Pain management

When Pain Management Becomes A Pain

/ Thomas Cohn, MD

chronic pain managementLet’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 Importance Of Complementary Medicine

/ Thomas Cohn, MD

As we talked about in our blog post on Tuesday, there’s no simple way to treat chronic pain. No magic pill is going to cure your pain. Instead, you need to have a comprehensive and multifaceted approach to controlling your chronic pain. Sometimes, that approach includes complementary medicine options.

We are a traditional pain clinic, but it would be wrong to simply ignore the benefits of some complementary options. We’ve talked about the benefits of acupuncture on our blog in the past, and our most viral post isn’t exactly a traditional medicine method.

Complementary Medicine Benefits

Mindfulness, acupuncture and other complementary medicine methods are key components to finding the best way to treat chronic pain, and that’s a sentiment shared by our friends at Burning Nights CRPS. In fact, they believe in the benefits of complementary approaches so much that they designed a wonderful infographic to help inform others. Take a look at the infographic below, and be sure to check out their site for more helpful information on how to best beat chronic pain!

complementary medicine

How Unregulated Opioid Use Can Lead To Heroin Addiction

/ Thomas Cohn, MD

Opioids pills heroinIn the 1960s, the drug culture was known for psychedelics, LSD and marijuana. Eventually, some of those users sought a stronger high, and that led them down the path to heroin. At least that was the message pushed by the government in its fight against drugs.

Heroin was actually not that common and it was often a drug of addiction found in Vietnam veterans due to its availability in that region. Intense drug programs and interventions to rid production significantly reduced heroin use in the U.S. from the 1970’s through about 2000. In the 1990’s, the era of everyone needing opioid pain management began and along came Oxycontin. The quick and easy option for most doctors to treat pain was to write a prescription for the magical opioid pill. For the last ten years, we now have discovered the rising tide of opioid addiction and now deaths from overdoses is catching up to the number from auto accidents.

Link Between Pills and Heroin

Oxycontin first came on the market in the 1990’s and was extensively marketed as a safe drug for management of pain. The manufacturer would fly physicians to resorts, wine and dine them, and then try to hire them to lecture other doctors on the wonder of their drug. By about 2005, some of the problems with addiction were becoming evident. The government convinced the manufacturer to develop a formulation that would deter abuse by making anti-crush pills, and these came on the market around 2010. It was still a potent drug, but it was not as fun to take and the pills became expensive on the black market. However, the damage had been done and now the main way to treat pain was with opioids, any many people had become addicted to the powerful medication.

A study recently done by the University of Pennsylvania and the Rand Corporation explains why heroin has now become a problem. The development of the new formulation of Oxycontin made this drug more expensive and harder to abuse. Heroin has become cheap, more pure, and once you’re hooked on opioids, it is now easier and less expensive to obtain. So once a person is addicted to pain pills, the cheaper route to get high and prevent drug withdrawal is to use heroin.

Now the latest trick for those with an opioid addiction to get high is to use heroin or oxycodone that is mixed with another synthetic opioid like fentanyl or cor-fentanyl which are a hundred to over a thousand times stronger. These drugs are often been manufactured in China or India, and they can be easily mailed anonymously without much suspicion into the U.S. If mixed wrong, these newer synthetic opioids are often deadly.

Takeaway Points

The message from the opioid crisis is that pain has many ways to be treated, and left unregulated the use of opioids is often more dangerous then helpful. Addiction is a disease; without treatment, some resort to the use of heroin since it is cheap, and many cut that drug with other potent drugs that are deadly.

Stopping the opioid crisis will take time and effort. Treating pain is not just about taking opioids – that has led to the addiction crisis. Money needs to be spent on pain research and the development of better pain management strategies. A third of the population has issues with pain, making it more prevalent than heart disease, cancer and diabetes combined. To solve the problem of pain and drug abuse, a concerted government investment into pain research and better medical management is needed.

The Complexity Of Pain Management

/ Thomas Cohn, MD

complex spine careBack 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.

Pain Management Needs To Be A Complimentary Approach

/ Thomas Cohn, MD

Complementary medicineA recent publication in Mayo Clinic Proceedings explored the benefits of complementary therapy in the greater picture of pain management. This is a subject we’ve preached on the blog time and time again; There is no magic pill for chronic pain, and you need to put in the effort to have the best results. Oftentimes this comes in the form of other activities in conjunction with the standard care of rest, rehab, physical therapy, etc. Some of these complementary methods include:

“Medications may not completely relieve chronic pain or can produce unwanted side effects, including the potential for addiction. Thus, many people may turn to complementary health approaches to help manage their pain,” said Richard L. Nahin, PhD, MPH, lead epidemiologist at the National Center for Complementary and Integrative Health.

Complementary Medicine Benefits

Without going into too much detail, the article looked at a number of complementary approaches to common chronic ailments. What they found was that acupuncture and yoga were beneficial for individuals with back pain, acupuncture and tai chi had benefits for knee osteoarthritis, and massage therapy was proven useful for individuals with cervical spine and neck pain. Considering that more than 120 million Americans deal with some sort of chronic pain, these complementary approaches have the potential to positively affect millions of people.

This beneficial link is important because unfortunately many people have to pay out of pocket for some of these treatment techniques. In fact, national data suggests that people pay more than $8.5 billion annually for out of pocket complementary treatments for back pain alone. Now that there’s a link between these approaches and chronic pain improvement, there may soon be a push to make some of these options at least partially covered by insurance. It may require insurance companies to spend a little more in the short-term, but if it helps people recover faster and more fully, it could greatly reduce expenses in the long run.

We need to continue investing money into chronic pain research to find the best methods to treat pain, reduce costs and help patients.