New Technologies For Pain Management

August 19, 2019 / Thomas Cohn, MD

Medicine is evolving as electronic technology invades all aspects of medical care, and pain management is no exception. The areas that have changed the most are imaging technology and implantable devices. What is interesting to patients is how imaging can improve care and implantable devices may help when nothing else is working. The improved imaging makes diagnostic and treatment decisions easier and also makes interventions more precise when tied to management by an astute clinician. No matter how good the technology is, without the skill of a good clinician to understand the medical problem, no solution would be helpful.

The new implantable technology available is peripheral nerve stimulation. This is designed for treatment of pain that is related to damage to a peripheral nerve, such as in the arm or leg. Pain can often be traced to an isolated nerve and preventing that nerve from propagating the pain signals helps to control the problem. These pain issues arise sometimes after amputations with phantom pains, and can be seen after trauma when nerves are damaged. These problems can also occur with surgeries like joint replacements, orthopedic interventions, spinal operations and some fractures. When the pain is not resolving and an isolated set of nerves can be found and successfully blocked with local anesthetic, then nerve stimulation may be appropriate. This is a treatment to consider when simpler interventions like medications, physical therapy, and injections have not been successful.

Nerve Stimulation For Pain Management

The idea of peripheral stimulation has been around for a long time. In the distant past, traditional spinal cord stimulators were used for peripheral nerve stimulation. Unfortunately, at some point this began being abused and since those systems were extremely expensive, this process stopped. In the last two years, new systems have been designed specifically for peripheral nerve stimulation that are very technologically advanced and effective.

One example is electrode stimulation. The electrode is a very thin wire coated in silicone that can be delivered to the right place along the specific nerve with a needle guided by ultrasound imaging. The wire contains a special signal receiver that can be used to help stimulate the nerve and drown out pain signals. Most importantly, the signal generator is now a very small rechargeable unit that is placed on the skin over the end of the electrode. In the near future the electrode may connect even further from the generator such that it may be able to be carried in a pocket or other safe place.

The new technology is FDA approved for peripheral nerve pain from any type of nerve injury. The easiest insurance approval is Medicare, but other providers are starting to approve of such treatments when proven simpler treatments have failed. There currently are at least two manufacturers of equipment, the difference appears to be mainly in the generator’s ability to deliver a variety of signals that may effectively block pain signals and not be uncomfortable to the patient. From experience developed in spinal cord stimulation, the electrical signals can be varied such that the nerve pain is blocked but the patient does not feel any other odd sensations. The net effect is that one can perform activities that were once painful without the ongoing sense of pain.

For pain patients, this new technology is nice since the only thing implanted into the body is a thin wire to the appropriate location. Testing prior to implant is first by a local nerve block with a long lasting anesthetic. If that is successful, than a trial implant can be done for a week or longer to determine if a final implant would be indicated. The permanent implant is a brief outpatient procedure and can be easily removed in the future if necessary.

Pain patients who may benefit from peripheral nerve stimulators include those where pain symptoms have a definite peripheral nerve origin and the pain can be extinguished by blocking just one or possibly two nerves that are nearby each other in the body. The first problems that have been treated have been pain related to shoulder injuries that do not resolve with surgery. Other common orthopedic problems include knee and foot pain after trauma or other surgery with nerve damage or nerve pain afterwards. Amputation phantom limb pain and complex regional pain syndrome are other pain problems that may benefit from this technology. An interventional pain specialist who does implants should be able to help determine if the pain problem may be helped with such treatment. Not all pain problems can be helped and if the pain is coming from multiple pain generators or is centrally generated in the brain, this treatment is less likely to be helpful.

What Science Says About CBD Oil For Chronic Pain

August 5, 2019 / Thomas Cohn, MD

cbd oil Cannabidiol, commonly referred to as CBD, is a compound found in the cannabis plant that many people swear by for its benefits when it comes to pain management, anxiety, stress or other health issues. We want you to find relief with whatever works, but what does science say about CBD’s effectiveness for pain management? Let’s take a look.

CBD and Pain Relief

If you’re like me, you can’t go a couple blocks it seems without seeing another business offering CBD products. Pizza places, movie stores, bakeries and wellness shops are all places where we’ve seen CBD being offered, but just how effective is it for your health condition? Scientifically, the jury is still out, but researchers are cautiously optimistic.

One of the reasons why we don’t have a lot of scientific data on CBD’s effectiveness for different pain conditions is because up until December 2018, cannabidiol was classified as a Schedule I substance. Now that it has been removed from that list, we’re quickly working to figure out its medical capabilities. Early studies have come to mixed conclusions, with some saying that the right combination of CBD products can help calm symptoms, while others say there exists a lack of good evidence that CBD can help with chronic neuropathic pain.

With that said, many researchers are still hopeful about CBD and it’s health uses in the future. The previous studies have had many limitations, so their conclusions may not be as accurate as we’d like. For example, many of these studies looked at the short-term impact of CBD in patients with a number of different pain conditions. Pain is the most unique health condition in the world, and everyone’s pain is unique to them.

We very well may eventually learn that CBD can help treat symptoms of certain types of arthritis or nerve pain, but it takes time to isolate all the variables and make these breakthroughs. In fact, a study published this year in the journal Pain found that CBD interacts with serotonin receptors in animals, which are believed to play a role in pain, depression and anxiety. By building on these studies, we may be able to come to stronger conclusions and better help patients in the not so distant future.

So as it currently stands, the jury is still out on the effectiveness of CBD oil for a variety of pain conditions. But as we said above, if you’re dealing with a pain condition, we want you to be able to find relief one way or the other. Some people find relief with diet and exercise, others with physical therapy, and others with CBD. What we will say is that while CBD may help your pain condition, it shouldn’t be your only form of treatment. Substances like CBD are a passive treatment, and they need to be combined with active treatments like stretching or exercise therapy to really help the underlying problem. Here’s hoping we learn more about CBD so we can best help our patients.

4 Ways You’re Incorrectly Treating Your Chronic Pain

June 20, 2019 / Thomas Cohn, MD

When you’re dealing with chronic pain, you’re willing to do almost anything to find respite. You’ve probably done some research online or talked to others with similar issues and come up with a plan. But what if you’re treating your chronic pain condition incorrectly? Not only can this prevent you from finding pain relief, in some cases, it can actually make pain worse. Below, we take a look at four ways you may be incorrectly treating your pain condition.

4 Wrong Ways To Treat Pain

It is in your best interest to talk to your doctor about how you can manage your specific condition, but in general, here are four ways that you may be mistreating your pain condition.

1. Not Exercising – You might think that rest is the best thing you can do for your body, and while it may be good in the short term, it may not be the best bet for your long term health. Exercise helps to increase healthy blood flow throughout your body and strengthen key structures that can help prevent pain. For example, if you’re dealing with back pain, although it may cause some discomfort to exercise because of your spine pain, strengthening your core and your back muscles can help to treat the underlying issue. Don’t just assume that rest is what you need to take care of your pain.

2. Over-Reliance on Opioids – Opioids certainly have a place in a pain care management plan, but they shouldn’t be your only source of treatment. Many people assume that because opioids help dull or eliminate their pain, that it is their best source of treatment. However, opioids do nothing to treat the underlying cause of pain. They may make it easier to exercise or fall asleep, but they need to be paired with active treatment options in order to be the most effective. Make sure you follow through on your other treatment options if you are given painkillers to help with your condition.

3. Isolation – There are times when it can feel great to have the house to yourself to do as you please or to shut out the world for a night, but if you’re constantly isolating yourself from others, it’s not going to help with your pain condition. Some people with pain problems avoid group settings or cancel plans because they don’t want to feel like a burden for others, but there have been studies on the importance of human and social interaction when it comes to pain management. We’re not saying you need to take up public speaking or be the office chatterbox, but social interaction, even if it’s just talking with a family member on the phone or having a friend over for dinner one night a week can really help your mental and emotional state. You’d be amazed at how much your mental and emotional health affects your physical health, so don’t shut out the world because of your pain.

4. Not Seeing A Specialist – The rise of the internet has made it much easier for people to research their symptoms and come up with a diagnosis and care plan of their own. The problem is that it’s easy to fall down a rabbit hole of misinformation or incorrectly diagnosis yourself based on inaccurate or surface level symptoms. If you truly want to get a grip on managing your pain, visit a Pain Management Specialist like Dr. Cohn. He’ll be able to provide a comprehensive diagnosis and set you up with an individualized care plan. Contact his office today to learn more about your options.

Could This Be The Next Big Thing In Pain Management?

June 10, 2019June 10, 2019 / Thomas Cohn, MD

Last Sunday in the science section of the newspaper there was an article about research on a new pain drug. The scientists behind the drug are convinced they have the next great drug. The skeptic in me hopes but doubts it. The reason the news has not made the traditional rounds in in all the reputable medical sites that spread news of discoveries. Furthermore, the work to date is only in animals and there has not been definite evidence this will transfer to humans.

The article discusses the work of Dr. Bruce Hammock, an entomologist at University of California-Davis. In the 1970’s he was working on an enzyme that converted a corn ear-worm to an insect. Removing the enzyme essentially killed the insect before it converted to the moth and was able to breed. Overall this was not found to be a cost effective strategy for this insect to be controlled. Since that part of his work did not pan out, he started looking for how the enzyme or related enzymes might occur in other species. especially humans.

Eventually Dr. Hammock found these compounds in humans and they supposedly reduce pain. Of note, he does not specify what these compounds are, but only says they are chemically broken down rapidly in the body naturally. He then found a way to keep them from being broken down in the body as quickly. Dr. Hammock believes this compound can somehow help relieve pain.

Believe It When We See It

The reason to be skeptic is that naturally this compound that reduces the intensity of pain is very transient in the body by the description given. This makes me believe it is likely easily broken down by chemicals in the body and is in a very limited location. This type of compound is very hard to deliver conveniently (like a pill) into the body and be absorbed. It is also likely to be easily broken down no matter what one does. Lastly, the chemical sounds like it may be something that exists in the nervous system, and thus isolated by something like the blood-brain barrier.

The researchers behind this new novel compound are just looking at starting human trials. So far there has been little funding toward the research from what has been said in the regular press. Further, as noted earlier there is no information in the extensive research pain literature on the animal-level studies discussing this compound. If the research was really promising, more money would be involved without question since pain treatment is a billion dollar industry with huge potentials.

The bottom line is that there is research going on in the field of pain medicine trying to develop new treatments and medications. However, whether any of the current research will lead to new drugs is difficult to guess. A lot of treatments have been proposed but most die as they are tested. Human studies usually take between five and 10 years to complete. Only time will tell if this research will ever lead to a new drug that is useful to treat pain.

Chronic Pain and Its Impact On The Workforce

April 18, 2019 / Thomas Cohn, MD

Many people have a vested interest in helping to solve the problem of chronic pain, and a new study suggests that you can add employers to the list.

According to a new study published in Integrated Benefits Institute, more than one-third of US workers take prescription pain medications. Interestingly, those workers who take prescription medications take significantly more sick days than those who don’t, and those who have problems with those medications take even more sick days. The study found:

Compared to those who don’t take prescription pills at all, painkiller users took an average of twice as many sick days.
Problematic painkiller users took more than three times the number of sick days on average as a healthy adult.
Prescription pain medications were associated with approximately 261 lost workdays per 1,000 workers per month.

For the study, researchers looked at the amount of time lost at work connected with prescription pain relievers when viewed in the contest of other substance use disorders in the American workforce.

“The high rates of prescription pain medicines among employees indicates a much larger issue for employers than lost productivity,” says IBI researcher Erin Peterson, MPH, the report’s first author. “The significant number of sick day absences by employees who use pain relievers without problems likely doesn’t represent the full impact. As most people abusing opioids started with prescribed medications, this is a very large number of people at risk for developing problematic behaviors associated with pain relievers.”

Chronic Pain and Lost Days of Work

If you suffer from chronic pain, regardless of whether or not you take opioids to help with discomfort, you know firsthand how difficult it can be to get out of bed on some mornings, let alone get through the work day. That’s one of the reasons why it’s so important to work with a pain specialist to get control of your issue or help to minimize the days when pain becomes overbearing. It’s not always going to be easy, but if you truly want to do whatever you can to get your pain under control, it’s worth it.

Dr. Cohn and his team have helped numerous workers get a handle on their pain and thrive in the workplace, and he can do the same for you. To set up an appointment so he can get to the bottom of your pain and chart a course for recovery, click here or give his office a call today. It’s never too late to take back control of your life from chronic pain.