Applying Pain Lessons To Our Every Day Life

June 1, 2016 / Thomas Cohn, MD

I try to skim the medical news every couple of days to see what’s making waves in the field of pain management. Most of what I see has to do with a variety of topics related to musculoskeletal medicine and pain.

A lot of articles I see have limited value to my current practice, but some topics have interest because there is science that may be important if it is applied in a more broad way. Other things are interesting because they are rooted in obvious facts.

Last week, the Star Tribune had an item on cancer prevention. JAMA Oncology had an article that 63 percent of men’s cancer and 41 percent of women’s cancer was preventable. The interesting thing was that if we just lived a healthy lifestyle, a lot of cancers would not occur. The obvious is the simple stuff, like not smoking and wearing sunscreen. The other aspects are a bit tougher, like eating healthier foods, not being obese, exercising, and sleeping adequately. It is a potent reminder of how we live life significantly impacts our overall health. The best way to cure cancer is to prevent cancer in the first place.

Another article in the paper was on baby powder causing cancer. The most common cancer was ovarian, but lung cancer may also be linked. The connection to cancer is that baby powder is a very fine particulate. It is also very similar to asbestos. If these fine particles get inside the body, they can cause immune reactions and stimulate abnormal tissue growth as well as cancer. So a supposedly harmless substance we use can cause deadly problems.

Take Away Points

There is a message here from these news pieces about cancer that applies to all of us. The first is that if we work at keeping ourselves healthy, we will have less illness and medical problems. Secondly, keeping compounds that naturally do not belong in our bodies out helps prevent cancer.

Applying this logic to pain management is natural. Let’s first look at the ideology of keeping ourselves healthy to prevent chronic pain. Exercises including stretching, strengthening and aerobically conditioning the body all help prevent pain. I used to be able to do parts of a program sporadically and function fairly well. As I have aged, consistency with a well-rounded program of exercise has been essential, as skipping days does not work well for me. Getting enough quality sleep is a problem; I have not yet focused on how I will try to improve my sleep. Eating healthy has been issue, but I am slowly changing my diet, lowering my carbohydrate intake, and concentrating on protein, vegetables, fruit and some cheese. I am trying to find a diet plan that makes sense and is sustainable.

The second point of focus is not adding things into my body that may not be healthy. That means keeping my medicine intake to what is necessary to prevent illness, such as taking cholesterol medicine (I have a familial variety of high cholesterol), and asthma medicine when needed. I keep away from addictive medicines. Overall, the most important aspect of health and pain control comes down to eating right, exercise, and good sleep. There is very little magic and a lot of personal work put in on my end, and my body thanks me for it.

Marijuana and the Reduction in Painkiller Overdoses – Part 2

September 10, 2014 / Thomas Cohn, MD

Last month we discussed the new study published in JAMA (The Journal of the American Medical Association) showing that drug overdose deaths due to opioids declined in 13 states that legalized medical marijuana. The study just looked at death rates overall due to opioids and noted that they happened to decline up to 30% in states that legalized medical marijuana. Today, I expand on the findings.

This study is great, sensational news, but in reality, it is a leap of faith that these two subjects are truly correlated. Opioid overdose and deaths are a very complex issue. The overdose of opioids is linked to many things, especially recreational use. The death rate from overdose is related to many factors, including whether the overdose was accidental or on purpose, such as a suicide. Furthermore, the access to treatment for overdose is important, especially whether first responders can recognize it and provide drug reversal rapidly and then get a person to a hospital for support. So, if you are using opioids to get high, it does not matter if marijuana for medical use is legal since they are not using it.

Medical marijuana is used for a variety of problems, including nausea related to cancer, seizures, and glaucoma. None of those conditions have much to do with opioids and drug overdoses. So if marijuana is legal for glaucoma or treating seizures, why would death rate due to narcotic overdose change? Rationally, it would not.

Unfortunately, this is just another example of a study finding a nice statistic that has no true correlation to the data. This study did not specifically look at factors that are related to opioid overdose death. If the study actually looked at reasons related to opioid overdoses, treatments, and deaths, there may be some validity. Rewarding medical marijuana with this lofty success is poor research and data interpretation. A prestigious journal, JAMA, should do much better at critically analyzing research and publishing articles. This is an amazingly poor job of data analysis and conclusions with an over simplification of causes of opioid related deaths.

Can a Physical Medicine Pain Specialist Cure My Pain?

April 23, 2014December 11, 2015 / Thomas Cohn, MD

Pain is a very complex problem. Acute pain is usually associated with discrete injury and tissue damage. As the problem heals, the pain quickly disappears. In subacute and chronic pain, the nervous system changes and sensory nerve actions are perceived as pain.

Treating acute pain is often very straight-forward; treat the cause and the pain resolves. Chronic pain often takes special skills to determine the cause and develop a comprehensive treatment strategy. Many physicians are pain specialists and only do interventions, but a good Physical Medicine pain doctor will work at fully developing a comprehensive plan based on a full evaluation. The patient is more than the next procedure for the physician; they are truly concerned and will find the right solution tailored to the specific needs of that patient.

Pain Training

Physical Medicine pain specialists often have unique training. After medical school they participate in a 4-year training program that is extremely diverse. Time is spent in multiple related disciplines including Neurology, Orthopedics, Internal Medicine, and Rheumatology. The general course also includes extensive training in management of complex chronic medical problems from strokes, spinal cord injuries, traumatic brain injuries, and severe trauma. Extensive outpatient training is also included, especially in all varieties of musculoskeletal disorders, sport injuries, and muscle, nerve and skeletal problems. The training teaches the evaluation and management of every problem that causes pain, and the strategies to correct the issues. Furthermore, the best trained doctors learn early that they are members of a team, and they will coordinate with all the specialists from physical therapists to other physicians to solve a problem.

Pain that is not acute needs a specialist who is willing to fully listen, exam, evaluate and treat the patient as whole. The physician who is mainly interested in performing a procedure may not see the whole picture of what is wrong, and complex problems often are not solved. For the patient this leads to frustration. A good Physical Medicine pain physician will be board certified in his primary specialty and in the subspecialty pain. Many are extremely skilled in intervention techniques and have years of experience. In every specialty, 90% of the physicians will do a good job, and the other 10% are exceptional. They are the ones who really care and will try to find the solution. The 10% are those who are compulsive, some are in academics, some in private practice; they are the ones who have the sixth sense and go the extra mile.

Pain is a complex and frustrating problem. There are new problems and solutions being discovered in this field. Better solutions for complex problems appear to be on the horizon. Take the time to find a specialist who will help develop a plan for your needs.

Low Back Pain: Causes & Treatment

June 12, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain can be the result of a number of medical problems in a variety of areas, including:

Muscles
Bones
Ligaments
Joints
Nerves
Spinal Discs
Other Internal Pelvic Structures

Any of these can cause pain that may be interpreted as low back pain. Fortunately, 95% of the time, the cause will heal quickly and the pain will go away no matter what treatment is performed.

Back Muscle Strains

The most common cause of back pain most people suffer is a muscle strain. Pain from a strain is localized in the muscles along the low back and in the buttock and they feel like tight bands. Usually this is from over stressing the muscles by lifting too much, twisting, and bending.

With mild to moderate strains, one is usually just sore and stiff when moving. In more severe strains, one may feel like they can hardly move due to the pain. If the pain is more severe, start with simple treatments such as:

Heat and ice
Stretching to loosen up the back muscles.
Over the counter medications like acetaminophen, aspirin, and ibuprofen

Joint Irritation in the Low Back

The next most common cause of pain is irritation of the joints in the low back or pelvis region. The facet joints in the back occur on both sides of the spine at every level. They are the same size and structure as the joints in the fingers but carry the weight of the whole body. The sacroiliac joints connect the bottom of the spine to the pelvis. Both of these joints cause deep pain in the low back region, but it does not usually radiate beyond the area, and may be worse with certain movements. Again, simple treatment with ice and heat, and over the counter medications will help.

When to See a Pain Doctor

The more complex the pain, the longer lasting the pain, the more benefit there is in seeing a doctor. If the pain does not go away within a week, start by seeing a primary care doctor. Sometimes resolving the problem can be accomplished through physical therapy and stronger medications. Rest is not recommended more than a day or two. The more active you are, the more likely you can solve the problem.

If the back pain continues for more than 4-6 weeks, then it is time to find a Physical Medicine doctor who specializes in Pain Medicine. These are highly trained doctors who really understand the complex elements of the low back that can cause pain. They can determine which structures are causing the pain and guide a person through successful long-term treatment. A good pain doctor will diagnosis what is wrong, and work with you to find the best solution for your specific needs.