Dr. Robert Cochran
Understanding Chronic Pain
5/18/05

[HOST_Carolann] I think we will get started now. Welcome everyone! And a special welcome to Dr. Robert Cochran. Dr. Cochran will be talking about Understanding Chronic Pain
[HOST_Carolann] Dr. Cochran has a solid reputation as a leader in chronic pain management and after treating patients for 40 years, has been able to understand the real scope of painfulness.
[HOST_Carolann] Welcome Dr. Cochran, and I will now turn our time over to you.
Robert_Cochran> Thank you Carolann for inviting me to your program. My name is Robert T. Cochran, Jr. I am a physician and the author of the book "Understanding Chronic Pain, A Doctor Talks To His Patients," published by Hillsboro Press, Franklin TN, January, 2004. My book is featured on Amazon and five-star reviewed there.
Robert_Cochran> I have been in the private practice of medicine for over 40 year, the last 15 or so dedicated almost exclusively to the study and treatment of those who suffer chronic pain. My book is a product of that endeavor. I write about people who do not recover from injury and illness. In most of us, pain is self-limited and brief. In some, however, the pain doesn't go away. The muscle sprain persists long after time sufficient for recovery and the pain spreads to adjacent body parts, evolving into the disease known as fibromyalgia. There are countless other examples of acute pain not going away and evolving into chronic head pain, back pain, or whatever.
Robert_Cochran> When this kind of thing happens, when pain persists beyond the anticipated time of recovery, a remarkable variety of behavioral and biologic changes occur.
Robert_Cochran> Sleep is disordered and interrupted by tremors known as restless legs. Energy is dissipated and the victim suffers an overwhelming sense of fatigue. Appetite changes, sometimes with anorexia and weight loss, but more often with appetite increase, sweet cravings, and enormous weight gains. Pain spreads beyond the bounds of the original injury, and the perception of pain increases. This is known as hyperpathia and is common in the disease fibromyalgia where the tender areas are known as trigger points.
Sharon> You are describing me exactly.
Robert_Cochran> Blood flow is altered. The site of chronic pain is cold to the touch due to diminished blood flow. Mood is altered with despondency and depression, but sometimes by restless hyperactivity. Memory is impaired and thought twisted into delusions. "There is an ocean wave in my head. I feel it beating me." "There is a hot poker in my spine." Also obsessions, with ceaseless calendar-keeping and note-taking focused on pain.
Alice> Me also, Sharon
Robert_Cochran> There is a lot more to chronic pain than hurting. The entire assembly of the way our body functions is altered. These changes are seen with great regularity and predictability in chronic pain, whether it is in the form of fibromyalgia, headache, backache, neuralgia, or whatever.
Robert_Cochran> Who gets chronic pain? Does it occur randomly and by chance? Emphatically no! There are risk factors for chronic pain just as there are risk factors for most diseases. I will return to that subject in the short-term, but I will stop now to see if any of the family has questions of me.
Rick> Dr. Cochran, once that pain cycle starts, are there things that can be done to break the cycle?
sueraec> Dr. Cochran, do I understand correctly that once Chronic Pain takes hold, it's a type of chemical imbalance?
[HOST_Carolann] let's hold off at this point and let Dr. Cochran answer these questions
[HOST_Carolann] just so we don't overwhelm him
Sharon> So many so-called health professionals say that all I have to do is go off sugar, coffee, etc., and most of my pain and problems can be greatly eliminated. What do you say to this?
Robert_Cochran> Thanks, Rick. Good question. It's convenient to think of the disease chronic pain as a state in which pain leaves the body and enters the mind. We have wonderful drugs for the treatment of chronic pain, drugs which restore sleep, diminish tremors, improve mood and even improve memory. Among these are a great number of drugs used originally for the treatment of depression, epilepsy, manic depression, and even schizophrenia and attention deficit disorder. As soon as the victim enters this sleepless/fatigue/depression mode, it is time to intervene with pharmacy.
Robert_Cochran> Suerac, Absolutely. It is a chemical disorder of the brain.
Sheri> The dietary changes would very likely help you to some extent. I t has helped me, but it is only one of many things that I have done and continue to do to improve my health and facilitate healing.
Robert_Cochran> Sharon, It must be truly rare for chronic pain to be relieved by dietary modification. . My opinion alone, but strongly held.
[HOST_Carolann] OK, thank you Dr. Cochran, do we have time for more questions
Robert_Cochran> Carolann, Sure.
[HOST_Carolann] OK, someone else with questions?
Rick> Dr. Cochran, I have certainly had drugs that seem to fit into the types you've listed prescribed, but the affects have been minimal at best. Is there something specific I should be asking my PCP about?
Rick> Ooops - feel free to take other's questions first.
[HOST_Carolann] that's OK
[HOST_Carolann] no one has jumped in yet anyways
LyghteKeeper> how long should it take for meds to start diminishing the pain - I've gone from morphine to oxycontin since January but with little relief
kezia> I heard there is a new med for fibromyalgia Is this true?
mayogram> the drugs all seem to be Band-Aids. They don't help all that much
sueraec> If Chronic Pain is a chemical imbalance of the brain, would you say, besides drugs, other areas of adjustments will help also. For example, exercise, pacing, resting, etc.?
[HOST_Carolann] OK< I think we better stop there - let's give Dr. Cochran a chance to answer the questions put up already, thanks
Robert_Cochran> Rick, Take a look at my book or my website, understandingpain.com. There are lots of drugs of potential benefit. None work in all patients, but all work in somebody. I prefer to start treatment with one of the tricyclic drugs and a class of drugs known as BZDP, of which Klonopin is an example. These drugs are held in disfavor by many doctors because they do have bothersome side effects (but all drugs have side effects). Also, they're rather old drugs, dating over 50 years or so and have been supplanted by newer, more fashionable but not necessarily more effective drugs, and I refer specifically to Prozac and its derivatives. (They're good for depression but not for pain.) It's hard to
BevinFL> I agree Mayo I have been on many drugs for pain and even had a pain evaluation done on my meds and I broken through all of them I am right under morphine use now and doc does not want to use that as it will be the only pain med left I break through that then there will be nothing left plus the brain injury adds in to where they are very limited with me only relief is massage therapy hurts but helps a little but can not afford it
Robert_Cochran> LyghteKeeper, Thanks. Sorry you're not doing well. Morphine and Oxycodone (Oxycontin) should start working within hours. "Psychiatric" drugs may take several weeks to kick in. It may be that you need a bigger dose of opiates or maybe a trial of some different drugs. Sorry, that's all I can offer you.
Robert_Cochran> Kezia, You're probably referring to Cymbalta, a new antidepressant also indicated for pain. Let me remind you, I am not giving you specific medical advice, only ideas you can discuss with your physician.
Rick> Dr. Cochran, I have SEVERE mast cell activation with opiates, are there other types of pain meds worth trying for break-through pain?
Sheri> I've had same experience as several of you with many pain meds not helping, or helping for a while . I am currently on a narcotic and still have pain, but I manage it using many other non-pharma methods. Many meds have no effect on me at all.
Robert_Cochran> Rick, My best answer is that there are many types of opiates, probably some 8 or 10, and you might have mast cell activation (hives) with some, but not with others. No way to predict.
Sheri> incidentally, I have no medication to use for severe break-thru pain, since they don't work. I use other methods to deal with it.
Louise> What is you are so sensitive to meds that even tiny doses knock you flat?
[HOST_Carolann] Dr. Cochran there was one more question from Suerac about alternative pain relief, eg resting, exercise,
BevinFL> also deep trigger point massage and how does one get the insurance company to accept that as not a pleasure type thing???
Robert_Cochran> Suerac, Your point is excellent. I am enthusiastic about pharmacy in the role of pain, but one has to be realistic. Very few people are totally relieved of pain by the medicines I use (but some of them are!), so modalities such as pacing, recreation, massage, and exercise are certainly useful.
Alice> Thanks BevinFL - I would like that answered, too
Sheri> suerac, those kinds of things are just what I was referring to, also things like appropriate massage therapy, acupuncture, nutrition, supplements, working on emotional health, etc.
Alice> How about reflexology?
mayogram> Dr Cochran, you mentioned a predisposition to pain before. Have you found anything from discovering this that will help stop the cycle of pain
sueraec> I think Chronic Pain requires a well-rounded approach to life; including alternative treatments, faith, pacing alongside the pharmacy drugs. Don't you think?
[HOST_Carolann] I think Dr. Cochran answered your question Suerac - see his last text
sueraec> It's not easy, sometimes very complicated, but worth the change.
Sheri> I agree completely, suerac. that's what is working for me, and I keep trying new ideas as needed.
BevinFL> Ok what about the question of deep trigger massage therapy> and how we can get insurance companies to pay for it???
Robert_Cochran> Mayogram, Predisposition to pain. Let me bring up an issue, a somewhat disturbing one, about who gets pain and why do they get it. Why do most of us recover from injury and a few do not? There are risk factors for chronic pain, just as there are risk factors for all diseases. They are a curious collection but I'll share them with you. Insomnia, curiously, is often a predictor of chronic pain, and many people who develop chronic pain have had restless legs for years. Another risk factor is irregular appetite, obesity, and fluctuating weight. Another risk factor, probably known to most people, is a history of depression in the past. Pain may strike even though the depression is in remission
mayogram> Dr Cochran, are there more factors?
mayogram> I have none of the ones you listed
Louise> My sister and first cousin have fibro also, as well as the extreme sensitivity to meds. Obviously a genetic connection for the 3 of us?? We do not have the risk factors you mentioned. Two of us dx with chronic fatigue syndrome also.
Robert_Cochran> While we're waiting, let me introduce some more positive ideas. We have wonderful drugs for the treatment of pain, and I'm not referring to opiates, although they can be quite useful. There are a variety (hundreds) of antidepressants, stimulants , mood stabilizers, and anticonvulsants that are used for the treatment of depression, manic depression, attention deficit disorder, post-traumatic stress disorder, and many others that are helpful in the treatment of chronic pain. My book explores these treatments and offers promise to those who suffer chronic pain. I believe it will help readers understand their disease. It will teach them that they are not alone, that they're not crazy, an
Sharon> I was on Prozac for 8 years, but gradually 'weaned' myself off it 3 years ago. At times I feel in a state of panic as I still suffer from depression (as well as a host of physical ailments. Do you recommend I go back on Prozac? Are there risks staying on a drug like this long-term, as I also live on pain meds (Fiornal C1/2, Tylenol #3)?
mayogram> After trying 20 or 30 different drugs only to get worse when I'm on them I am just not ready to explore others
Robert_Cochran> Mayogram, Sorry you have pain. Glad you don't have any of those risk factors because they are pretty bad things. Sometimes chronic pain will appear after major life events, such as death of a loved one, relocation, change in relationship. I will have to admit, I occasionally see people who develop chronic pain out of the blue, but honestly, I don't see many. Reference your last comment, I quite understand, but I do believe that pharmacy will be the answer when all is said and done.
Alice> Mayo - sounds like you have Multiple Chemical Sensitivity like I do.
Robert_Cochran> Sharon, Careful. I'm not offering specifics, but if Prozac really helps you, it seems reasonable to stay on it. Should be no long-term side effects. However, as I indicated before, Prozac in my judgment is really not a very good pain drug.
Louise> Doctor what about the genetic component.?
Robert_Cochran> Louise, I don't know much about it. One does tend to see chronic pain run in families, just as one also sees depression, manic depression, drug abuse, and childhood abuse runs in families. There may be some kind of genetic connection, but it will be hard to figure it out because chronic pain is such a complex and common disease.
[HOST_Carolann] Dr. Cochran we are almost the end of our hour, is there any last comments you would like to make ?
[HOST_Carolann] I'm sorry that the time goes so quickly
Robert_Cochran> God bless you all.
[HOST_Carolann] I'm sure there are lots more questions but always not enough time
[HOST_Carolann] thank you so much for coming today and everyone can check out your web site
Sheri> thanks for your time and information Dr. Cochran
sueraec> Thank you Dr Cochran
Shadow> Thank you Dr. Cochran
[HOST_Carolann] we appreciate your taking the time to try and explain some things and address our issues
Alice> Thanks Doctor and Carolann
BevinFL> thank you Dr Cochran
[HOST_Carolann] thanks everyone for coming
Anne> Thanks, Dr. Cochran
Shadow> Thank you Carolann also for your time
[HOST_Carolann] you are all welcome
BevinFL> thank you carolann
LyghteKeeper> thanks for your time
Alice> Guess our most important remedy is PRAYER - and staying close to our Lord.
sueraec> Yes thank you Carolann
Shadow> right Alice
Anne> thank you Carolann
BevinFL> sure is Carolann
[HOST_Carolann] yes Alice
sueraec> And to walk side by side with each other...
[HOST_Carolann] support is so important, Sue, you are right