You’re in Pain and You want Relief Naturally

You’re in pain, and ibuprofen just won’t cut it. Nonsteroidal anti-inflammatory drugs, or NSAIDs, don’t agree with your stomach, and you’re wary of stronger meds.

Fortunately, you have alternatives — natural ones. From herbs that attack inflammation to techniques that leverage the brain’s remarkable healing powers, nature offers many treatments for conditions such as arthritis, fibromyalgia, and even muscle strains.

Here are eight natural remedies that may enhance or replace conventional antidotes, and leave you happier, healthier, and pain free.

Capsaicin: For Arthritis, Shingles, or Neuropathy

What the science says: An active component of chile pepper, capsaicin temporarily desensitizes pain-prone skin nerve receptors called C-fibers; soreness is diminished for 3 to 5 weeks while they regain sensation. Nearly 40 percent of arthritis patients reduced their pain by half after using a topical capsaicin cream for a month, and 60 percent of neuropathy patients achieved the same after 2 months, according to a University of Oxford study. Patients at the New England Center for Headache decreased their migraine and cluster headache intensity after applying capsaicin cream inside their nostrils.

How to try it: Capsaicin ointments and creams are sold in pharmacies and health stores. For arthritis or neuropathy, try 0.025 percent or 0.075 percent capsaicin cream one to four times daily; best results can take up to 2 weeks, says Philip Gregory, PharmD, a professor at Creighton University and editor of the Natural Medicines Comprehensive Database. But research on capsaicin and headaches remains limited — and don’t expect stronger versions anytime soon: “Current formulations are better suited for more acute problems, like a sore muscle or an arthritis flare-up, than everyday pain and stiffness,” Gregory says.

InflaThera or Zyflamend: For Arthritis

What the science says: Both supplement brands contain ginger, turmeric, and holy basil, all of which have anti-inflammatory properties. Turmeric (a curry ingredient) may be the best: A component, curcumin, eases inflammatory conditions like rheumatoid arthritis and psoriasis, according to the Methodist Research Institute in Indianapolis. Researchers are now testing Zyflamend in RA patients, but some experts are already sold: “Each herb has its own scientific database of evidence,” says James Dillard, MD, author of “The Chronic Pain Solution.”

How to try it: ProThera, InflaThera’s maker, will only sell to health care professionals, so your doctor has to order it for you; that said, it’s reportedly stronger (and slightly cheaper) than Zyflamend. InflaThera’s suggested dosage is twice daily with food. For the more readily accessible Zyflamend, take one capsule two or three times daily, but avoid it near bedtime — each pill contains 10 mg of caffeine (another version, Zyflamend PM, is reportedly less stimulating). Save money and try curcumin to start: Taking 500 mg four times daily, along with fish oil and a diet low in animal fat, can ease arthritis, says Jane Guiltinan, ND, immediate past president of the American Association of Naturopathic Physicians.

Arnica: For Acute Injury or Post Surgery Swelling

What the science says: This herb comes from a European flower; although its healing mechanism is still unknown, it does have natural anti-inflammatory properties. Taking oral homeopathic arnica after a tonsillectomy decreases pain, say British researchers, and German doctors found that it reduces surgery-related knee swelling.

How to try it: Use homeopathic arnica as an adjunct to ice, herbs, or conventional pain meds, suggests Guiltinan. Rub arnica ointment on bruises or strained muscles, or take it in the form of three lactose pellets under the tongue up to six times per day. Boiron is among the most reputable arnica manufacturers.

Aquamin: For Osteoarthritis

What the science says: This red seaweed supplement is rich in calcium and magnesium. A preliminary clinical study showed that the ingredients may reduce joint inflammation or even help build bone, says David O’Leary of Marigot, Aquamin’s Irish manufacturer. In a study of 70 volunteers published in Nutrition Journal, Aquamin users reduced arthritis pain by 20 percent in a month, and had less stiffness than patients taking a placebo.

How to try it: Marigot recommends 2,400 mg a day (two capsules) of Aquamin in tablet form, sold domestically in products such as Aquamin Sea Minerals and Cal-Sea-Um. A 60-pill jar of Swanson Vegetarian Aquamin Sea Minerals costs about $6 at swansonvitamins.com.

SAM-e (S adenosylmethionine): For Osteoarthritis

What the science says: SAM-e is made from a naturally occurring amino acid and sold as capsules. Doctors aren’t entirely sure why it tamps down pain, but it reduces inflammation and may increase the feel-good brain chemicals serotonin and dopamine.

Studies by the University of Maryland School of Nursing and the University of California, Irvine, showed that SAM-e was as effective as some NSAIDs in easing osteoarthritis aches; the California researchers found that SAM-e quashed pain by 50 percent after 2 months, though it took a few weeks to kick in. SAM-e produced no cardiovascular risks and fewer stomach problems than the conventional meds.

How to try it: Costco and CVS both carry it; a month’s supply costs $30 to $60. Guiltinan prescribes 400 to 1,600 mg daily, often with turmeric or fish oil. SAM-e can interact with other meds, especially MAO-inhibitor antidepressants, so it’s vital to talk with your doctor before taking it (and avoid SAM-e entirely if you have bipolar disorder).

Also, inspect the packaging before buying, advises Gregory: Make sure the product carries a USP or GMP quality seal, contains a stabilizing salt, has a far-off expiration date, and comes in foil blister packs — SAM-e can degrade rapidly in direct light.

Fish oil: For Joint Pain from Arthritis or Autoimmune Disorders

What the science says: Digested fish oil breaks down into hormonelike chemicals called prostaglandins, which reduce inflammation. In one study, about 40 percent of rheumatoid arthritis patients who took cod-liver oil every day were able to cut their NSAID use by more than a third, Scottish scientists recently reported. People with neck and back pain have fared even better: After about 10 weeks, nearly two-thirds were able to stop taking NSAIDs altogether in a University of Pittsburgh study.

How to try it: Taking 1,000 mg is proven to help your heart, but you should up the dose for pain. For osteoarthritis, try 2,000 to 4,000 mg daily; for rheumatoid arthritis and autoimmune diseases associated with joint pain (such as lupus), consider a much higher dose of upwards of 8,000 mg daily — but ask your doctor about such a large amount first, says Tanya Edwards, MD, medical director at the Cleveland Clinic’s Center for Integrative Medicine. (The same rule applies if you take BP or heart meds, as omega-3s can thin the blood.) Read the nutrition label carefully: The dosage refers to the amount of omega-3s in a capsule, not other ingredients. Nordic Naturals (nordicnaturals.com) and Carlson (carlsonlabs.com) are both reputable brands.

Methylsulfonyl-Methane (MSM): For Osteoarthritis

What the science says: MSM is derived from sulfur and may prevent joint and cartilage degeneration, say University of California, San Diego, scientists. People with osteoarthritis of the knee who took MSM had 25 percent less pain and 30 percent better physical function at the end of a 3-month trial at Southwest College of Naturopathic Medicine and Health Sciences. Indian researchers also found that MSM worked better when combined with glucosamine.

How to try it: Start with 1.5 to 3 g once daily and increase to 3 g twice daily for more severe pain, suggests Leslie Axelrod, ND, a professor of clinical sciences at Southwest. Patients in the Indian trial improved on dosages as low as 500 mg three times daily. Vendors of OptiMSM, the brand tested in Axelrod’s trial, can be found at optimsm.com.

Counting Out Loud: For Brief “Needle Stick” Pain

What the science says: Patients who counted backward from 100 out loud during an injection experienced and recalled less pain, according to a recent Japanese study. None of the 46 patients who counted complained afterward, and only one of them could remember pain from the injection at all (among the 46 who didn’t count, 19 said the injection hurt and 10 recalled what it felt like). Recitation might work by distracting the brain from processing the sensation, says study author Tomoko Higashi, MD, of Yokohama City University Medical Center in Kanagawa, Japan. The trick is probably only useful for short or acute periods, she says, adding: “The degree of pain reduction really depends on how well patients concentrate on counting.”

Cervical Discogram Fluoroscopy

I was told not to drink any fluids or eat any food for 2 hours prior to my procedure. I took this advice seriously as I didn’t want to get nausea or throw up with needles stuck in my Neck.

Arrival at the Imaging Center

I arrived at the outpatient scan center, filled out the typical mountain of paperwork and releases.  Here sign this… blah blah.  Who can really read and understand all that fine print when they are in pain?  My advice is to research Discograms BEFORE you have yours so you know what to expect.

After the paperwork shuffle was completed I was seated in the lobby and waited about a half hour until I was called back.  I changed into the standard hospital scrubs – a gown that opens in the back and a pair of the pants.  I then was taken into the operating theater where I was given an IV.

Preparation for the Cervical Discogram

I received 1gm of an inter venous antibiotic, and placed into position on the table under the fluoroscopic arm.  I was also hooked up to a machine to monitor my blood pressure.  The Radiologist that did my procedure made sure a full 45 minutes passed before he began (This is a precaution to prevent infection and possible Discitis).  During that time he took time to explain to me the procedure and the risks and answered my questions.

My main question was about swallowing during the procedure.  Having needles protruding to the center of your cervical spine and swallowing seemed like it was a potential problem, but it’s not. He told me it was okay, but at certain points during the test he would tell me not to.  I didn’t know if I would be able to talk with needles in my neck, but it was no problem. I also asked about the gauge of the needles.  He told me they would be 25 gauge needles.  I had read some Doctors use 22 gauge needles (Lower the gauge the thicker the needle), and sometimes used the 22 gauge to the disc, the slipped a thinner 25 gauge inside the thicker needle.  He said there was no reason to do this.

The worst part of the 45 minute ordeal prior to beginning the test was the alcohol based scrub that was pretty powerful!  The smell was a bit overwhelming so they placed oxygen in my nostrils to help.  They topped off the Alcohol based prep, with another thick yellow gooey prep.  And for the record, this is very hard to wash off… you have to just let the last bit wear off after a few showers.

The Actual Cervical Discogram Begins

After all the preparation it was time for the Doctor to begin testing my discs. I was given a small amount of Versed (Midazolam) through my IV drip and off we went. The Doctor said he would be testing 4 levels between C4 and C7. For those of you who are new to this the level tested is named after the LOWER Vertebra… so the disc material between C3/4 would be called the C4 disc.  You have 7 Cervical Vertebrae but only 2 Discs because C1/2 is a bone in bone joint.  Anyways… moving on with the test experience.

The Doctor did not tell me the levels he was testing (So I would not be biased in my responses). And I could not tell what level he was working on. With the first needle puncture he said (This is going to feel like a bee sting… and it kind of did), then he would push the needle in slowly to the disc.  He used just enough anesthetic to make the procedure unpleasant, but bearable.  When the point of the needle arrived on the edge of the disc, he would tell me then he would push the needle in and tell me as he was injecting.

I should mention that just before each injection I could hear the Fluoroscopic arm move into position.  For those of you who don’t know the Fluoroscope takes X-Ray images in rapid succession so the Doctor can see EXACTLY where he is placing the needles.

He asked me to describe the pain on a scale of 1-10, tell him the location of the pain, and if this was typical of my “normal” pain or different from my “normal” pain.  Then he would withdraw the needle.  At the next level he said “bee sting” and then repeated the process until all 4 levels were complete.

I was told the test would take about half an hour, and that is probably pretty accurate.  It’s hard to keep track of time when you have Versad flowing through your veins.

Your personal pain tolerance will no doubt be different than mine.  I have had many IV’s and Needle procedures so this was pretty commonplace for me.  Yes it hurt!  But it is really not much worse than having dental work done (Okay it’s worse then regular dental, but not much worse than a root canal and it takes less time for the actual test than a root canal!).  The needles hurt most going in, then only for a few seconds during the active injection of the contrast agent.  Not all my discs caused pain… 3 of 4 were painful.  Only 2 of 4 above the “5″ Threshold on a scale of 1 to 10.  What was surprising was the disc that hurt the most was NOT the one I expected to hurt the most. I know this because after the test I asked the Doctor which disc it was that caused the most pain.

On to the CT SCAN

Immediately following the completion of the Cervical Discogram I was wheeled into another room and placed in the CT Scanner.  I’ve had CT Scans before and they are pretty easy.  Because they needed to scan my C6/7 level and I have broad shoulders (Plus my neck was in mild spasm from all the needling) I asked for the straps to help pull my arms down.

The CT Scan was a breeze and only took a few minutes.  Unlike MRI’s CT Scanners are basically open so you don’t need to worry if you are claustrophobic. The Downside to CT Scans is RADIATION.  And they blast you with a pretty high amount.  Be sure to ask your Doctor BEFORE the test about the precautions they use to minimize your exposure.  You want the least amount of radiation possible.

After the CT was complete I asked to talk to the Doctor because I had some questions about followup pain and I was pretty sore.  He offered to give me an injection of pain medication (I declined because I was pretty much doped up from the Meds I had from the IV).  But he did write me a script for a few pills to get me through the next couple of days and told me to be sure to call in to the Scan Center or to my Doctor if I got a fever or felt ill.

I never went to a recovery area, and no one really came to check on me. I waited seated on the side of a bed for about half hour to talk to the Doctor and then got dressed and went home.  Total elapsed time start to finish in the Scan Center was about 3 hours.

And while I felt okay, later on that night I was pretty sore.  I am about 36 hours post procedure at the time of this writing and pretty close to my normal all day everyday chronic pain self.

About the Cervical Discogram Test

Is the risk worth the benefit?  Maybe.  It depends on your own condition and a whole host of other factors.  Most Doctors will not order a Discogram unless they are seriously considering surgery.  The point of the test is to correlate Discogenic Pain to your regular pain.  If your discs are not causing your pain then surgery may not be a good answer for you.  It’s more complicated than that, but that’s the theory anyway. Sometimes the evidence on MRI is so overwhelming that the test is simply not needed.  Other times patients have pain that is just not explained until they have the test. Discograms are subjective test, but can be valuable.  They are also quite expensive!

That’s it… another test another day.

Cervical Discograms are a Diagnostic Test and do NOT treat pain.

– Kevin McKeever
HealthDay
Posted: 2008-04-28 19:05:04

Note: This article was funded by ADR Manufacturer Medtronic, maker of the FDA Approved prestige Cervical Artificial Disc. The real cost of surgery is not just in the upfront expenses.

MONDAY, April 28 (HealthDay News) — Treating cervical degenerative disc disease by surgically implanting an artificial vertebrae onto one’s spine may cost more initially than a traditional disc fusion operation, but it saves the patient almost $6,000 within two years, according to a new study.

The cost savings is primarily from the patient’s ability to return to work sooner after surgery and his or her need for fewer follow-up procedures.

The study — which was funded by Medtronic, the maker of the artificial cervical disc — was expected to be presented April 29 at the annual meeting of the American Association of Neurological Surgeons, in Chicago.

More than 200,000 procedures are performed each year in the United States to relieve compression on the spinal cord or nerve roots. The most common involves spinal fusion surgery to unify two or more vertebrae in an effort to strengthen the spine and alleviate chronic neck pain.

A year ago, the U.S. Food and Drug Administration approved the use of the first, and to date only, artificial cervical disc in certain cervical spine surgeries. Medtronic’s PRESTIGE disc is a stainless-steel device with a ball-in-trough design, held in place with bone screws.

Researchers conducting a cost-benefit analysis on 541 patients who received either the artificial cervical disc (arthroplasty) or fusion surgery found arthroplasty saved the patient an average of $5,988 over two years following the surgery.

The cost of initial surgery, secondary procedures and medical devices per patient and the average initial procedure cost were both higher for arthroplasty patients than for fusion patients; however, the artificial disc recipients saved long-term, because they needed fewer secondary procedures and returned to work following surgery an average of 38 days sooner than fusion patients.

The return to work alone yielded a gain in work productivity of $6,368, the report said.

“From a societal perspective, the economic benefits associated with these outcomes may offset the increased device costs associated with arthroplasty therapy,” said study presenter Dr. Vincent C. Traynelis, of the University of Iowa, in a prepared statement.

by James J. Yue (Author), Rudolph Bertagnoli (Author), Paul C. McAfee (Author), Howard S. An (Author)

Book Link: Motion Preservation Surgery

This is the most authoritative text available at the time of this writing (August 2008).

* Publisher: Elsevier Health Sciences
* Pub. Date: June 2008

Product Description

New motion-preserving devices are revolutionizing spine surgery but the learning curve for these operations is steep, and great attention must be given to patient and device selection and the perfect execution of each procedure. Only one reference spells out exactly how to perform these new techniques and its peerless author team, comprised of key investigators involved in the devices’ actual clinical trials, is uniquely qualified to help you get the best results! These global leaders in this area discuss the advantages and disadvantages of the full range of non-fusion technologies and present the step-by-step, richly illustrated operative guidance you need to achieve optimal outcomes! 3 hours of surgical video on DVD demonstrate how to perform key procedures, and access to the complete contents of the book online enables you to reference it conveniently from any computer.

* Select the best device and approach for each patient!
* cervical total disc arthroplasty
* lumbar total disc arthroplasty
* lumbar partial disc replacement: nucleus replacement
* lumbar posterior dynamic stabilization: pedicle screw based
* lumbar posterior dynamic stabilization: interspinous based
* lumbar facet replacement
* Produce optimal outcomes with detailed advice on
* advantages and disadvantages of each option
* indications and contraindications
* patient selection
* interpretation of imaging studies
* surgical anatomy and biomechanics
* surgical techniques
* tips and pearls
* See how to perform each technique, thanks to
* step-by-step, full-color illustrations
* more than 3 hours of surgical videos on DVD, narrated by the experts!
* Access to the complete contents of the book online lets you perform rapid searches, follow links to Medline and PubMed abstracts, and more.

Abstract:
Study Design. Prospective clinical study enrolled in 2 centers (Munich and Liberec) as part of a prospective European multicenter study with ProDisc C (Synthes Inc., Paoli, PA).

Objectives. The first goal of the study was to evaluate the rate of heterotopic ossifications identified with plain radiograph following total cervical disc replacement (TCDR). The second goal was to show whether segmental motion can be preserved, and whether TCDR can provide improvement of the patient’s ability to perform activities of daily living as well as a decrease of pain.

Summary of Background Data. Only a few reports about the radiologic outcome after TCDR are published so far. Heterotopic ossification is a well-known phenomenon after total hip arthroplasty. The rate of heterotopic ossification following TCDR is unclear.

Methods. The radiographs of 54 patients (in total, 77 implanted prostheses) were analyzed 1 year after TCDR with a ProDisc C prosthesis. We classified the heterotopic ossification in 5 grades according to a recently published classification system for lumbar total disc replacement. For clinical parameters, the visual analog scale and the Neck Disability Index were evaluated preoperatively and 1 year postoperatively. The Student t test and Wilcoxon test were used for statistical analysis.

Results. In 26 treated segments (33.8%), no heterotopic ossification was detectable. Grade 1 ossifications were present in 6 levels (7.8%). A total of 30 segments (39.0%) showed grade 2 ossifications. Heterotopic ossifications that led to restrictions of the range of motion were present in 8 cases (10.4%). One year postoperatively, 7 cases (9.1%) had a spontaneous fusion of the treated segment. The clinical parameters improved significantly and were similar to previous reports about TCDR.

Conclusions. Only 33.8% of the patients did not show any signs of heterotopic ossification, and the rate of spontaneous fusion after TCDR 1 year after surgery was unexpectedly high. There were 49.4% of the patients with grade 2-3 ossification, which lets us suspect an even higher rate of spontaneous fusion after long-term follow-ups. Motion preservation after TCDR is only guaranteed if spontaneous fusion can be prevented. Thus, mobility of the implanted segments needs to be further studied.

(C) 2006 Lippincott Williams & Wilkins, Inc.

Abstract:
Study Design. Prospective, randomized, controlled and double-blinded study on imaging of artificial discs.

Objective. The purpose of this study is to compare postoperative imaging characteristics of the 4 currently available cervical arthroplasty devices at the level of implantation and at adjacent levels.

Summary of Background Data. Cervical arthroplasty is being performed increasingly frequently for degenerative disc disease and, in most cases, with frank neural compression. Unlike lumbar arthroplasty, performed mainly for axial back pain, decompression of neural elements may need to be confirmed with postoperative imaging after cervical arthroplasty.

Methods. Preoperative and postoperative magnetic resonance imaging scans of 20 patients who had undergone cervical arthroplasty were assessed for imaging quality. Five cases each of the Bryan(R) (Medtronic Sofamor Danek, Memphis, TN), Prodisc-C(R) (Synthes Spine, Paoli, PA), Prestige LP(R) (Medtronic Sofamor Danek), and PCM(R) devices (Cervitech, Rockaway, NJ) were analyzed. Six blinded spinal surgeons scored twice sagittal and axial T2-weighted images using the Jarvik 4-point scale. Statistical analysis was performed comparing quality before surgery and after disc implantation at the operated and adjacent levels and between implant types.

Results. Moderate intraobserver and interobserver reliability was noted. Preoperative images of patients in all implant groups had high-quality images at operative and adjacent levels. The Bryan(R) and Prestige LP(R) devices allowed satisfactory visualization of the canal, exit foramina, cord, and adjacent levels after arthroplasty. Visualization was significantly impaired in all PCM(R) and Prodisc-C(R) cases at the operated level in both the spinal canal and neural foramina. At the adjacent levels, image quality was statistically poorer in the PCM(R) and Prodisc-C(R) than those of Prestige LP(R) or Bryan(R).

Conclusions. Postoperative visualization of neural structures and adjacent levels after cervical arthroplasty is variable among current available devices. Devices containing nontitanium metals (cobalt-chrome-molybdenum alloys in the PCM(R) and Prodisc-C(R)) prevent accurate postoperative assessment with magnetic resonance imaging at the surgical and adjacent levels. Titanium devices, with or without polyethylene (Bryan(R) disc or Prestige LP(R)), allow for satisfactory monitoring of the adjacent and operated levels. This information is crucial for any surgeon who wishes to assess adequacy of neural decompression and where monitoring of adjacent levels is desired.

(C) 2007 Lippincott Williams & Wilkins, Inc.

April 20, 2005 (New Orleans) — With two-year follow-up data on just under 100 patients, it appears that multiple-level arthroplasty with the Porous Coated Motion (PCM) cervical disc is as effective at reducing pain and preserving spine function as single-level arthroplasty with the device, the lead investigator reports.

Luiz Pimenta, MD, a neurosurgeon at the Clinica Mattos Pimenta in Sao Paolo, Brazil, presented the data here at the American Association of Neurological Surgeons annual meeting on behalf of the multiple centers participating in the PCM study. Dr. Pimenta has served as a consultant to PCM’s developer and manufacturer, Cervitech, Inc.

That company is based in the U.K. and the U.S., with headquarters in Rockaway, New Jersey.

According to Cervitech, the PCM disc is designed to allow “translational motion in an arc consistent with the natural motion of the cervical spine segment.” The disc has an ultra-high molecular weight polyethylene bearing surface attached to the lower endplate. Both of the endplates are made of cobalt chrome.

In the trial presented by Dr. Pimenta, 41 patients had a single-level replacement, 34 patients had a two-level replacement, eight had three-level replacement, and four had four-level replacement.

For single-level replacement patients, mean scores for the neck disability index (NDI) and the visual analog scale (VAS) score decreased by 38.7% and 38.6%, respectively, compared with 65% and 61.4% for the bilevel group. For the multiple-level replacement patients, the NDI decreased by 95.3% and the VAS by 86.6%.

Dr. Pimenta also reported on Odom scores at two years. Almost 13% of single-level replacement patients had excellent Odom scores compared with 16.3% of bilevel patients and 20.8% of multiple-level replacement patients.

In patients with multiple-level replacements, the clinical outcomes were generally better, and range of motion was much improved also, said Dr. Pimenta. Clinical studies of single-level arthroplasty might be underestimating the true benefit of the procedure, he said, but added that a large-scale randomized study was necessary.

Edward Benzel, MD, director of spinal disorders at the Cleveland Clinic Foundation in Ohio, said it appeared that the PCM disc is helping to establish and maintain lordosis. Fusion, he said, is well known for leading to decreased range of motion and degenerative changes at adjacent levels.

With the PCM disc study, it seemed that restoration of sagittal alignment was a key to the success seen with the multiple-level replacement patients, Dr. Benzel said. The maintenance of sagittal alignment may, in fact, be one of the most important variables, he said.

Total disc arthroplasty is likely to be much more costly than fusion, but “if there is greater quality, we may be willing to accept a greater cost,” Dr. Benzel said. He called the PCM disc study a “seminal work.” I am republishing here because it is one of the few articles explaining the potential benefits of Cervical ADR at multiple levels.

AANS 2005 Annual Meeting: Abstract 755. April 19, 2005.

Reviewed by Gary D. Vogin, MD

A 6’6″ tall basketball playing student was involved in a fracas with gate crashers at his sister’s birthday party and was severely beaten up by six soldiers. He subsequently suffered neck and arm pain and was seen at a hospital on several occasions and told that because his pain neck x-rays were normal there was no dramatic lesion. He presented two years later unable to continue playing basketball because of an insidiously evil and spastic paraparesis and evidence of bilateral C7 root lesions.

Myelography revealed a severe traumatic C6/7 disc lesion which required surgery. The root pain was relieved, but recovery from the cord damage was incomplete. This case exemplifies once again the dangers of accepting that normal x-rays indicate there is no abnormality.

Where a neck injury occurs in a patient who already has an abnormal neck due to cervical spondylosis. In such patients sudden flexion or extension of the neck following a simple trip or rear end collision in a car they produce acute root symptoms or even a cute cord damage. Usually the root symptoms are bilateral may affect multiple routes and the accompanying cord damage may cause an acute tetraparesis. The potential seriousness of even minor traumatic events affecting the cervical spine in this way in patients with severe pre-existing spondylosis must be recognized.

Source: Neurological Differential Diagnosis By John Patten

5 Painful Facts You Need to Know

First off, let’s set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found “researchers don’t yet know how to determine which [treatment] is best for individual patients.” From studies of drugs to surgeries and alternative medicines, “We have found that there are huge gaps in our knowledge base,” said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?

Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy.

Here’s what’s known:

Fact 1 – Scientist Don’t Understand Pain

When you’re in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as “an unpleasant sensation and emotional response to that sensation.” Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. “Pain is complex and defies our ability to establish a clear definition,” says Kathryn Weiner, director of the American Academy of Pain Management. “Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation.”

Fact 2 – Chronic Pain Shrinks Brains

If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that’s only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don’t know why. “It is possible it’s just the stress of having to live with the condition,” said study leader A. Vania Apkarian of Northwestern University. “The neurons become overactive or tired of the activity.”

Fact 3 – Migraines and Sex Go Together

It may not eliminate the phrase “Not tonight, honey …” but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

Fact 4 – Women Feel More Pain

Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

Fact 5 – Some Animals Don’t Feel Our Pain

Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

What You Can Do

Meanwhile, exercise is a useful remedy for many types of chronic pain.

In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

“Physical activity is actually a natural pain reliever for most people suffering from arthritis,” concludes another study published in the Arthritis Care and Research journal in April. “Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” said Dr. Patience White, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”