Men and Women Similar When It Comes To Chronic Pain

September 25, 2014 / Thomas Cohn, MD

Although there have been previous studies that suggest women have a higher pain tolerance than men, a new study out of the University of Malaga suggests that a person’s resiliency, not their sex, determines how well they handle chronic pain.

For their study, researchers analyzed numerous traits among 400 patients suffering from chronic spine pain (210 women and 190 men). What they found was that personal qualities, not genetic differences, was the best indicator of how a person dealt with chronic pain.

In essence, certain men and women have a very difficult time managing chronic symptoms, while others are able to work through the discomfort. The people who don’t let the pain bog them down are the same people you’d want on your basketball team when you’re down 10 points in the fourth quarter or if you need a big last week to meet your quarterly sales goals, because the research suggests that how a person handles adverse circumstances is the primary quality linked to an individual’s pain tolerance and how they adjust to chronic pain.

According to the researchers, the findings suggest more similarities than differences between men and women.

“More resilient individuals tend to accept their pain, that is, they tend to understand that their ailment is chronic and they stop focusing on trying to get the pain to disappear, to focus their energy on enhancing their quality of life, despite the pain, said Carmen Ramirez-Maestra, the study’s lead author. “In this regard, patients who are able to accept their pain feel less pain, they are more active on a daily basis and have a better mood.”

So remember, treating chronic pain is only half the battle. Dealing with, accepting, and not letting pain wear you down are other pieces to the pain puzzle.

Related source: Daily Digest News

What Types of Patients Do Pain Doctors Treat?

July 14, 2014May 10, 2016 / Thomas Cohn, MD

Finding the right care for each individual patient who is dealing with chronic pain can be difficult. If a patient has ongoing difficulties with pain symptoms, additional medical expertise is often helpful with symptom management. The comprehensive Pain Care program at CDI is designed to help manage these complex and difficult problems.

Pain Management at CDI

The Pain Care program at CDI will see any patient who has ongoing problems with pain. The program is run by a Board Certified Physical Medicine and Rehabilitation specialists with subspecialty training in Pain. We are available to help evaluate and diagnose medical problems that are causing ongoing pain symptoms in any region of the body. Common problems that we usually see include patients with:

neck pain
headaches
joint pain
neuropathy
low back pain
mid back pain
multilevel pain problems.

The goal is to develop an individualized comprehensive treatment plan to better control symptoms on a conservative basis. Early management of pain problems often leads to solutions that completely solve the issues.

Treating Pain Problems

A typical low back pain patient may have muscles strains, disc issues, nerve irritation, lumbar facet joint pain, or even pelvic problems. A comprehensive evaluation and examination often leads to an appropriate diagnosis and a number of treatment options. A Physiatrist can work with a patient to complete further testing, and if necessary, assist with physical therapy, medication, and interventions to overcome the medical problems causing low back pain. Muscle strains for instance may only need physical therapy and appropriate short-term medications. Lumbar facet joint problems cause axial low back pain and may benefit from a combination of injections, radio-frequency neurolysis/lesioning, and physical therapy. Depending on the diagnosis, a comprehensive treatment plan with the available options for management can be discussed and implemented with the patient.

Neck pain issues often cause headaches and can be treated with a number of conservative interventions. The Pain Care team can help diagnose and develop a comprehensive management strategy. One common problem causing headaches is irritation of the cervical facets, and this often occurs after trauma, especially motor vehicle accidents. This pain is often known as a whiplash injury. It often resolves with conservative physical therapy and short-term medication, but about 10% of cases require more intense intervention. These patients are often helped with injections and sometimes radio-frequency lesioning of nerves in the neck. Successful management often cures the problems for a prolonged time.

Pain is a complex problems, and every patient is unique with their own set of important issues. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, having the skills of a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new field. At CDI we have recognized the need to provide a more comprehensive service to help with the management of these complex and difficult patients. With a comprehensive approach to the evaluation and management of these patients by a Physiatrist, we hope to bring a successful approach to resolving these difficult problems within the community. At CDI we hope to partner with a community of physicians to better serve these patients and their providers.

What is Reflex Sympathetic Dystrophy (RSD)?

December 11, 2013June 24, 2014 / Thomas Cohn, MD

Reflex sympathetic dystrophy is one of the older terminologies for what is currently known as Complex Regional Pain Syndrome (CRPS). Other terms used include:

Causalgia syndrome
Sudeck’s atrophy
Algodystrophy
Algoneurodystrophy
Reflex neurovascular dystrophy

History of RSD and CRPS

At this time the preferred medical term is CRPS. In 1993 the terminology changed from RSD to CRPS to better define underlying problems associated with the syndrome. Two types of CRPS were further defined:

CRPS Type 1 has the characteristic painful limb, but has no definite nerve injury as the cause
CRPS Type 2 has obvious previous nerve damage

Quality of Treatment

Quality of treatment for RSD/CRPS depends on the knowledge and experience of the practitioner coordinating care. CRPS is a complex problem, many physicians work with the syndrome on an occasional basis. A pain physician who treats this condition almost daily is likely the best source to turn to for management and treatment options. Experience in recognizing the problem and offering a comprehensive multi-disciplinary approach is essential.

It truly requires a “hands on” physician who coordinates all aspects of care. The mark of a good physician is one who not only recognizes what is wrong, but one who can determine all the contributing factors to the syndrome and what is maintaining the problem. Few pain specialists truly understand the condition, finding a good physician may seem like finding a needle in the haystack.

Diagnosis and treatment of CRPS and RSD depends on finding the right physician. It is not guess work at management. It often takes time and patience by both the physician and patient. Experienced physicians will be much more successful in management, do not settle for just anyone who just claims to have treated the condition.

Complex Regional Pain Syndrome (CRPS) – Causes & Treatment

September 30, 2013November 17, 2015 / Thomas Cohn, MD

Complex regional pain syndrome (CRPS) is a pain problem manifested by severe pain. It is a poorly understood disorder that causes intense pain.

With CRPS, the nervous system becomes hyper sensitized – normal sensations become amplified. The thermostat for pain sensitivity becomes set at the wrong level. The sympathetic autonomic nervous system also becomes hyperactive. This combination of problems leads to severe pain in the affected area, often a hand or foot.

2 Types of CRPS

There are two basic types of CRPS:

Type I occurs with no known nerve injury
Type II occurs in association with a known nerve injury

CRPS describes an array of painful conditions characterized by regional symptoms seemingly disproportionate to the usual course of trauma or injury. The pain is regional, not in a specific nerve or muscle distribution. The patient will report sensory changes such as:

Hyperesthesia
Changes in skin color
Edema and temperature changes
Motor changes – inability to move the affected region

It usually begins in one limb, often diagnosed months after onset, and is 3 times more common in females. The initial injury is usually minor, such as an ankle sprain. Because of this, there is often a delay in finding an expert who recognizes the diagnosis and can initiate treatment.

How to Treat CRPS

Treatment of CRPS is difficult, but should be done in four steps:

The first step is evaluating and treating any treatable injuries that contribute to the pain. This may include surgical interventions for injuries such as ankle sprains.
The second aspect is controlling the sympathetic aspects of pain and the neuropathic pain with injections and medications.
The third part is rehabilitation and physical therapy, restoring mobility and decreasing pain sensitivity.
The last part is psychology to use cognitive strategies to control central pain perceptions.

Complex regional pain can be devastating. The earlier it is diagnosed, the better the prognosis. Experienced pain management physicians are essential in improving the outcome. It can be successfully treated and there are many good interventions available. Find an experienced Pain physician, and find a solution.

Opioid Use can Lead to Low Testosterone

July 24, 2013September 27, 2016 / Thomas Cohn, MD

Opioids are medications that include many of the common pain drugs that are prescribed for acute and chronic conditions. A few common examples of these drugs include:

Morphine
MS Contin
Oxycontin
Percocet
Oxycodone
Vicodin
Hydrocodone
Methadone
Dilaudid
and many are trade name medications

How Opioids Impact Testosterone

They are effective medications for management of pain at times, and block transmission and perception of sensory signals related to pain. However, in recent studies long-term use has been shown to cause significant hormone problems, especially androgen deficiency and low testosterone.

Androgen deficiency affects both males and females and may have a significant impact on quality of life. Common symptoms and complaints include loss of libido, fatigue, erectile dysfunction, hot flashes and depression. Physical findings may be:

Loss of muscle mass
Body hair loss
Anemia
Osteoporosis
Hypogonadism

Diagnosis & Treatment

Diagnosis is made by history of symptoms, exam, and laboratory analysis of blood for hormone levels. Treatment can be two-fold:

Reduce opioids
Hormone replacement

Opioids can affect the brain and the regions that control hormone production. Specifically, they affect the hypothalamus region and inhibit the gonad releasing hormone. This causes a decrease in critical hormones for both males and females including FSH, LH, and testosterone. Opioids also are thought to increase enzymes that metabolize and breakdown the above hormones in the body. Thus, these medications decrease these critical hormones in several ways causing significant side affects.

Long-term opioids are not a benign treatment for pain. If the pain is better, why would a person want to have depression, loss of hair and muscles? The problems associated with opioids are significant, and treatment with hormone replacement is often helpful, but may not reverse the damage these medications can cause.

No silver bullet exists for treating pain. Every treatment has risks and benefits. A good pain physician looks at problems in a comprehensive manner to reduce all risks and maximize benefits.