Articles Posted in Chronic Pain


The Centers for Disease Control estimates that 1.4 Million people yearly suffer a traumatic brain injury.  When troops returned from the First World War suffering what was then called “Shell shock”, the first associations were made between chronic pain and brain injuries. As a Sacramento Brain Injury Lawyer, I have been well aware of how many of my clients suffering concussions or brain injuries also suffered from chronic headaches.

I saw confirmation of this correlation in a recent medical  review of some 1100 Medline articles over the past 50 plus years.  The study showed a prevalence of chronic headache pain in 56 percent of individuals suffering a brain injury, even a “mild” brain injury.  The full article can be found here.

As a Sacramento personal injury lawyer, I have had occasion to represent many minority members in auto and trucking accidents since 1982.  Over the years, I’ve noticed that, in general, different people and different cultures experience pain differently. I recently came across an article entitled Hispanic Inpatient Pain intensity.

The gist of that article summarized is that non English speaking Hispanic  patients in hospitals tend to underreport pain by some 30 percent compared to  English speaking Hispanic patients.

Personal injury victims, especially those who have been injured as a result of a rear-end collision, often suffer from painful injuries as a result of a whiplash type injury.  Whiplash is a common injury to the neck and upper back caused by a sudden back and forth motion of the head. This sudden violent snapping motion puts enormous strain on the neck and upper back muscles and ligaments. This type of injury is commonly referred to as hyperextension/hyperflexion injury neck sprain or strain, myofascial injury  or cervical strain or sprain.

Symptoms related to a whiplash type injury caused by an auto accident may include the following:

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I. Background

2000 years ago, Hippocrates, the father of medicine, coined an adage that for millennium medical doctors have adhered to: “First, do no harm.” By overwhelming numbers, most individuals called to medicine have a deep desire to comfort, help and heal.

Finger amputations may sound small but they really cause a lot of changes in the way the patient performs certain activities, such as punching the buttons on a phone or using a keyboard. This is why the surgeon will attempt to put the finger back on if it is severed from the hand.

When a finger is initially severed, the bystander should wrap the amputated finger in moist, cool gauze. The finger should not be immersed in water because it can become waterlogged. Simply use a paper towel if you have no medical gauze. Put the finger on ice with a Ziploc bag. Do not use dry ice for this part of the process. If there will be an attempt to reimplant the finger, there should be immediate medical attention with a surgeon who can put arteries, veins and nerves back together. The time from amputation to reimplantation should be less than 12 hours.

People can sustain burns and heat-related injuries from their motor vehicle. Children, pets and the elderly are at the highest risk of injury. Such injuries can show up even after being in a motor vehicle for a short time. For example, when it is 93 degrees Fahrenheit outside, the vehicle can reach 125 degrees Fahrenheit after only 20 minutes. Within 40 minutes, the temperature can reach 140 degrees Fahrenheit.

Don’t allow kids to play inside vehicles or their trunks in extremely warm weather. They can get heat stroke, which can lead to permanent injury and death within just a few minutes. Don’t leave a child in a hot car unattended and teach kids not to play around vehicles in hot weather. Make sure all passengers in your car have left the vehicle. Don’t leave a sleeping child or older person in the car. Stay away from leather seat, safety belt buckles and latch plates when riding in a hot car until they cool down. Shade the front and rear windows when not using your car so the heat doesn’t build up.

Spinal cord stimulation is used to manage chronic pain. Doctors implant a pulse generator that delivers an electrical pulse to the spinal cord. The electricity impairs the function of the nerve signals sent by the painful area to the pain.

Spinal cord stimulators are implanted in the back using sedation and local anesthesia. A trial run is done first using a small, temporary pulse generator. This type of percutaneous stimulator is a temporary pain-relieving device because it tends to migrate under the skin. If it works, however, a permanent spinal cord stimulator is implanted under the abdominal skin with wires passed around to the back and inserted in the spinal cord. This stimulator is considered more stable and can be used for years.

There are two facet joints at either end of a vertebral segment in the spine. In the lumbar spine, these joints help give stability to the spine and help guide its motion. Because of a back injury, arthritis or mechanical stress on the lumbar spine, there can be low back pain. One treatment of this type of pain is the lumbar facet injection. The relief of pain the person receives can help them participate in physical therapy in order to strengthen the back and keep it pain free.

Lumbar facet injections have two primary goals: the first is to help diagnose the cause and location of the low back pain and the other is to give pain relief. A facet joint injection can find the source of the pain by injecting the joint with an immediate relief anesthetic. If the pain is relieved at a particular facet joint, it is the likely source of the pain. This is especially true if complete relief is obtained.

Thoracic discography is done at a lesser rate than cervical or lumbar discography because the thoracic spine is relatively stable and disc problems are much less likely in the thoracic area when compared to the cervical area and the lumbar area. It is a test to look for disc problems in the thoracic part of the spine. There are many more problems with the thoracic spine, such as muscle pain, pain with the spine, visceral pain masking thoracic pain and facet joint pain.

The purpose of having a thoracic discogram is to see if a damaged disc is causing thoracic pain. It is similar to a lumbar and cervical discogram in that it is used to identify specific discs that are pinching on nerves causing pain in the back or in the area a peripheral nerve serves. It is done in cases of thoracic back pain or pain in the trunk and is a more successful test than an MRI or CT scan of the thoracic spine because a disc severely damaged on CT scan may not be painful while a mildly damaged disc can be the source of the pain.

An intrathecal pump is one way doctors can provide pain medication directly to the spinal cord. The pump is placed beneath the skin of the abdomen and is programmed to deliver a specific amount of pain drug to the spinal cord. The pump itself is attached to a catheter similar to the one used on women during childbirth.

The catheter goes into the back and is inserted into the intrathecal space around the spinal cord itself. Because the spinal cord is given the medicine directly, there are fewer generalized symptoms and less medication needs to be given. One needs only about 1/300 of the medication necessary when given by intravenous means.