Another NASCAR Driver Dealing With Problematic Pain

April 22, 2015 / Thomas Cohn, MD

Denny Hamlin is the latest NASCAR driver to have his season impacted by debilitating pain, as he needed to withdraw from Sunday’s race at Bristol Motor Speedway with neck pain.

Hamlin told reporters that he pulled something in his neck during the 12th lap, and he didn’t feel want to compete if he thought he was a danger to others.

“I can’t move my head or neck like I need to, and I’m not doing this team any justice if I go out there like this,” Hamlin said after withdrawing from the race. “I have no idea what happened. I think it’s just a pull, something where you jerk your head around and you feel a pain. Almost like you slept on it wrong.”

It’s surprising that the injury occurred so early in the race. We’ve shared ideas for avoiding pain and injuries while driving in the past, but NASCAR drivers don’t typically have the luxury of getting out of their car and stretching to break up the drive.

Despite pulling out of Sunday’s race, Hamlin said he plans to compete in three races this week, which seems a little aggressive for a driver who only completed 22 of 500 laps last week. He added that he’s received treatment early this week, and he’s excited to compete this week at a track 20 miles from where he grew up.

“After treatment this week, I feel close to 100 percent, and I’m confident that I’ll be good to go this weekend in Richmond,” Hamlin said. “It’s a great track for our team, and one that means a lot to me personally. Hopefully we can go out there and compete for the win.”

Another NASCAR Injury

Hamlin’s neck pain is the one of the first NASCAR injuries we’ve heard about this year, but last season the injury news centered around Jeff Gordon, who claimed that chronic back pain could force him into retirement. Over the course of his career, Gordon has undergone professional treatment, strengthening exercises and received anti-inflammatory medications and cortisone injections to manage his back pain.

Although he hasn’t publicly stated that it’s due in part to his back, Gordon has already announced that this season would be his last full-time season in the Sprint Cup Series.

I’ll keep tabs on Gordon and Hamlin as the NASCAR season progresses, but under the playoff structure, Hamlin has already qualified for the Chase for the Sprint Cup championship, so it wouldn’t be surprising if he missed some races to ensure he enters the Chase as healthy as possible.

The Benefits of MRI For Whiplash Injuries

April 2, 2015 / Thomas Cohn, MD

Whiplash injuries typically occur during a car accident, but they can happen during any event that causes your head and neck to move in in a violent manner. The majority of people who suffer a whiplash injury fully recover within a month or two, but for about 25 percent of the population, long-term pain and chronic pain persists.

Thankfully, we’re getting better at predicting which whiplash sufferers will have to deal with long-term effects through new MRI techniques. According to researchers, scientists can now predict which patients will develop chronic pain and partial disability within the first one to two weeks of the initial injury. They believe the earlier diagnosis will help doctors better develop a specialized treatment plan to treat the condition.

What The MRI Reveals

Researchers said the MRI reveals fat/water ratio in a person’s muscles, and unusual muscular changes one to two weeks post-injury can predict future chronic pain. The MRI uncovered that excess fat entering the patient’s neck is the key indicator.

“We believe this represents an injury that is more severe than what might be expected from a typical low-speed car crash,” says lead investigator James Elliott, assistant professor of physical therapy and human movement sciences at Northwestern University Feinberg school of Medicine. “This opens up a new door for research on whiplash. For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

Elliott added that routine x-ray imaging does not reveal this fat infiltration, and the MRI appears to be an optimal route. Despite the findings, researchers haven’t pinpointed a preferred treatment option for whiplash sufferers who are at risk for future chronic pain.

“We haven’t found an effective treatment for these folks with chronic whiplash,” said Elliott.

Although they are still working on a solution, researchers said the findings are important because they help prove to whiplash sufferers that their chronic pain isn’t just in their head.

“If you’re a whiplash patient with ongoing chronic pain, but no objective imaging finds anything wrong, people are frequently informed that nothing is wrong with them,” Elliott says “It’s been a huge problem. That fat appears to be a response to an injury. What has actually been injured remains for us to find out. But now we know to look more deeply into the problem.”

Related source: Northwestern University

What Virtual Reality Can Teach Us About Chronic Pain

February 23, 2015 / Thomas Cohn, MD

Virtual reality may be the next innovation in the gaming world, but it also may offer real world benefits for chronic pain sufferers.

According to research published in Psychological Science, virtual reality is being used to see how physical and physiological factors impact chronic pain. Researchers say that misrepresenting physical positions through virtual reality can change how someone experiences pain. For example, researchers would outfit patients with a virtual reality device that appeared to show their neck torqued in a position of discomfort to determine how a perceived position impacts brain signals.

“Our findings show that the brain does not need danger messages coming from the tissues of the body in order to generate pain in that body part — sensible and reliable cues that predict impending pain are enough to produce the experience of pain,” said researcher G. Moseley of the University of South Australia. “These results suggest a new approach to developing treatments for pain that are based on separating the non-danger messages from the danger messages associated with a movement.”

The Virtual Study

To see how virtual movements impacted chronic pain perception in your brain, researchers recruited 24 chronic pain sufferers whose pain stemmed from several different conditions, including poor posture, tension, repeated strain, trauma and scoliosis. Participants were equipped with a virtual reality head-mounted display and were positioned to prevent excessive torso movement.

Once the headsets were in place, researchers asked participants to rotate their head until they experienced pain. What the participants didn’t know is that their virtual reality devices either:

Provided an accurate representation of their neck rotation.

Projected an over-rotated representation of the person’s neck.

Projected an under-rotated representation of the person’s neck.

After looking at the data, researchers uncovered that the feedback display had a significant impact on when the participant reported pain. Researchers found:

When head rotation was understated, participants rotated their heads about 6 percent farther than normal before reporting pain.

When head rotation was overstated, pain-free range of motion was reduced by an average of 7 percent.

Intensity of pain did not differ across the various representations.

“We were surprised at how robust and predictable this pattern of results was,” said Moseley. “If cues signaling danger amplify or indeed trigger pain, then these cues present a novel target for therapy.”

Acupuncture – Is it Effective for Treating Pain?

January 26, 2015January 18, 2016 / Thomas Cohn, MD

Acupuncture has been around for centuries and has been a part of Chinese medicine as a modality to treat a number of conditions. It is based on ancient theories of the body having flow patterns of energy. In the body there are 12 meridians for flow of energy and acupuncture either blocks bad energy flow or promotes the flow of positive energy. The placement of needles in certain places is to decrease bad pain and improve the flow energy promoting pain relief. Those who trust in acupuncture say it can treat numerous different conditions. Western medicine first was exposed to these interventions in the early 1970’s when China opened up to the western world.

Western research initially tried to discover how acupuncture worked by attempting to identify flow patterns and meridians. They looked at MRI scans to see if they could see changes in the brain scans, and none were seen initially. The research turned to studies to see if treatment with acupuncture was better than a fake treatment with only sham placement of needles, and they compared it to no treatment at all. Unfortunately, both traditional and “sham” acupuncture worked equally well, and both worked better than no treatment for many chronic pain conditions. Studies in the early 2000’s showed that for chronic low back pain, acupuncture did work better than no treatment and did have extended benefits lasting a year with increased functional ability.

So How Does it Work?

The question of how and why acupuncture worked was puzzling to researchers. A neuroscientist from the University of Toronto was responsible for making the first discoveries of how acupuncture worked. Initially, animal studies showed that acupuncture blocked painful sensations to the paw of the animal, however it took about 20 minutes for this to work. This was about the same time that it took opioids to become effective, and this researcher had the insight that there might be some relationship, like it stimulated the body’s own substances to act as a natural pain reliever. Now researchers have also found that the chemical adenosine increases with acupuncture, and this is another endogenous pain reliever.

Through the use of functional MRI scans, researchers can look at the brain in real time and view activity changes of various areas. Acupuncture has effects on the hypothalamus and amygdala, areas of the brain that control fear and influence pleasure. The scans have also identified that acupuncture promotes connectedness throughout the body.

Over time, acupuncture is now being better understood. It stimulates several of the body’s own compounds that help prevent pain. It also helps in the appropriate interpretation of signals. Furthermore, studies have shown it to be effective for low back and neck pain, at least in the short term. There is also data showing it can be helpful for headaches and osteoarthritis. It does not work for everyone, but there is at least some clear scientific evidence of how it works and there are reasonable studies showing its effectiveness.

5 Tips For Dealing With Chronic Pain During The Holidays

December 17, 2014 / Thomas Cohn, MD

Chronic pain is never fun to deal with, but it can be especially difficult to manage during the holidays. Your diet, sleep schedule and travel plans can get your body out of whack, so today I’m sharing some tips to help you control your chronic pain during the holidays.

1. Travel Tips – If you’re dealing with chronic back or neck pain, being crammed on a plane or in a car for hours on end can be painful. That said, there’s still some ways to make yourself more comfort while traveling. If you’re traveling on a plane, see if you can get an aisle seat. That way you can stand up and stretch if needed without waking up any sleeping patrons in your aisle. If you’re in a car, leave earlier so you have time to stop at a rest stop and move around if your joints start to get stiff.

2. Eat Right – The holidays are a time when our waistbands can expand to Santa’s size, so be cognizant of what you eat. Eating junk food can aid to your chronic pain, make you more lethargic, and as a result, keep you from exercising, which is beneficial in chronic pain management. If you have to travel, pack a healthy option so you’re not gorging on fast food during your travels.

3. Keep Exercising – As I’ve said in earlier posts, regular exercise is crucial in controlling and preventing chronic pain symptoms. Getting your regular workout in during the holidays is no easy task, but don’t use the company party or a family visit as a reason to skip your exercise. Wake up early or carve out some time – even if it’s only 15 minutes – to exercise. Getting out of a routine makes it easier to stay out of your exercise routine, so don’t let the holidays slow you down.

4. Medication Management – Most people who take medications to help with their chronic pain have a pretty set schedule for managing their meds, but as this post suggests, the holidays can throw your routine out of whack. Double check to make sure you have all your medications for a long stay, but also be aware of where you store them so young nieces and nephews can’t accidentally access your medications. If you’re going to run out of a prescription while out of town, contact your doctor before you leave instead of having to jump through hoops from afar.

5. Rest Up – Sleep is a restorative process where your mind and body relax and rejuvenate, so try not to skimp on sleep this holiday season. It may be easier said than done, but it’s important nonetheless. That means no staying up in the wee hours of the night trying to catch Santa Claus!

Follow these tips to have a pain free (or at least a little less painful) holiday break! If you have any tips on how you manage chronic pain during the holidays, please share in the comments section.