Many people suffer from a condition commonly known by the name “whiplash injury”. This condition is caused by a sudden acceleration/deceleration of force; the head and neck are hyper extended when whipped backward and immediately following, the head and neck are thrown forward and hyper flexed. This motion is usually caused by car accidents, falls, horseback riding, snowboarding, skiing, and contact sports. Following such an incident, the muscles and many other structures of the neck are sometimes left damaged. The symptoms involved with this condition include pain in the neck, shoulder, back, jaw and/or arm; headaches, dizziness, and weakness are common as well.
Often, the pain from whiplash injury doesn’t start until hours or even days after. But once it arrives, it can partner with other strange symptoms, including dizziness, ringing in the ears, hearing loss, insomnia, the loss of concentration, fatigability, memory loss, jaw pain, chest pain and even fever. The combination of any of these symptoms with a known whiplash injury is called whiplash associated disorder.
The trauma caused by whiplash injury can be very elusive. Consequently, it is not uncommon for X-Rays, MRIs, and CAT scans to not show the source of the problem. In order to properly treat whiplash, it is important to understand the progression of a patient’s symptoms. The multiple factors revolving around the injury make management of the pain highly variable from patient to patient. Our physicians will listen closely to the patient and may also rely on advanced minimally invasive spinal interventions to locate the exact source of the pain. Once the source has been determined they can develop an appropriate treatment plan. Nerve blocks under imaging guidance are a specific interventional technique that aid in both the identification of the pain source and its subsequent treatment.
Evaluation and treatment of all whiplash related pain is recommended as soon as symptoms appear. If the condition is ignored, whiplash pain has the potential to become chronic.
If you or a loved one is suffering from whiplash injury, contact Spine Pain Diagnostics Associates today. We have over 45 years of combined experience in treating whiplash injuries and can help you find relief from your lingering pain. Don’t continue suffering and masking your pain with pain medications, let the physicians at Spine Pain Diagnostics Associates treat it at the source so you can get back to enjoying life.
For more information or to schedule an appointment, you can visit our website at www.paindiagnostics.net or call us 1-888-PAIN.DRS. In most cases, no referral is necessary and we accept most major insurances.
Back pain, specifically low back pain, is the leading cause of disability in the country.i More than depression. More than diabetes. Low back pain is the number one contributor to years of life with disability.
Spinal stenosis is an abnormal narrowing of a space in the vertebra. Nerves, arteries and other non-bony tissues pass through these spaces. When this narrowing interferes with these tissues you can have pain, numbness and, if sever, poor muscle control. The disease typically occurs in the low back or neck, and is more common in older patients.
One of the hallmarks of spinal stenosis of the low – a.k.a. lumbar spinal stenosis – is shooting pain from the buttocks to down the leg that gets better when bending forward or sitting. A second hallmark is pain in the leg that worsens when walking. There may be numbness, and the pain remains even when you stop walking. It’s not until you sit or bend forward that you find relief.
There are a number of good treatment options available for spinal stenosis: activity, modification, epidural steroid injections, decompressive laminectomy, microdecompression and interspinous spacer.ii Activity modification includes things like using a cane and bending forward. Epidural steroid injections are one of the more familiar interventional pain management treatments applies anti-inflammatory medicine to the suspected source of pain. Decompression laminectomy and microdecompression are spine surgeries that have been performed primarily by spine surgeons, but can also be done using minimally invasive techniques. And finally, interspinous spaces are like drywall anchors that keep two vertebrae from narrowing the suspected spinal stenosis. It is not a new concept – spacers have been around since the 1950s – but the device took a hiatus from the therapeutic tool chest for the past 40 years to receive an engineering upgrade. They have recently seen an uptick in use as more spine pain physicians become trained in them.
All these treatment options have been shown to improve symptoms in some patients, but there is no resounding conclusion on which is the best for whom. We do know, however, that in patients’ with the hallmarks of spinal stenosis conservative therapies focusing solely on exercising and occasional over the counter pain-relievers do not relieve these symptoms. And so the practice is really to secure a specific diagnosis, identify the patient’s goals and functional health, and match a suitable treatment option.iii
i The stat of US health, 1990-2016: Burden of Diseases, injuries and risk factors among US States. The US burden of disease collaborators. JAMA. 2018;319(14):1444-1472.
ii Markman JD. Lumbar spinal stenosis: current therapy and future direction. Current therapy in pain. Saunders/Elsevier; 2009:316-322
iii Lurie J, Tomkins-Lan C; Management of lumbar spinal stenosis. BMJ 2016; 352 :h6234
Most middle-aged adults in America are overweight, and 35.1% are classified as obese. That means, every third person is obese.* In 1962, every 10th person was obese.[i] What happened?!
We don’t have an answer. Most scientists think it’s a combination of genetics, lifestyle factors and changes in food access (e.g. more sedentary work, more restaurant dining, more TV, daily soda and sugary drinks, and thrifty-genes). [ii] But there are also other theories including disrupted sleep, exposure to exogenous hormones and things called endocrine disruptors, changes to your gut bacteria, oppression, and sunlight exposure. There are even theories about infectious disease causing obesity.
With so many obesogenic forces at play, you would think that we would have a battery of interventions. But we don’t. For the most part, we leave it to the patients and doctors to deal with it on an individual level.
And the treatment? Eat less! Yep. Fifty years of obesity research and the resounding conclusion is that you need to take in less calories than you burn in order to lose weight.[iii] Even with bariatric surgery and medications, the end goal is to help the patient eat fewer calories. But, anyone who has dieted knows this is very hard. If people could just “eat less,” we would not have an obesity epidemic.
What makes losing weight hard? At a biological level, it’s your fat cells. They don’t like to disappear. You get a set of fat cells when you are born, and then another set when you go through puberty. By the time you are in your early twenties, you should pretty much have all the fat cells you can generate. [iv] So weight gain mostly leads to filling up those fat cells. But something in the past 50 years has changed (re: the second paragraph from the top) where more fat cells are being generated into adulthood, leading to obesity. And it’s really hard to get rid of them. Even with liposuction—the most popular cosmetic surgery in the world[v]—fat cells return!
Fat cells aren’t all bad. They do great things like release important hormones and regulate reproduction. But in obesity**, it’s as if they can’t stop sending signals, so you are constantly fighting the urge to feed yourself.
However, there is hope. A high-intensity, in-person intervention provided by a behavioral specialist, nutritionist or other trained profession with at least 14 sessions in 6 months is effective. The components of the intervention are no surprise: reduced-calorie diet, increased physical activity and strategies to trouble-shoot dieting challenges. When this isn’t possible, food-tracking seems to be effective, too. But you have less personal support. Free online apps like Lose-it and MyFitnessPal are popular.
There may be a future when we’ve figured out all the environmental causes of obesity and coordinated a really effective population-based treatment. In the meantime, we should try our very best to pack half of our plates with fresh fruits and veggies at every meal, and to exercise everyday. And if you are obese or overweight, don’t be afraid to ask your doctor or healthcare provider for help. They want to help. It’s what they are there for. Your whole health is important to them.
*The term obesity means fatness, and the most common way we measure it is by the body mass index, a.k.a. BMI. That is equal to your weight in kilograms divided by your height in meters-squared. A BMI greater than or equal to 30 is considered obese. Sometimes the BMI can be high because of a lot of muscle, but for most people it is due to fat composition.
** Obesity has been debated as to whether or not it is a disease in itself. Regardless, it can be a cause of heart problems, blood clots, diabetes, joint problems, social problems, breathing and sleeping difficulties, and cancer.
[i] Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960–1962 through 2011–2014. National Center for Health Statistics Data, Health E-Stats, July 2016. https://www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm
[ii] Williams, E.P., Mesidor, M., Winters, K. et al. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep. 2015). 4: 363. https://doi.org/10.1007/s13679-015-0169-4
[iii] Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Obesity. 2014;2:S5–39. doi: 10.1002/oby.20821.
[iv] Rosen ED, Spiegelman BM. What we talk about when we talk about fat. Cell. 2014 Jan 16;156(1-2):20-44. doi: 10.1016/j.cell.2013.12.012. Review. PubMed PMID: 24439368; PubMed Central PMCID: PMC3934003.
Why is it when you aren’t feeling well, having someone rub your back makes you feel a little bit better? Or, when your knees ache, you automatically rub them? It may be that this instinct actually helps dull the pain in part by activating other senses—such as touch and vibration.
For our brains to detect sensations, we have receptors throughout the body that, when activated, transmit signals up the nervous system. The ones that detect touch and vibration are known as mechanoreceptors. Other ones include thermoreceptors, chemoreceptors, and photoreceptors. But the notorious one is the nocireceptor because it is the one that senses pain.
Using electricity as medicine
Some receptors, like the mechanorecptors in the skin, require less stimulation to be activated than other receptors. Activating these lower threshold receptors may interfere with the activation the higher threshold nocireceptors. This idea is famously known as the “gate control theory of pain.” And though not a complete
picture of the neurophysiology of pain, doctors used this idea in the 1960s to treat patients with chronic pain. They designed a device that had a small electrical generator connected to an electrode, and implanted the electrode near major nerve centers.
Like a pacemaker for the spinal cord
The device transmitted varying frequencies of electrical impulses. It functioned like a pacemaker in the heart, but for the nervous system. When it was implanted near the spinal cord, known both as both a dorsal column stimulator and spinal cord stimulators (SCS), it appeared to interfere with the sensation of pain. Neurosurgeons and interventional pain specialists now use them consistently to treat chronic pain. Patients can use an external controller to modulate electrical impulses.
SCS is indicated for many chronic pain syndromes
SCS is supported in the treatment of multiple disorders, but the best—at least 50% improvement in pain symptoms for the first year post procedure—seems to be for neuropathic limb pain. It is also indicated in aiding in the management of chronic pain associated with the following:
Usually, SCS is a near-last line of treatment for chronic pain. Only you and your physician can determine if you are a candidate. You may call us at 888.724.6377 to learn more or to find out if you may be a candidate.
Everyone is affected by the opioid crisis. For many of us, the crisis has been personal. Illicit drugs, prescription drugs and mental health have all played their part. Some argue that the crisis started with an effort to treat pain, codified in hospital protocols.[i] Others said that drug companies played down the addictive effects of opioid prescriptions and incentivized prescribing them.[ii] In response, the medical community has tried to help. There is now renewed focus on mental health and substance abuse treatment.[iii] Unfortunately, there has been a history of naiveté amongst many physicians, especially two decades ago when prescribing opioid long term for chronic pain was much more common. However, at least one physicians group sounded the alarm very early on, and dedicates much of its time towards advocating for opioid prescription accountability.
Angelie Singh, MD, MPH, MS