4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.

Spondylolithesis of the Spine: Definition, Causes, & Treatment

August 14, 2013May 24, 2017 / Thomas Cohn, MD

Spondylolithesis is a condition in the spine where one vertebral body has slid forward or backward in relation to another. It is most common in the lumbar area.

As people age, the likeliness of spondylolithesis increases. The presence of spondylolithesis is not necessarily a problem, however it may lead to the spinal cord or nerve roots being compressed. The compression of the spine or nerve roots is often gradual, and sometimes leads to numbness, weakness, and pain especially in the legs. The slippage can also appear without any symptoms; therefore its presence does not necessarily mean that a problem exists. Even very significant spondylolithesis can be present with no or minimal symptoms and can be managed by very minor levels of treatment.

Causes of Spondylolithesis

The slippage in the spine is caused by problems in the posterior elements of the spine – the facets and connecting bony structures. When these joints are not functioning correctly, slippage can occur. Joint damage can occur from:

Birth defects
Physical damage by trauma or stress fractures
Arthritis

Spinal slippage can also result from sports injuries and arthritis as people age.

Diagnosis & Treatment

Spondylolithesis can be easily diagnosed with plain X-rays. Again, the presence of the slippage does not necessarily mean that there needs to be any special treatment. Many people are completely without symptoms. However, if painful symptoms do exist, there are several options for treatment.

Treatment starts with using proper body mechanics for movement, and maintaining core muscle strength. Seeing a physical therapist may help learning the right strengthening and stretching. If spondylolithesis is irritating nerves, more intense physical therapy may be necessary, and working with a pain physician may be beneficial. Chiropractic manipulation of the slippage is not advisable. If significant weakness occurs or bowel and bladder control is lost, then surgical intervention may be necessary.

Facet Joint Pain of the Low Back – Symptoms and Treatment

July 22, 2013June 24, 2014 / Thomas Cohn, MD

Low back pain can have many causes. Structures in the lumbar region include:

Muscles
Bones
Joints
Discs
Nerves
Pelvic organs

Sensory feedback from these structures can be similar. As a result, determining the cause of low back pain often becomes more complex since multiple areas can produce sensory signals that are perceived the same way. Furthermore, there are often multiple structures contributing to the pain perceptions we have and it may be necessary to treat multiple pain generators to control symptoms.

The facet joints in the spine are small joints the size of our finger joints that articulate on both sides of the spine, posteriorly, between vertebral bodies at every level. They have significant mobility and carry the full body weight. Bending backwards closes the joint, while bending forward tends to open the joint. Since they have the same size and mobility as the finger joints, we can see the same wear and tear type changes in the hands, and assume fairly accurately that the same changes will be present in the low back facet joints.

Symptoms of Facet Joint Pain

The symptoms related to facet joint pain are similar to pain from other joints:

Stiffness after sitting or lying in one position
Pain often with extension of the spine backwards

Pain from facets is often just along the spine and does not radiate significantly into the legs. Often, the lumbar muscles are very tight, trying to prevent excessive spine movement. Severely degenerated facets have significant bony overgrowth, and then can narrow the exit of spinal nerves and cause radiating pain into the leg.

The diagnosis of facet pain is made by:

Patient history
Physical exam
Radiologic imaging
Nerve blocks to the joints

The typical history of facet joint problems is pain along the spine without significant radiation. X-rays and CT scans often show facet problems in detail, but pain can be present even with normal radiologic studies. Diagnostic medial branch blocks are the most reliable tool to establish the etiology of pain from facet joints, and two nerves provide the sensory feedback from each joint.

Treatment

Treatment of facet joint pain must be multifaceted to be successful. Basic level management includes stretching and core strengthening of the lumbar region, with using good body mechanics. Nonsteroidal anti-inflammatory drugs like naproxen and aspirin often are very helpful. More advanced physical therapy including a TENs unit for electrical stimulation and traction of spine is sometimes helpful in addition to the above. For persistent symptoms, facet joint steroid injections and medial branch blocks with radiofrequency denervation of the joint can be extremely beneficial.

Top 4 Causes of Back Pain

July 10, 2013October 30, 2015 / Thomas Cohn, MD

The human spine consists of roughly 30 bones, known as vertebrae that are stacked on top of each other. In between each of these vertebrae are discs – bits of cartilage that prevent the bones from rubbing against one another. When something disrupts the organization of the spine, it often results in back pain.

Many people suffer from back pain, but it’s often difficult to pinpoint what exactly is causing the pain. Here are four of the most common causes of back pain:

Injuries to the muscles, and ligaments. This can include injuries from sports, car accidents, or simple slip and fall accidents. Jarring your back in an unnatural way can result in move the vertebrae or discs out of their place, resulting in chronic back pain.
Herniated Disc. This is also known as a slipped disc. It happens when a spinal disc expands and presses against the nerves in the spinal column.
Degenerative Changes. Over time all areas of the body gradually break down. The spine is no exception. As a person ages their bones generally weaken, and the spinal discs can weaken or shrink (causing vertebrae to rub against each other).
Pinched Nerve. When discs bulge or shift, they can press against or pinch nerves, resulting in sometimes extreme pain.

You don’t have to live out your life just dealing with back pain. There are numerous treatment options available that can help you get back on the road to a pain free life.

Do Opioids Reduce Inflammation in Chronic Pain Patients?

July 3, 2013September 27, 2016 / Thomas Cohn, MD

A recent preliminary study found that inflammation in patients with chronic pain is persistent despite long-term opioid treatment.

The study was carried out by Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina. Dr. Tennant examined 40 patients from July 2012-October 2012. All of these patients had been receiving heavy doses of opioids to treat their chronic pain for the past 10 years.

While many patients reported improved levels of depression and function, 20% of those surveyed still had high levels of inflammation markers. Further, a number of patients had abnormally high hormone levels.

Dr. Cohn Comments

Opioids are used to treat all types of pain, but they do not treat inflammation. If a chronic condition causes pain, such as osteoarthritis, treating this with opioids will not change the inflammation that is occurring. The pain may be better with the opioids, but the disease is not being modified and one should expect to see inflammatory markers.

Chronic pain is defined as pain lasting longer than 3-6 months. Pain can be caused by any number of factors, and is a response to ongoing stimulation of pain receptors in the body. It is not very surprising that if we monitor blood borne markers, we can find elevations in those that are indicators of inflammation.

Osteoarthritis is a chronic degenerative joint disease. If it is painful, there is likely active destruction of tissue, and the joint may be warm and swollen. Osteoarthritis of the knees is very common, and we all know many older adults who complain of painful, swollen knees. Furthermore, the most common treatments are nonsteroidal anti-inflammatory drugs, like Motrin and Aleve.

Low back pain has many causes, such as:

Inflammation of nerves causing radiculopathy
Degeneration of the facet joints

First line treatments are meant to reduce inflammation. This is done sometimes by oral steroids, or long-acting steroid epidural injections. Steroids treat inflammation directly, and finding inflammatory markers when someone has low back pain is not surprising.

If a person has chronic pain, a good pain physician will recognize the causes of the condition. Treating the cause of pain with interventions that modify the disease is the best strategy. Treat the disease, and the disease markers will improve. Opioids are often a Band-Aid – they help in the short term but fail to address the underlying condition.

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