Disability After Disc Herniation – What Predicts? -The Pain Of Course

Despite the advent of the fear-avoidance and acceptance psychology, it is becoming abundantly clear that pain level determine disability. This is but the latest article in that regard.

J Orthop Sci. 2013 Jan 24. [Epub ahead of print]
A predictive model for disability in patients with lumbar disc herniation.
Chen HN, Tsai YF.    abstract here

  • 216 patients in an orthopedic outpatient clinic in Taiwan

Disability factors by regression coefficient significance [higher the b – more important]:

  • Pain – a whopping b=0.746
  • Fatigue – b= 0.138
  • Depression – only b= 0.1

Whats-more,

” The depression level was directly affected by the fatigue level (b = 0.416) and the pain level (b = 0.367), the fatigue level was directly affected by the pain level (b = 0.538), and the pain level was directly affected by age (b = 0.140) and previous surgery (b = 0.260).”  This makes depression more dependent on pain level and fatigue.

More effort needs to be spent on the pain. Central acting agents in Fibromyalgia and diabetic neuropathy are lucky to get 20% more relief than placebo does .

Only 50% of pain victims can either tolerate opioids or find them beneficial. None of above measure “cure” the patient and hence create a form of “dependency”.

Comment –  I believe more effort needs to be put into peripheral treatments for chronic pain despite the fact they do not cure the patient. Ferreting out poor copers for study and making them the rule for chronic pain does a disservice to this condition.

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One Response to Disability After Disc Herniation – What Predicts? -The Pain Of Course

  1. I agree totally, as a professional driver, 18,000 miles a month running solo all over USA / Canada, fatigue was my enemy; From Hypnotism from white line fever, to the ugliest of weather conditions. But what really did me in, was severe pain, which resulted from multiple workplace injuries; At first the pain was controlled with low level narcotics, which allowed me to function and suffer furthering of my undiagnosed injuries. Shoulder and Spine;

    I loved my job, and could not afford to quit working with a family to support;

    I went from doctor to doctor begging for help, only to be prescribed stronger and stronger narcotics, little did I know my injuries were worsening with every physical exertion, the pain would worsen, then after a few months it would settle, and I would return to work none the wiser.

    My multiple trips to emergency resulted in no diagnostic tests as I was always told, you just have arthritis, or you just have a muscle spasm from over-exertion,

    On one particular day, I was going down the highway, and was experiencing something that never happened before, the pain which had escalated, which required more narcotics to quell, resulted in severe symptoms, I became very weak, and started to lose consciousness, little white things began to float in my eyes, I could barely keep my eyes on the road due to the severe pain.

    Luckily a wide spot in the road with no shoulders appeared, I slammed the brakes on and dived into the bunk were I lay for hours until the pain subsided.
    I only wish, I would have died that day as what workers compensation cooked up for me, due to the consequences of my multiple injuries was far worse than death itself;

    Please sign this petition;

    PETITION;

    TO THE HOUSE OF COMMONS IN PARLIAMENT ASSEMBLED
    We, the undersigned residents of Canada, draw the attention of the House to the following:

    THAT systemic misconduct by Workers Compensation Boards and Appeals Commissions across Canada relate to specific sections of the Criminal Code of Canada and the Charter of Rights and Freedoms such as (but not limited to) discrimination, harassment, intimidation, fabrication of evidence, fraudulent misrepresentation, fraudulent concealment, omission of duty, misappropriation of money held under direction, criminal negligence, extortion, disobeying an order of the court, disregarding presumption of innocence and subjecting injured workers to cruel and unusual treatment;

    THAT misconduct by WCBs violates section 7 of the Charter that “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice” by leaving injured workers and their families susceptible to the ravages of poverty;

    THAT WCBs routinely put the burden of proof upon injured workers contrary to WCB Act legislation that gives presumptive status to injured workers thus forcing an adversarial system upon injured workers contrary to the WCBs’ duties under Administrative Law and contrary to the Charter of Rights and Freedoms section 15(1) that “Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination” ;

    THAT the Canada Health Act discriminates against injured workers by excluding them from “access to health services without financial or other barriers” by excluding “any health services that a person is entitled to and eligible for under any . . . Act of the legislature of a province that relates to workers’ or workmen’s compensation” and that this leaves injured workers vulnerable to wrongdoing by the Workers Compensation system;

    THAT because provinces benefit financially and politically from WCB wrongdoing, injured workers have had no success in resolving these issues provincially and have been left as a marginalized group of Canadians who are left without access to natural law and fundamental justice;

    THAT the Criminal Code, the Charter of Rights and the Canada Health Act are under federal jurisdiction;

    THEREFORE, your petitioners call upon the House Of Commons In Parliament Assembled, to enforce and uphold the Criminal Code and the Charter of Rights and Freedoms by convening a Public Judicial Inquiry to investigate misconduct by Workers Compensation Boards and Appeals Commissions across Canada and to assess Provincial WCB Act legislation and the Canada Health Act with regard to the Charter of Rights.

    ____________________________________________________

    Saskatchewan WCB and their CRIMINAL DOCTORS, who refuse to investigate a workers, work injuries, and are paid exorbitant fees to deny timely diagnosis, timely medical care for work injuries, MUST be held accountable;

    ____________________________________________________

    How is it even possible to see 5 ortho surgeons and 3 neurosurgeons, with specific complaints that are not investigated; NO MRI / NO CT SCAN / NO PHYSICAL EXAMINATION?

    ____________________________________________________

    WCB preaches this “ROAD TO ZERO INJURIES” but reality is, WCB will due or say anything to deny medical care, diagnostic tests, operations, and has no qualms about returning you to work AGAINST your treating physicians recommendations!

    WCB is a smoke and mirrors PSYCHOPATHIC CORPORATION
    staffed with LIARS who will do or say anything to deny costs;

    Doctors are now afraid to help any injured worker, as WCB employees PHONE them and cause nothing but TROUBLE for the treating doctors;
    How is it even possible for a NON-Medical workers compensation high school drop-out to deny a request for an operation for a work injury, without even requesting the help of a WCB Medical Adviser?

    Criminal Negligence is a CRIME, yet Sask Party Justice Minister won’t allow a investigation?

    Good Luck getting any medical care in this Province of Sask’CUNKASTAN; because Government owns the medical system and frankly laughs at injured workers when they complain to GOVERNMENT!

    ——————————–

    To downed worker from admin:
    Several things I find very disturbing about WCB
    1) Victims a supposed to be given the benefit of doubt. However, if case worker can find ONE specialist who states it is no longer a WCB issue, they hear nothing else.
    2) From a recent article I wrote on Modic changes in spine, I referred to an article that found exercise therapy ineffective in back pain cases with modic changes (vertebral end plate becomes hard and shiny on mri in about 56% chronic back pain cases). Yet some chronic back pain cases have been tortured by ill-suited Functional Capacity Assessments and rehab measure and when they are too sick to cooperate, are summarily terminated from insurance coverage.
    3) Case workers have no idea of chronic pain. The look at acute pain books that tell them a victim should be better at such and such a time and naturally assume chronic pain disease does not exist. Such case workers think it is only natural to terminate coverage after a certain time period and think they were really nice to have allowed coverage up to a certain time. This ignorance of the persistence of chronic pain is nauseating.
    4) MRI’s are useful in obvious cases of neck/back radiculopathy but useless in most cases chronic pain – I have published studies where it is shown that many cases of frank radiculopathy (sciatica) have normal MRI’s. Yet it can be assumed there is nothing wrong if MRI is normal. That again is just wrong.
    5) Once you have seen a faker, everyone looks like a faker. These workers quickly become jaded and burnt out.

    good luck
    -admin

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