September Is Pain Awareness Month

September 14, 2017 / Thomas Cohn, MD

If you don’t deal with pain on a regular basis, odds are you don’t realize how big of a problem pain is in our society. That being said, there’s a good chance you do deal with pain, because roughly one in three adults is the United States is battling a pain condition. Whether it’s from arthritis of the hips, carpal tunnel in the wrist or another painful conditional, pain is very prevalent here in America.

To help bring awareness to the pain problem, September has officially been declared Pain Awareness Month. Today, we hope to share some facts about pain and bring attention to the problem so that we can work towards a solution.

Everyone’s Pain Is Different

Pain is unique to the individual. Even though you may share a diagnosis with thousands of other people, your pain is going to be unique to you, so it should come as no surprise that treatments can differ greatly even if two people are diagnosed with the same pain condition. For some, physical therapy, exercise and a diet change can help keep pain at bay, while others will find relief with acupuncture, yoga and anti-inflammatory medications.

The key to treating pain is to treat the underlying condition, not the symptoms. Some passive treatment techniques like opioids or pain injections help to decrease pain levels in the short term, but they do nothing to treat the underlying problem, which means these patients will never truly be rid of pain. Pain specialists are great at finding the underlying cause and developing treatment strategies to fix the true source of pain. It’s not always going to be easy, but trust us when we say it will be worth it in the long run.

Treating pain also needs to be a two-way street. There is no magic pill to cure your of your pain, so while a doctor can help diagnose your pain and suggest treatment options, we can’t force you to take part in therapy or eat a healthier diet. The desire to get rid of daily pain needs to come from the patient. We will do everything possible to help you on your journey, but we can’t do it for you. Meeting with a pain specialist is a great way to set and manage expectation between doctor and patient.

Facts About Pain

To better explain just how prevalent chronic and acute pain is in today’s society, check out some of the facts about pain below.

Over 75 million Americans deal with a pain condition, more than those diagnosed with cancer and diabetes combined.
30 percent of adults between the ages of 45-64 experience pain that lasts longer than 24 hours.
The estimated annual cost of chronic pain in the US is more than $100 billion.
1 in 5 people experience pain that disrupts their ability to sleep.
Back pain is the leading cause of disability for people under the age of 45.
Less than half of pain sufferers feel like they have control over their pain.
More than 75 percent of individuals with chronic pain say they suffer from depressive thoughts or anxiety.
Headaches were the most common type of pain that led to lost productivity in the workplace.
Only 15 percent of people with a pain condition go to a pain specialist. Most prefer their primary care doctor.

If you are dealing with a pain condition, consider setting up an appointment with a pain specialist. Your doctor has a wide range of medical knowledge, but they lack the depth of knowledge about specific pain conditions that a specialist has. If you want to set up an appointment, reach out to Dr. Cohn’s office today.

Could We Be Pain Free In The Future?

July 11, 2017 / Thomas Cohn, MD

Although not as much money is being spent on understanding pain as doctors would like, there is still some promising research taking place throughout the world. For example, new research published in Nature Neuroscience took a closer look at re-wiring the brain’s transmitters when it mistakenly interprets signals as pain.

The research began by looking at mice who had peripheral nerve damage and chronic pain from a previous leg surgery. In these mice, a broken circuit in the pain-processing region of the brain caused hyperactivity that led to pain for more than a month. Scientists realized that the peripheral nerve damage deactivated a set of interconnected brain cells, called somatostatin (SOM), which usually work to lessen pain signals.

Fixing The Broken Circuit

Researchers were interested in learning if this connection could be fixed, and if it could, how we’d go about repairing it. One method they tried was to manually activate the SOM interneurons, and they found that this led to a significant decrease in the development of chronic pain.

“Our findings suggest that manipulating interneuron activity after peripheral nerve injury could be an important avenue for the prevention of pyramidal neuron over-excitation and the transition from acute postoperative pain to chronic centralized pain,” the authors, led by neuroscientist Guang Yang at New York University School of Medicine, conclude. They believe future drug therapies or magnetic brain stimulation could mend these SOM interneuron connections and prevent pain signals from misfiring.

The authors are cautiously optimistic, but they realize that there is a big difference in the brains of mice and the brains of humans. The study needs to be repeated and the results verified before any similar testing in humans could take place, but it’s a start.

“Our study provides, to our knowledge, the first direct evidence that impaired SOM cell activity is involved in the development of neuropathic pain,” the researchers wrote.

They hope to confirm their results and examine whether manipulating other cells could play a role in the reduction of chronic pain. If they can, we may have specific cells in which to base our intervention techniques. This is exciting.

Why Are We Treating Pain The Same As We Did During The Civil War?

July 4, 2017July 4, 2017 / Thomas Cohn, MD

It is no secret that there is an opioid problem in the United States. It seems like there is a new report being published every week on the problems with opioids in this country. This week the government published data on the number of emergency room visits related to opioid use in a single year.

The data shows roughly a 100 percent increase in the last ten years in the number of hospital visits and admissions related to opioid problems. Not surprising is that despite some differences from state to state, in general, the problem affects everyone equally – male and female, rich and poor – just like any other addiction. The focus of most data being published is on opioid addiction. Unfortunately, rarely is someone talking about some of the reasons behind the problem, especially as it relates to how the United States treats pain.

How The US Treats Pain

It is really no surprise that there is an opioid problem in the United States. Pain is a very complex set of medical issues, but unlike diabetes or cancer, very little money has been spent on any aspect of pain as a medical problem, and medical school and physician training in understanding and managing pain is virtually nonexistent. Research sponsored by any government or industry sources is minimal compared to all other areas, maybe 2 percent of all money spent by the National Institute of Health and there is no comprehensive strategy to look at treating pain. Most importantly, the tools used to treat pain are the same tools we used at the time of Civil War – opioids. Most other diseases from hypertension to diabetes and cancer over the last fifty years have seen major advancements in how we treat these conditions, but not pain.

On top of the publishing of new data of how many people are being affected by opioids, the news media is full of sensational information on every aspect of the opioid epidemic. Time magazine this week had information on how drug companies and drug treatment centers are profiting from opioid problems. One of the biggest lobbying groups for money and guidelines on opioids are addiction specialists and drug treatment centers; just a slight conflict of interest. Then the sensational news moves to all the individuals who have become addicts and the problems of addicts. Unfortunately, opioid addiction and how it affects individual lives is not really significantly different from other addictions from food to alcohol, it’s just less glamorous. The latest highlight in the news is the potent drugs and overdoses, and how just touching some of these illegal drugs or using for the first time can cause overdoses.

Opioids are a problem in the United States and more data does not help solve the problem – it just makes it sensational. The real issue that is being ignored is the issue behind opioids and how we treat pain. Most of the pain treatments available date back to before the Civil War. Pain is extremely complex, and to solve the opioid issue the United States needs to get serious about finding better pain management tools and invest in them.

When Pain Management Becomes A Pain

May 2, 2017 / Thomas Cohn, MD

Let’s be honest, taking part in a daily pain management routine is rarely fun, and at times it can become downright exhausting. Sometimes all the things you need to do to care for your pain become more burdensome than the pain itself, but that doesn’t mean you should give up and give into pain. Today, we share some tips for what to do when pain management becomes a pain.

Tips For Managing Pain

Whether you’re dealing with chronic regional pain syndrome, asymptomatic back pain or irregular headaches, here are some tips to keep in mind to help pain management become less burdensome.

1. Active Distractions – If you can distract your mind from your pain, all while working to rid yourself of chronic pain, you’re winning the battle. Things like Netflix or a bowl of chocolate ice cream can help take your mind off the pain, but they won’t actively help you strengthen your body and keep symptoms at bay. Try to find activities that are somewhat physical in nature that don’t feel like exercise or therapy. Activities like swimming, Tai Chi, cycling, walking, or yoga can all help strengthen key muscle groups and keep your mind off your pain without feeling like a regular exercise routine.

2. Vent – It can be healthy to vent about your pain once in a while, but don’t dwell on it. Most patients with chronic pain try to hide their pain from everyone because they don’t want to be seen as weak or “complainers,” but it’s perfectly healthy to express frustration with your pain. Whether it’s just yelling out loud for five seconds each day or blogging about your pain on a message board, these channels allow us to speak out about pain when so often we remain silent. Find what works for you.

3. Professional Help – Pain management physicians are trained in helping people who are battling complex pain problems, so reach out to one if you have questions or concerns about your pain. Odds are we’ve heard the question before, or we can think it over and give you some healthy advice. It doesn’t need to directly relate to your pain, either. You can ask about different therapy techniques or support groups in the area, and we’ll do our best to help give you some professional guidance.

4. Small Victories – Fighting the daily battle against chronic pain can feel like an uphill battle where for every two steps you take forward, you find yourself taking one or more steps backwards. This will be undoubtedly frustrating, but try not to dwell on the bad and instead focus on what you’ve accomplished and the progress you’ve made. Maybe your chronic back pain was so painful that you couldn’t go for a run like you planned, but instead you bucked up and did 20 minutes of therapy stretches. Don’t focus on the missed run – focus on the therapy you did to kick your pain’s butt! Enjoy the small victories as they come along.

The Complexity Of Pain Management

February 1, 2017 / Thomas Cohn, MD

Back pain patients often state if they just lost some weight, maybe their low back would feel better. It would be nice if it were that easy, but it is often much more complex. Usually someone who has back pain has multiple causes of the pain, from simple lack of strength in the muscles, to nerve irritation, degeneration of the joints and discs in the spine and problems with body mechanics. Yes, weight can stress every structure in the back and make things harder and more painful, but oftentimes all the other things causing pain may be more important in order to control back problems.

Controlling Back Pain

Asking most doctors about how to lose weight is often not very helpful. About 75 percent of medical schools do not provide the recommended 25 hours of nutrition training, and many older physicians have had minimal to no training in nutrition. Complicating everything is the fact that older research was often sponsored by major manufactures of food and conclusions of the studies were not scientifically sound. Current research is showing that every person often responds differently to a diet, and what is helpful for one person will not always work for another. The more one reads, the more complex the human digestive system becomes and our understanding is really limited. Everything affects us, from our genetics, to what our mother’s ate during pregnancy, to the bacteria in our gut.

Eating a healthy diet is probably the most sound advice, and then pay attention to the amount you eat as well as when you eat. Healthy eating means eating less processed substances like pre-made foods. Some people equate this to eating from the fringes of the grocery store, where the fresh fruit, vegetables, salads, lean meats, and diary if often kept. Limiting simple carbohydrates like bread, potatoes, pasta, sugar and white rice can help many people as well. Protein sources from poultry, fish, beans, nuts and diary, and not from red meat are recommended in many diets. If you have gastrointestinal problems like inflammatory bowel disease or celiac disease with gluten intolerance, diets change play an even bigger role in solve the pain equation. In general, a plant-based diet is often the healthiest.

Managing Weight and Back Pain

Since low back pain is caused by many factors, it is rare that the most important issue is weight. The most common factor is usually the lack of exercise. Often a patient will go to physical therapy and learn what to do but after the formal sessions, they do nothing on their own. Those who are overweight are no different than most patients; they are not actively exercising and taking care of their health. Every patient must find their own internal motivating factor to take care of themselves and exercise. Staying healthy takes a lot of work. There is no quick fix and those who actually do the best take care of their physical and mental health. Those who do the best follow through with the three components of exercise – stretching, strengthening and aerobic conditioning. If you are doing the work of exercising appropriately and eating a healthy diet, it is likely that weight will not be an issue.

Those who do have back pain and who are significantly obese often can improve their back pain with weight loss. However, the improvement is relatively minor with the loss of weight. The patients who notice the most improvement in pain are those who adopt a healthier lifestyle. Despite being obese, they start consistently exercising, often finding a way to participate in a pool exercise program so they do not stress their joints. They also have changed their eating habits, and the combined efforts usually lead to a sustained weight loss of 1-2 pounds per week. Believe it or not, it becomes obvious who actually is exercising, as they start feeling better and have markedly less pain. Low back pain affects millions of people nationwide, the simplest solutions often are the best – exercise and a healthy diet.