Shoulder-Neck Pain and Total Body Pain

Work-related musculoskeletal pain is a huge expense, and recently OSHA has taken some steps in making the workplace easier for workers. This study examined one aspect of worker pain by evaluating the relationship between shoulder-neck (SN) pain and total body pain (TBP). The authors also wanted to evaluate the effect of nonspecific pain on a patient’s report of mental distress and self-experienced health. The study looked at 8,116 people in the general population. The authors organized their data according to work status (employed or retired) and age to see if total body pain was related to working status as well.

The analysis was performed mainly through questionnaires. Body aching was assessed by the Standardized Nordic Questionnaire (SNQ), in which 4 regions of the body were illustrated on a body map. The General Health Questionnaire assessed mental health, and a seven-point scale was used to measure self-reported health.

72% of those reporting shoulder-neck pain had more than one painful body area. Total body pain scores were higher as shoulder/neck pain scores increased, and self-experienced health scores were significantly affected. Yet men and women scored quite differently in the remainder of the findings:

  • Women had higher TBP scores than men, but the scores decreased in the 60 year old age group—their condition improved when out of work.
  • The relationship between TBP and SN pain was more pronounced in the female group than the male group.
  • Men who were not working had the lowest reported health scores in relation to their pain status.
  • Women showed higher mental stress and distress in relation to their degree of shoulder-neck pain.
  • Emotional distress was found in 30.9% of women and 23.3% in men.
  • 42.3% of employed women had SN pain, and 55.7% had widespread pain.

 These findings show that the amount of pain experienced in the shoulder/neck area is dependent on the total burden of body pain. “The findings suggest that a majority of a middle aged general population could be sensitized to develop pain when subjected to repeated musculoskeletal strain in a particular part of the body, e.g. work situations demanding repetitive shoulder movements.” They also mention that mental stress is often overlooked with chronic musculoskeletal pain patients. The authors make the following recommendations for handling these cases:

“Our results emphasize the need for assessment of the number of pain locations as well as the primary pain location when investigating possible causal relationship between repetitive low force musculoskeletal load and the development of localized pain…In the treatment and rehabilitation of patients reporting chronic musculoskeletal pain, a multidisciplinary approach focusing also on mental distress, is important already before work capacity is lost.”

Ektor-Andersen J, Isacsson S, Lindgren A, et al. The experience of pain from the shoulder neck area related to the total body pain, self experienced health and mental distress. Pain 1999;82:289-295.

Recent Onset Headache

This study examined 100 consecutive patients who presented at neurological unit with headache of recent onset (described as headache that “appeared for the first time ever in the last 12 months. Patients with past history of headache were excluded except, if a change of character of the previous headache had been the reason for the referral.”) Every patient was examined by a physician and given a CT scan with and without intravenous contrast. Some of the patients were given lumbar puncture, blood tests, MRI, and magnetic resonance angiography, if needed.

90% of the patients had headaches for the first time, while 10% had previous—but now different—headaches.

The study reported that the neurological examination was normal in 80% of the patients. Further investigations, however, turned up some very serious conditions: Intracranial neoplasm (21%); subacute meningitis (5%); intracranial hematoma (3%); and hydrocephalus (2%). In all, “Headaches were considered organic in 39 (39%) of the 100 patients, and in 21 (26%) of the 80 with normal neurological examination.”

“It has been suggested that with recent-onset headache, a CT or MRI should be obtained if the headache is severe or occurs with nausea, vomiting or abnormal signs. However, headache in four patients with intracranial tumors in our study was mild, no nausea or vomiting occurred, and was not aggravated by Valsalva nor did it awake them during the night, and were unassociated with abnormal neurological signs.”

“We suggest that neuroimaging studies should be performed in all adult patients with non-vascular headache of recent-onset, and no previous history, irrespective of the characteristics of the headache…”

Duarte J, Sempere AP, Delgado JA, et al. Headache of recent onset in adults: a prospective population-based study. Acta Neurologica Scandinavica 1996;94:67-70.

Whiplash Injury, Neck Ligaments Weakened

This study is important, because it shows that the ligaments of the cervical spine are weakened after even a “minor” auto collision. This weakening of the integrity of the cervical spine can result in abnormal motion of the spine, pain, and premature degeneration of the vertebral joints – more commonly known as osteoarthritis.

After years of study, it is clear that the spinal ligaments can be stretched or torn during an auto collision. Previous studies have shown that the anterior longitudinal ligaments, the transverse ligaments, and the facet capsules can be damaged, even in “minor” crashes.

The scientific consensus is this: during an auto collision, the individual vertebrae of the spine move so rapidly and so extremely, the ligaments that hold the spine together are sprained.Whiplash weakens the neck

A new study from Yale University has taken an important new step in understanding the exact nature of these injuries. First, the researchers started with six cadaver spines that they had previously exposed to simulated rear end collisions. They took these spines apart and tested the failure point of each of the individual ligaments. They then compared the failure rate of the whiplash spinal ligaments to previously collected data on normal, non-injured spines.

The authors studied four different characteristics of the ligaments: failure force, elongation, energy absorbed, and stiffness. The data from the whiplash-exposed ligaments was then compared to the control ligaments.

The authors found that the whiplash ligaments were significantly weaker than the control specimens:

“The present study determined the dynamic failure properties of whiplash-exposed human cervical spine ligaments and compared the results with previously reported control data. Significant decreases in ligament strength were observed following whiplash, supporting the ligament-injury hypothesis of whiplash syndrome. Clinical studies, which have documented pain relief in whiplash patients following nerve block and radiofrequency ablation of facet joint afferents provide support for the present results which indicate whiplash loading causes decreased ligament strength.”

The study provides a suggested sequence of events that may occur after injury to the ligaments that can cause chronic pain and disability after a collision:

  1. The violent stretching of the ligaments causes subfailure injuries to the ligaments and nerve receptors in the ligaments.
  2. This weakening of the ligaments may lead to altered joint motion and loading patterns, compressing the joint tissues.
  3. This compression can result in inflammation, pain, and accelerated degeneration of the joint tissue, resulting in osteoarthritis of the neck.

This study is the first to show that the individual ligaments of the spine are weakened after a whiplash-type motion. Clinically, it is important to carefully measure range of motion and to use flexion/extension radiographs in these patients to help pinpoint those areas of the spine that have been injured.

Tominaga Y, Ndu AB, Coe MP, et al. Neck ligament strength is decreased following whiplash trauma. BMC Musculoskeletal Disorders 2006;7:103.

Retropharyngeal Tendinitis

This interesting case study illustrates the potential relationship between neck trauma, delayed onset of neck pain, and dysphagia.

“A 42 year old secretary in excellent health fell, in the sitting position, into a stream. She had minor abrasions of the limbs but did not hurt her neck or head.Ten days later she developed a stiff neck. Turning the neck to the left side was painful, making driving difficult. After two days pain increased; prescribed methocarbamol failed to provide relief. On day 3 she had painful difficulty in swallowing, not in the throat but in the right side of the neck ‘as if the muscles and ligaments were strained,’ and painful movement was relieved when flexing her neck.”

The dysphagia increased to the point where the patient could swallow only sips of water. “She held her neck to ease swallowing. She also took to holding her head with both hands to enable her to lay her head on the pillow, and to sit up when getting out of bed.” Her symptoms gradually improved, and by day 12 they had resolved.

“The unusual combination of such distinctive symptoms suggests a lesion in the retropharyngeal space involving the prevertebral muscles…The salient features are: (1) The curious location of pain, mainly in the side of the neck. This is quite different from that experienced in common neck sprains of whiplash injury, which are maximal in the posterior neck muscles with radiation to the shoulders, occiput, and interscapular regions. (2) Pain aggravated by movement… (3) Pain is dramatically increased by swallowing. (4) Painful dysphagia is felt not in the throat, but in the side of the neck. Patients may be obliged to hold their necks to allow swallowing. (5) The illness is unaccompanied by fever or systemic disturbance and is self-limiting.”

The author attributes the symptoms to damage of the longus cervicis colli.

Pearce JMS. Longus cervicis colli “myositis” (syn: retropharyngeal tendinitis). Journal of Neurology, Neurosurgery, and Psychiatry 1996;61:324.

Alcohol Abuse and Neuropsychological Tests

This study, which was presented at the 18th Annual National Academy of Neuropsychology Conference, examined the effects of chronic alcohol abuse on test scores of neuropsychological tests in patients who experiences a traumatic brain injury (TBI). The researchers compared the results of the tests between two groups: those with and those without a history of chronic alcoholism.

They found the TBI patients with a history of alcoholism had difficulty on the tests that measured higher level brain functioning—such as verbal fluency and categorization. The authors conclude:

“The findings lend support to the hypothesis that pre-existing executive system deficits exist in the chronic alcoholic and that poorer performance is related to the additive effect of chronic [alcohol] use and sustained brain injury.”

Professionals who work with TBI patients need to take a careful history, to be aware of the history of alcoholism, as such a history can dramatically influence the results on neuropsychological exams.

Kreuch, TJ, Falcon P, Gabel B, Hudson D. Effects of chronic alchohol abuse on neuropsychological test performance in individuals with traumatic brain injury. Archives of Clinical Neuropsychology 1999;14(1): 34.

Drinking in Moderation Eases Fibromyalgia

Drinking in Moderation Eases Fibromyalgia Winding down with a glass of wine could ease fibromyalgia symptoms. In a new study, patients with fibromyalgia who drank alcohol in moderation had fewer symptoms and a better quality of life than nondrinkers.

Mayo Clinic researchers believe alcohol could reduce symptoms of fibromyalgia syndrome (FMS) by increasing a neurotransmitter in the brain known as GABA. However they also pointed out that nondrinkers as a group may have more severe fibromyalgia and could be avoiding alcohol if they are using opioid painkillers.

The study, published in the journal Arthritis Research & Therapy, included 946 patients enrolled in the Mayo’s Fibromyalgia Treatment Program. The patients completed a number of tests to assess their fibromyalgia symptoms, quality of life, and overall health. They were also asked to report how frequently they consumed alcohol.

People drinking low to moderate amounts of alcohol (3-7 drinks a week) had higher physical function and quality of life scores, less fibromyalgia symptoms, and less pain than nondrinkers. This association held after adjusting for BMI and social variables. Heavy drinkers ( more than 7 drinks a week) did not experience the same benefits.

The researchers explained that people with fibromyalgia tend to have lower amounts of GABA in their brain. GABA is an inhibitory transmitter, and not having enough of it may cause the nervous system to react in a way that amplifies pain. It’s possible that alcohol binds to the GABA receptor in the central nervous system to reduce the transmission of pain.

“However the effects of alcohol may also be due to improved mood, socialization and tension, and while moderate drinkers have fewer symptoms there are still many questions about how this happens,” stated researcher Dr. Terry H. Oh in a press release. The authors cautioned against FMS patients increasing their consumption of alcohol since more research is needed.

If you’re not looking to up your alcohol intake anytime soon, patients with fibromyalgia can benefit from natural treatments like chiropractic care.

Reference

Kim C, et al. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Research & Therapy 2013; 15 (R42). doi:10.1186/ar4200.

Which vitamins are right for you?

Do you take vitamins? If so, you’re in the company of more than half of Americans who report taking a multivitamin or other dietary supplement. These tiny little capsules have garnered a lot of attention in the news lately.

The varying results from these studies remind us of the complexity of nutrition and vitamins. While many supplements can be beneficial for your health, other supplements still need further research to understand their full impact.

There are some guidelines though that can help you determine which supplements you should include in your diet:

First, not all supplements are created equally. Low-grade supplements are often not as soluble, which means the body has difficulty accessing the nutrients. If you’re going through the trouble of taking vitamins, you want to make sure they’re high-quality so your body can experience the full benefits. Many chiropractors have quality supplements on hand in their office or can recommend good sources.

Second, there seems to be a consensus among doctors that the best way to receive vitamins is through eating healthy food.  A lot of people have grown accustomed to eating primarily processed foods which often lack the nutritional benefits of unprocessed foods. And taking a vitamin isn’t a simple answer to that lack of nutrition either. Nutrients inside of food interact in complex ways that can’t always be replicated in supplements. Taking supplements can be a good way to enhance your healthy diet or fill-in if you have vitamin deficiency, but they aren’t meant to replace a healthy diet. Ask your doctor for more information about healthy nutrition and vitamin deficiency.

Finally, every person will have a unique set of vitamin needs. What supplements you should take depends on several factors like your diet, age, and sex, whether your have a deficiency. Your chiropractor has received nutritional training and can counsel you on which supplements are right for you.

Your chiropractor does more than just treat pain; they’re there to help you lead a happier, healthier life.

Dark Chocolate: Good for your sweetheart and your heart

Getting chocolate from a sweetheart could benefit your romance and your heart. A new study suggests that dark chocolate can help prevent heart problems. At an estimated annual cost of $42 a person, dark chocolate could reduce fatal and nonfatal cardiovascular events.

Previous research suggested that chocolate can lower blood pressure and cholesterol levels but every study has been short-term in scope. To estimate the long-term effects of chocolate consumption, researchers analyzed data from the Australian Diabetes Obesity and Lifestyles study which included 2,013. Using statistical models and risk-prediction algorithms, researchers estimated how daily consumption of dark chocolate would affect patients with metabolic syndrome over 10 years. Under the best case scenario, daily consumption could prevent 70 nonfatal and 15 fatal cardiovascular incidents for every 10,000 people. If patients were only 80% compliant, those numbers dipped to 55 and  10 respectively. Even with these lower numbers, researchers concluded that eating dark chocolate is a cost-effective preventive measure.

But milk-chocolate lovers be weary: these cardiovascular benefits are only apparent in chocolate containing 60-70% coco or enriched with polyphenols. The coco bean is rich in polyphenols and flavonoids with antihypertensive properties and positive metabolic effects. Flavonoids have also been shown to slow cognitive decline in older adults and prevent stroke.

 

References

Zomer E, Own A, Magliano D, et al. The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. British Medical Journal 2012; 344:e3657.

Dark Chocolate: Good for your sweetheart and your heart

Getting chocolate from a sweetheart could benefit your romance and your heart. A new study suggests that dark chocolate can help prevent heart problems. At an estimated annual cost of $42 a person, dark chocolate could reduce fatal and nonfatal cardiovascular events.

Previous research suggested that chocolate can lower blood pressure and cholesterol levels but every study has been short-term in scope. To estimate the long-term effects of chocolate consumption, researchers analyzed data from the Australian Diabetes Obesity and Lifestyles study which included 2,013. Using statistical models and risk-prediction algorithms, researchers estimated how daily consumption of dark chocolate would affect patients with metabolic syndrome over 10 years. Under the best case scenario, daily consumption could prevent 70 nonfatal and 15 fatal cardiovascular incidents for every 10,000 people. If patients were only 80% compliant, those numbers dipped to 55 and  10 respectively. Even with these lower numbers, researchers concluded that eating dark chocolate is a cost-effective preventive measure.

But milk-chocolate lovers be weary: these cardiovascular benefits are only apparent in chocolate containing 60-70% coco or enriched with polyphenols. The coco bean is rich in polyphenols and flavonoids with antihypertensive properties and positive metabolic effects. Flavonoids have also been shown to slow cognitive decline in older adults and prevent stroke.

 

References

Zomer E, Own A, Magliano D, et al. The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. British Medical Journal 2012; 344:e3657.

Citrus and flavones reduce risk of stroke

We know citrus for its immunity-boosting vitamin C properties, but the fruits may have another health benefit: reducing your risk of stroke. Citrus fruits are a good source of flavones, a subclass of flavonoids, that were tied to lower rates of stroke in a recent analysis of the Nurses’ Health Study. Flavonoids are a class of plant pigments that act as antioxidants and have been found to reduce the risk of heart disease and cancer.

In the study, 69, 622 participants completed questionnaires on their food intake every four years for 14 years. Researchers also tracked whether participants had strokes, and which types of strokes they had.

Using a state-of-the art food database, researchers analyzed participants’ diets for the presence of six common flavonoids. They discovered that people who consumed less flavones had an increased risk of ischemic strokes. In the fourteen years of the study, ischemic strokes occurred more frequently than other types of strokes.

Citrus was not the only source of flavonoids in participants’ diets. Tea, non-sugary citrus juices, apples, and blueberries all contributed to increasing participants’ flavonoid intake. But only flavones were linked to a significant decrease in strokes, and none of the flavonoids were associated with a decrease in hemorrhagic strokes.

There’s no magic vitamin or nutrient for preventing strokes, but an overall healthy, balanced diet may significantly decrease your risk. Talk to qualified nutritionist or a chiropractor trained in nutrition to learn more about healthy dietary and vitamin choices.

Anderson, Pauline. Flavanones in Citrus Fruit May Lower Stroke Risk. Medscape Today. February 23, 2012. //www.medscape.com/viewarticle/759097. Accessed April 3, 2012.

Cassidy, A, Rimm E, O’Reilly E, Logroscino G, Chiuve S, Rexrode K. Dietary Flavonoids and Risk of Stroke in Women. Stroke 2012;doi: 10.1161/​STROKEAHA.111.637835.