Tag Archives: Pain

Why does everything hurt worse in the cold weather?

By Michael Cassaro

Most people with a chronic pain problem have noticed that pain is worse in winter.  It doesn’t matter what type of pain, it’s worse this time of year than it was in the summer.  So, what is the answer?  Why is pain worse in the winter?

There have been some attempts to come up with an answer.  But, the search continues.  We have some partial answers.  I’ll cover some of them here.  We also have some scientists who believe it’s all imagined.  They claim there is no scientific basis for pain to vary with the weather.  Of course, in my office, I see a parade of people who beg to differ.  My own conclusion is that the alleged men of science are fortunate to not be afflicted with arthritis.  When they develop their own pain, they will change their opinion.

Let’s start by considering the effect of temperature.  People in Minnesota and people in Georgia experience worsening pain as the mercury drops.  But, the actual temperatures are far different.  Also, people spend a lot of time indoors.  In the summer, the indoor temperature may be lower than the winter, indoor temperature.  My conclusion is the temperature probably has less to do with pain severity than other things that change with the season, unless you have implanted metal.

If you have rods in your back, artificial joints, or other metal implanted in your body, there is likely to be an increase in associated pain, during the winter.  Your body’s cells each generate heat.  Your metal parts do not.  Your circulating blood brings heat to all of your natural body parts.  Your metal parts do not have the same heat distribution system.  The metal parts rob heat from surrounding tissues.  They are a heat sink.  The more warmly you dress, the more protection you will have.

Let’s consider daylight.  It seems there is an inverse correlation between the hours of natural light and pain.  At least part of this correlation may be due to Vitamin D.  As you know, your skin makes Vitamin D in response to sunlight.  Less natural light means less opportunity to make Vitamin D.  Unless you take a Vitamin D supplement, the amount of Vitamin D in your body is likely to decrease with the daylight hours.  A convenient way to keep adequate Vitamin D is to take a Vitamin D supplement, daily, beginning in the early fall and continuing until mid spring.  For most people, 5000 units of Vitamin D3 can help.  You may also notice fewer colds and flu when you take Vitamin D this way.

Your immune system also plays a role in how much pain you experience.  One of the biggest contributors to pain is inflammation.  The more inflammation you have, the more pain you feel from the inflamed area.  The word arthritis means inflamed joint.  Other types of itis refer to inflammation of other body parts.  If your immune system is over reactive, it will promote more inflammation, and you will feel more pain.  If you spend more time indoors in the winter, you are likely to be bombarded by bacteria and viruses.  The constant bombardment keeps your immune system in a state of high activity, promoting inflammation, and pain.  And if you should get sick, all of your pain will likely get worse.

While you don’t want to prevent your immune system from doing its job, you can make it easier by getting outdoors.  Sure, it’s winter, but fresh air and sunshine are a good antiseptic.  Combine this with some regular physical activity, and you’ll limit your inflammation.  And, as mentioned above regarding Vitamin D, you may notice fewer colds and flu.

Finally, probably the most important thing you can do to keep your chronic pain in check during the winter is to take control of what you eat and drink.  With three major holidays in less than six weeks, there is plenty of opportunity for excess.  Once you start down the path of excess, it’s easy for it to become routine.  At the top of the list of foods that promote pain are sugar, alcohol, and baked goods.  One of the bad things about the foods that promote increased pain is the lag time.  It may take a week or more of overindulgence for the pain to increase, and weeks of abstinence for the pain intensity to subside.  Keep it under control.

It’s not just the cold air that makes pain worse in winter.  Everything that goes along with the season contributes.  Control your diet, exercise, and sleep well, so you can survive winter without increased pain.

Journey of a Pain Sufferer: Part Two

Pain is not always a matter of who you are or what you do. Remember that old adage: You are what you eat.

By Steve Kaufman

In November, I began telling you about my journey with everyday pain, a journey that would take me to a pain medicine specialist.

First, though, I brought the subject up with my primary care physician. In my insurance PPO (Preferred Physician Organization), I had to get a referral from the primary doc before I could move on to a secondary specialist.

He scoffed.

“All they are is pill-pushers,” he said. “They’ll take your money and prescribe a whole bunch of tests and medicines.”

Well, medicines didn’t sound all that bad – especially since all he was prescribing were hot baths, cold compresses and plenty of sleep.

You may recall, from last time, that I was drawn to Dr. Michael Cassaro, a pain medicine specialist in Jeffersonville. So imagine my surprise when the first thing the nurse said when I called for an appointment was, “Dr. Cassaro doesn’t prescribe medicine. If that’s what you’re looking for, we suggest you contact someone else.”

“If I said I was going to prescribe pain medication, I’d have a line around the block,” Cassaro told me later, during our first appointment. “But I’ve decided I don’t want to do that. When I tell people I don’t prescribe pain medication, I end up seeing the people who want to get well instead of the people who kind of like being sick. Then we’re all on the same page for me to help them.”

Okay, so much for the “pill-pusher” charge. Encouraging.

Cassaro’s office is immediately off of the Clark Memorial Bridge if you’re going there from Louisville, a long strip of one-story medical offices. It somehow comforted me that the office was unremarkable, a suite of functional examination rooms. Anything much fancier would have given me concern about his motives. Anything much less fancy would have given me concern that this practice of medicine was somehow operating on the margins of the AMA’s ethical guidelines.

I know, it sounds paranoid. But this was all new territory to me.

So where do these pain medicine specialists come from? In Cassaro’s case, it was from the world of anesthesia – which is a form of pain-management, of course, though only in the most extreme circumstances.

Why did he abandon anesthesia for the pain-management sub-specialty? “Because, in anesthesia, my patients are asleep,” he explained. “I prefer working with people who are awake, who’ll remember me, who are appreciative of what I did for them. I’m a people person.”

That was evident from the moment I entered his exam room. He felt my areas of pain, poked here and prodded there, had me bend this and flex that. He watched me stand and walk. He looked at my hands and feet, elbows and knees, wherever my chronic pain often erupted.

But mostly we talked. For the better part of two hours. There was no rushing through this. And he listened!

He asked me some of the usual questions: How I slept. How I ate. But he seemed to absorb what I said. And he never resisted a follow-up question from me. He even seemed to enjoy the back-and-forth. This was a conversation we were having.

What he said about diet was the most eye-opening – especially sugars. Not just table sugar, but all the hidden sugars in just about everything. He analogized it to a toothache.

“Have you ever had a cavity and eaten a candy bar?” he asked. Who hasn’t?

“Sugar is an irritant,” he explains. And so are preservatives, chemicals, starches – there are myriad hidden irritants in your kitchen and on menus. “They go around your system lighting things up,” he says. “And if you have arthritis or nerve injury, and these chemicals are lighting things up, you’re going to have pain.”

Diet? Who knew?

It’s more than just diet, of course. It’s lifestyle, occupation, medical history, genetics, bad habits and what you thought were good habits. As Cassaro says, he’s not only my physician, he’s my pharmacologist, my nutritionist, my dietician, my behavioral counselor, my physical therapist, my occupational therapist, even my psychologist.

So what did my physician, nutritionist, et al., do for me? Tell you next time.

Journey of a Pain Sufferer: Part One

By Steve Kaufman

I’m going to a medical specialist for my chronic aches and shooting jolts of pain. Will I get relief? Might you get relief, as well?

I wake up every morning in pain.

Whether it’s the familiar dull throb of my lower back, muscle pains in my calves and thighs, some sharp pain in my hands or something new – my foot, my wrist, an elbow – something is always clouding my first-thing-in-the-morning brain.

Some of that goes away gradually. Some of it benefits from a brisk, pre-dawn walk around my neighborhood. Some responds to a hot bath.

And some of it never does go away, not the rest of the day, not for several days. It’s just always there. Always ready to remind me with a sharp zing when I suddenly reach for something on my desk or quickly twist past an open drawer. When I raise my arm to run a comb through my hair or just take a wrong step.

Do I know what it’s from? I guess. Some is clearly arthritis in my joints. Some is the inflammation and irritation of what I’ve self-diagnosed as bursitis in my elbows and knees. Some is degeneration in my back. Some is just age.

I don’t always know.

What I do always know is that pain is a constant companion, distracting, disabling, slowing me down and keeping me from my creative best when I need that the most.

Like a lot of people, I live with it. I always chuckle when doctors’ offices ask me to rate my pain on a scale of 1 to 10. People like me have long ago lost the perspective to rate our pain.

I always felt that the stabbing everyday pain, the kind that I maybe rate a 4 or 5 on the scale, would have drawn a 9 or 10 from my ex-wife. We’re all calibrated to tolerate pain differently. And much of it comes from living with, accommodating and adjusting to it.

Doctors’ offices. They used to help. Today, not so much. They’re afraid to prescribe almost anything for patients’ pain-relief. And I realize that even bringing that subject up probably makes someone out there nod and say, “Addict!”

Opioid addiction is clearly one of the elephants in the room. But you know what else is? The true addict is going to somehow score his Oxycontin or Percoset somewhere on the street. The poor, pain-addled person like me, just seeking some relief so I can function more or less normally, has to hope his doctor is willing to write a prescription for even a low-grade analgesic like Tramadol.

I know. It’s not an easy conversation to have. Of course, if you don’t raise the conversation with your doc, the conversation goes away. But the pain doesn’t. And really, do we chronic pain sufferers have to live our lives with the constant, throbbing, familiar pain? And, more importantly, should we?

I’ve been aware for some time that there are a number of what are called “pain-management centers.” What do they do? Are they physical therapy facilities? Hypnosis? Chiropractic? Acupuncture? Some other mystical art? Or are they a legitimate branch of medical science?

I recently decided to find out for myself. Maybe I could realize some genuine relief. Or maybe it would result in just a good magazine story.

This summer, I contacted pain-relief specialist Dr. Michael Cassaro of Painless Living in Jeffersonville. In fact, I’d seen an ad for his practice in this very publication and thought maybe this was someone who could help me, provide some relief or just offer some understanding in how I should cope with the pain I feel.

I’ve been seeing Mike Cassaro since September. I’m really quite confident that I’m going to feel better. And I plan, in this space, to share my experience with you in subsequent issues of Extol.

Maybe you, too, will have your curiosity sated. Or maybe you’ll discover that perhaps you don’t really have to live with pain after all. Stay tuned. I know I am.