How the Body Feels Pain

July 8, 2013September 27, 2016 / Thomas Cohn, MD

Pain is a complex issue. Acute pain is usually related to one of the following:

Tissue damage
Perceived damage
Injury

Chronic pain can be associated with chronic damage or a short circuit in the transmission of pain signals. Treatment of pain depends on the cause. In acute pain, if you treat the cause the pain will normally go away. However when pain becomes chronic, treatment often does not take away all the symptoms.

Pain Signals & Sensory Stimuli

Chronic pain is generally defined as pain lasting longer than 3 to 6 months. Often, it outlasts the initial injury. In some ways it becomes independent of the initial stimulus or cause. Damage may be ongoing, and there may be a chronic inflammatory response, all causing ongoing sensory stimuli, which are subsequently linked in the spine and brain, to the perception of pain. Often, non-painful sensory signals then become linked to nerves that previously transmitted pain signals. Normal signals then become perceived as pain.

All sensory signals are processed in the brain at some level. The brain has an incredible ability to determine the importance of each signal and then form a response. Depending on the circumstance, the brain can ignore the same signal that would be horrific pain. For example, we all have heard about soldiers in war who have been shot, but continue fighting with no loss of focus. Therefore, the real key player in all responses to pain signals is the brain and its interpretation of the signals.

Blocking Pain Signals

The key to treatment of pain then is altering the brain’s ability or desire to interpret sensory signals as pain. Blocking signals can be done anywhere along the path from the sensory receptor including:

The peripheral nerve to the spinal cord
Along the spinal cord pathways
In the brain itself

Although pain can be treated in multiple ways, all treatments try to prevent transmission and interpretation of sensory signals that are perceived as pain. There is no magic bullet and no one treatment alone that will work for everyone.

The simple reason why there are so many treatments for pain is that there are so many ways to alter signals that are perceived as pain. Medications have been designed to affect sensory impulses at a variety of locations from the skin and periphery to the spine and brain. Furthermore, there are a variety of techniques from proper movement, to acupuncture, to psychological training that can effectively treat pain.

Do Opioids Reduce Inflammation in Chronic Pain Patients?

July 3, 2013September 27, 2016 / Thomas Cohn, MD

A recent preliminary study found that inflammation in patients with chronic pain is persistent despite long-term opioid treatment.

The study was carried out by Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina. Dr. Tennant examined 40 patients from July 2012-October 2012. All of these patients had been receiving heavy doses of opioids to treat their chronic pain for the past 10 years.

While many patients reported improved levels of depression and function, 20% of those surveyed still had high levels of inflammation markers. Further, a number of patients had abnormally high hormone levels.

Dr. Cohn Comments

Opioids are used to treat all types of pain, but they do not treat inflammation. If a chronic condition causes pain, such as osteoarthritis, treating this with opioids will not change the inflammation that is occurring. The pain may be better with the opioids, but the disease is not being modified and one should expect to see inflammatory markers.

Chronic pain is defined as pain lasting longer than 3-6 months. Pain can be caused by any number of factors, and is a response to ongoing stimulation of pain receptors in the body. It is not very surprising that if we monitor blood borne markers, we can find elevations in those that are indicators of inflammation.

Osteoarthritis is a chronic degenerative joint disease. If it is painful, there is likely active destruction of tissue, and the joint may be warm and swollen. Osteoarthritis of the knees is very common, and we all know many older adults who complain of painful, swollen knees. Furthermore, the most common treatments are nonsteroidal anti-inflammatory drugs, like Motrin and Aleve.

Low back pain has many causes, such as:

Inflammation of nerves causing radiculopathy
Degeneration of the facet joints

First line treatments are meant to reduce inflammation. This is done sometimes by oral steroids, or long-acting steroid epidural injections. Steroids treat inflammation directly, and finding inflammatory markers when someone has low back pain is not surprising.

If a person has chronic pain, a good pain physician will recognize the causes of the condition. Treating the cause of pain with interventions that modify the disease is the best strategy. Treat the disease, and the disease markers will improve. Opioids are often a Band-Aid – they help in the short term but fail to address the underlying condition.

Related Sources:

MedpageToday

How to Choose a Good Pain Doctor

June 17, 2013September 27, 2016 / Thomas Cohn, MD

Choosing a good doctor is always a challenge. There are many options to consider, including:

Insurance Requirements
Where you Live
The Degree of Specialization of the Physician you’re looking for

The best pain doctors will be those who have a broad range of experience, and a broad range of ability to evaluate and treat a variety of problems.

The Definition of Pain

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is how the body interprets certain sensory signals in the nervous system, which includes how the brain processes the signals and determines how to react to them. Pain sounds simple, but becomes extremely complex due to many causes and interactions.

Qualities of a Great Pain Doctor

A good pain doctor needs to have many qualities in order to successfully manage what can be an extremely complex problem. Pain often comes from multiple sensory sources, and finding each sensory source is a challenge. The start to finding the source is listening to the patient, the story, and where and what is happening. The story is often critical, and a good doctor will be able to recognize what story matches various internal problems. An experienced doctor can match a story very quickly to the pain problem.

In addition to listening to the patient’s story, a doctor may also need to perform other tests in order to grasp the full scope of your pain, such as:

Analysis of a patient’s movements
Checking motion in various body parts
Examining the neurologic and musculoskeletal system
Scans and X-rays

The best doctors have done this many times, and can put complex information together rapidly to determine a treatment plan.

Finally, all the good pain doctors should at least be fully licensed, and have subspecialty boards in Pain Medicine. Backgrounds in Physical Medicine and Rehabilitation are also a huge plus. Expect a good physician to be familiar with your history and examination, and have a comprehensive treatment plan, and be willing to address a number of complex issues contributing to your unique problem.

5 DIY Neck Pain Treatments

June 10, 2013November 17, 2015 / Thomas Cohn, MD

The neck is an incredibly complex part of the body that is in almost constant use. As a result, it’s easy to incur overuse injuries and chronic pain in the neck. Neck pain is, quite simply a “pain in the neck.” It can hinder your daily activities and put you in a bad mood. Below are 5 treatments for neck pain that you can do at home:

Good posture. Your neck is directly connected to your spine, and thus directly affected by your posture. When you slouch, your lower back bends forward, causing your neck to strain forward in order to compensate.
Over the counter pain relievers. Common pain relievers like aspirin and ibuprofen can decrease inflammation and pain in the neck. As with all medication, be careful not to overdo it with these pain relievers. Only take them as needed.
Heat & Ice. A combination of hot and cold can help relieve neck pain. Wrapping a handful of ice in a towel and resting it on your neck for 5-10 minutes can reduce inflammation, while applying heat (by taking a hot shower for example) can increase circulation.
Massage. Having someone rub your neck and shoulders is a great way to loosen up the muscles and help you relax.
Workplace habits. It’s important to stay at eye level with your computer at work. If your monitor is higher or lower than your eye level, you will strain your neck by constantly looking up or down. This can have a terrible toll on your neck muscles, especially if you’re on your computer for 8 hours a day.

If you still have persistent neck pain after trying these treatment methods, there may be a more serious underlying issue. If this is the case, it’s a good idea to consult a doctor who specializes in pain management.

Acute Pain vs. Chronic Pain: Definitions & Differences

June 3, 2013September 27, 2016 / Thomas Cohn, MD

There are many definitions of pain. Because pain is often subjective, everyone will define and describe it in their own personal terms.

Dictionary vs. Medical Definition of Pain

The dictionary describes pain as physical suffering or discomfort caused by illness or injury. Medicine becomes very technical in its description of pain, often concentrating on the physical aspects, structures involved, and trying to determine if it is “real.” The International Association for the Study of Pain (IASP) defines pain as:

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Pain has both physical and emotional correlates. If someone has pain, there is usually a physical cause in the body that needs to be found. Pain may also have significant emotional correlates in the brain. The processing centers in the brain for many pain signals sit next to the areas that control emotional stability. Therefore, if people have significant amounts of pain, spread of pain signals to emotional areas of the brain can easily occur, affecting mood and depression.

Pain is always subjective. It is a learned experience, and it is very individualized. A person learns what pain is through experiences related to injuries as a child and as they grow up.

Acute vs. Chronic Pain

In medicine, pain is the interpretation of certain sensory signals, generated from a variety of receptors in the body. When the sensory signals are ongoing, most people interpret these as pain, and seek treatment to relieve them. There are two primary types of pain:

Acute pain is from definite tissue injury and will fade after the cause is identified and treated. A common example is cutting a finger – it hurts, it heals, and the pain is gone.
Chronic pain occurs when damage causes ongoing sensory signals for long periods of time, and in some degree becomes independent of the actual tissue damage. This type of pain is difficult to stop, and often the best treatment is working on systems to manage the pain.

Understanding the complexities of pain, the body, the sensory nervous system, and the overall interactions in the body are some of the important aspects for a medical doctor who treats patients with pain. A good pain physician understands people and medicine and how all these interact, allowing them to find the causes and improve the quality of your life.