Video - Padda Institute Center for Interventional Pain Management

Nine reasons why weight loss is so important for chronic pain patients.

Nine reasons why weight loss is so important for chronic pain patients.

1. Pain reduces activity

Pain often leads to reduced activity and exercise, which can cause patient’s to gain weight, due to loss of metabolically active muscle.

2. Pain prevents restful sleep

Pain disrupts sleep, reducing growth hormone production, which causes patients to gain weight.  Pain also causes elevated cortisol levels and epinephrine levels, which reduce sleep and independantly cause obesity.

3. Pain effects hormones

Excessive fat accumulation leads to a buildup of visceral fat which produces xenoestrogens, which inhibit the production of testosterone, which causes further fat weight gain and loss of muscle mass.

4. Obesity predisposes patient’s to diabetes

Excessive fat accumulation decreases insulin sensitivity and produces insulin resistance, a form of pre-diabetes.

5. Pain effects your pocketbook

Pain often leads to significant functional disability, reducing the patient’s standard of living, which encourages the consumption of subsidized foods, often rich in carbohydrates (food stamps buy significantly more calories of carbohydrates than protein).

6. Obesity effects joint load bearing

Excessive weight dramatically increases the amount of load joints must support. For every extra one-pound of fat you have, you increase the force on your lower back by nearly 20-24 pounds. If you are 10 pounds overweight, your back is carrying an extra 240 pounds of force, and if you lose 10 pounds of weight you will reduce load bearing by 240 pounds.

7. High blood sugar reduces the effects of pain medications

Patient’s with elevated blood glucose experience significantly more pain and find that their pain medications are less effective as the glucose level rises and more effective as the glucose levels fall. There is a direct effect on the opiate receptor by excessive glucose, which prevents activation of the receptor.

8. High blood sugar makes proteins sticky (Glycation)

Glucose or sugar is a sticky carbohydrate. Imagine if you poured sticky goo into the engine of your car, it would bind up the machinery. Extra glucose binds onto nearly all of the proteins in your body, making them work less efficiently, and predisposing patient’s to heart attacks and early aging.

9. Carbohydrates are themselves addictive

Although eating sugar may give you an immediate lift or rush, it quickly disappears when insulin drives the blood sugar into the cells, which then leaves you craving for more sugar because your blood sugar level drops precipitously. Elevated blood sugar temporarily seems to partially activate the endogenous opiate receptors and some people do actually become “addicted” to carbohydrates, requiring ever increasing dosages, which leads to fat accumulation.

 

Whiplash Injury (Nagging neck pain after an accident)

Following a car accident, your nagging neck pain may not be just “soft tissue.”  Neck pain is one of the most common chronic pain conditions in modern medicine and can lead to depression, sleep disturbance, and inability to work.  Even though there may be minimal damage to your car, you can still sustain significant whiplash.  In fact, even at low speeds, occupants can experience severe whiplash, the video above demonstrates whiplash injury with a 5 mph collision.

 

 

 

 

 

The rapid motion of the neck during a crash can result in a number of injuries, with the majority of these injuries involving “soft tissue”:

  • Muscles
  • Tendons
  • Ligaments
  • Nerves
  • Discs
  • Micro fractures
  • Facet subluxation
  • Hemorrhage or edema of the pariarticular tissues (facet joints)
Soft tissue ligaments involved in whiplash

The term “soft tissue” is frequently tossed around as if it is an insignificant injury; this could not be farther from reality, as even the brain, liver, and heart are soft tissue, and it doubtful you could survive long with any of these structures damaged.

Nerves involved in whiplash injury

Soft tissue injuries are difficult to see on x-rays or MRI, and frequently require a diagnostic interventional workup to define.  Soft tissue injuries can lead to significant permanent impairments, and should be treated in a timely and medically appropriate manner in order to mitigate long-term consequences.

 

Injuries to bony structures are less common, but are usually apparent on x-rays

  • Rim Lesions
  • Endplate avulsions
  • Tears of the anterior longitudinal ligament
  • Uncinate process
  • Articular subchondral fractures
  • Articular pillar
  • Articular processes

 

 

 

Whiplash affects the cervical vertebrae of the neck as well as the first few upper thoracic vertebrae, and is most commonly caused by car accidents when the force of a blow from the rear causes the head to whip backward and forward.  The most common facets to be injured are at C2/C3 and C5/C6, which frequently results in referred pain at the locations indicated. As a result of facet joint injury, whiplash patients frequently encounter, headaches, back and shoulder pain in addition to neck pain.

Referred pain from facet injury

This action can cause tears in the muscles, tendons or ligaments of the neck. It can also cause a nerve to become pinched between two vertebrae, resulting in pain or numbness that may radiate down to the shoulder, arm and hand.

 

The neck is a particularly vulnerable part of the spine because:

  • The head is a free floating weight attached to the fixed thorax like a pendulum
  • The neck has relatively little muscular support
  • During an accident the head is moved with tremendous force back and forth, concentrating the biomechanical forces to just a few cervicothoracic vertebral bodies and their limited support

 

 

When the neck is moved quickly and forcefully, it places tremendous strain on the facet joints of the spine — which are located at the rear of the spine. The facet joints normally allow the spine to move in a very flexible manner through flexion, extension and rotation.

 

Xray of facet joints, range of motion
Normal motion of cervical facets
Damage to facet with whiplash

 

Injured people with cervical facet syndrome usually present with severe posterior neck pain and muscle spasms. Outpatient to the neck produces pain over the cervical facets. The pain typically increases with extension of the neck with symptoms of pain overlying the cervical facet joints or regionally to the head, neck or shoulder region.

 

Unfortunately radiographic diagnoses of these injuries are very difficult. Cervical spine x-rays may reveal focal or diffuse cervical spondylosis or loss of normal lordosis, but will not reveal the facet injury itself. The medial branch of the dorsal ramus transmits the pain from inflamed facet joints. Stimulation of the facet nerves often results in referred pain.

 

 

Cervical facet blocks at the appropriate level are frequently necessary in the accurate diagnosis of cervical facet pain. The cervical facet block at the appropriate level usually brings immediate relief to the injured person, with pain relief lasting four to six hours after injection being diagnostic.  If successful diagnosis with facet blockade is made, then a more permanent solution may be radiofrequency neurolysis.

 

Low back pain with lumbar facet involvement can also be diagnosed similarly. However, lumbar facet joint injuries are far less likely to occur following an auto accident; because the lower back (lumbar spine) is generally supported and not subject to fast and extreme range of motion following a rear end car accident. This is different than the neck (cervical spine), which can only rely on a headrest for protection from these quick acceleration injuries (whiplash).