How To Be Realistic About New Year’s Resolutions

January 3, 2018January 3, 2018 / Thomas Cohn, MD

It’s the beginning of a new year, and we all need to be realistic and open to looking at ways to improve ourselves. It is not an easy proposition, but with a little devotion it can be done. Take sometime now and begin by writing down tangible things you want in the next year, and then begin planning how you will achieve those goals. Look at the different aspects of your life from work to home life, and figure out what would you like to see change.

How To Make These Changes Happen

The first thing about change is to be realistic. Weight loss and exercise are some of the most common areas people want to be change. If you gained 50 pounds over the last five to ten years, it is unlikely that in 3-6 months that you will permanently lose the weight. However, losing a pound a week with a plan that involves changing your food intake, exercise, and having support of others and more knowledge of what has led to weight gain, may lead to success.

To be successful one also has to make the time for the change to happen. If exercising daily is a goal, sitting for an hour watching TV may have to change. You need to look at your current schedule and see what can be changed to make something happen. Further, do not fight with yourself. If you are not a morning person, do not try to wake up extra early to exercise since it is unlikely to happen. Find a time like after work and make it a priority, and combine it with something you like doing, such as watching TV at the same time or maybe listening to audio books.

Having help to make a change in your life is useful and motivating. Being part of a community with similar goals can help drive you through positive social connections. Sharing the challenge of exercise or weight loss with others who have the same desires can push you forward when you may have doubts. A team of support and friends to share the triumphs can make the grind easier since it is not only about you.

Finding Motivation

One of the hardest things to make a change is having motivation. Everyone has something different that makes one tick. Finding what keeps you going is tough and usually you need multiple reasons. Exercise makes almost everyone feel better overall, but that is often insufficient. For many, without exercise, their pain increases, stress increases, energy levels go down, sleep deteriorates, and for some if they stop, surgery may be the next treatment option. Further, some people are self-motivated while others need to be with others to be consistent and be part of a community or team.

Lastly, change is difficult, and consider a secondary plan if the goals are not being met. Sometimes there are a variety of factors that interfere with meeting a new goal. Do not get stuck with negative thoughts of failure. Change the targets and keep trying to move forward. Look for a different strategy and seek out help to make change. No one is alone in this world and there are numerous resources for help to meet almost any reasonable goal. Think positive and move forward, do not try to change too many aspects of your life at once. Choose just a few things and make it point of achieving them, and then add in new challenges.

Thoughts On Attending The Latest Pain Conference

November 20, 2017 / Thomas Cohn, MD

Every physician is required to obtain continuing education credits. Depending on a when one was board certified, the types of boards one has, and what state you live in, the number of credits needed each year varies.

At least once a year, I try to attend some sort of conference in order to to add to my knowledge about how to treat pain. This year I have ventured into the new realm of the American Society of Regional Anesthesia (ASRA). Since pain care crosses the line into a number of different disciplines, one of the best ways to improve is to pick up knowledge outside your normal specialty.

Thoughts From The ASRA Meeting

For the last several days I have been at the annual pain meeting of the ASRA. It is a group of about 5,000 practitioners, which is actually one of the smaller major groups involved in pain management. Each group has a different focus, and finding a good balance is hard. So far I have enjoyed the meetings; it’s like being back in an intense school all day long. Best yet, most of the information has been very relevant to my regular practice. It also has included a lot of practical knowledge, and there hasn’t been too much esoteric academic information or stuff aimed at an someone just beginning to practice pain medicine. Many of the pain conferences are aimed at physicians who do not do any advanced procedures or only at physicians doing injections, and both extremes can be lacking balance for patient treatment.

One of the most important things a conference does is challenge your thinking. Hopefully questions are entering your mind about what can you improve upon and how to do better patient care. A conference like this is great. It is not focused on a single topic and there are many areas of my practice it could impact. General topics have ranged from very specific aspects of implantable pain technologies to the best ways to evaluate and treat very specific medical problems. One odd topic that has caught my interest is how to deal with changing government regulations to prevent burnout of physicians.

The hot topic at any of these conferences is now opioid use and abuse. However, at a pain conference it is not about a crisis of addiction, but a crisis of lack of treatments available to treat complex pain. The money is being spent on addiction management and not finding treatments that would manage the root cause of pain, and thus markedly reduce addiction.

The hardest thing at a conference (besides sometimes staying awake) is trying to sift through what is truly good information. After going to enough of these conferences, one begins to recognize those who are in it for self promotion. Every conference seems to have several people who promote the latest fad. If there is no money to be made with regards to a topic, the information is probably more science and less sales.

Learning new information is good. Missing seeing patients is tough, but the time gone is for the good of all patients in order to provide the best care. Benefits will be made on everything from what to do for patients to learning new things that may help tough patients. New treatments now will be tried for everything from CRPS to knee or elbow problems. The only sad part of going to these conferences is that often I see no other pain physicians from my location, but I’m certainly glad I went to this conference.

Timberwolves Star Speaks Out In Favor Of Medical Marijuana

November 15, 2017 / Thomas Cohn, MD

Medical marijuana has been a hot topic on this blog and in the national news. Minnesota currently allows individuals to apply for a medical marijuana license if they meet a certain number of health characteristics set forth by the state. We’ve made our position about medical marijuana known on several occasions, but we’ll refresh it here briefly if you didn’t check out those other blogs.

We believe the medical marijuana is certainly an avenue worth pursing, but we need to learn more about the compounds inside marijuana before rushing it to the market. It’s certainly shown some promise, but if we want it to be truly effective, we need a better scientific understanding of each individual compound in different strains of marijuana. We should consider putting more money into researching and learning about the medicinal properties of marijuana.

Now, a high profile athlete in Minnesota is speaking out in favor of medicinal marijuana. He may not be championing medical marijuana for chronic pain, but he has seen it work first hand.

Karl Anthony Towns Talks Medical Marijuana

Minnesota Timberwolves star Karl Anthony Towns recently spoke out in favor of removing marijuana from the listed of banned substances for NBA players, agreeing with a sentiment pushed by former NBA commissioner David Stern.

“I agree with David Stern with marijuana,” Towns told ESPN “You could use the [chemical] properties in it to make a lot of people better.”

NBA players deal with pain and discomfort on a regular basis throughout the season, and Towns believes marijuana could help some players deal with that discomfort.

“That’s something that Adam Silver has to do. That’s out of my control, but maybe legalizing marijuana. Not fully legal, where people are chimneys, but using [marijuana] as a beneficial factor as an athlete, as a person living daily.”

Towns has already seen how medical marijuana can be used to help certain individuals. His girlfriend’s nephew is autistic, and a medical dosage has helped the boy and the family with the condition.

“I’ve seen nothing but benefits for him,” Towns said. “And I’m very happy that he finds comfort. He finds that normalcy every day. Just like a father, a mother, a parent with a child, you’d do anything for your child.”

It sounds like Towns is in the same boat. He has seen the benefits of medicinal marijuana in his life, but he understands that simply legalizing it without researching the science behind the drug could lead to unintended consequences. We should be pouring more money into chronic pain research if we really are committed to helping people manage their pain.

Combating Sleep Problems Associated With Chronic Pain

November 7, 2017 / Thomas Cohn, MD

Sleep for individuals with chronic pain is often a major struggle. Unfortunately, just like the cause of pain itself, it is a difficult and multifaceted problem with different issues contributing to sleep struggles. Pain and discomfort at night are the leading complaints, but often it is more complicated and usually not a simple issue to solve.

Underlying medical problems may also be contributing to sleep disturbances, and not addressing these may prevent adequate solutions. Addressing sleep problems often requires intervention from multiple specialists.

The Importance Of Sleep Hygiene

Sleep problems can range from simple to complex problems. Starting with the simple issues is always important. First is trying to discover what are the difficulties with sleep and what habits and patterns for sleep occur with a person. Sleep hygiene is one of the leading areas of problems. One of the most common problems is the consumption of caffeine or similar stimulants during the day. Most people are sensitive to caffeine, and it is found in many drinks, especially various sodas and teas. Drinking these after the lunch hour for many can affect sleep. The use of alcoholic beverages can also interrupt sleep, initially it may make one tired, but as it wears off, the body awakens and one may be running to the bathroom.

Sleep hygiene also includes the habits one has in the bedroom. Currently, the most common problem is screen time including computers, tablets, television and phones prior to sleep. Watching a screen tends to activate the brain and wake a person up, and the color spectrum produced with lots of blue light is also awakening. Turning off the all the screens one hour before bedtime is advised. The bedroom should be reserved for sleep. Doing work in bed and spending time in bed not sleeping gives the brain the wrong signals to stay awake. Lastly, most people sleep better in a cool room, being to warm leads to restlessness.

Your Mattress and Sleep

The most common question that is asked to me is should I get a new bed and what bed should I get? Anyone who has shopped for a bed knows this is an expansive proposition. Before buying a new bed, try to get everything right in the bedroom first, from the room temperature to the sleep hygiene. If the bed is old, first try a mattress topper with 3-4 inches of quality memory foam. A good topper is far cheaper then a full mattress and may be perfect solution. A new bed is only needed if your mattress is ancient and beyond salvage.

Since beds can be extremely expensive, start with determining your budget and then look at your options from memory foam mattresses to adjustable air bladder types like the Sleep Number bed. The mail order memory foam mattresses are often extremely affordable, comfortable and are reported to be a good quality. Everyone has a different preference for a bed, but if it is rock hard, it will not provide uniform body support and probably cause more pain. A bed that is too soft will probably also be uncomfortable and not provide adequate support to the body. The first recommendation would be try a memory foam type mattress for a new bed. If your budget is less constrained, the ability to change a bed’s hardness and support with an air bladder type bed is wonderful. Adjustable bed frames that can raise the head or feet is a further luxury.

The last issue with chronic pain and sleep is once you have optimized the sleep environment, what else can be done? The first concern is to see if there another medical concern preventing sleep. A sleep specialist often best evaluates these issues, and those who are neurologists often have the broadest understanding of all the issues. They can address problems from restless legs, sleep apnea to interrupted sleep by pain. They can be extremely helpful in determining the best medication routine for improving sleep. If a safe simple solution is not working, a sleep specialist is extremely important in determining the path forward.

Electricity’s Role In Chronic Pain Management

November 3, 2017 / Thomas Cohn, MD

Electricity and its role in treating chronic pain oftentimes gets a bad rap because some people automatically associate neurostimulation with shock therapy. Yes, electrical current is used in order to help quell your pain, but we’re not sending painful volts into your body like you sometimes see in Hollywood films. With opioids becoming a growing concern in many circles, more professionals and medical researchers are looking to see if electricity could be the next big thing in chronic pain management.

Nueromodulators and Chronic Pain

Neuromodulation or neurostimulation is not exactly a new approach to chronic pain management, as versions of these devices have been around for decades. Like any medical device, the first prototypes are a step in the right direction, but it takes a while for researchers to work out the kinks and really perfect the technology. Dr. Mark Malone, founder of Advanced Pain Care in Texas, believes we’re getting much closer to perfecting these neuromodulators.

“In the last 18 months or so, a new generation has come out including (Abbott’s) Burst and Dorsal Root Ganglion,” said Malone. “These two techniques are far more effective and it’s really an amazing revolution. For the first time ever, we’ve been able to say things like ‘cure chronic pain.'”

So how exactly does neuromodulation work? Essentially, it uses electrical impulses to trick the brain into believing the area is no longer sending pain signals.

“This is the application of electrical energy in the nervous system to quiet down pain impulses,” said Malone. “It’s more of a language. You’re speaking to the nervous system in the language of the nervous system and telling the brain the pain is no longer important.”

Neuromodulation is similar to the process that happens if you were to accidentally hit your thumb with a hammer. When you do this, you probably grab your thumb and rub it to help dull the pain. By rubbing your thumb, you’re providing the area with a new sensory signal and helping to block the pain signal. This process is known as tonic stimulation, and it’s an underlying principal of the electrical stimulation process. The small implantable device can drown out pain signals by stimulating other areas.

No Addictive Side Effects

Dr. Malone has been using a neuromodulator of his own for a little over six months. He had been on disability for more than a year and only working at his clinic on a part-time basis, but after seeing how successful it was for his patients, he decided to give it a shot for his pain. He’s been thrilled by the results, and electrical stimulation does not have the same potential drawbacks as opioids.

“It’s really an amazing gift that we suddenly have this treatment that’s so effective for even the worst pain patients and it’s completely drug free,” said Malone, noting that electricity isn’t addictive and that it produces no euphoric side effects.

The neuromodulator isn’t a perfect device, but it’s a big step in the right direction. It can’t stop certain types of pain, like widespread fibromyalgia, but it has been successful in patients with certain types of complex regional pain syndrome and failed back surgery syndrome. So if you’re still looking for answers to your chronic pain problem, ask a pain management specialist about your options with neuromodulators and electrical stimulation.