggests that it can have a severe impact on your buying power or your ability to secure credit.

According to a new study published in the National Pain Report, a survey of 840 chronic pain sufferers found that a whopping 63 percent were unable to secure credit. As you might have guessed, this has far-reaching consequences for pain sufferers.

Chronic Pain and Your Credit

Researchers said that there were a number of different reasons why chronic pain sufferers had difficulty securing credit. Some of the most common challenges individuals with chronic pain run into credit-wise include:

Difficulty obtaining credit because chronic pain makes it hard or impossible for them to maintain employment.
High interest on credit cards or loans that they are able to secure.
Difficulty getting a cell phone contract.
Inability to get approved for a home loan or apartment rental.
Inability to secure utilities, like electricity, propane or gas.
Difficulty getting automobile or life insurance, and when they do, rates are often very high.

“The inability to secure credit brings a long list of challenges, particularly for those who also suffer with medical conditions, like pain,” said Jim Shanahan, President and CEO of Prepaidian, Inc, a company who specializes in Prepaid debit cards that are intended to provide buying power for people who are unable to secure credit. “You may be unable to get a checking account, or pay exorbitant fees on those accounts, in addition to trying to manage medical bills.”

How To Improve Your Credit While Dealing With Chronic Pain

Improving your credit score while you deal with chronic pain isn’t always easy, but there are things you can do to improve it bit by bit. For example, always try to make your payments on time, even if it’s just the minimum amount. Paying on time helps to improve your credit score. Secondly, don’t be in a rush to close your accounts. Closing accounts, even ones you don’t use, negatively impacts your credit score because it limits your buying power. If you absolutely have to close out an account, see if you can increase your line of credit on a different account. Even if you don’t plan to spend that much, your credit score improves when you have more potential buying power at your disposal.

Secondly, try to settle up past due accounts. Odds are if you’re willing to pay at least a portion of the bill, the credit card company will be willing to erase the debt, because getting some money is better than getting nothing. You can call in and see if they’ll waive late fees or some interest charges, because it never hurts to ask, and if waiving a fee gets the credit card company their money, oftentimes they’ll be willing to compromise. It never hurts to ask.

Lastly, if medical bills from chronic pain are stacking up, try to get on a payment plan with your health center or insurance company. Making regular payments and working towards a zero balance will do wonders for your credit score. Explain your situation, and people may be more willing to help.

Thoughts On Attending The Latest Pain Conference

November 20, 2017 / Thomas Cohn, MD

Every physician is required to obtain continuing education credits. Depending on a when one was board certified, the types of boards one has, and what state you live in, the number of credits needed each year varies.

At least once a year, I try to attend some sort of conference in order to to add to my knowledge about how to treat pain. This year I have ventured into the new realm of the American Society of Regional Anesthesia (ASRA). Since pain care crosses the line into a number of different disciplines, one of the best ways to improve is to pick up knowledge outside your normal specialty.

Thoughts From The ASRA Meeting

For the last several days I have been at the annual pain meeting of the ASRA. It is a group of about 5,000 practitioners, which is actually one of the smaller major groups involved in pain management. Each group has a different focus, and finding a good balance is hard. So far I have enjoyed the meetings; it’s like being back in an intense school all day long. Best yet, most of the information has been very relevant to my regular practice. It also has included a lot of practical knowledge, and there hasn’t been too much esoteric academic information or stuff aimed at an someone just beginning to practice pain medicine. Many of the pain conferences are aimed at physicians who do not do any advanced procedures or only at physicians doing injections, and both extremes can be lacking balance for patient treatment.

One of the most important things a conference does is challenge your thinking. Hopefully questions are entering your mind about what can you improve upon and how to do better patient care. A conference like this is great. It is not focused on a single topic and there are many areas of my practice it could impact. General topics have ranged from very specific aspects of implantable pain technologies to the best ways to evaluate and treat very specific medical problems. One odd topic that has caught my interest is how to deal with changing government regulations to prevent burnout of physicians.

The hot topic at any of these conferences is now opioid use and abuse. However, at a pain conference it is not about a crisis of addiction, but a crisis of lack of treatments available to treat complex pain. The money is being spent on addiction management and not finding treatments that would manage the root cause of pain, and thus markedly reduce addiction.

The hardest thing at a conference (besides sometimes staying awake) is trying to sift through what is truly good information. After going to enough of these conferences, one begins to recognize those who are in it for self promotion. Every conference seems to have several people who promote the latest fad. If there is no money to be made with regards to a topic, the information is probably more science and less sales.

Learning new information is good. Missing seeing patients is tough, but the time gone is for the good of all patients in order to provide the best care. Benefits will be made on everything from what to do for patients to learning new things that may help tough patients. New treatments now will be tried for everything from CRPS to knee or elbow problems. The only sad part of going to these conferences is that often I see no other pain physicians from my location, but I’m certainly glad I went to this conference.