January « 2008 « necksolutions.com Blog

January 31, 2008

Impact of Neck and Arm Pain

Filed under: Disc Problems, Neck Pain — Administrator @ 5:07 am

Impact of Neck and Arm Pain on Overall Health Status

From: Spine 28(17):2030-2035, 2003.

Degenerative conditions of the cervical spine can cause debilitating symptoms of neck and/or arm pain. The lifetime prevalence of neck pain has been estimated to be nearly 67%, with a point prevalence of 22%. Although the financial and social impacts of low back pain have received emphasis, the disability caused by neck and arm pain may also impose a substantial financial burden and a major impact on the lives of those affected. Few studies, however, have examined the impact of neck and/or arm pain on the overall functional and health status of patients. Disability associated with neck and arm pain may extend beyond the patient’s obvious symptoms to affect overall health status. The degree to which overall health is impacted may be an important factor in determining which patients may benefit from more intensive nonoperative and operative treatment.

Results: Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales. Scores for patients with only axial pain were significantly lower than for patients with only radicular pain. Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales. PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain.

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January 30, 2008

Medicare Coverage Decisions Based on Irrelevant Populations Trials

Filed under: General Health — Administrator @ 11:19 am

Variations Between Clinical Trial Participants and Medicare Beneficiaries in Evidence Used for Medicare National Coverage Decisions

Centers for Medicaid and Medicare Services often make national coverage determinations based on clinical trials among subjects whose demographics differ substantially from those of Medicare beneficiaries.

From: Arch Intern Med. 2008;168(2):136-140.

Background There is a paucity of data on the adequacy of the resources and tools used by the Centers for Medicaid and Medicare Services (CMS) in making national coverage determinations about services for beneficiaries. The objective of this study was to determine the extent to which clinical trials relied on by the CMS are applicable to Medicare beneficiaries.

Methods We performed a meta-analysis of data on 40 009 individuals from all 141 trials included in the technology assessments for the 6 cardiovascular disease meetings of the CMS advisory panel and compared them with the demographics of the Medicare population.

Results Medicare beneficiaries differ significantly from the cardiovascular clinical trial participants used to inform Medicare coverage decisions. Clinical trial participants, compared with beneficiaries, are more likely to be younger (60.1 vs 74.7 years), male (75.4% vs 41.8%), and non-US residents (60% vs 0%). The clinical trials, moreover, rarely included outcome stratification by age, sex, and race.

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January 29, 2008

Strength Training for Neck Muscle Pain

Filed under: Neck Pain — Administrator @ 6:19 am

Specific Strength Training Helpful for Neck Muscle Pain

From: Arthritis Care Res. 2008;59:84-91.

This randomized controlled trial evaluates the effects of specific strength training targeted to the affected muscle and general fitness training on acute and prolonged neck muscle pain, aerobic fitness, and muscle strength in adults with trapezius myalgia.

Specific strength training was associated with a marked decrease in neck muscle pain during training and with a lasting effect after the training ended.

Strength Training Helpful for Neck Muscle Pain Notes

In adults with neck muscle pain, specific strength training leads to prolonged relief of pain, whereas general fitness training leads to transient acute relief of pain.
In adults with neck muscle pain, specific strength training increases isometric muscle strength and general fitness training increases aerobic fitness.

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January 28, 2008

Omega-3 Fatty Acid relieves neck and low back pain

Filed under: Arthritis, Back Pain, Neck Pain — Administrator @ 3:23 pm

Omega-3 Fatty Acid Supplements May Help Relieve Neck, Low Back Pain

From: Surg Neurol. 2006;65:326-331

More than 70 million NSAID prescriptions are written each year in the United States, and 30 billion over-the-counter NSAID tablets are sold annually with an estimate that 5% to 10% of the US population and 14% of elderly use this class of medication for pain control. NSAID-associated adverse effects affect up to 50% of users and 8% to 20% will have ulceration with 100 000 hospitalizations and a cost of 1.5 billion dollars for complications, according to the current authors.

Omega-3 EFAs found in fish and in pharmaceutical-grade fish oil supplements have as active ingredients EPA and DHA that can competitively inhibit the proinflammatory interleukins and may be useful for anti-inflammatory effects on joints. However, according to the current authors, the US Department of Agriculture has limited fish consumption to 1 serving weekly for children and pregnant women because of concerns about toxic contaminants in fish.

The authors selected omega-3 EFA as a fish oil supplement to examine its effect on pain and use of NSAIDs in patients with nonsurgical discogenic and arthritic neck and back pain presenting to a neurosurgical unit in a nonrandomized, non–placebo-controlled retrospective descriptive study.

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Qigong and exercise for neck pain

Filed under: Neck Pain — Administrator @ 11:29 am

Qigong, Exercise Therapy Effective for Long-Term, Nonspecific Neck Pain

From: Spine. 2007;32:2415-2422.

In the Western world, two thirds of the population have neck pain during their lifetime, which is a significant source of disability and healthcare costs. Physiotherapy for neck pain may include massage, nonspecific strengthening exercises, manipulative therapy, transcutaneous electric nerve stimulation, and heat therapy. Exercise therapy incorporates mobilizing exercises, stretching, and strength and endurance training to improve functional capacity, decrease pain, and educate patients on pain mechanisms.

Qigong is a Chinese therapy involving slow movements, breathing exercises, and meditation aimed at maintain or restoring balance and harmony of mind and body. The efficacy of qigong in neck pain has not been scientifically tested. The objective of this study was to compare the effectiveness of qigong and exercise therapy in patients with long-term neck pain.

Qigong and exercise for neck pain notes

Improvement in neck pain was significant (> 50%) in both groups (qigong or exercise therapy) immediately after treatment, and this was maintained at 6- and 12-month follow-ups in 5 of 8 outcome variables.
No apparent between-group differences at any time point were detected on any outcome measure with qigong vs exercise therapy.

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January 26, 2008

Interleukin 1 and Intervertebral Disc Degeneration

Filed under: Arthritis, Disc Problems — Administrator @ 4:03 pm

Interleukin 1 Polymorphisms and Intervertebral Disc Degeneration

From: Epidemiology 2004;15: 626–633

Background: Enzymatic breakdown of the extracellular matrix, and possibly local inflammation, contributes to intervertebral disc degeneration. We investigated whether polymorphisms within the IL-1 gene locus are associated with lumbar disc degeneration and whether the effect of occupational physical load on disc degeneration is modified by the polymorphisms.

Methods: Genotypes were determined from 133 middle-aged men who underwent magnetic resonance imaging of the lumbar spine. The participants represented 3 occupations: 40 were machine drivers, 42 carpenters, and 51 office workers. We evaluated decreased signal intensity of the nucleus pulposus, disc bulges, and decreased disc height as signs of degeneration in the L2/L3–L5/S1 discs.

Results: The odds ratio for disc bulges was 2.4 (95% confidence interval . 1.2– 4.8) and 1.9 (1.0 –3.7), in carriers of the IL-1.T889 or IL-1.T3954 alleles, respectively. The TT genotype of the IL-1. gene carried more than 3-fold risk of disc bulges as compared with the CC genotype.

Conclusions: IL-1 gene cluster polymorphisms could affect the risk of disc degeneration. The effect of physical workload seems to be modified by the IL-1 gene polymorphisms. Degeneration of the intervertebral disc is a process that begins early in life and is a consequence of a variety of intrinsic and extrinsic factors as well as of normal aging. Among the risk factors most commonly suspected of accelerating degeneration are occupational physical loading, back injury, and smoking. Epidemiologic studies of twins suggest that inheritance is the largest single determinant of disc degeneration. Recently, an association of disc degeneration with polymorphisms in the vitamin D receptor, collagen IX, aggrecan, and matrix metalloproteinase-3 (MMP-3) genes has been reported.
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January 25, 2008

Genetic disc degeneration and back pain

Filed under: Arthritis, Back Pain, Disc Problems — Administrator @ 11:26 am

Heritability of low back pain and the role of disc degeneration.

From: Pain. 2007 Oct;131(3):272-80

Twin studies suggest that both disc degeneration and back pain have a genetic component. We were interested in estimating the heritability of low back pain in men and examining whether genetic influences on back pain are mediated through genetic influences on disc degeneration. Thus, we conducted a classic twin study with multivariate quantitative genetic models to estimate the degree to which genetic (or environmental) effects on back pain were correlated with genetic (or environmental) effects on disc degeneration.

Subjects included 147 monozygotic and 153 dizygotic male twin pairs (N=600 subjects) from the population-based Finnish Twin Cohort. All subjects underwent lumbar magnetic resonance imaging and completed an extensive interview, including back pain history and exposure to suspected risk factors. Disc height narrowing was the degenerative finding most associated with pain history, and was used to index disc degeneration in the models. Statistically significant genetic correlations were found for disc height narrowing and different definitions of back pain, such as duration of the worst back pain episode and hospitalization for back problems, as well as disability in the previous year from back pain.
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January 24, 2008

Chronic whiplash syndrome

Filed under: Chiropractic, Neck Pain, Whiplash — Administrator @ 8:12 am

Chiropractic management of intractable chronic whiplash syndrome

From: Clinical Chiropractic (2004) 7, 16—23

Hyperflexion extension injuries are common and often result in neck and low back pain. As a neuromusculoskeletal complaint, chiropractors, as primary healthcare clinicians, are increasingly providing treatment in such cases. In the case described, a 22-year-old female presented 3 years after a whiplash type injury complaining of chronic neck pain and stiffness and frontal headaches. The neck pain had commenced 24 h after a road traffic accident (RTA) and had remained severe for 2 weeks, during which time a soft collar was worn. The neck pain and stiffness had persisted and had worsened in the 6 months leading up to presentation. In addition, frontal headaches had also developed.
chronic whiplash syndrome
This case demonstrates that chronic whiplash injury patients can respond well to appropriate conservative management, even in the presence of poor prognostic indicators. The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post-isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, no headaches and unrestricted cervical spine range of motion. At 4 months follow-up, the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain. This case demonstrates the use of chiropractic management of chronic whiplash type injuries. However, more high-quality evidence is required to support the use of chiropractic care for chronic and, indeed, acute whiplash cases.

Grade 0 No complaint of pain or discomfort. No physical sign(s) of injury
Grade 1 Neck complaint of pain, stiffness or tenderness only. No physical sign(s) of injury
Grade 2 Neck complaint of pain, stiffness or tenderness and physical, musculoskeletal sign(s) of injury such as point tenderness or decreased range of motion
Grade 3 Neck complaint of pain, stiffness or tenderness and neurological sign(s) or injury
Grade 4 Neck complaint of pain, stiffness or tenderness and fracture or dislocation

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January 23, 2008

Intervertebral Disc Degeneration

Filed under: Arthritis, Disc Problems — Administrator @ 10:18 am

What is Intervertebral Disc Degeneration, and What Causes It?

From: Spine Volume 31, Number 18, pp 2151–2161, 2006

Study Design. Review and reinterpretation of existing literature.

Objective. To suggest how intervertebral disc degeneration might be distinguished from the physiologic processes of growth, aging, healing, and adaptive remodeling. Summary of Background Data. The research literature concerning disc degeneration is particularly diverse, and there are no accepted definitions to guide biomedical research, or medicolegal practice.

Definitions. The process of disc degeneration is an aberrant, cell-mediated response to progressive structural failure. A degenerate disc is one with structural failure combined with accelerated or advanced signs of aging. Early degenerative changes should refer to accelerated age-related changes in a structurally intact disc. Degenerative disc disease should be applied to a degenerate disc that is also painful.

intervertebral disc degeneration
Justification. Structural defects such as endplate fracture, radial fissures, and herniation are easily detected, unambiguous markers of impaired disc function. They are not inevitable with age and are more closely related to pain than any other feature of aging discs. Structural failure is irreversible because adult discs have limited healing potential. It also progresses by physical and biologic mechanisms, and, therefore, is a suitable marker for a degenerative process. Biologic progression occurs because structural failure uncouples the local mechanical environment of disc cells from the overall loading of the disc, so that disc cell responses can be inappropriate or “aberrant.” Animal models confirm that cell-mediated changes always follow structural failure caused by trauma. This definition of disc degeneration simplifies the issue of causality: excessive mechanical loading disrupts a disc’s structure and precipitates a cascade of cell-mediated responses, leading to further disruption. Underlying causes of disc degeneration include genetic inheritance, age, inadequate metabolite transport, and loading history, all of which can weaken discs to such an extent that structural failure occurs during the activities of daily living. The other closely related definitions help to distinguish between degenerate and injured discs, and between discs that are and are not painful.

The purpose of the present article is to propose and justify a working definition of intervertebral disc degeneration, and show how it facilitates interpretation of the diverse research literature. Initial sections review the evidence concerning intervertebral disc functional anatomy, metabolism, aging, structural failure, and pain. This review is followed by an account of disc degeneration as suggested by animal models and epidemiology. Finally, 2 “interpretation” sections consider what disc degeneration is and what causes it.

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January 21, 2008

Chronic back pain causes brain atrophy

Filed under: Back Pain — Administrator @ 3:36 pm

Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density

From: Journal of Neuroscience, November 17, 2004. 24(46):10410 –10415

The role of the brain in chronic pain conditions remains speculative. We compared brain morphology of 26 chronic back pain patients to matched control subjects, using magnetic resonance imaging brain scan data and automated analysis techniques. chronic back pain patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage, and non-neuropathic groups. Pain-related characteristics were correlated to morphometric measures. Neocortical gray matter volume was compared after skull normalization.

chronic back pain brain atrophy

Patients with chronic back pain showed 5–11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10 –20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter density in 17 chronic back pain patients was compared with matched controls using voxel-based morphometry and nonparametric statistics. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic chronic back pain. Our results imply that chronic back pain is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.

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