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Types Of Painful Conditions

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San Francisco Medical Clinic for the Treatment of Pain

What Types of Painful Conditions Do We Treat

Pain Resulting from Injuries:

Injuries can occur suddenly in car accidents, slips and falls, sports; or they can occur gradually over a period of weeks, months, or even years from repetitive strain at the workplace. Let's discuss various types of pain resulting from injuries.

I. Pain resulting from car accidents:

With automobile accidents, the extent of injury is not usually appreciated at the time of the accident. Although pain is usually felt right away after laceration or direct impact on the body, the pain from muscle sprain and strain may not occur immediately but may intensify into much more acute pain and muscle spasms hours or days later. Whiplash injury and back sprain, which often result from rear end collisions, are prime examples. The victim may initially feel no symptoms or only minor aches but this is often followed by a tired sensation in the involved muscles which subsequently gives rise to spasms and pain. Other unpleasant sensations, normally not described by patients as pain, such as numbness, tingling, and weakness may follow. Pain is a physiological phenomena, not a mechanical one. When a bottle is broken the result can be easily observed; but when a muscle is torn or pulled, the brain does not always respond immediately and may change its reaction with time. Sometimes, the pain may radiate to different parts of the body that have not been injured. For example, a shoulder sprain may produce pain down one's arm along with tingling and numbness in the hand without those parts actually being injured. The pain may also move from place to place during the course of time since pain is a dynamic rather than a static process.

II. It is critical to treat the pain as soon as possible:

The longer the pain resulting from a car accident lingers, the more likely the pain will become chronic. During an acute injury, a pain circuit is activated and set up within the central nervous system, and if it is not quickly diffused, the pain circuit may persist because the brain seems to memorize its function. So the longer it becomes ingrained, the more difficult it is to get rid of it. It has been well documented that herpes zoster (shingles), painful blisters caused by viral infection of a nerve, can become chronically painful long after the skin has healed. This chronic painful phase is known as post-hepatic neuralgia which literally means nerve pain after blisters and can last for years. However, it has been found that if nerve blocks are used to control the pain during the acute phase, the incidence of chronic pain is markedly reduced. The old addage that time will heal all wounds is simply incorrect. In fact, time may seal all pain. Time allows pain to fester, therefore, waiting for the pain to go away after a car accident is not a good idea. A variety of therapeutic modalities are available to alleviate pain and not all of them are equally effective. Some may not change the long-term outlook of the chronic pain. For example, pain medications are used mainly to suppress the pain without causing the body to get rid of it.

III. Other non-painful medical conditions that may result in car accidents:

While chronic pain is the most common symptom following injury in an auto accident, it is by no means the only one. Many injured individuals complain of dizziness and ringing in the ear associated with headaches even though there has been no direct trauma to the head. These symptoms are usually associated with neck injury including sprains and strains. Others may complain of nausea and vomitting and other gastrointestinal symptoms. Women often find their menstrual cycle and flow disturbed subsequent to the accident. While the exact physiological mechanisms causing the symptoms are unknown, they are commonly recognized as stress related. Other symptoms and complexes include a peak of depression, insomnia, nightmares, and an exaggerated fear which may be general but usually specifically related to driving or riding in a car. Such a group of symptoms is quite similar to the post-traumatic stress syndrome that is often found in soldiers after exposure to combat. It appears that the body's alarm system goes off in the face of danger whether it is a combat situation or a car accident. And once such a system is activated, it remains so either indefinitely or for a protracted period of time, even if the danger is long past.

IV. How can the physical and psychological injuries be treated?:

Many treatments are currently available for treating injuries resulting from car accidents and have varying degrees of efficacy. Following is a list of commonly used therapeutic modalities. The list is by no means exhaustive.

1. Physical therapies which include hot and cold packs, electrical stimulation, massages, ultrasound, and infrared treatments.

2. Trigger point injections.

3. Nerve blocks

4. Auriculoneural therapy

5. Acupuncture

6. Osteopathic or Chiropractic manipulation

7. Biofeedback

8. Hypnosis

9. Therapeutic Exercises

10. Traction

V. How to pay for the treatments for car accident injuries:

1. Car insurance: Most car insurance policies cover medical expenses incurred as a result of automobile related injuries with varying dollar limits. This is like a health insurance policy specifically related to auto injury regardless of whether the injured is at fault or not. A person who does not own his individual policy may also be covered by a policy of a member of the same household. For instance, a teenager hit by a car while crossing the street (an auto related injury) may be covered by the insurance policy of his older brother with whom he lives.

2. Health insurance: Health insurance usually covers the treatment expenses but it is generally a good idea to check with one's own insurance company to see what services are covered before treatment. If you belong to a HMO health plan, it is quite possible that you will be covered only if you see your primary care doctor or another specialist only if you are referred by your own family doctor.

3. Worker's Compensation Insurance: If you are injuried in an automobile related accident while you are dicharging your duties as an employee, you may be entitled to coverage by worker's compensation insurance. A messenger side-swiped by a bus while delivering a package should be covered by worker's compensation insurance.

4. Medical Lien: When one is injured in an accident caused by another party who as at fault, he may be entitled to compensation by the other party under the law. However, if the injured does not have his own insurance or adequate coverage, he may have difficulty coming up with the finances to defray the medical costs for his treatments because it may take quite some time before he can obtain compensation for the responsible party under the law. Certain health professionals may be willing to accept an IOU from the patient providing the patient agrees to secure the IOU with future proceeds from the compensation he receives from the at fault party. This is known as a medical lien which is similar to a car loan using the car as a collateral or getting a loan for mortgaging one's house.

5. Medicaid (known in California as Medical): This is health insurance provided by the Federal or State government. It may cover some but not all of the treatment modalities.


II. Injuries at the Workplace:

Thousands of people are injured daily while at work. There are generally two categories of work injuries, namely acute and chronic:

A. Acute injuries: Work injuries may be due to a myriad of causes including slipping and falling, lifting heavy loads, twisting arms and legs, chemical burns, falling objects, and flying projectiles. Generally, if acute injuries are properly treated, they may heal quickly; but frequently, a chronic component of disability may persist. For example, a dishwasher at a restaurant accidentally cut his finger with broken glass severing a nerve and a tendon. The nerve and the tendon were repaired surgically, the wound was sutured, and the finger healed quickly. In the ensuing months, however, severe pain developed and the pain gradually moved up from his finger to his hand and forearm and was accompanied with a marked difference in the skin's appearance. This patient suffers from what is known as reflex sympathetic dystrophy which is chronic and notoriously difficult to treat. Acute injuries as in injuries suffered in car accidents, if treated early and properly, can heal quickly and with a marked reduction of chronic problems. Unfortunately, most injuries, especially severe ones involving various kinds of muscular and tendon injuries as in back sprains, are not adequately treated. The patient is only given pain medication, muscle relaxant, and rest.

B. Chronic injuries: If one sustains repeated trauma, the cumulative injury may eventually reach a threshold where severe and disabling symptoms suddenly develop. A legal secretary who types several hours a day may have enough cumulative trauma to the finger joints to develop arthritis. A butcher using wrist motion a great deal for cutting can develop chronic pain at his wrist. A forklift operator that needs to use an arm to push a lever for several hours in a shift can experience chronic pain in his elbow. A trained engineer who needs to stick his head out of a window and look to one side to check for signals day after day may have chronic neck pain and headache. Repetitive trauma known as repetitive strain, does not even have to involve physical activities. In fact, physical inactivity may do just as much harm to the body. A computer operator who sits in a chair in the wrong position without taking frequent breaks may put enough strain on the back muscles to cause chronic back aches. A computer operator with his hand stretched forward without the proper elbow and arm supports can develop pain in both arms, often diagnosed as carpal tunnel syndrome. The reasoning is rather simple. Tense muscle causes pain and an immobile position actually requires the muscle to stay contracted to maintain that position. And after a long period, the muscle learns to stay tense all the time, and that makes it much more likely to hurt. If the process is repeated for months or years, problems will eventually develop.

C. Medical treatments commonly used to treat workplace injury:

1. Physical therapies, including hot and cold packs, electrical stimulation, massages, ultrasound treatments, infrared, and diathermy.

2. Trigger point injections.

3. Nerve blocks

4. Auriculoneural therapy

5. Acupuncture

6. Osteopathic or Chiropractic manipulation

7. Biofeedback

8. Hypnosis

9. Therapeutic Exercises

10. Traction

III. Sports Injuries:

A. Different parts of the body may be injured in different kinds of sports, and like injuries in the workplace, they may occur acutely or chronically. The incidence of specific types of injuries are commonly associated with a specific sport; for example, swimmers often get shoulder pain, tennis players tend to develop tennis elbow as well as knee and ankle pain, weightlifters often have back sprain, and athletes in contact sports often have severe sprains and contusions. Again, when injuries are treated mainly with pain medication, muscle relaxant, and rest, the internal pain mechanism set up by the injury may persist and become chronic if proper treatment is not given in the initial phase following the injury.

B. Special note: A situation unique to sports injuries is that the athlete who sustains the injury may try to ignore the warning signs of pain and continue with strenuous activities unabated. For instance, a basketball player who twists his ankle may continue to finish a game despite pain and swelling from a bad sprain. The continuous stress on an injured body part will lead to more severe injury and will likely lead to long-term adverse effects such as chronic pain.

C. Chronic Injuries from Sports: The situation is very similar to workplace injuries where repetitive strain or cumulative injury play an important role in the generation of pain. An avid tennis player or runner may continue to engage in strenuous sports despite development of what is initially felt as minor aches and pains. In the course of time, these minor aches and pains become incremental worse and with enough accumulation, a permanent pain circuit is set up which can perhaps lead to long-term impairment of physical functions. Since the injury is cumulative, the patient may not remember a specific episode which brought on the acute pain.

IV. Other injuries:

In addition to the above mentioned categories, physical injuries to the musculo-skeletal system can occur virtually at any place and many such incidents occur in none other than one's home. Consider the following cases:

1. A housewife developed chronic shoulder pain after doing a great deal of chopping in the kitchen in preparation for a large dinner party at home.

2. A veternarian developed pain in his right calf after a period of planting flowers in his hillside backyard at home after he spent many hours standing on the slope constantly putting his body weight on his right leg. His right leg was relatively uphill to the left leg. He was initially misdiagnosed as his family doctor as having a vascular problem.

3. A young professional remodeling his own home was hanging wallpaper for twelve hours a day for two consecutive days during a long weekend and consequently developed a strong shoulder and back ache. He was standing on the ladder for protracted periods of time putting an excessive amounts of strain on his back and shoulder on a flimsy old ladder.

4. A retired gentleman exerienced stiffness and pain in his neck for several weeks after he tried to fix the plumbing underneath his kitchen sink and kept his head and neck in an unnatural posture for hours.

Examples like the above simply cannot be ennumerated. Once again the ideal approach is to take care of the pain early by getting proper treatment as mentioned under treatment modalities to keep them from becoming chronic.


What health factors may contribute to the tenacity of chronic pain?:

Generally speaking, the healthier a person is, the less likely he is to develop chronic pain after a traumatic experience whether acutely or chronically.

Acute Pain & Chronic Pain Resulting From:

• Automobile Accident

• Car Accident

• Workplace Injuries

Pain as a Result of Diseased States

• Headaches

• T.M.J.

• Neck Pain

• Low Back Pain

• Sciatica

• Arthritis

• Causalgia

• Abdominal Pain

• Pain Following Operation

• Chest Pain

SOURCE: http://www.sfpain.com/

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