Health Update: NEUROPATHY

LEARN MORE ABOUT
PERIPHERAL NEUROPATHY

There are more than 100 known types of peripheral neuropathy, each with its own characteristic symptoms, pattern of development, and prognosis.

Approximately 30% of peripheral neuropathy cases are linked to diabetes. Other common causes of neuropathy include autoimmune disorders, tumors, hereditary conditions, nutritional imbalances, infections or toxins. Another 30% of peripheral neuropathies are termed “idiopathic” when the cause is unknown.

Types of Neuropathy
    * Autonomic Neuropathy
    * Cancer-Related Neuropathies
    * Compressive Neuropathies
    * Diabetic Neuropathy
    * Drug-Induced and Toxic Neuropathy
    * G.I. and Nutrition-Related Neuropathies
    * Hereditary Neuropathies
    * Immune-Mediated and CIDP
    * Infectious Diseases and Neuropathy
    * Neuropathic Pain

Peripheral neuropathy symptoms and signs can vary in how they begin.  Some neuropathies come on suddenly; others gradually over many years. There are three types of peripheral nerves affected, and symptoms depend on these nerves and their location:

    Sensory Nerves:       Affect sensation
    Autonomic Nerves:   Affect internal organ functions
    Motor Nerves:          Affect muscles

Many types of peripheral neuropathy affect all three types of nerves to various degrees, but some affect only one or two.

Here are some peripheral neuropathy symptoms and warning signs as described by patients:

Weakness in the Arms or Legs
Legs: Usually caused by damage to the motor nerves, leg symptoms often include difficulty walking or running; a feeling of "heaviness" in your legs; finding it takes a lot of effort just to climb the stairs; stumbling or tiring easily.  Muscle cramps may be common.

Arms: In the arms, you may find it difficult to carry groceries, open jars, turn door knobs or take care of your personal grooming.  A common frustration is dropping things.

Numbness, Tingling and Pain
Sensory nerves, when damaged, can cause various symptoms. Early on, there may be spontaneous sensations, called paresthesias, which include numbness, tingling, pinching, sharp, deep stabs, electric shocks, or buzzing. These sensations are usually worse at night, and sometimes become painful and severe.

You may also experience unpleasant abnormal sensations when you touch something, sensations called dysesthesias because they are caused by stimuli.
Or, you may find yourself feeling nothing at all, in this case experiencing anesthesia, a lessening or absence of sensation.

Impaired Sense of Position
When you lose the ability to “sense” or feel your feet, you may find yourself being uncoordinated because when you walk because you are not sure about the placement of your feet.   Patients may find themselves walking differently without really knowing how or why they are doing so. Chances are they have either widened their style of walking (in an unconscious effort to keep their balance) or they may be dragging their feet.

“Glove and Stocking Sensation”
This phrase describes what doctors call a patient’s odd feeling of wearing stockings or gloves or slippers when, in fact, the patient’s hands and feet are completely bare.

Symptoms of Autonomic Damage
When it occurs, autonomic nerve damage can potentially cause: a drop in blood pressure and, consequently, dizziness when standing up; intestinal difficulties such as constipation or diarrhea; sexual dysfunction; thinning of the skin (with susceptibility to bruising and poor healing), and other symptoms.
If you or a loved one is experiencing any of these neuropathy symptoms, we encourage you to visit your physician as soon as possible and discuss your symptoms and your concerns.

Neuropathy Support Group:  www.neuropathy.org

Health Update : Fibromyalgia

Fibromyalgia :   
Dietary Guide

Fibromyalgia (FM) is a chronic condition affecting multiple body systems is not limited to any one aspect of health. Because of this, there is no ONE diet that works the same for all FM patients. Since most dietary guidelines that address FM are based on general healthy eating principles utilized for many conditions such as hypoglycemia, diabetes, food allergies, headaches, digestive disorders, and fatigue, let’s review some of the most popular and successful dietary approaches that have been reported regarding FM.

Basic Guidelines:

1. Carbohydrates: AVOID all refined carbs (white flour products). Eat whole grain bread, oatmeal, granola, nuts. Avoid artificial sweeteners and limit sugar intake to a max. of 40g/2000 calories. Eat roughly 14 grams / 1000 calories consumed of soluble dietary fiber such as apples, oats, and legumes vs. insoluble fiber such as bran. Your total carb intake from all sources should be between 30-55% of your total calories.

2. Fats: AVOID saturated fats (these clog up circulation, lead to inflammation and pain). That means <10% of total calories consumed, so limit or eliminate foods such as cheese, beef, milk, oils, ice cream, cakes, cookies, mayonnaise, margarine, chips and chicken skin. Eat mono- and poly-unsaturated fats and include regular amounts of omega 3-fats. Eat < 300mg/day of cholesterol; Try to avoid ALL trans fats such as cakes, cookies, crackers, pies, bread, margarine, fried potatoes, chips, shortening. Take omega 3 fatty acids like alpha-linolenic acid (ALA) as these help make other omega 3 fats like EPA and DHA, and are very helpful for the brain. ALA is found in flaxseed, linseed oil, or cod liver oil. Limit total fat intake to 20-35% of calories consumed.

3. Protein: Go easy on red meat as they are high in saturated fat. Instead, eat more fish and vegetable protein (legumes and soybeans are great). When eating meat or poultry, remove all visible fat and skin before eating. Maintain protein at 20-40% of total caloric intake. AVOID: processed meats, especially salt-cured, smoked or nitrate-cured.

4. Fruits & Vegetables: Whole fruits are superior to juices. Include blackberries, strawberries, raspberries, kiwis, peaches, mango, cantaloupe melon and apples. Some FM sufferers cannot tolerate citrus fruits but if you can, fruits like oranges and grapefruits are great. Vegetables are crucial. Good choices include carrots, squash, sweet potato, spinach, kale, collard greens, broccoli, cabbage, and Brussels sprouts. These foods reduce the risk of developing chronic diseases (diabetes, heart disease, stroke and cancers).

5. Dairy Products: Choose reduced or fat-free varieties of cow or soy milk. This also applies to yogurt and cheese.

6. Healthy drinks: Drink 8 glasses of water a day or diluted fruit juices, or herbal teas. Drinking water helps flush out toxins. Avoid coffee, tea, and alcohol as these increase fatigue, increase muscle pain and interfere with normal sleeping patterns. Limit or eliminate alcohol.

7. Healthy Snacks: Chopped vegetables, unsalted nuts and/or seeds; AVOID ALL commercial snack foods (except salt-free air-popped popcorn) as these are high in trans fats & salt. Avoid chocolate and candy.

8. Junk Food: Regular consumption of this is BAD for FM patients due to the high levels of fat, sodium, calories and general lack of nutrition.

9. Artificial Sweeteners: AVOID them! Examples: aspartame, NutraSweet, & saccharine.

10. MSG: (monosodium glutamate (MSG) and Sodium (Salt) can aggravate FM!

11. QUANTITY: Eat smaller light meals, especially in the evenings.

Video: Fibromyalgia Nutrition

To find out if you are a candidate for their customized treatment approach call 732.719.8148 or visit us online at New Jersey Pain Management.

Health Update: Whiplash Injury Guide

This guide has been carefully prepared to educate those who have suffered-whiplash types of injuries of the neck and spine. The information presented is for general health education only. Individual health concerns should be addressed with a knowledgeable health care provider.

The Severe
“Whiplash Injury Guide”
INCLUDING… The Four
Dangerous Whiplash Myths

Whiplash injury is a very real type of problem that costs communities billions in health care and disability dollars.

Studies have recently shown that about 10-20% of the population suffers from neck pain, and car accidents/traumas are a big cause of this type of pain.

But you've probably wondered how something so minor as a fender-bender to your bumper could be such a pain in neck.

    Maybe your doctor told you, "give it a couple of weeks"..."you'll be fine."

But you're not fine.

Your neck hurts when you work at the computer, when the dog pulls too hard on the leash... maybe sleep has become more difficult with a lot of tossing and turning, or you've become dizzy...or always tired when you used to be full of energy and pep.

Maybe you've noticed how your neck moves differently since the accident. Looking over the shoulder perhaps isn't as easy as before.

Does all of this sound familiar?

It's quite surprising when you look at whiplash research and its global impact-the entire body is affected. You probably didn't think that headaches or fatigue were part of the whiplash bargain, but they are.

Your Bumper Doesn't Tell the Whole Story…

    You can't look at a dent in the bumper and conclude that the neck wasn't injured.

For instance, they're called 5 mph bumpers for a reason-designed to not be damaged in very low speed collisions. 

This is good for the bumper, but not necessarily for your neck!

What researchers have discovered is that when collisions are of enough force, this causes the vehicle to crumple and absorb energy.

Low speed collisions will often not cause the crumple zones to be engaged.

    If you have a rigid fixed bumper (seen on many older cars and trucks), that does not crumple-this can make the whiplash injury even more severe.

For the above reasons, you might be even more injured in an accident below 20 mph than one above that speed.

There are of course limits to this effect. Collisions at very high speeds (above 40 mph) will often cause the occupants to suffer severe injuries, even though the crumple zones are absorbing some of the energy.

You may have heard someone profess skepticism for your whiplash injury.

Maybe they thought you were gaming the system or out to make a fast buck.

Where does this perception come from?

Probably the insurance companies, who seem to have a profit-motive for denying the realty of whiplash injuries.

Some physicians are simply ignorant about whiplash trauma, perform cursory spinal examinations, or offer treatments that have little or no scientific evidence to back them up.

But is there really such a thing as “Whiplash?”

The science says “YES!”

Whiplash- a soft tissue injury to the neck-is also called neck sprain or neck strain.
It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion.
The disorder commonly occurs as the result of an automobile accident and may include injury to the joints of the spine, disks, and ligaments, cervical muscles, and nerve roots.
Symptoms such as neck pain may be present right after the injury or may be delayed for several days.

In addition to neck pain, other symptoms may include:

• Neck Stiffness
• Injuries To The Muscles And Ligaments (Myofascial Injuries),
• Headaches
• Dizziness
• Abnormal Sensations Such As Burning Or Prickling (Paresthesias)
• Shoulder Pain
• Back Pain

In addition, you may be experiencing cognitive, somatic, or psychological conditions such as:

• Memory Loss
• Poor Concentration
• Nervousness/Irritability
• Sleep Disturbances
• Fatigue, or Depression.

Video: Whiplash Injury

Special Thanks to Dr. Nabil Ebraheim, M.D.

But Why Can Whiplash
    Be So Devastating?

Your head and neck is simply not designed to be accelerated three times the acceleration of gravity....or come in contact with an air bag deployed at 190 mph. 

When these injuries occur, muscles and ligaments of the neck cannot resist the force, which then tears tissues apart.  This then sets the stage for degeneration/osteoarthritis years later.

        The basic principal in a rear-end whiplash, is anything that makes your vehicle not accelerate as fast when hit, is going to make the injury less damaging to your neck.

        If your car is small, it will accelerate much more quickly than a larger vehicle.

        If you're hit on a low friction surface such as rain-drenched pavement, or ice, the car will accelerate very quickly…and some of the worse injuries occur when your vehicle is slightly rolling when hit, because it's easier to get a vehicle moving that is not stopped.

Women are more injured by whiplash, because they generally have less neck musculature development. The ratio of their head size to their neck size is much greater than in a man. There's a very good reason why professional football players have those massive necks.

   

The Four Dangerous Whiplash Myths:

Myth #1: Car Damage = Occupant Injury
It might seem intuitive that if a car is smashed, the neck will be badly injured, and conversely if it's a simple fender bender, then the neck was spared. Some low speed collisions can be even more damaging than high-speed accidents, within certain limits.  The kinds of things that may be more important are if your head is turned, or the size of the vehicle that is hitting you.

Before the accident, was the vehicle was rolling or stopped, how was the headrest positioned? Other factors include getting hit from behind vs. a head-on impact.

Research shows that people are not as badly injured from frontal impacts. It could be the airbag, anticipating the collision and tightening up, or the chin hitting the chest. All other factors being equal it's worse to get hit at the side and behind, than at the front.

Airbags have done a lot to save lives from frontal collisions. Unfortunately, side and rear impacts are less protected by an airbag. Seatbelts also save lives by keeping the occupants inside of the vehicle. Although they save lives, they tend to actually accentuate whiplash injuries in low speed collisions where the torso is more restrained relative to the head and neck.

Even car seats can be a factor in how badly you're injured.  Cars with soft thick seats will cause the head to whip more than occupants in a thin firm seat.  If the headrest was placed too low, it will act as a fulcrum and make the neck injury much worse.  That's why your headrest should always be positioned at the very highest level, and just touching the back of the head. 

Myth #2: No Pain = No Injury
I don’t feel pain so I’m ok. Most people who get in an accident will feel flustered and shook up. In low speed collisions, it is more rare to have pain right after accident. Usually symptoms develop over days, and it is not uncommon for the pain to come on two weeks post trauma. Conversely if you feel immediate pain, then substantial tearing and damage has occurred.

Another thing to consider is that the spine can be injured and yet may not cause much neck pain.  However, these patients usually have tender spines to the touch, even if there are no outward symptoms.  Less than 20% of the nerves that come through bundles between your vertebrae carry pain signals.  That means it's important to examine for more than just pain, such as neurological and muscle function. A doctor needs to carefully palpate the tissues of the neck, check range of motion, and examine the flexibility of individual spinal joints.  With this type of comprehensive exam you will be able to know if you've been injured. 

Myth #3: Kids Don't Get Whiplash
Kids aren’t injured in whiplash. Maybe you thought little Johnny wasn't injured in the car seat, or since kids tumble around when they play, they couldn't possibly be injured. This couldn't be further from the truth. Infants and young children have very undeveloped spines with much less muscle strength. This makes their ability to resist the forces lessened. You have to also consider the size of the head compared to the size of the neck. This difference is greatest in young children. When infants are injured they can show behavioral changes such as irritability and disrupted sleep patterns or nursing difficulties.

Myth #4: X-rays Always Show Whiplash Injury
If you've had a severe whiplash, you may have taken a trip to the emergency room where an x-ray was taken. If you're like many patients, the x-ray was read as normal. The problem is the x-ray you received, probably taken with you in one position, does not show injuries to the soft tissues such as ligaments and muscles, unless massive injury has occurred. Only if motion x-rays are obtained, can you see how the joints are moving in the neck. Since the injury is a sprain of ligaments, and x-rays show only bones-they do not give the complete picture.

Unfortunately for some whiplash victims
neck trauma will lead to arthritis of the spine

Don't be too alarmed, but concern is helpful.

People hear the word arthritis and think of rheumatoid arthritis and crippling joints.

What I'm talking about is osteoarthritis, or degenerative joint disease. 

Osteoarthritis is one of most common diseases afflicting humans, more common in people over age 55 than any other health condition.

Billions of dollars are spent each year on drug treatments that really do nothing to prevent degeneration of the joint.

In fact, some scientists suggest that injuries do not heal properly when patients take NSAIDs such as ibuprofen. 

This is in addition to the known rare side effects such as stomach bleeding, liver, and kidney problems.

    Arthritis occurs in spinal joints that have damage to the ligaments and disks. As degeneration progresses, the mobility of vertebrae are altered. The stretched out ligaments will allow excessive motion and after injury, scar tissue develops. Over months and years, the scar tissue contracts and the disk size decreases. This will make the mobility of the neck abnormally low (more stiffness). This scar is also not as elastic as tissue that has not been injured. Persons who have pre-existing degeneration and arthritis at the time of impact, will suffer whiplash more frequently (lower threshold) and with more severity when it does occur. Since older adults are most likely to have this type of degeneration arthritis, they are put more at risk in whiplash accidents.

_________________________________________  

    Hello.

    My name is Dr. Cilea, D.C.,


    One of the mainstays of medical treatment of whiplash is to immobilize the neck with a collar. Except in rare cases, it is something that I never use in practice.

    While good in theory, it just weakens the muscles and fails to preserve movement, which the neck needs to heal properly. 

    I am glad to see that many medical physicians are using them less and less, and promoting more active rehabilitation. Neck collars/braces are needed for fractures or dislocations, but strains/sprains are generally made worse with this treatment.

    I have spent years studying the mechanics of neck problems, and effective treatments, and I've successfully cared for many patients over the years, getting their quality of life back and reducing pain. But I'm still surprised by how many still take the medical approach-hot packs, collars and pain pills.

    Treatments ideally should be mechanical, not chemical, and not just cover up or mask the pain.

    I'm not saying my approach is scientifically proven to be the best...or that I have all the answers.

    But I do think there is a general lack of appreciation for the seriousness of these types of neck injuries, and that people are often convinced by insurance companies and others, that no injury occurred.

    This can sometimes result in no examination, no professional treatment, or the patient self medicates with various over-the-counter drugs or maybe you were required to see a "gatekeeper," that didn't appreciate the complexities of whiplash injuries and never referred you to the appropriate doctor.

    In any case, I'm not surprised if you're going through a health care maze-most of my patients do so.

    Not seeking proper treatment when indicated can lead to more problems down the road.

I WANT TO OFFER YOU ANOTHER WAY, AN APPROACH

BASED ON EVIDENCE AND THE MECHANICS OF THE BODY.

The most crucial point I want you to get from this Guide, is that it may be important for you to get a Comprehensive Whiplash Examination to determine if you've been injured.
Call our office at 732-719-8148 and schedule a FREE* consultation.



Don’t forget…it is important for your treatments to make your spine more flexible where it is not, and restrict movements where it is unstable.

Conventional MRIs immediately after the accident will not show these mobility changes and X-ray cannot show the disks of the spine. Only tests of mobility can show you where mechanical treatment is needed.

I strongly recommend that you have me evaluate your condition. There is ABSOLUTELY NO OBLIGATION for care. It is merely a chance to document any injuries and to find out if you need additional treatment.

*The free consultation offered here does not apply to patients who participate in a Federal program such as, but not limited to, Medicare.

Health Update: Low Back Pain

What Causes Low Back Pain?

I can’t tell you how many times a day this question is asked! Obviously, there are MANY causes of low back pain (LBP) but you may be surprised about some of the following:

1. Trauma: Let’s start with the easy one – falling down, over lifting, twisting, pushing, pulling, bending over, sporting activities, work activities, sex, sneezing, raking, shoveling……OK, I could fill the page with possible injuries that can cause LBP so I’ll stop here. We’ve all sprained an ankle or a finger and based on statistics, most of us have also suffered from LBP as a result of a single event injury. These types of injuries include sprains (ligament injuries), strains (muscle/tendon injuries), disk injuries (tears, ruptures), and include many possible findings including subluxations (areas where vertebrae stop working well together or have shifted from their proper location). When there is radiating leg pain that travels below the knee, a pinched nerve may be involved, often caused by disk pressure or a combination of things.

2. Insidious or, “I don’t know what I did!”: Believe it or not, this is probably the most common cause of LBP we see as the majority of people can’t recall anything as causing their LBP. The “cause” in these cases often stems from a series of events that accumulate to a point where pain/swelling occurs, often hours or even days after several over-use activities may have been performed. Thus, more investigation into the activities that preceded the onset of LBP needs to be considered. We can usually uncover several possible culprits but we can’t ever be 100% certain that we’re right about the cause(s). In some cases, people will wake up with LBP, while others don’t have it until they’ve been active.

3. Biomechanical causes: This category might be involved in the 2nd category discussed but deserves a separate discussion because of the many possibilities. First, we are 2 legged / not 4 legged animals and that by itself puts a lot of pressure on our lower backs. In fact, 2/3rds of our weight is carried from the waist up and as a result, just bending over for a pencil can, “…throw the back out.” For example, a 180# person lifts about 120# of body weight just by bending forward! Another common problem is one leg being shorter than the other. It has been reported that 87% of us have unequal leg lengths and when the shift measures 7-9mm (about ¼ inch), the probability of back, hip, or sciatica pain is 2x greater. When the difference is 16mm, there is an 8x greater chance of having back trouble. The “fix” in this case can be quite simple as using heel lifts in the short leg shoe. Flat feet and ankle pronation can also create an unstable pelvis and can contribute to LBP so foot orthotics can also be very helpful in the management of LBP. Obesity (body mass index >30) has been identified as a risk factor for a lot of conditions including LBP and a weight management program can be highly effective.

4. Dangerous loading activities: It has long been known that jobs where 50-100# is lifted or carried, especially if frequently handled, have an increase in occurrence of LBP. Using proper lifting methods is very important in jobs like this!

Weekly Health Update

Courtesy of:
Advanced Wellness
www.newjerseypainmanagement.net
www.advanced-wellness.net
(732) 719-8148

Mental Attitude: Social Class And Depression Treatment.  Current treatments for depression don't help working-class and poor patients as much as they help middle-class patients improve their ability to function at work. Depression has a profound impact on an individual's productivity. That's particularly true for those in lower social classes and with low levels of education.
Psychiatric Services, Nov 2010

Health Alert: Kicking It All!  The American Cancer Society's annual Great American Smokeout took place on November 18. Cigarette sales have declined for decades, but smokeless tobacco sales have grown 7% annually over the last four years. Using smokeless tobacco products is not a safe way to quit or safer than smoking. The use of these products just shifts the risk of cancer to the mouth, head, and neck. Use of cigarettes and smokeless tobacco is the leading cause of cancers of the head and neck, which can result in partial or full removal of the lip, tongue, cheek, and portions of the throat, including the voice box. Smokeless tobacco users run the same risks of heart disease, high blood pressure, and addiction as cigarette users, but an even greater risk of oral cancer.
American Academy of Otolaryngology - Head and Neck Surgery, November 2010

Diet: Red Meat And Cancer Risk.  A possible link between red meat and esophageal cancer; and a link between DiMelQx and cancer in the stomach close to the esophageal opening was found. DiMelQx is a compound, a type of heterocyclic amine (HCA) found in red meat after it is cooked at high temperature. Those who eat red and processed meats have a 79% higher risk of developing esophageal cancer.
American Journal of Gastroenterology, October 2010

Exercise: Flat Abs?  Here are a few exercises and tips to help flatten your abs. Improve Your Posture. Slouch and your stomach pooches. For better posture while standing, align your ears over your shoulders, shoulders over hips, hips over knees, and knees over ankles. Keep the fronts of the shoulders open like a shirt on a hanger, instead of a shirt on a peg and draw your navel to your spine. Try the Canoe Twist. Sit upright, interlace your fingers over your stomach to create a solid grip. Exhale, and sweep the interlocked hands, arms, shoulders, and chest to the left, as if "rowing a canoe." Inhale and return to the starting position. Exhale and perform the movement to the right. Alternate for 20 repetitions.
WebMD Feature: Tips for Flat Abs

Chiropractic: Happy Backs!  This is a satisfaction survey of chiropractic care within a military hospital, from a Canadian Armed Forces Pilot Project. Chronic low back pain accounted for most presentations to the chiropractic clinic. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services.
Military Medicine, June 2006

Wellness/Prevention: Tea And Your Heart. Drinking three cups of tea per day was associated with a decrease of 11% in the incidence of myocardial infarction, or heart attack.
American Journal of Epidemiology, 2001

"I can accept failure, but I can't accept not trying."

~ Michael Jordan

Health Update: Fibromyalgia

Fibromyalgia: How Do I know I Have It?

“I wake up every morning with this stiff, sore lower back pain. When I roll over to get out of bed, I feel like a log and almost have to fall out of bed. When I finally get to my feet, I’m all bent over and can’t stand upright for what seems like forever! It takes a couple of hours before it gradually loosens up enough so I don’t have to shuffle with each step. I was told by a friend that I might have something called fibromyalgia and should ask my chiropractor. What do you think?”

To answer this inquiry, let’s first define fibromyalgia (FM) so that we can compare the two properly. FM is a condition that is diagnosed basically by eliminating all other possible causes, including inflammatory joint conditions, by running various blood tests such as an arthritic profile. This usually includes tests for rheumatoid arthritis, gout, lupus, and infection. A Lymes disease test is often included as that condition can often manifest as a chronic back condition from any cause. There are essentially no blood tests, x-ray or other imaging tests, or neurological tests that can specifically diagnose FM. It is when all these tests come back negative, that the diagnosis of FM is then entertained. The history is probably the most important aspect of the clinical encounter that helps in the diagnosis of FM. Most of these patients will report that the onset is gradual, often present for years. There is usually no specific cause though there are specific conditions (such as irritable bowel syndrome, trauma, rheumatoid arthritis and others) that can result in “secondary fibromyalgia” where the cause is well known. The big differentiating historical feature is the presence of widespread, whole body pain – NOT just low back pain, as reported in the first paragraph above. In FM, there is often pain in the legs, arms, torso, back, neck and these people basically, “…hurt all over.” Typically there is no radiating pain down the leg or arm that follows a specific nerve pathway and no exam findings of neurological deficits. Another unique feature of FM includes sleep dysfunction. In many cases, sleep interruptions occur 2, 3 or more times a night, often with difficulty in returning back to sleep. The quality of pain is often described as numbness, tingling, burning, achy, deep, boring, and most importantly generalized in location (all over the body). The intensity is usually reported as high (>6/10 pain scale scores). The past history usually includes multiple visits to many different types of doctors and many attempts at different medications is common – most of which do not help significantly.

Even with these unique historical features that are consistent with the diagnosis of FM, it is still necessary to “rule out” other conditions by running tests as previously described. This is especially important when FM is secondary to other conditions as FM can get “lost” in the shuffle, overshadowed by the other condition.

Treatment for FM includes many of the same methods for treating other musculoskeletal conditions. Spinal manipulation, soft tissue release techniques (massage therapy, trigger point therapy, myofascial release), and various forms of physical therapy (low level laser therapy – LLLT, ultrasound, interferential electrical current – IFC, and pulsed magnetic therapy can also improve function, reduce pain, and reduce the need for medications. Cognitive therapy, addressing psychosocial issues, can also be very effective. One of the most important treatment approaches is exercise. This has been consistently described as being an important form of care for the FM patient. In addition, dietary management using an anti-inflammatory diet (gluten free diet) and supplementation (a multiple vitamin, calcium/magnesium, omega 3 fatty acids, Vit. D, and CoQ10) can also be very effective.

We recognize the importance of including chiropractic in your treatment and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Health Update: Low Back Pain

Low Back Pain
and Bone Density

So, what does bone density have to do with low back pain? The relationship between bone density and back pain is quite intimate. In fact, when the degree of bone density declines to the point of fracture, back pain becomes very real. The classic condition and cause of spinal pain associated with the loss of bone density is compression fracture.

Compression fractures occur when the strength of the bone decreases to a point where minor trauma and sometimes, no trauma whatsoever can result in fracture. Compression fractures affect the vertebral body (front of the spine) most often in the upper lumbar or lower thoracic spine but the pain associated with these types of fractures frequently radiates into the low back and pelvic region. In the elderly osteoporotic spine, these types of fractures usually do not result in spinal cord injury or nerve damage but this is quite the opposite when compression fractures occur in younger, normal bone density individuals. This is because when the bone is dense (or normal), the vertebral body basically explodes or bursts shifting some of the bony fragments back into the spinal canal where the spinal cord is located. When bone density decreases, there is no bursting of fragments – only collapse, resulting in pain but no neurological damage. Besides pain, another problem with compression fractures is that the once upright or vertical spine is now bent and angles forward shifting the patient’s weight to the front. This shift places yet more pressure on both the fractured vertebra and the surrounding vertebra which increases the risk of fracture to the surrounding adjacent vertebra. Therefore, multiple compression fractures are not uncommon when brittle bones occur from osteoporosis.

So who is more at risk for osteoporosis? The usual predictors include age, (older than 65), gender (female), race (Asian or Caucasian), low body weight, and previous fracture. Others include smoking, previous use of corticosteroids, a family history of fracture, excessive alcohol use, and rheumatoid arthritis. Additionally, vitamin D deficiency, thyroid or parathyroid increased function, and celiac disease (gluten intolerance) as well as poor balance (repeated falls), muscle weakness and a DEXA (dual-energy X-ray absorptiometry) T-score of -1.1 to -2.4 (osteopenia) or -2.5 or greater (osteoporosis) are also important predictors of brittle bone disease or osteoporosis. To best determine your risk using these factors, go to FRAX (www.sheffield.ac.uk/frax) developed by the World Health Organization (WHO) to determine your 10-year fracture probability (do not just use of the T-score on the DEXA scan).

Video: Bone Density Screening

From a treatment standpoint, it depends on the age of the patient, the degree of osteoporosis, and whether fracture has already occurred. In the younger, osteopenic person (that is, no fractures have occurred yet but bone density is low), non-medication approaches such as weight bearing exercise, no smoking, calcium / vitamin D supplementation, and minimize the other risk factors described above may be the proper choice. For others already with fracture, medication (bisphosphonates such as Actonel, Boniva, & Fosamax) may be appropriate. Further, injecting a cement into the bone (called kyphoplasty) may be appropriate for some.

We realize you have a choice in healthcare providers. If you, a friend or a family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome:
Why Braces?

For those of you who have had Carpal Tunnel Syndrome, you probably know all about braces. These are devices worn on the wrist that stop you from bending the wrist up or down. They may be worn anytime of the day if they don’t interfere too much with one’s current activity but are especially worn at night. One might think it would be more important to wear these during day when we are active and moving our fingers and hands a lot as we go about our normal work or play activities – not at night when we’re basically just laying there doing nothing but sleeping, right? Wrong! It’s more important to wear these at night. This is because we cannot control our hand/wrist position at night as we tend to curl up in a ball when we sleep and the wrist gets cocked up or down, often to the end point of the range. So, why is this so bad? To answer that question, let’s look at the chart below on the left.

      

In the chart (above left), you are looking at a cross section of the wrist through the carpal tunnel. This illustrates the many structures that are inside the tunnel making it very compact or tight. Notice the small white circles in the middle of the tunnel. Those are the tendons that pass through the tunnel – there are 9 of those and they attach the muscles in our forearms (on the palm side) to our fingers so we can shake someone’s hand or carry a suitcase (grip). Just to the left of center, on top of all the tendons sits the median nerve, which is just below the “roof” of the tunnel (the transverse carpal ligament). Now, normally, the pressure inside the carpal tunnel will approximately double when we bend our wrist, putting more pressure on the nerve and pushing it into the roof (ligament), which creates the numbness and/or weakness in our grip. But in the CTS sufferer, there is already more pressure in the tunnel due to the swollen tendons so when the wrist is flexed or extended, the pressure goes up much more the twice – more like 6 times more pressure – hence, more symptoms. So, if we’re sleeping with our wrist bent either way, the pressure pushing the nerve against the roof is a lot more than normal – 6x more! Now, can you see the reason for the “night splint?” It is VERY effective in keeping the wrist straight or “in a neutral position,” which is needed to allow the nerve to NOT be pinched so it can heal.

Video: Carpal Tunnel Syndrome

Regarding braces, there are MANY different kinds of braces available and deciding which one to use is no easy task, not to mention the fact that they come in different sizes! When you are treated for CTS at this office, we will fit you with the proper size brace, if it’s necessary. We realize you have a choice in health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

We hope this information is useful to you or someone you care about. For more information, visit us at www.newjerseypainmanagement.net or call us directly 732.719.8148 for a free consultation.