Chronic Nerve Pain Can Impact Mood and Motivation

June 10, 2015June 10, 2015 / Thomas Cohn, MD

Chronic nerve pain doesn’t just make it painful to go through your daily routine, it may actually make it psychologically harder for your brain to get motivated to complete certain tasks, according to California researchers.

Researchers at UC-Irving and UCLA say their findings suggest that brain inflammation caused by chronic nerve pain can have significant psychological effects. In a lab study, researchers uncovered that rodents with brain inflammation exhibited “accelerated growth and activation” of immune cells known as microglia. These microglia cells cause chemical signals that restrict the release of dopamine, a chemical that helps control our brain’s reward and pleasure centers.

New Approaches To Chronic Pain Care

What’s more, the researchers may have uncovered new evidence in the battle to control and conquer chronic pain. Researchers found that certain opioids designed to spur the release of morphine may actually be ineffective in certain cases. One such case occurred with these rats. In rodents with brain inflammation, these opioids did not stimulate dopamine release as designed.

Instead, when the same rodents were treated with an opioid designed to inhibit the release of the microglial cells, dopamine levels returned to normal.

“For over 20 years, scientists have been trying to unlock the mechanisms at work that connect opioid use, pain relief, depression and addiction,” said Catherine Cahill, an associate professor of anesthesiology & perioperative care at UCI. “Our findings represent a paradigm shift which has broad implications that are not restricted to the problem of pain and may translate to other disorders.”

Cahill and her team hope to recreate the study in humans in order to combat mood swings, depressive attitudes and behavioral disorders.

“We have a drug compound that has the potential to normalize reward-like behavior,” she said, “and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuity found in rodents occurs in chronic pain patients.”

Regular Exercise Isn’t Easy, But It’s Worth It

June 3, 2015June 3, 2015 / Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.

Could Chili Peppers Be The Key To Chronic Pain?

March 19, 2015 / Thomas Cohn, MD

Red Hot Chili Peppers isn’t just the name of a band, it could be the key to unlocking the problem of chronic pain.

According to researchers at the Institute of Physiology of the Czech Science Academy, capsaicin receptors contained in chili peppers can help quell chronic pain. Capsaicin receptors are the part of the chili pepper that makes the food spicy.

Institute spokeswoman Diana Moosová said capsaicin plays a significant role in blocking TRPV receptors, which participate in the transfer and triggering of painful stimuli. These receptors can be activated and blocked through a variety of stimuli, one of which is hot temperatures and low pH levels. Capsaicin fits that bill perfectly.

“Our experiments have proved that the TRPV1 receptors in the central projections of neurons of spinal ganglions play an important modulation role in the transfer of information provoking pain,” said Jiří Paleček, head of the functional morphology team. “By blocking these receptors’ activity, the pathologically increased sensitivity to mechanical and temperature impulses, which is a symptom of many chronic painful conditions, is considerably decreased.”

In essence, when you eat chili peppers, the compound capsaicin causes an initial excitation of nuerons inside your body. This leads to a period of enhanced sensitivity, but as Newton Third Law taught us, for every action there is an equal and opposite reaction. The firing of these neurons is followed by a “refractory period with reduced sensitivity and, after repeated applications, persistent desensitisation,” according to a similar study.

So while peppers may cause painful flare ups in the short term, over time, they might actually help you to desensitize to chronic pain.

Related source: Oxford Medicine, Prague Post

Chronic Pain Treatment: A Growth Industry

January 28, 2015January 18, 2016 / Thomas Cohn, MD

A recent article suggested that treating pain is a “growth industry”. In reality, pain treatment has been terribly under-treated, and we are now just starting to figure out that we need to start providing more care. The statistics are clear. Over 40% of the population suffers problems associated with chronic pain. If we recognize how large the problem of pain is, then obviously, we can start increasing the number of treatments for the problems. The article is based on information from Minnesota claim data.

It should not be shocking that we have been seeing an increase in expenditures and number of treatments being performed for those suffering from pain. The true shock is the ignorance we have about the lack of treatment provided for one of the biggest health problems. It is not surprising that from 2010 to 2012, the number of procedures performed for pain increased by 13%. The shock should be that most people are unaware of how severe the problem of pain is and the total lack of government support to guide research toward solutions.

New Solutions

Chronic pain can be a devastating problem, and studies show that it affects nearly half of the global population. The headlines often talk about problems with prescribing opioids and the subsequent drug abuse. We should not be surprised then when we see physicians trying different approaches including more interventions and injections to treat pain problems. With our awareness of problems with drug abuse, and the huge number of people having pain problems, it should be no surprise that expenditures for pain patients may be increasing. Maybe this should actually be applauded, that the underserved are getting some more attention, and we should be asking if we are spending enough yet.

Since chronic pain is such a major problem, more money is definitely needed to be spent on research and treatment. There is virtually no federal research dollars being directed toward pain. Unlike cancer or diabetes, there is no office in the National Institute of Health that is directed toward research for pain despite the size of the problems. If there is a concern about the increase in dollars being spent on pain management, then we need to seriously look at quelling those concerns. Data only tells us we are spending more money on a pain. The real issue is why are we spending a lot more money on this problem and not finding better solutions.

Control Chronic Pain With Healthy New Year’s Resolutions

January 2, 2015 / Thomas Cohn, MD

Every New Year’s Day, many of us make resolutions of what we like to change in our lives. When making New Year’s resolutions, we should work on changing things that would improve our lives. If we are like 40% of Americans who have pain, then there are many things in our lives we can do improve our quality of life.

The first resolution is that you can “manage” your pain and move forward in life. Pain has physical and psychological components, and we can control the cognitive, interpretative parts. When pain becomes chronic, there are normal sensory signals going to the brain that are being perceived as pain. The pain does not change, and you feel it regardless if you are moving or if you are doing nothing. Stop doing nothing, move forward, and get busy. If you are busy, you will not have time to worry about the pain, and you will feel better.

The second resolution is part of the first; get regular exercise. Start slowly and work up to a significant level. Two things must be done, stretching and strengthening, and aerobic conditioning. To tolerate more activity, having adequate muscle strength is essential. Core muscle strength is necessary. These are the muscles of the trunk including your abdomen, along the spine, and those about the pelvis and hips. These are muscles that we normally do not specifically work on and most everyone needs guided training to get started. With strengthening, stretching the muscles daily keeps them from becoming too tight and allows them to maintain normal function. Cardiac health is also necessary. This is done through traditional exercises, like walking, running or biking, in order to increase the heart rate. Aerobic exercise helps burn more calories and control weight.

The third resolution is to lose weight and get close to your ideal body weight. Excess weight stresses the body, especially the muscles and joints. Fat also has been shown to produce compounds that cause inflammation, and those who have pain already do not need to promote more pain within their bodies. If we eat healthier, we tend to feel better and have more energy. Mentally, being close to ideal body weight also promotes a better self image. We can control what we eat, and if we eat healthier, there are many rewards.

It is a new year. Step forward and start taking control of your life. Choose wisely and start doing the things that will improve the quality of your life. Stop making excuses for your behavior and change the bad and reward yourself for the right stuff. Start tracking your diet and exercise, and stick to the plan. Use a fitness tracker and pay attention to diet. If you need help, work with your health care providers. Start now and make positive changes in your life.