Opioid Success Rates in Women With Chronic Pain

November 18, 2015May 10, 2016 / Thomas Cohn, MD

A recent study has found that using opioids to treat chronic pain in females is often not helpful. The study found that less than 20 percent of females receive pain relief with the use of narcotic-type medications. The article was published in the July 2015 issue of the Journal of Woman’s Health, and it indicates that women often do not receive any significant chronic pain relief pain from the use of an opioid. About 50 percent of men receive adequate pain relief from opioids, but only a small percentage of women have a response.

Chronic pain is a complex problem. There are often multiple problems occurring that cause the pain, and it is rare that there is a simple solution. Pain is complex and a multitude of different techniques and methods are necessary to treat these types of problems. Not only are there multiple peripheral generators of pain signals, the interpretation by the brain of pain is often short-circuited.

Opioid Use and Women

The brain, when it receives multiple pain signals, develops what is called “central sensitization.” Both abnormal and multiple pain signals are interpreted as significant pain, and normal signals can be also perceived as pain. Central sensitization and many of the peripheral receptors are not responsive to opioid medications. When looking at the big picture, it’s not surprising that women don’t respond well to opioid therapy.

As noted above, chronic pain is a complex condition. Simple solutions like opioids often do not work to help with pain. New research is being done to better understand all aspects of pain, and we’ve made huge gains of the last few years. That said, pain care has not received a lot of research funding, but hopefully that will change. Research can lead to better solutions to prevent and treat pain, we just need to put in the time, money and effort.

Your Chronic Pain Doesn’t Define Your Life

September 14, 2015August 25, 2016 / Thomas Cohn, MD

Having chronic pain is tough both physically and emotionally. Pain at times seems to control your life. In reality, one needs to become the captain of the ship and take control of your pain and your life. Everyone has problems in life, but if you deal with pain, you need to learn how to manage it and move forward with life. Do not wallow in pity and do not expect others to suffer with you. Taking control of your life involves managing your pain and your emotional status. It also means not using pain as an excuse for doing nothing in your life.

Pain is complex. Once it is chronic, it may be functioning independent from the original cause. It also may be due to constant stimulation of the pain sensors in the body and develop into a central sensitization type of pain status. Over time, the brain may become overly stimulated by pain reception, and in a practical sense, a short circuit develops in pain reception and the brain is overwhelmed by the pain signals.

The Brain and Pain

One of the main functions of the brain is to perceive and interpret all the signals it is receiving. There are conscious and subconscious levels on which the brain translates signals. Some sensory impulses are translated on a reflex level without significant interpretation, while others have extensive cognitive and emotional components. A person has tremendous cognitive control over many aspects of brain function, including the power to modify the meaning of pain signals. The brain can choose to ignore pain signals, especially when they are the chronic background pain signals.

The brain perceives unpleasant sensations in the body. The perception of direct pain signals from painful sensory stimulation can be considered as primary suffering. Overlaid upon this are the feelings, emotions and memories associated with the pain. The feelings associated with pain lead to anxiety, stress, depression and are the secondary suffering felt by a person. Over time, the primary suffering may be minimal and the secondary suffering becomes the major component of pain.

Anxiety and Stress

After years of practice and noticing that pain seems to never improve in the patients who have high anxiety, stress and depression, science has actually helped explain the problem. Using special functional MRI scans of the brain, a psychologically normal person with acute pain has only a couple areas in the brain that enhance. A stressed, depressed and anxious person with pain will have multiple areas of enhancement and abnormalities on a functional MRI scan. Other studies have also shown a normal person exposed to pain can endure much more stimuli, and those who are already stressed have a much lower threshold to similar stimuli. Thus, anxiety, stress and depression have a very negative impact on pain control.

The next level of research that has been done has been focused on treating the anxiety, stress, emotions and depression in the pain patient. A variety of techniques have been used to decouple suffering and treat these components of pain. Techniques have included mindfulness, hypnosis, cognitive behavioral therapy and medications. When the emotional secondary suffering has been treated, often the physical perceived pain can almost be eliminated.

Different people will respond to a variety of techniques. Most people who have chronic pain do have emotional suffering components to their pain. Treating the emotional suffering often becomes more important to solving pain control issues as time passes than finding traditional medical interventions. Further, most people are in denial of any emotional components of pain. However, when the patient is withdrawing from activities of life, it is evident to everyone around the pain patient that there are components of emotional suffering.

When pain becomes an excuse not do something, and one starts withdrawing from life, you are emotionally suffering. Stop asking for pity. At this point, you need to find your solution to your psychological problems and get help to solve them. Solve the psychological issues, and it is amazing how much better the chronic pain issues become. The patients who have a healthy psychological status function and move forward in life. These are also the people who do not make excuses for themselves and have very little dependence on addictive substances. If the stress of life is affecting pain, then get help and find the solution that helps you treat and eliminate the negative behaviors in your life. Stop making excuses and start moving forward in treating the right problems, your stress, anxiety, and emotional well-being.

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.

Psychological Treatments and Parenting With Chronic Pain

August 19, 2015August 25, 2016 / Thomas Cohn, MD

As we mentioned in Monday’s post, treating pediatric chronic pain is a comprehensive process. Today, we take a look at the psychological side of chronic pain in children.

Pain is extremely complex when it becomes chronic. Oftentimes it takes multiple strategies to modify the impact of pain. When it hurts, it’s harder for your body to function normally, and if the body does not have the ability to fully cooperate, pain and function may decrease. It may be a constant challenge to control pain.

Psychological challenges are enormous, as the brain wants to focus on the pain signals and the patient wants the brain to ignore them. Furthermore, the centers for pain in the brain and centers for anxiety and depression are next to each other, and sometimes their signals can interact. Preventing this short circuit and diminishing the transmission of pain signals is a constant cognitive and physical activity that can be extremely fatiguing. In complex cases of chronic pain, often it takes every type of intervention to combat the pain signals from physical activity, to complementary medicine, to natural remedies and then traditional medications, interventions and psychological treatments. The battle is not easy on either the patient or the parent watching the struggles.

That’s where a pediatric pain psychologists can be extremely helpful in developing treatment strategies that help in managing the interactions of pain and stress in the brain. They can help the patient understand why they’re experiencing pain and how to deal with pain when it rears its ugly head. By better understanding pain, we can help prevent some common side effects, like anxiety and depression during a crucial time of childhood development.

Parenting Kids With Pain – My Story

As a parent of a child with chronic pain, the most important role is to encourage wellness and a normal lifestyle. Never encourage the sick role of the child and never reward pain behavior. It should never be better to be at home and be rewarded for having pain while being excused from all other normal activity. Watching a child struggle with pain is not a fun experience, but seeing them later conquer life independently is amazing. It is what is often reffered to as “tough love”. It may make you cry a little at times, but your role is to be the coach and get them back out there in life.

From my own experience, dealing with a child with significant chronic pain is extremely challenging. Trying to make the right decisions is not easy. Often, every nontraditional method to manage pain may be an option. Having the correct diagnosis and treatment often is also a challenge. Furthermore, with all challenging cases, 90 percent of the doctors and therapists do a good job. Unfortunately, on complex cases, you may need to find those 10 percent of doctors who are far superior to the others and this isn’t an easy task. As a physician, it is difficult when you can see the problem, but are not in the position to change the situation. The one truth is always be supportive and guide the person in the best direction possible. Empathy does go a long ways, but they do not need your sympathy.

Talking Therapy May Help Ease Chronic Pain

June 19, 2015 / Thomas Cohn, MD

Talking therapy, where patients focus on easing psychological stress to make it easier to complete physiological activities, may be another avenue for chronic pain sufferers.

The therapy – also referred to as Contextual Cognitive Behavioral Therapy or CCBT – works by helping people overcome stress that can exacerbate chronic pain symptoms. For example, some people with chronic pain may become stress/fear avoidant, meaning they’ll avoid certain activities simply because they fear the potential outcome. Not only can limited activities make a chronic pain condition worse, but it can also make it harder for the patient to fully overcome the condition.

“We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments,” said Dr. Stephen Simpson, director of research and programs at Arthritis Research UK. “This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”

Talking Study

For their study, researchers recruited 89 patients with chronic back pain and split them into two groups. The first group received just physiotherapy, while the second group received CCBT and physiotherapy. After completing their assigned therapy, researchers noted that physiotherapy was more successful if patients also received CCBT. Additionally, patients who received both therapies said they believed CCBT helped them be successful in physiotherapy.

“Our study found that CCBT is acceptable to patients,” said Tamar Pincus, a professor at Royal Holloway University of London. “Interestingly many patients who took part, as well as several of the clinicians involved — both psychologists and physiotherapists — thought the best treatment was a combination of both physiotherapy and CCBT.”

Researchers concluded that physiological treatment is just as important as physical treatment when dealing with chronic pain, as mental therapy can improve patient conditions and reduce treatment costs.

Related source: UPI.com