How Do Chiropractors Measure Pain?

Measuring the amount of pain being experienced by a patient is an essential part of chiropractic assessment prior to treatment.  However, unlike objective measures such as the degree of spinal curvature or the range of joint movement, the amount of pain cannot be determined directly, but is instead inferred from the patient themselves or from signs usually associated with it.  These two methods—patient self-reporting and inference by examination—are the basic tools chiropractors will use to assess a patient’s pain level.

While the degree of discomfort reported by a patient is an important guide, the subjective experience of pain means that each person will have a different level at which they call pain mild, moderate or extreme.  Likewise, patients will all have varying degrees of verbal and physical reactions to different levels of soreness.  Taken together, however, self-reporting and examination provide a combination of evidence which can be used to determine pain levels with a reasonable degree of accuracy.

Most chiropractors treating a patient will use an assessment form that asks about the kind of problem that the patient is currently experiencing and the amount of pain it is causing.  A basic diagram of the body may also be used to mark locations and levels of pain.  Further questions, either in the form of a questionnaire or through a patient interview, may be asked to ascertain the frequency of pain and the nature of movements and activities that may trigger pain or worsen it.

The level of perceived discomfort is often assessed using a pain scale in which the patient is asked to assign a figure to their experience such as from 0 (no pain) to 10 (extreme pain).  Although such a scale will be subjective, most patients demonstrate a good deal of internal consistency when it comes to reporting relative pain levels.  This means that patient-reporting using this type of pain scale can be useful in determining whether a condition is responding to treatment over time or getting worse, as well as in determining how pain levels fluctuate over the course of a day or in response to certain kinds of activity.  In addition to the simple pain scale, there are several specially designed questionnaires that are also used to assess the degree of pain and disability associated with spinal injuries, such as the Quebec Back Pain Disability Scale.

Chiropractic assessment of a patient actually begins the moment the patient walks in the door.  A skilled chiropractor can tell much about a condition and how much pain someone is in by their overall posture, how they walk, facial expressions of discomfort and involuntary verbalization.  While being examined, palpation and movement of problem areas will often give rise to further articulation and tensing against painful movement, which provide further clues both to the location and degree of soreness.  A chiropractor may use pain scales during the examination so that patients can communicate in a more focused way how much a certain movement or palpation hurts.  Marking these pain levels on a chart provides a baseline measurement that a chiropractor can use to judge the effectiveness of treatment over time.

Although pain measurement is only one method of assessing both the degree of injury and success of treatment, it is an important one.  Pain is both a clear sign that something is wrong and an impediment to normal daily activity.  In contrast, a reduction in pain following chiropractic therapy increases feelings of wellbeing and provides subjective evidence of improvement.  For the chiropractor too, this is an essential indication that they are doing something right.  Together with other signs such as increased strength, range of movement and endurance, reduced pain is a welcome indicator that a patient is making progress.

Dr Dubois, DC, CCSP

Dr. Dubois, a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

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What is “Referred Pain”?

“Referred pain” can be a perplexing phenomenon for anyone who experiences it. Referred pain is what happens when you feel pain in an area of your body that is not actually the original source of the pain signals. The most common example of referred pain is when pain is felt in the left arm, neck or jaw of a person suffering a heart attack, while they often have no feelings of pain in the chest area itself.

It’s important to note that referred pain is different from radiating pain, in which the pain felt in one area travels down a nerve, causing pain along the length of the nerve. This is often the case with sciatica, where pain originates in the lower back and radiates down the leg.

Researchers are still not exactly sure what causes referred pain. Some experts believe that it is due to a mix-up in nerve messaging. The central nervous system (CNS) is constantly receiving a barrage of different messages from different parts of the body. These messages may get mixed up somewhere along the path between the place where the irritated nerve is signaling and the spinal cord or brain where pain signals are processed. With an extensive network of interconnected sensory nerves that serve the same region of the body, such as the nerves of the lower back, thighs and hips, it may be more common for signals to get mixed up than you might imagine.

Although referred pain is usually felt as painful, it can also cause feelings of numbness, tingling or the sensation of pins and needles. Another example of referred pain is a tension headache, in which headache pain is due to an irritation of the nerves in the neck.

Referred pain tends not to cross sides of the body. In other words, if the pain signals are originating in the liver or gallbladder (which are on the right side of the body), you may feel pain in your right shoulder. If the signals originate in the pancreas (on the left of the body), you may feel pain in your left shoulder, etc.

Chiropractic adjustments can address the source of the referred pain, leading to long-term pain relief. Nerves in the area of the spinal cord that are irritated due to a spinal misalignment (subluxation) can be a cause of referred pain. When your chiropractor adjusts your spine, he or she removes the source of irritation, thus providing relief. Your chiropractor is knowledgeable about which tests can be performed to determine the underlying cause of your pain (whether direct or referred), and can treat it accordingly.

Dr Dubois, DC, CCSP

Dr. Dubois, a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

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What is “Lumbago”?

When you first hear the word “lumbago”, it probably sounds more like a dance from your grandparents’ generation than a medical condition.  However, lumbago is actually a musculoskeletal disorder that is more commonly referred to as low back pain.  An estimated 80% of Americans suffer from low back pain at some point in their lives, and it is one of the most frequent causes for people missing work.

The lower back provides support to the majority of the body, and consists of many different support structures, including the spine, ligaments, tendons and muscles as well as the associated nerves that run through all of them. A problem can occur anywhere, particularly when an inappropriate load is placed on these support structures. This often happens when people lift heavy objects incorrectly, or during a sport or physical activity in which excessive strain is taken by the lower back and causes a sprain, strain or fracture. Lumbago may also be caused by aging of the spinal discs, osteoporosis, arthritis, or a more serious underlying condition such as a herniated disc, scoliosis, spondylosis or a spinal tumor. Then again, it may be due to something as (relatively) simple as poor posture or a vertebral subluxation.

In addition to generalized low back pain that can range from mild to severe, symptoms of lumbago may include a sharp, shooting pain radiating down the leg, muscle spasms, and tingling, numbness or weakness in the area of the low back and upper legs. Sneezing, coughing or laughing may exacerbate the pain, which may be either acute or chronic. Lumbago is often related to sciatica, a condition in which the sciatic nerve that runs from the lower back, through the hip and down the leg becomes compressed or pinched. The compressed nerve can send pain radiating throughout the lower back and down the leg as far as the toes in some cases.

Conventional conservative treatments include rest, using hot or cold packs, taking anti-inflammatory medications such as ibuprofen and acetaminophen, and chiropractic care.

Your chiropractor has plenty of experience in treating low back pain and can perform the necessary diagnostic tests to determine what is causing your lumbago. He or she can perform spinal adjustments to correct any subluxations you may have that are contributing to the problem, in addition to suggesting exercises that can stretch, strengthen and stabilize the muscles that support your back.

Whatever the cause of your lumbago, your chiropractor has the skills and knowledge to help relieve the immediate pain and address the underlying condition.

Dr Dubois, DC, CCSP

Dr. Dubois, a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

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Diet and the Hyperactive Child

Having a child with Attention Deficit Hyperactivity Disorder (ADHD) can be a challenging—and sometimes heartbreaking—experience, and it’s one that affects many families.  According to the Centers for Disease Control and Prevention, 4.7 million children in America have been diagnosed with the condition.  Approximately 9.5% of children between ages 4 and 17 have at some point in their lives been diagnosed with ADHD, which has increased 5.5% on average each year between 2003 and 2007.

Why the sudden upsurge in the prevalence of ADHD?  A few years ago, a number of studies found a strong association between ADHD and diet, and there was a strong push to try treating ADHD with diet modification.  This approach has met with very mixed results.  In the end, no conclusive evidence was found of a direct cause-and-effect link between specific dietary factors and ADHD.  As a result of the contradictory and inconclusive data, diet modification lost a lot of its support within the medical community as a possible treatment.  However, that started to change with the 2007 publication of a seminal British study now commonly referred to as the “Southampton Study”.

In the Southampton Study, a drink containing a mixture of artificial food coloring and the preservative sodium benzoate was found to aggravate hyperactivity in three-year-olds and did the same thing to a lesser extent in eight- to nine-year-olds.  A 2010 study published in The American Journal of Psychiatry found similar results, and suggested that children made more hyperactive by food additives were likely to have problems with the genes that regulate histamine release (in response to potential allergens).  In February 2011, another follow-up study was published in the prestigious journal The Lancet, which found that nearly two-thirds of the children who were following an elimination diet (in which food additives were eliminated in favor of fresh grains, meats, vegetables, and fruit) experienced significant reduction of their symptoms of hyperactivity and defiant behavior.

This research was strong enough to restart discussions about the possible role of food additives in causing or aggravating ADHD, and has led to the British government requesting that manufacturers remove most food dyes from their products.  The European Union now requires warning labels on products that contain any of six food dyes that “may have an adverse effect on activity and attention in children.”

There has been a recent resurgence in interest in “elimination diets” as a possible approach to treating ADHD.  Even though they may not work for all children with ADHD, they may work in a significant enough percentage of cases to warrant their use.  Basically, such a diet consists of eating more protein (meat, eggs, cheese, nuts, etc.), eating fewer simple carbohydrates (candies, corn syrup, breads made from white flour, etc.) and eating more complex carbohydrates (whole grains, fresh vegetables and fruits).  Proponents of such diets also recommend taking supplements of omega-3 fatty acids (fish oil) and a general vitamin supplement.

The real “elimination” part of the diet involves trying to remove from it ingredients or food additives suspected of causing or aggravating ADHD to see if not eating them results in fewer symptoms.  These additives include sodium benzoate and food dyes Yellow Nos. 5, 6 and 10, Red Nos. 3 and 40, and Blue Nos. 1 and 2.

Naturally, if your child has been diagnosed with ADHD, consult with a qualified physician before trying any type of elimination diet.  He or she may be able to perform tests to help determine which dietary changes might be the most beneficial.

Dr Dubois, DC, CCSP

Dr. Dubois, a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

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Diagnostic Imaging Explained: X-Rays, CT Scans, Ultrasounds, MRIs and PET Scans… Oh My

Next year celebrates the 100th anniversary of the first medical use of X-rays.  In the century since William Coolidge first designed an X-ray tube for medical purposes, the science and art of imaging has made quantum leaps.  Physicians and their patients now have an alphabet soup of options to choose from when it comes to diagnostic imagery that can help them visualize the body’s internal anatomy without invasive exploratory surgeries.

Modern day X-ray devices still follow the same scientific principles as the first X-ray machines but implement a broad range of safety features to protect patients from the harmful effects of radiation exposure.  X-rays are electromagnetic radiation waves that are absorbed or deflected by materials at different rates.  Human tissue allows most of the rays to pass through, whereas bone and other more solid parts of the anatomy absorb or deflect significantly more rays.  This allows an X-ray-sensitive film or detector placed on the opposite side of the body to produce a high-quality monochrome image of the interior of the body.  Due to the damaging effects of X-rays, an X-ray picture is a single instant exposure and therefore captures static images of the interior.

Computed Axial Tomography (CAT or simply CT) expands upon the principle of regular X-ray machines by moving the X-ray beam around the patient, thereby scanning the body from numerous angles. A computer then constructs a 3-D image from the resulting scans.

Ultrasound devices apply a somewhat similar procedure but use far safer sound waves.  With the transmitter and detector built into the same, easy-to-handle wand, it allows for real-time views of the body’s interior that can be adjusted and redirected as needed.  Ultrasound devices deliver safe, high-frequency sound (i.e., ultrasound) waves that bounce off the target as they encounter changes in density.  These waves are picked up by the detector and are converted into images by the computer.

Magnetic resonance imaging (MRI) employs a complex combination of extremely powerful magnets and radio frequencies.  These create resonances in the atoms that make up the tissues being examined to produce a highly detailed, slice-by-slice series of images of the inner body.  Injectable contrast medium is often used to enhance certain areas of interest.  Although there are currently no known side-effects of exposure to high-intensity magnetic fields and few from the injectable contrast medium, the powerful magnetic fields require strict precautions due to the danger posed by metal objects within or around the patient as they are being scanned.  If these objects are magnetic, they will tear loose and may injure the patient.

Positron Emission Tomography (PET) scanners create images by detecting the radiation given off by substances containing radioactive particles that are injected into patients just before scanning.  PET scanners have a donut-shaped housing that contains a circular gamma ray detector that is attached to a computer.  The detector picks up the radiation as the patient is moved through the housing on a table, and the computer translates the data into slice-by-slice images of the areas containing the radioactive substance.

These imaging devices have helped to remove much of the uncertainty from the diagnosis and treatment of internal injuries and conditions.  When used appropriately, imaging analysis can significantly improve a patient’s chances of survival and reduce the cost of treatment.

Dr P. Dubois, DC, CCSP.

Dr. Dubois,a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system.Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

 

Smoking Linked to Chronic Pain in Women

If you need yet another good reason to quit smoking for good, here it is.  A study conducted by researchers at the University of Kentucky has found that women who smoke may be at greater risk of suffering from chronic pain than those who do not.

Researchers surveyed over 6000 women (18 years of age or older and living in Kentucky), asking them (1) whether they smoked and (2) if they suffered from any of the following  conditions: chronic head pain, chronic neck pain, chronic back pain, sciatica, fibromyalgia, joint pain, nerve problems and pain all over their body.  A statistical analysis of their responses suggested that women who currently smoked or who had smoked previously were more likely to report having at least one symptom of chronic pain than women who had never smoked.  Those who smoked daily were 104 percent more likely to suffer from chronic pain.  Occasional smokers were 68 percent more likely.  Even former smokers were at 20 percent greater risk of chronic pain.

Study results revealed that chronic pain was more strongly associated with a daily smoking habit than older age, low academic achievement, obesity or living in a county in Appalachia.

Co-author of the study, Dr. David Mannino, a pulmonary physician from the UK College of Public Health, suggested that the study results could represent something of a “chicken and egg” scenario.  He explained, “This study shows a strong relationship between heavy smoking and chronic pain in women, but what is the direction of this association?  Does smoking cause more chronic pain, or do more women take up smoking as a coping mechanism for experiencing chronic pain?”

Since acute pain is a protective response to some sort of injury, Mannino hypothesized that women smokers may have experienced an acute pain that then developed into chronic pain because their normal mechanisms of protection had been damaged by smoke exposure.

Another co-author of the study, Dr. Leslie Crofford, director of the Center for the Advancement of Women’s Health, noted that it would be a good idea for researchers to now investigate if there is a link between smoking, psychopathology, quitting smoking and how chronic pain is managed.

Crofford says, “Our results show there is a dose-response relationship between smoking classification and chronic pain syndromes.  It’s possible that patients experiencing chronic pain could benefit from smoking cessation treatment in addition to the treatment for their pain.  Similarly, it’s possible that appropriate treatment of chronic pain could increase a smoker’s chances of successfully quitting.  Right now, more research is needed on these interventions.”

 

Dr P. Dubois, DC, CCSP.

 Dr. Dubois,a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of   the musculoskeletal system.Amongst hispatients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levelswho benefited from his chiropractic care.

Choosing the Right Lumbar Support

Lumbar back support products are designed to help prevent neck and back pain, which can lead to pain in other parts of the body as well. Many of these products are pillows or cushions that offer additional support when you are seated for long periods of time.

The lumbar region of the spine is usually referred to as the lower back. It is the area just above your tailbone and below the thoracic (middle back) region. The lumbar area includes your spine and all the muscles, ligaments and tendons surrounding your spine. If your ligaments are pulled or torn, you will experience a lumbar sprain or strain, which can lead to muscle spasms and significant pain in your lower back.

What can cause lumbar sprains and strains? Poor posture, poor lifting technique, obesity, and other health-related factors can contribute. In fact, sitting for long periods without lumbar support can itself aggravate lumbar pain. Finally, one of the greatest contributors to back pain is using the wrong type of chair for your body. Surfaces that are too hard or too soft do not encourage proper posture and do not provide adequate support for your back.

Usually all that is required to relieve lower back pain is sufficient rest, but most of us are unable to rest for long enough to overcome lumbar problems. So preventing these problems with a good lumbar support is essential, especially if you spend significant amounts of time sitting down.

The first step to choosing the right lumbar support is to ensure that it fits perfectly in the chair you spend the most time in. An even better option is to choose an ergonomically designed chair that includes a built-in lumbar support, or an individual lumbar support that is specifically designed to be used with your chair. “One size fits all” lumbar support products rarely provide any benefits and should be avoided.

Make sure you test the product in the store before you buy it. If you can, sit with the lumbar support for at least 15 minutes to see if it feels good or aggravates back pain. The best lumbar supports are adjustable, so you can fit it to the chair’s height. Ergonomic chairs with lumbar supports included usually allow you to adjust the height and width of the support. Adjustable separate supports are particularly useful if you use more than one chair throughout the day.

Good health is a combination of many factors including your nutrition, preventative care, appropriate corrective care and the small choices you make every day in the course of living. If you have questions about this article, your general or spinal health, please ask. We are here to help!

Call Us Today at 919.484.1400

Dr. P. Dubois, DC, CCSP.

Are Supplements Dangerous part 1

This is a series of three very interesting articles  written by my good friend Professor Steve Chaney, and that I am sharing with you with his authorization.

“Many of you have been asking me about the article titled “10 Surprising Dangers of Vitamins and Supplements” in the September 2012 issue of Consumer Reports. This article reminds me of the political advertisements that we have seen so much of recently. There is a kernel of truth in there somewhere, but by the time the ad airs it has been so magnified and distorted that it’s almost unrecognizable.

So let’s look at the warnings that the authors have made one by one, and put them in perspective.

The first warning is that supplements are not risk-free.

That is true up to a point. There are some bad players in the industry but they produce a very small minority of the supplements in the marketplace – probably less than 2%.

To understand just how small a problem this really is, we really need to put the warning into perspective. The authors said that there were 6,300 reports of serious adverse effects and 115 deaths associated with dietary supplements between 2007 and 2012. That corresponds to 1,260 serious adverse effects and 23 deaths per year.

In contrast, there are over 2.2 million adverse drug reactions and over 125,000 deaths per year from medications taken as properly prescribed.

So which is more dangerous – food supplements or prescription drugs?

The second warning is that some supplements are really prescription drugs.

Again that is a true statement, but it represents only a few bad apples in the industry – it’s not the industry norm.

The worst offenders are among supplements marketed for bodybuilding, weight loss, and sexual enhancement – especially those that promise instant or effortless results. These supplements often contain stimulants or synthetic steroids.

I have warned you about some of these supplements in my past columns. As I have said in the past “If it sounds too good to be true, it probably is”. So just avoid those supplements that advertise that they will make the pounds just melt away or enable you to leap tall buildings in a single bound.

The third warning is that you can overdose on vitamins and minerals.

That’s kind of a no-brainer. You can overdose on almost anything – even water.

Now I do not want to minimize the possibility of overdosing on vitamins and minerals. It can happen. Most of those 1,260 serious adverse effects reported each year are probably due to overdosing – although some of them may represent drug – nutrient interactions.

If you are taking high levels of vitamins and minerals, I do recommend that you familiarize yourself with the safe upper limits set by the Institute of Medicine and the Office of Dietary Supplements. You can find that at http://www.ods.od.nih.gov.

The fourth warning is that you can’t depend on warning labels.

Again, that is true with a small minority of the supplements out there. In fact, it is a good way to distinguish between the fly-by-night companies and the reputable companies.

My advice to you is to do your due diligence. Look for responsible, reputable companies that that put warning labels on their supplements.

The fifth warning is that no supplements have been proven to cure major diseases.

As the authors point out the FDA does not allow claims that supplements can diagnose, cure, mitigate, treat, or prevent diseases. These claims are only allowed for FDA approved drugs.

You wonít find many companies making those claims, but this is yet another good way to separate the reputable companies from the not so reputable companies. If you see claims that a supplement can cure or treat a disease, run the other way. Reputable companies would not make such a claim.

The sixth warning is to buy with caution from botanicas.

The authors are referring to stores that sell traditional medicinal plants for physical or spiritual healings – the California medicinal pot stores come to mind. The botanica type stores are completely unregulated, so you have no idea what you’re actually getting.

I agree strongly with this recommendation, but it has very little to do with the supplements that you and I are likely to be purchasing on a regular basis.

That’s enough for one week. Next week I will cover warnings 7 through 10 in the article.

In short, there is some truth to each of the warnings that I have covered this week from the Consumer Reports article. But, it is important to keep those statements in perspective. Each of them is true only for a very small percentage of the supplements in the marketplace.

So those warnings should not scare you away from supplementation. But they will help you choose high quality supplements from reputable manufacturers, and hopefully will make it less likely that you’ll fall for the hype and deceptive advertising used by a very small segment of supplement manufacturers.”

Written by Prof. S. Chaney.

About the Author: Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He did hold the rank of Professor at a major university where runs an active cancer research program and has published over 100 scientific articles and reviews in peer-reviewed scientific journals.

Additional resources: Social Marketing Connection