5 Things Patients With Chronic Pain Should Do Every Day

August 22, 2018April 5, 2023 / Thomas Cohn, MD

As anyone with chronic pain will tell you, it is a daily battle against their pain condition. Some days are good, some days are not. You have to take it one day at a time when it comes to managing your chronic pain and focus on winning small battles. While it’s easier said than done, we’ve found that if chronic pain patients perform some or all of the following activities on a daily basis, they put themselves in a better position to have more good days than bad.

Daily Habits For Chronic Pain Patients

If you deal with chronic pain on a regular basis, strive to do a couple or all of the following activities on this list every day.

1. Eat Healthy – Now, you don’t need to eat a perfect balance of fruits, vegetables and whole grains at every single meal, but you should strive to hit all the important food groups throughout the day. Getting a wide range of vitamins and nutrients from our diet can help to strengthen structures and keep muscle groups healthy. On the flip side, fatty or sugary foods can contribute to the onset of inflammation, which can compress structures and make chronic pain worse.

2. Exercise – We don’t expect you to go to the gym every day, but if you want to fight back against your chronic pain, activity is your friend. Even if it’s just in the form of a 30-minute walk around the neighborhood, mild and moderate intensity exercise helps to promote healthy blood flow throughout the body, strengthen muscles and wards off inflammation. More intense exercise can also lead to the release of endorphins, which can mask pain sensations.

3. Challenge Your Mind – While it’s important to exercise your physical body, it is just as important to challenge our minds each and every day. Not only can brain stimulation enhance our mood, but it can also take our mind away from the pain. Don’t just lay in bed watching Netflix, challenge your brain by reading, doing crossword puzzles or playing along with Jeopardy. If your mind is focused on a task it won’t be as focused on your chronic pain.

4. Laugh – Speaking of enhancing your mood, few things are better for your mindset than a good laugh. Whether you find humor in a conversation with a friend or in a book or a movie, let some laughter into your life. Being able to change your psychological state for the positive can go a long way with helping you manage and deal with the annoyances of chronic pain.

5. One Active Treatment – Finally, take time each day to do one active treatment to manage your chronic pain. Painkillers and rest are passive treatment options, but physical therapy, aqua therapy, yoga, cycling, cognitive behavioral therapy or meditation are all ways we can actively confront our chronic pain issues. Your active treatment may differ depending on your specific pain condition, but if you can end the day saying you did at least one active treatment to fight back against pain, you’re going to have a lot more good days than bad.

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.

Sleep and Caffeine May Play Key Role In Controlling Chronic Pain

May 9, 2017 / Thomas Cohn, MD

New research out of Boston suggests that sleep and caffeine may play integral roles in controlling chronic pain flareups.

It’s probably not a huge surprise that sleep is beneficial for controlling chronic pain, as we’ve talked about the restorative benefits of sleep on our blog many times before, but the part about caffeine is interesting. Here’s what the researchers had to say.

Benefits of Sleep and Caffeine

For their study, researchers looked at the effects of sleep (or lack thereof) and caffeine on mice and their pain sensitivity. Researchers began by tracking normal sleep cycles and measuring brain activity, then they began to disrupt this healthy sleep cycle by giving mice toys and activities that entertained them and kept them awake (much like Netflix or our iPads do for humans).

“Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball,” says Dr. Alban Latremoliere, PhD and pain expert at Boston Children’s Hospital. “Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball.”

Researchers kept mice awake for up to 12 hours in one night or for six hours five nights in a row. They examined that fatigue, stress and pain sensitivity all increased during this time.

“We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice,” says Dr. Chloe Alexandre, a sleep physiologist.

Caffeine’s Role

According to researchers, common painkillers did not help mice combat pain, and morphine was less effective in sleep-deprived mice, meaning chronic pain patients who are tired may have to up their morphine dose in order for it to be effective. However, researchers found that caffeine helped to block pain sensitivity.

This led researchers to conclude that a good night’s sleep combined with caffeine during the day (along with other good habits like regular exercise and a healthy diet) may be more effective for managing chronic pain than simply relaying on analgesic medications.

“Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities,” Dr. Kiran Maski, M.D. at Boston Children’s hospital who studies sleep disorders. “This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care.”

Opioids and a Healthy Mindset For Managing Pain

May 4, 2017 / Thomas Cohn, MD

The most common treatment option in America for individuals suffering from chronic pain is opioids or pain medications. According to statistics, the US is home to 5% of the world’s population yet we consume 80% of the world’s opiates. Our pain isn’t any different than pain felt by someone in Africa or Asia, so why do we rely so heavily on opioids?

According to Dr. Aneesh Singla, it’s because we have the wrong mindset when it comes to setting expectations for opioid effectiveness.

The Myth of Zero Pain

The Centers for Disease Control and Prevention states that the number of prescription opioids sold in the US since 1999 has quadrupled, yet the number of Americans reporting pain hasn’t changed. That’s because opioids are viewed as a solution, not as an aid to simply decrease pain while other treatments are performed. Opioids will never cure a chronic pain condition on their own, yet we expect them to rid us of all our pain. In a recent article, Dr. Singla said this problem can sometimes be traced back to the physician, who fails to explain that a chronic pain situation is not a zero sum game.

“I believe that pain is protective to us and that opiates will never cure pain 100%; so we set expectations for perhaps 50% pain relief from opiates, so that opioids are not overused in search of 100% pain relief,” said Dr. Singla. “I tell my patients that a 50% reduction in pain is a reasonable goal when treating chronic pain, and we seek this with multiple treatment options, not simply through opiates.”

There are two key takeaways from that quote. First, that the main goal of pain care treatment needs to be a reduction in pain, not its elimination. If you’ve been dealing with chronic back pain for years, it’s unreasonable to think that treatment will completely cure the problem and leave you with zero pain or discomfort, so the focus needs to be on making every day or every week less painful than the previous. The second point is that opiates alone will never solve this problem.

Opioids and Pain Expectations

We talk about pain medications on this blog and on our social channels a lot, and it’s interesting because the topic often brings out a knee-jerk response from different people. When we write articles about painkiller abuse or that pain will never be solved by a pill alone, many people are quick to defend their responsible opiate use and feel that we are attacking individuals who truly need pain pills to help them get through their day. The problem is that knee-jerk reaction couldn’t be farther from the message we’re trying to convey when talking about addiction, abuse or painkillers in general.

Opioids can be a key component to effectively managing chronic pain. We aren’t against opioids at all. What we’re trying to show in these articles is that our current views on them are misguided and that they need to be re-evaluated. It starts with the pharmaceutical companies who only care about their bottom line; It trickles down to the doctors who over-prescribe or under-educate patients on what they should expect from the opioids and how they can be used in conjunction with other treatment modalities, and it ends with the patient who decides to take an extra pill because their back is more painful than normal because they’ve skipped their last three physical therapy sessions.

Managing pain is not easy, and opioids play a vital role, but we need to do a better job of setting expectations and pairing pills with active rehab options to ensure the best results for our patients.

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.