Could Music and Art Lower Chronic Pain Risk?

August 14, 2018 / Thomas Cohn, MD

If you’re a frequent reader of this blog, you know that we like to pitch certain conservative treatment options for chronic pain. Activities like controlled exercise, stretching techniques and a healthy diet can help to control chronic pain and decrease your likelihood of flare ups. But what if other activities could provide similar benefits? Activities like going to a concert or checking out an art exhibit?

According to a new study published in the Journal of Pain, adding some culture to your regular routine could help to reduce your likelihood of chronic pain. For their study, researchers looked at data from a 10-year study that tracked the progression of pain in more than 2,600 older adults living in England. None of the participants were experiencing pain at the beginning of the study, but after 10 years, more than 42 percent said they experienced moderate to severe chronic pain.

Chronic Pain and Culture

Some of the findings were not all that surprising. Researchers found that individuals with poor sleep patterns, those who had mental health problems and those who were poorer and less educated were more likely to suffer from chronic pain. But one aspect they found interesting was the association between participation in cultural or social events and the development of chronic pain. Researchers noticed that stretching and endurance training were more likely to reduce the risk of developing chronic pain when those activities were paired with participation in cultural and social events.

“This study also found evidence that psychosocial factors may be protective against the development of chronic pain, in particular engagement in cultural activities such as going to museums, art galleries, exhibitions, concerts, the theatre or the opera,” wrote lead author Daisy Fancourt, PhD, a senior research associate at University College London. “It is notable that the odds ratios for cultural engagement were directly comparable with those of vigorous physical activity, suggesting a reduction of 25-26% in risk of chronic pain incidence.”

Why The Reduction In Chronic Pain?

So why do researchers believe that chronic pain likelihood may be reduced by visiting a museum or checking out a summer concert? According to them, the event is likely paired with some gentle physical activity, which can be beneficial for your body, as well as psychological benefits that come from social engagement and positive cultural experiences.

“This study is the first to explore simultaneously potential physical and psychosocial protective factors for the development of chronic pain in older adults. Our results demonstrate that both vigorous weekly activity and regular cultural engagement appear to reduce risk of incident chronic moderate-severe pain,” the researchers concluded.

Although the study was observational in nature, it points to an interesting correlation. Get outside, explore new places and find an enjoyable cultural experience, and you may be able to reduce your chronic pain risk. A visit to the museum shouldn’t be your only treatment technique, but when added to a regular care plan, it may have some rewarding effects!

Psychiatric Disorders and Pain Perception

June 27, 2018 / Thomas Cohn, MD

Chronic pain clearly isn’t just in your head, but according to a new study, psychiatric disorders or mental health issues may lead to an uptick in perceived conditions.

For their study, researchers in Brazil examined more than 200 individuals who believed they were suffering from Gastroesophageal Reflux Disease, or GERD. GERD is very similar to chronic acid reflux, where patients suffer a burning sensation when stomach acid makes its way back through the esophageal sphincter and into their lower esophagus. All individuals received a comprehensive medical exam and were asked to complete a 14-question survey that analyzed their mental health for signs of depression or anxiety.

Anxiety, Depression and Pain Perception

After completing the medical exams and reviewing the survey results, researchers came to an interesting conclusion. Nearly half of the patients who reported having anxiety or depression had normal acidic pH values in their esophagus, suggesting that they most like did not have GERD. However, this doesn’t mean that patients are crying wolf about their perceived symptoms.

“Patients with anxiety and depression or other mental health issues display a ‘hypervigilance’ or ‘hypersensitivity’ to pain sensations,” said lead researcher Dr. Fernando Herbella.

Moreover, researchers uncovered an inverse relationship between anxiety levels and esophageal pH; the more anxious a patient was, the less damage they had in their esophageal lining.

Dr. Vic Velanovich, a co-author on the study, offered a neurological explanation for the link between mental disorders and pain perception.

“It’s called the ‘pain modulation network.’ Pain is converted to electrical signals that travel to the brain. It’s interpreted there by the frontal cortex. So anything happening in the frontal cortex, including mental disorders, makes pain perception worse.”

The subject matter is near and dear to Dr. Velanovich, who worked on a similar study back in 2011. In that study, Dr. Velanovich studied patient satisfaction after GERD surgery. Most notably, surgery satisfied 93.5 percent of patients without psychiatric disorders, but only 11.1 percent of patients with a disorder.

“It was a classic ‘nocebo’ effect,” Velanovich says. “For both groups of patients the GERD pain was greatly relieved. But only anxious patients found the aftereffects of the surgery intolerable. Which tells me that there’s something else going on.”

These two studies highlight the importance of getting a comprehensive medical diagnosis by a pain care provider who knows all the signs to watch for. Unless all the underlying issues are treated, you’re not going to acheive full relief. To learn more about the association between mental health and the perception of chronic pain, or to talk to a specialist about another issue, reach out to Dr. Cohn today.

How Much Sleep Is Chronic Pain Costing You?

June 19, 2018 / Thomas Cohn, MD

In order to fall asleep, we usually need to have a calm physical and mental presence, and that can be very difficult to achieve if you have chronic pain. Chronic pain conditions can make it difficult for patients to not only fall asleep, but stay asleep. In order to get a better understanding of how chronic pain affects the amount of sleep we receive, we turn to two recent studies on the matter.

Chronic Pain and Sleep Deprivation

For the first study, the National Sleep Foundation wanted to see how chronic pain impacted sleep duration and sleep quality. After looking at the data, researchers found that individuals with chronic pain had an average of a 42-minute sleep deficit between the amount of sleep they need and the amount they are getting.

“The relationship between pain and sleep is complex, as the consequences of sleep problems can affect perception to pain and, in turn, pain can interfere with sleep quality,” said Professor Robert Landewe, Chairperson of the Scientific Programme Committee, EULAR. “This is why these studies are important as they help elucidate the role of sleep in chronic pain and highlight it as a potentially important modifiable risk factor for alleviating the distress in these patients.”

Researchers also wanted to see if sleep problems could predict the eventual onset of chronic pain. The four sleep factors they analyzed were:

Initiating Sleep
Maintaining Sleep
Early Morning Waking
Non-Restorative Sleep

According to researchers, all factors except early morning waking predicted the onset of chronic widespread pain at 18 years.

“Our results demonstrate that sleep problems are an important predictor for chronic pain prognosis and highlight the importance of the assessment of sleep quality in the clinics,” said Katarina Aili, PhD, of the Spenshult Research and Development Center in Sweden.

Anxiety and Chronic Pain

In the second study, researchers explored the link between chronic pain, anxiety and the inability to achieve restful sleep. When compared with a normal population, individuals with chronic pain were much more likely to report both anxiety and severe sleep problems.

“Although the relationship between sleep and pain is complex, our results clearly indicate a strong association which needs to be explored further,” said Julia S. Malmborg, PhD student at Halmstad University. “As both problems affect the physiological and psychological well-being of sufferers we hope that these results will be used by school health professionals to promote student health.”

Getting good sleep is hard enough before chronic pain gets in the way, but if you want to give yourself the best chance to fall asleep and stay asleep, consider the following tips:

Avoid caffeine within three hours of going to bed.
Avoid working out right before bed.
Make the bedroom as dark as possible.
Turn off distractions like the television or your phone.
Invest in a supportive mattress and pillow.
Keep the bedroom temperature cool.

For more tips on maintaining healthy sleep if you have chronic pain, reach out to Dr. Cohn today.

Chronic Pain Can Be A Mother

May 14, 2018 / Thomas Cohn, MD

Mother’s Day has come and gone, and hopefully you were able to celebrate the day with your family. However, for countless Americans, just getting out of bed each day is a struggle due to their chronic pain condition.

There is no one size fits all way to handle chronic pain, but that doesn’t mean you should just sit back and hope it gets better on its own. Instead, take an active role in managing your condition. Today, we share five things you can do to help take back control over your pain condition.

Taking Back Your Life From A Pain Condition

Here are five things you can do to take an active role in managing your pain condition.

1. Eat Well – Eating a healthy diet is probably the easiest thing to control thing on this list. Even if pain makes it difficult to move around, you can still make some good dietary choices. Make it a habit of getting plenty of fruits and vegetables each day, and rely on lean proteins instead of fats and oils. On your good days, do some healthy meal prep so you can have some easy to reheat options later in the week when cooking may feel like a chore. Eating healthy helps you maintain a healthy weight, which can help take stress off painful structures.

2. Exercise – Find time to work in some daily exercise, even if that just involves walking around the block. Exercise has physical and psychological benefits, and it can also work to calm inflammation that may be contributing to your pain condition. Ask your pain care provider about exercise routines that you can perform that will help calm your pain. Try to find time to get out and exercise for 30 minutes at least 4-5 times a week. Your mind and body will thank you for it.

3. Progress Journal – It can be difficult to see just how far we’ve come after an injury or with a pain condition, so some patients find it helpful to keep a progress journal. This allows you to see how your therapy is progressing over time, and it also allows you to keep track of your diet and exercise. Being able to tangibly look back and see the progress you’ve made is a great psychological way to keep your recovery on track.

4. Be Open About Your Condition – By this, we don’t mean that you need to share the gory details or tell everyone you meet how much pain you’re in. Instead, we mean that you should be open and honest with your friends and family about your condition and the limitations it presents. If you’ve been living with a chronic pain condition for some time, odds are you’ve had to miss some events or cancel plans at the last minute due to pain. From an outsider’s perspective, it can be tough to comprehend why you can’t just “buck up” or why your ideal night is at home in comfortable clothes watching a cheesy movie with friends.

Let those close to you know that you want to be involved with their lives, but pain makes that hard, and it’s nothing personal if you have to cancel last minute. Also, reach out to them on your good days. If they’re always asking you to do things and you’re turning them down because of pain, they may stop asking. But, if you’re open about your condition and make an effort to be a good friend and family member, they’ll understand and your relationship will thrive.

5. Talk To A Pain Specialist – Finally, make it a point to see a pain specialist for your condition. A primary care doctor is unlikely to have all the tools needed to give you the best course of treatment. Instead, seek out a pain management specialist who has a deep knowledge of the intricacies of pain. We’ve been helping people find treatment techniques that are tailored to their individual needs, and we can do the same for you. Contact our office today for more information.

Opioids For Long-Term Pain Relief

March 12, 2018 / Thomas Cohn, MD

The latest copy of the Journal of the American Medical Association has a lead article on the use of opioids in the long-term management of low back pain. The article is a study of some 200 people who were managed either with opioid-type medications or without them. The conclusion was that there was no difference in level of function with the use of opioid medication.

There is a large problem with this study, since it does not distinguish between the wide variety of patients who have back pain. Back pain can be due to everything from spine problems to nerve damage and residual surgical issues. As it has been preached multiple times, opioids are only one tool in the treatment of back issues and there are often many different strategies to control pain.

Opioids and Back Pain

The reality of life is that many different things can cause pain, and treatment should be aimed at the cause of pain. Depending on what is causing the sensory complaints, management will vary based on the individual’s needs. A combination of strategies is often necessary to treat every different component contributing to a problem. Treatments may be simple, such as ongoing exercise, to complex, including injections and surgery. Sometimes simple strategies fail and the only medication that does help are opioids. Since these drugs have tremendous problems, they often are not a good solution especially for long-term use. Pain specialists often know a wide realm of treatment options and can help lead one to better choice or a combination of choices.

The biggest problem with the use of opioids is that they are cheap and they have been pushed in the United States as a great, inexpensive tool to manage any type of pain. It takes a lot of work to manage pain, and in this country many have opted out of the challenges. On top of the drug companies pushing these medications, often the insurance companies are equally complicit by not allowing treatments that may be more expensive. Everything from physical therapy, massage, chiropractors, acupuncture and even fitness centers with athletic trainers are often more beneficial than many medications and may well be cheaper. However, most insurance companies turn a blind eye towards alternative treatment strategies. Now that opioids are a problem, insurance companies still want to say no to alternatives to drugs, but are not willing to pay for the better alternatives.

Alternative Treatment Options

The important message from the study of opioids is that for most people there are better treatment strategies than these drugs for the management of pain in the long term. For short-term, these medications may be okay. For surgery and several days immediately afterward it may be reasonable to use them. After that time period, medications that are not addictive may be used with the strategy to return the body to normal functional patterns. The body needs to move and relearn normal movement and function. As the body moves and functions as it was originally designed, the body acts appropriately and does not generate pain sensory signals.

If you have a body that cannot move and function normally due to permanent changes, these may constantly send sensory signals that are interpreted as pain. Designing treatments that bring the body as close to normal motion and function as possible can reduce pain. This is difficult and requires significant effort; rarely is there a magic pill that performs this function. If one gets past the thought that life is pain free and then focuses on making life as close to ideal motion and function, then one can improve their quality of life.

The last take home message is that medicine needs to understand that some people honestly have tried everything available to treat their problems and nothing has worked. If they have worked with a legitimate pain expert, sometimes it is found that opioid medications are appropriate in the management of a problem long term. This should be considered a last option in most cases. Hopefully our culture will get a more realistic understanding of opioids in the management of pain and all those involved in treatment will support the use of reasonable alternative strategies. Initially it may not be cheaper, but a healthier society is likely the final outcome.