4 Pain Myths, Busted

November 6, 2013June 24, 2014 / Thomas Cohn, MD

Pain is a complex beast. Since it’s based on subjective factors, each person experiences pain differently than the next. If two people break their arms under exactly the same circumstances, their perception of pain will undoubtedly be different.

With this subjectivity comes a lot of misconceptions and myths about pain. These myths often lead to societal “rules” and mantras that, in reality, are not based in fact. Here are some common pain myths, and the truths behind them:

No pain, no gain. This is a common mantra amongst athletes who believe that they must push their bodies to the point of pain in order to improve. This is incorrect. If your exercise routine is causing you pain beyond simple muscle soreness, it’s probably not a good thing. Listen to your body, and seek medical help if you hurt yourself during exercise.
Going to the doctor won’t help. Some people who are in pain believe that their pain will never go away no matter what, and this sometimes prevents them from seeking medical assistance. The truth is a physician or pain management specialist can help you craft a plan for managing your pain and getting you on track to a better life.
Pain meds are addictive and I shouldn’t take them. It’s true that pain medication can be addicting. However, that should not deter you from using meds to manage your pain. If used in a responsible manner, pain medication can be a great help in alleviating your pain.
Every type of pain can be cured. This is not necessarily true. There are several forms of chronic pain (such as CRPS) that cannot be completely cured. Instead, the best course of action is to come up with a plan to manage the pain.

When it comes to pain, you can’t always trust what your mother says (unless she’s a pain doctor of course!). She may be wise beyond her years, but the way your body experiences pain is drastically different than anyone else. So don’t stick to these old mantras. If you’re in pain, or have a question about treatment options, reach out to a qualified medical professional who can analyze your unique situation and help relieve your pain.

5 Tips for Sleeping Through Pain

October 24, 2013June 24, 2014 / Thomas Cohn, MD

When you’re in pain as the result of an injury or other condition, oftentimes the best remedy is to get plenty of rest and sleep. But sleeping through pain is easier said than done. Rolling over onto a painful back, leg, or arm can wake you up (and keep you up) in the middle of the night. More pain equals less sleep, and less sleep slows your recovery. It’s a vicious (dare I say painful) cycle.

But there are a steps you can take to help sleep soundly through the pain. Here are a few tips:

Take your pain relief medications as directed, and right before bed if possible.
Reduce your caffeine intake. Coffee, soda, and energy drinks are jam packed with caffeine. They are designed to keep you awake and alert. This is great if you need a pick me up at work, but not when you’re trying to sleep. If you can’t cut out the caffeine completely, try to only drink it in the morning.
Cut down alcohol consumption. Many people find that a “nightcap” helps put them to sleep. While it’s true that alcohol can induce drowsiness, the sugars in alcohol are more likely to wake your body up later in the night.
Get into a sleep cycle. Try to go to bed and wake up at the same times every day. This will help your body get into an internal rhythm or groove.
Relax and avoid physical activity before bed. Exercising is a great way to reduce your pain, but exercising too late in the evening can keep you up and make it difficult to fall asleep.

Whether you’re dealing with chronic pain from an illness, or acute pain following an injury or surgery, getting a good night’s sleep is essential for your overall health. Follow these tips and you’ll be off to dreamland in no time.

Fibromyalgia Pain Treatment Options

October 2, 2013November 17, 2015 / Thomas Cohn, MD

Fibromyalgia is a painful condition in which the body hurts all over. It is more common in women, and often comes with other problems such as:

Stomach acid issues
Irritable bowels
Sleep issues
Depression
Headaches

Treatment is aimed at managing the symptoms and understanding the disease. Fibromyalgia treatment begins with making an accurate diagnosis, and educating the patient on the best treatment options.

A Team Approach to Treatment

The most effective approach to treatment is attacking the condition with a team of medical professionals consisting of:

Nurses
Physical therapists
A Psychologist
A Physical Medicine Doctor

A multi-disciplinary approach is helpful to shift the patient away from a perception of helplessness, defeat, and frustration and toward a positive and active lifestyle. Psychology is beneficial in changing attitudes from defeat and depression to understanding and self-motivation. Psychologists use a variety of techniques including cognitive behavioral therapy and biofeedback to influence changes. Physical therapy is necessary to teach the patient to go from being inactive, to exercising. Nursing is helpful to work with sleep problems, diet, nutrition, and understanding lifestyle and medication issues.

Medications & their Effectiveness

Pharmacologic strategies include prescription and non-prescription medications. There are three drugs approved for Fibromyalgia, and many others that have limited affects. The most commonly used drugs that are approved are Cymbalta and Lyrica. They both decrease the sensitivity of the nervous system to excessive signals that influence pain. Amitriptyline and Nortriptyline at low doses also have similar affects and are helpful with sleep. Narcotics and anti-inflammatory medications are not effective in management and usually lead to more problems than solutions.

Nonprescription medications have varied success rates and the research is not solid to support their effectiveness. S-adenosine-L-methionine(SAM-e) has been used for joint pain and general pain, and is commonly used in Europe. Tryptophan and melatonin may improve sleep and help with mood. Fish oil is felt to help with joint and spine pain, and may help control cholesterol levels. Glucosamine and chondroitin sulfate have been used to help control joint pain. These supplements are generally felt to be safe. Whether they are going to be helpful is open to question but they should not cause problems.

Fibromyalgia is best treated by a knowledge team of practitioners, headed by an experienced Physical Medicine pain physician. The goal of treatment is to improve function and activity level, and manage pain symptoms. Education and psychological well-being are important. Fibromyalgia is a real syndrome, when treated appropriately can be successfully managed.

Pain Medication & Alcohol – A Dangerous Mixology

September 27, 2013June 24, 2014 / Thomas Cohn, MD

It is always wise to be careful about drinking alcohol when taking any medication. All medications can interact with other substances you ingest. For example, meds can interact with vitamin supplements, and even certain foods that you eat.

It is no surprise then that one should be careful with mixing alcohol and medications (including pain medications). In this article, I will discuss some of the most common medications and how they interact with alcohol in the body.

Opioids & Pain Meds

The most common concern about alcohol is with opioid/narcotic pain medications. These drugs include:

Percocet
Vicodin
Oxycodone
Oxycontin
Morphine
Codeine
Fentanyl

All narcotics can affect your cognitive ability and judgment, and alcohol can have the same effect. The combination of the two is not always additive, and the alcohol can greatly diminish both of the above. Thus your judgment could become very poor, and the toxicity increased such that either drug can essentially cause death. If one is on a stable dose of narcotic, people can usually function without impairment. An occasional alcoholic drink should be safe. You may feel more impaired then usual, but you should not be toxic.

Neuropathic Meds

Many pain patients also use neuropathic medications like gabapentin, or other seizure type drugs, and antidepressants. These drugs also can affect cognition, and mixing with alcohol can worsen this ability. Alcohol is metabolized and broken down in the body by the liver, and the same process is also used by many of these medications. Therefore, alcohol and these medications can also interact in unpredictable ways. Again, if you have been on these medications long-term, then an occasional drink is likely safe, but heavy drinking is not a good idea.

Ibuprofen, Tylenol, & other Over the Counter Meds

Over the counter pain medications such as ibuprofen and acetaminophen/Tylenol are generally very safe if taken as directed. Unfortunately, people often take a little more than directed in the hopes that they will work better. Mixing alcohol with these drugs can be very dangerous. Anti-inflammatories like ibuprofen can cause stomach irritation. Mixing them with alcohol can cause severe ulcers and stomach bleeding. Acetaminophen alone can easily be toxic to the liver. Mixing this with alcohol has led to fatal liver failure.

The answer to drinking alcohol with pain medications is not simple. If one takes their medications only as directed, and has been stable on them, then having an occasional alcoholic beverage, not daily and not more than one, should be safe. Your judgment, memory, and cognition could be affected even with one drink, and you may not be safe to drive, but it should not be toxic to the body.

Yoga and Pain Relief

September 25, 2013June 24, 2014 / Thomas Cohn, MD

Note: this is a guest post by yoga instructor, Lynn Shuck.

As a yoga instructor, I’m expected to say that yoga can relieve pain. And I truly believe it can. But I do urge caution when approaching yoga for pain relief because, in fact, a class that moves too fast, or an instructor who pushes you beyond your limits can actually cause pain rather than relieve it. With good instruction and personal attention, yoga can most decidedly help with pain relief by bringing the muscles and skeleton into their natural balance.

It’s All About Skeletal Alignment

When the skeleton is aligned, the muscles work in tandem the way they are intended. If some muscles get overworked through habitual movement patterns, other muscles will stop doing their jobs and weaken. Those tight muscles can bring the skeleton out of alignment (picture the person who sits at a computer all day and becomes hunched over, chin thrust forward). If those patterns are repeated on the yoga mat, tight muscles will just continue to overwork and the skeleton will not be supported any differently than it already is.

Imbalance can also occur starting with the skeleton. Shin bones that bow back affect everything above the legs, tipping the thighs and pelvis out of alignment, which then impacts the spine. A broken bone that doesn’t heal correctly or an accident that impacts any part of the skeleton will invariably affect the way the muscles work as well. If the skeleton isn’t upright, muscles will do their best to hold up the body any way they can.

Fixing Imbalances

As an Eischens Yoga instructor and yoga therapist, I look for imbalances such as:

Tight, overly developed muscles
Bones that don’t stack properly
Collapsed or locked joints
Constriction in the breath

When a student wants to use yoga for pain relief, my intention is to keep the body from going further out of balance. Often, using simple, easily accessible asanas, we can bring the body back to better alignment – thus reducing pain and tension.

Uttanasana

As an example, Uttanasana is a simple forward fold commonly taught in most classes. Sometimes, hip and low back pain can be addressed using this pose. If I observe thighbones that sit too far away from the mid-line of the body, I might have the client roll up a towel to about 2 or 3” wide. They would place the roll between the legs at the top of the thighs near the groin. Pressing firmly into the towel at the top of the thighs without rolling onto the inside edges of the feet, I will then have the client perform Uttanasana, moving down and up in a limited range of motion several times, continually pressing into the towel. When finished, the legs will usually come into better positioning in the hip sockets reducing hip and back pain momentarily. The more regularly these muscles are used to re-align the thighbones, the longer the body will maintain this new positioning. I refer to this as using effort in the pose to create effortlessness after the pose.

Utilizing yoga for pain relief requires understanding the physical imbalances, and then using asana to bring the body back into balance. Practicing yoga without awareness may well be counter-productive, so find a teacher who specializes in pain relief and then trust your own experience. Yoga shouldn’t hurt; it should make you feel better.

Author Bio:

Lynn Shuck is a certified Eischens Yoga Instructor. She has been practicing yoga for nearly 25 years, and has been teaching yoga since 1996. Her training with Roger Eischens led her to work specifically with alignment as well as injury recovery/prevention. From 1998 to 2011, she led workshops and classes throughout the Detroit metro-area. Lynn is known for her keen eye for individual movement patterns, as well as her ability to bring yoga to all kinds of people: experienced and beginning yogis, athletes, weekend warriors, and those who think they are too stiff for yoga. Lynn relocated to Minnesota in 2011.