Category Archives: Insurer issues
I have a patient with psoriatic arthritis that had widespread pains. His rheumatologist told him it was “fibromyalgia” He developed such bad bronchitis I had to put him on steroids – at which point his “fibromyaglia” pains went away. He … Continue reading
New cases series of patient twith chronic headache that oft went thru a litany of doctors without success with a clearly treatable disease. Each gave a history of headache on arising and relieved by lying down that was discounted because … Continue reading
One study demonstrates that chronic back pain is associated not so much with plain disc degeneration but with disc degeneration combined with end plate or vertebral body schmorl nodes. Another study found that people with back pain and modic type … Continue reading
Increased Connection Of Medial Prefrontal Cortex to Nucleus Accumbens(pleasure center) Predicts Chronic Pain
Saw recent talk by Dr. Apkarian where he noted overactivity of nucleus accumbens (pleasure center) in chronic pain – he called it “addicted to pain” (no relation to painkillers). Now this appears to be driven by increased white matter circuitry from … Continue reading
What Determines Severity of Neuropathic Pain – The Neuropathicity, Not the Mood – and Good-Bye Fear Avoidance Model(FAM)
Factors such as pain on light touch (allodynia) and excessive pain on pinprick (hyperpathia) were strong indicators of pain severity. “Female gender, age, and history of serious mental disorders were found to be weaker indicators.” Psychological factors are played up … Continue reading
Will MRI Localize the Site of Back Pain? – Epiduroscopic Study Suggests No – What this means for Insurers
Cases of chronic back pain with or without non-radicular leg referrals (in leg but not classic sciatica) were examine clinically, with MRI and by using a “keyhole” scope instrument in the spine called an Epiduroscope. Scoping and probing area during … Continue reading
Primary Care Back and Leg Neuropathic Pain (thought sciatic) common. – MRI, and Straight Leg Raise Useless.
Recent study of neuropathic pain in leg associated with back pain, in a primary care setting, found MRI evidence of nerve root impingement unlikely and straight leg testing useless. Their conclusion: “[the] neuropathic pain may be caused by irritation of nervous … Continue reading
Radiculopathy (sciatica) cases were categorized by their pain diagrams and physical findings. Only 16- 37% of cases showed MRI findings. If there is an MRI-visible issues – only 22-78 % cases have symptoms (positive predictive values of MRI-visible nerve involvement). … Continue reading
Several studies presented at the International Association for Study of Pain at Montreal 2010, all find the association of psychological problems and Chronic pain to be weak.
Previously, Dennis Turk has contended that only 1/2 of chronic pain sufferers will tolerate of find opioids effective. See: http://painmuse.org/ref/turk.pdf Now a Norwegian study suggests even in “planned” opioid users, only 23% will be taking opioids 3 years later. Meanwhile, doctors in Orthopaedic Medicine, … Continue reading
MRI Imaging Often Useless in Chronic Pain – Leading to the “There’s Nothing Unusual on MRI so Your Pain is all in Your Head”
You never fully appreciate how poor a certain procedure is until a better one comes out and belittles the old one. Most MRI articles spend time telling you what they can do -not what they can’t do… how poor MRIs … Continue reading
Recent study found lameness to be 36% in diary farms but control would take effort and there are financial constraints to fixing it. It just like being on WCB.
FCE study shows it can predict working in short term but reinjury
Recent Article takes a survey of concerns of low back pain patients sent for rehab. The results are no surprise.
Limitations of Functional Capacity Assessment Like Fall Risk Assessment In Elderly – One Shot Assessments Don’t Account For Good and Bad Days.
Read Recent Article on How Fall Risk Assessments tools in elderly might lack validity because they don’t take into account how elderly will have good and bad days. Similarly, Functional Capacity Evaluations (FCE’s) do not take into account that discs … Continue reading
Others might content that if it’s just pain – take a pill and move on – but it’s more than that – it includes the fatigue
One of the problems defining chronic pain as a psychological condition, is the fact that psychological treatments have somewhat mediocre results. So when I find an article claiming results, I am suspicious. Here is an example:
I would like to compile resources for Car Accident Victims to help deal with their claims. In this province, there is “no-fault” really meaning it’s the victims fault for being in chronic pain. They have to deal with case workers … Continue reading
Given Vocational Advice to Chronic Pain Patients And terminating Coverage – The “You Could be A Funeral Director Scam”
Recent study of “disability pensioners” given vocational advice and brief cognitive behavioural program found it only got “negligible” amounts of people back to work. Terminating disability coverage, because vocational advice was given, is nothing more than a scam.
Brain damage in certain areas has been seen in chronic back pain, Complex Regional Pain Syndrome, Fibromyaglia, and so on. The question is whether the damage causes the pain or visa versa. In hip pain patients, the at least partial … Continue reading
The following is a verbatum copy of an article in the Canadian Pain Coalition Newsletter with permission from Mr. Wheeler, and contains some useful Canadian info.
I get the impression some car accident victims get an eye rolling response to claims of multiple injuries. Here’s an example of low back and upper thoracic (high chest) back fractures while wearing a three point seat belt.
In the neck, imaging can be next to useless in many cases of unresolved neck pain. Incredibily, some people are told nothing showed on imaging so it has to be in their head. Now functional (multipositional) upright MRI is demonstrating … Continue reading
I have a picture that portrays my view of fear-avoidance:My perspective is that, in a good many of cases, everything is controlled by pain intensity. Some articles try to avoid the issue by saying “they just thought they were in … Continue reading
A Canadian Pain Society Survey found medical students only get on average 11 hours training in pain education. A vet, however, gets on average 98 hours education. This might explain why patients are treated poorly by some doctors.