Traumatic Brain Injury Centers » chronic pain and TBI

Going to A Specialist

admin — Sun, 01 Nov 2009 18:48:06 +0000

Medical Specialist Appointment and You

By Amy Price PhD
You have been sent to a specialist…what next? First of all sort out what you expect to happen as a result of this visit. What are your goals? Make sure they are realistic. If this was easy your primary care doctor could probably fix it.

Before your visit explain what records you have and ask which of these they would like you to copy and pre-send. Usually you can get copies of MRIs or other diagnostic tests on CD. They are easier to carry with you or send than bulky films. If you choose to send your diagnostic results and films call and confirm they arrived. Get a cost for a cash price unless you have medical insurance which will cover your visit so that you will know your costs and if you can absorb them.

If you are making a distance appointment insist on a phone consultation so you will know if your expectations are viable. If the staff you speak with don’t have information about a certain area make arrangements to call back when it is available. This way all the preliminary material is out of the way and your appt can focus on what is most important. Explain you are travelling from out of town and are in pain and request the best time of day to be seen promptly. Emergencies or office back ups can still happen but this step minimizes the possibility.

Write down what you consider to be the most important things you want covered in your visit. The reason you may want to do this is because chronic pain and injury can cause us to be sidetracked by emotion. You may get a compassionate response but it may eat away at the time available.

This is the place to get your MRI and other diagnostic tests explained. The doctor that ordered the test is the one who needs to explain it. Get an advance copy of the report and ask about what you don’t understand. We get emails every day from people who want us to translate the MRI or other diagnostics. We cannot do this because the MRI is only part of the equipment needed for a diagnosis. It is your job to make sure you understand your diagnosis before you leave the doctor’s office.

It is helpful to plan a nice dinner out or a treat for yourself for afterwards and if you can, take someone with you who will remember what the Doctor says. The reason for this is it will be difficult for you to reconcile yourself to a 40 minute appt when the injury has taken over your life 24/7. Even though your appointment time may be quite generous, logic and rational thought cannot always be counted on, when you just want it fixed.

Now relax and trust the specialist you have chosen!

TBI and Talking To The Doctor

admin — Sun, 01 Nov 2009 17:51:31 +0000

Dr and TBI

How you communicate with your doctor will often determine the quality of care you recieve and that your legal rights are protected. Here is a practical guide from Michael Kaplen a lawyer at BrainLaw. For other survival skills to help you through a doctor’s appointment this post is good reading

When you schedule your first appointment, tell your doctor that you will require extra time. Tell him that you need at least an additional 20 minutes (or more if you need it) for your appointment. The challenge here is to not feel rushed, as when you are stressed your cognition erodes.
If distractions bother you, arrange with the doctor’s office (when you make the appointment) for a quiet place to wait, such as a quiet exam room. If this is not possible, ask for somebody to come and get you in the foyer or your car.
Get to your appointment at least 15 minutes ahead of time, so you can collect your thoughts, become settled and unwind from the drive.
Write down everything you want to tell or ask your doctor. Cross each item off the list after you have covered it. Write down instructions that your doctor gives. Recap at the end of each issue, to make sure you understand.
Ask your doctor to write down your diagnosis. Ask for a written explanation in layman’s language. Ask for a written description of the preferred treatment and goals, with an estimate of the costs and the expected time frame.
Trust your instincts. If you don’t think that a diagnosis is valid, or if you think it minimizes your problems, remember this: YOU ARE PROBABLY RIGHT. Remember, you are the “expert” about you.
Always ask your doctor about the contraindications when he prescribes new medications. Additionally, have the doctor provide you with a written list. Take charge of knowing everything about the drugs you take.
Ask your doctor to make a notation in your file stating that you should receive a copy of all reports and tests as soon as they are received by the office.
Never sign a blank release form. Make sure all authorization forms are completely filled out. Read what you’re signing. Make sure the release has ONLY the names on it that YOU want. Get a copy of each and every release form/letter you sign.

Does Your Neck Really Matter?

empower2go — Thu, 21 May 2009 16:07:25 +0000

According to a report released back in 1993, the total costs for motor vehicle accidents in the US were $333 billion in 1988. WHO states “On average in the industrialized countries, and also in many developing countries, one hospital bed in ten is occupied by an accident victim.”

Traffic accidents are a major cause of severe injuries in most countries. Studies involving live humans have demonstrate that a motor vehicle accident of as little as 5 mph can induce cervical (neck) injury. However, other studies show cars can often withstand crashes of 10 mph or more without sustaining damage. Explanation? A vehicle is solid a human is not. A good comparison would be to drop an apple and a metal toy car from a flight of stairs. Will the metal car have bruises or go bad because of this experience?

Many studies have found a significant number of individuals to be symptomatic for many months and even years after a motor vehicle accident. In one such study, 75 percent of individuals remained symptomatic 6 months after the accident. If you have pain after 3 months there is a 78% chance of still having pain after two years. Another study shows when disabling levels of pain are still present after one month there is an almost 100% chance this pain will be present at six months. Another study, published in the European Spine Journal, found that during the period of time between the first and second years following a motor vehicle accident over 20 percent of individuals had symptoms worsen.

In parts of Canada, individuals who could suffer a life time of pain with whiplash grade two are allowed less than 3000 dollars to cover the costs of the injury over a lifetime! Is this justice?

According to the National Safety Council (NSA), there are more than 12 million motor vehicle accidents annually including more than 20 million vehicles. This results in over 5 million non fatal accidents annually of which approximately 2 million are disabling injuries including approximately 1 million work-related auto disabling injuries. A 1990 National Highway Traffic Safety Administration (NHTSA) study reported 28 percent of occupants in motor vehicle accidents incur minor to moderate injury while 6 percent incur severe to fatal injuries. Vehicle crashes are the leading cause of death for individuals under 34 years of age according to NHSA Forensic Epidemiologist states in an interview with Anderson Cooper ” You’re eventually being judged by what your car looks like, not by what your doctor says. Or by what the impact of a particular crash has had or an injury has had on your life. That’s not fair. It’s not right. It’s fraud “(cited in Anderson 360 click here and scroll to insurance surprises)

The US Department of Transportation estimates that the typical driver will have a near automobile accident one to two times per month and all will be in a collision of some type on average of every 6 years.

Industry insiders say 80 to 90 percent of accident victims don’t fight. They take what the insurance company offers. A

In an 18-month investigation across the country, CNN found that if you are injured in a minor accident, chances are high the two companies would challenge your medical claim, offering you barely a fraction of your expenses. They would do it by forcing people into court, dragging out court cases for years and by convincing the public it was all designed to fight growing fraud in the car accident business. The three Ds Delay, Deny, Defend are the fingers pointing back to insurance company rhetoric.

According to Nevada Insurance Law Professor, Jeff Stempel, the new get tough strategy is adding up to billions in profit for the insurance companies and little, if anything, for the public. We can see that policyholders individually are getting hurt by being dragged into court on fender bender claims. And yet we don’t see collateral benefit in the form of reduced premiums, even for the other policyholders. So, I think now we can say to continue this kind of program is, in my view, institutionalized bad faith.

For an interesting look at what both sides are saying click here and scroll quite a ways down. Here is an older but still informative picture of international safety and fatality statistics

Technorati Profile

Brain pills? Piracetam Shows Promise

empower2go — Sun, 17 May 2009 15:10:00 +0000

By Amy Price PhD

One significant problem in traumatic brain injury is that secondary cell death occurs when the injured cells block the path for the other cells to get oxygen. One product that is used extensively in other countries but not the USA is Piracetam. It is interesting that research in pub med is showing promise for efficacy in human trials. There have been rat, rabbit, and fruit fly trials available for years but there is a lot that can differ between these and seeing actual human benefit.

I used this product to good effect many years ago without side effects and am encouraged to see studies supporting its effectiveness. The alternatives available to many people with TBI as far as psychotropic meds to restore some measure of function are concerned can sometimes have unexpected reactions or be of no effect.

Piracetam has been shown to alter the physical properties of the plasma membrane by increasing its fluidity and by protecting the cell against hypoxia. It increases red cell deformability and normalizes aggregation of hyperactive platelets according to Winnicka K, Tomasiak M, Bielawska A (2005) They are saying treatment with piracetam improves learning, memory, brain metabolism, and capacity by the interaction of this molecule with the membrane phospholipids to restore membrane fluidity . The graph below is from smart publications

The positive therapeutic effects of piracetam on cognitive (memory, attention, executive functions) and motor (coordination) functions as well as the speed of cognitive and motor performance were demonstrated in a study done by Zh Nevrol Psikhiatr Im S S Korsakova. 2008 for adolescents who sustained TBI’s.

Its efficacy is documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia according to Winblad B (2005).

The results of a meta-analysis Waegemans T, Wilsher CR, Danniau A, Ferris SH, Kurz A, Winblad B. (2002) demonstrate a difference between those individuals treated with piracetam and those given placebo, both as significant odds ratio and as a favourable number needed to treat. While there may be problems in meta-analyses and the interpretation of the statistical results, the results of this analysis provide compelling evidence for the global efficacy of piracetam in a diverse group of older subjects with cognitive impairment.

This post does not in any way constitute any medical advice or recommendation. These posts are educational only to share with others some of the direction research is taking. Any medical information gained online should be supported and endorsed by your own doctor.

References:

[The consequences of closed traumatic brain injury and piracetam efficacy in their treatment in adolescents]
Zavadenko NN, Guzilova LS.
Zh Nevrol Psikhiatr Im S S Korsakova. 2008;108(3):43-8. Russian.
PMID: 18427539 [PubMed - indexed for MEDLINE]
Related Articles

Piracetam–an old drug with novel properties?
Winnicka K, Tomasiak M, Bielawska A.
Acta Pol Pharm. 2005 Sep-Oct;62(5):405-9. Review.
PMID: 16459490 [PubMed - indexed for MEDLINE]
Related Articles

Piracetam: a review of pharmacological properties and clinical uses.
Winblad B.
CNS Drug Rev. 2005 Summer;11(2):169-82. Review.
PMID: 16007238 [PubMed - indexed for MEDLINE]
Related Articles

Clinical efficacy of piracetam in cognitive impairment: a meta-analysis.
Waegemans T, Wilsher CR, Danniau A, Ferris SH, Kurz A, Winblad B.
Dement Geriatr Cogn Disord. 2002;13(4):217-24.
PMID: 12006732 [PubMed - indexed for MEDLINE]
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Fibromyalgia and Brain Fog

empower2go — Mon, 08 Dec 2008 18:38:00 +0000

By Amy Price PhD

Photo courtesy of (Earthopod, 2009 )depicting pain areas in fibromyalgia.
Fibromyalgia (FMS) comes from three words, the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Another way of saying this is muscle knots tied by painful ropes. This condition is not amenable to the medical model so clinicians fell back on the old standby “It’s all in your head” implying the problem is generated by emotional instability rather than specific biological origins.

Fibromyalgia was tagged a syndrome (Fibromyalgia, com, 2008). Patients got mad. They refused to be stonewalled by ignorance or marginalized. Instead they formed strong lobby groups and started campaigning for funding and action (Fibromyalgia network, 2008). This resulted in research getting funded, better treatment options and social change. (CRISP lists 695 NIH funded projects since 2000)

Researchers are finding that FMS could be a disorder of the central processing system resulting in neuroendocrinal and neurotransmitter dysregulation (Bennett, 2008). The FMS patient experiences pain amplification because their pain sensors are slow to recognize pain but the pain they feel spreads across a wider area, lasts longer and is more severe than in a person without FMS ( Staud et al, 2008). Increasingly scientific studies demonstrate physiological abnormalities in the FMS patient including increased levels of substance P in the spinal cord (Helle et al ,1998), low levels of blood flow to the thalamus region of the brain (Kwiatek et, 2000), HPA axis hypo function (McBeth et al, 2007) low levels of serotonin and tryptophan plus abnormalities in cytokine function (Crofford, 1998). Abnormalities like these spell pain. This leads to losses in sleep quality, cognition and coordination, and to increased drug use susceptibility.

New research strengthened by the advent of physical evidence such as SPECT, PET, FMRI and QEEG is confirming fibromyalgia is a biological problem that may cause psychological distress rather than a psychosomatic hysteria pioneered by women as appears to be insinuated by Mcdermid et al, (2008)

New hope may come for some FMS sufferers in the discovery of the brain’s ability to regenerate dendrites a process known as neuroplasticity (Toates, 2006). It is possible that targeted brain and body training may alleviate the severity of chronic pain and cognitive dysfunction associated with FMS (Leurding et al, 2008)

Leurding et al (2008) demonstrates that in fibromyalgia both white and grey brain matter is compromised. Brain imaging studies in FMS patients point to alterations in regional cerebral blood flow (Mountz et al., 1995), in cerebral processing of sensory and nociceptive stimuli (Gracely et al., 2002; Cook et al., 2004) also in dopamine response to pain (Wood et al., 2007). Leurding (ibid) used these imaging studies as a foundation for neuropsychological tests to show that the changed state of brain matter leads to “brain fog” rather than psycho-social maladaption, drug induced confusion, or loss of sleep as primary factors.

Patients offered cognitive rehabilitation tools may improve mental function when these tools are offered before significant white and grey matter dysfunction appears. Neuroplasticity can still be of benefit after damage occurs but progress is slower (Saczynski, 2004)
Brain areas responsible for proprioception damaged in fibromyalgia may be modified by body awareness training according to a pilot study carried out by (Kendall et al, 2000). Targeted body awareness physiotherapy programs led to patient improvement in pain levels and functional capacity even when patients were retested eighteen months after treatment (Kendall et al 2000).
Kendall et al (2000) were dismissive of positive effects realized by stress reduction, hypnosis or neurofeedback training but other researchers such as Meuler et al, 2001 found these treatments were beneficial. FMS is not one size fits all (Bennett, 2006).

A trial of cognitive rehabilitation synergised with neurofeedback and cognitive rehabilitation is underway to determine how combining passive and active therapy can multiply positive effects. Participants will be tested at timely increments and their ongoing level of progress studied.

Another option is to decrease pain to restore function. This is where regenerative medicine can help with therapies like adult stem cell treatment and prolotherapy. Another option is a treatment called IMS where overly sensitized nerve points are reset using a medical system similar to acupuncture.

Bennett, R. (2006) Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries Oregon Health Sciences University, National Fibromyalgia Association. A non-profit 501 (C)(3) organization 2121 S. Towne Centre, Suite 300, Anaheim, CA 92806 714.921.0150 Copyright ©1997-2008 National Fibromyalgia Association (NFA) http://www.fmaware.org/site/PageServer?pagename=fibromyalgia_science (accessed 12/01/2008

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