Monthly Archives: December 2012

Chronicity Common for TMJ Patients

jawpain2Many auto-injury patients develop jaw disorders in their temporomandibular joint (TMJ). While these symptoms may resolve quickly for some patients, a new study suggests they can last for up to fifteen years.

The study compared volunteers with and without TMJ symptoms to determine the progression of the disorder. Researchers found in most participants with TMJ disorders, symptoms persisted at the fifteen-year follow-up. A small percentage of patients experienced worsening symptoms including bone changes, development of new disk displacement, and aggravation from reducing to non-reducing disk displacement.

Although the study did not look at auto-injury patients specifically, it does demonstrate that while many patients do not develop additional symptoms, the disorder is often chronic.

A Drug for Avoiding Alzheimer’s?

For years scientists have searched for ways to slow the cognitive decline of Alzheimer’s disease. Now researchers believe that a drug for fighting Alzheimer’s may be ready in the next five years.

With the start of 2013, a recent article from Medpage Today takes a moment to reflect on the major discoveries in Alzheimer’s research of the previous year.

In 2012, a host of drug trials showed that shutting down production of the beta-amyloid protein may slow cognitive decline, but only when detected early in the disease. For people showing signs Alzheimer’s though, it may be too late to shut down beta-amyloid production.

Other studies suggested that slowing the development of tau protein could inhibit the development of the disease.

It’s likely that a single drug won’t work on its own, researchers pointed out. A combination of therapies—including exercise and lifestyle changes—may be what’s needed to stop the development of the disease.

Cultural Expectations Don’t Influence Prevalence of Whiplash

Beliefs Important in Whiplash Recovery Research shows that patients’ beliefs and expectations influence their recovery from whiplash injury. But what role do cultural expectations play in shaping patients’ expectations? Do people from countries with a higher incidence of whiplash tend to have more negative expectations of the injury?

To answer these questions, researchers compared the cultural differences in whiplash beliefs between people from Australia and Singapore.

Despite that Singapore has a relatively low rate of whiplash injury and Australia has a relatively high rate, people from Singapore actually had a slightly more negative outlook on whiplash injury than Australians. Both groups held generally positive views on whiplash recovery. Only gender played a significant role, with women holding slightly more negative expectations.

The research demonstrates that cultural expectations do not neatly reflect the prevalence of whiplash in a given country.

Negative Beliefs Predict Poor Whiplash Outcomes

Chronic whiplash as a somatic syndromeWhiplash injuries, often caused by motor vehicle collisions, frequently result in long-term pain or disability. However, little is known about why some whiplash cases become chronic while others do not. Beliefs about pain are known to be important factors in recovery. A team of researchers recently set out to explore the predictive capacity of early post-injury pain beliefs in explaining the chronicity of whiplash injuries.

The study involved 72 people undergoing treatment for acute whiplash in physical therapy or chiropractic clinics. Participants were asked about their pain attitudes, beliefs, and perceptions immediately following the whiplash injury, and at 3 and 6 months post-injury. Pain severity and self-reported disability were also recorded.

Pain expectancy beliefs were found to be negatively correlated with the intensity of pain at 6 months. Catastrophizing was also found to be predictive of continuing pain. This research provides additional support for the idea that pain expectant or avoidant thoughts and behaviors should be addressed during treatment for whiplash injuries. The cognitive-behavioral approach to pain management necessitates that cognitive factors, such as beliefs about pain, be examined soon after the injury.

This study provides support for the Fear Avoidance Model, which attempts to explain the chronicity of whiplash. According to this model, patients’ experiences of pain may lead to anxiety concerning the harmfulness of the pain, causing them to fear certain movements and situations that could lead to pain. As a result, the patient begins to avoid activities that could be painful, leading to disability.

Reference

Bostick GP, et al. Predictive capacity of pain beliefs and catastrophizing in Whiplash Associated Disorder.Injury 2012: doi: 10.1016/j.injury.2012.10.007.

Work Disability Common Even in Mild Injury Patients

WorkDaysMost studies on work compensation after auto injuries focus on severely-injured patients who require hospitalization, while less is known about the disability burden faced by patients with more mild injuries. A new study sought to fill that gap by examining the work disability outcomes in patients who were hospitalized compared to patients who were not hospitalized for their injuries.

The researchers found that patients with no hospital stay accounted for 27% of all work disability days, with the majority missing less than a week of work. Female gender, being under 35 years of age, and early prescriptions of painkillers also increased the risk of work disability six months after the collision. In patients who were hospitalized, the burden of work disability increased significantly with length of hospital stay.

Despite the relatively reduced burden of disability in patients who aren’t hospitalized, the study confirms that many patients with mild injuries are still forced to miss work days as result of their injury.

Dropped Head Syndrome After Whiplash

A new report describes a rare case of Dropped Head Syndrome after whiplash injury. Dropped Head Syndrome (DHS) occurs when neck extensor weakness results in constant “chin on chest” state.

The report outlines how one 56-year old developed DHS after a violent whiplash injury. Twenty years before suffering from whiplash, the man had previously received successful treatment of Hodgkin’s lymphoma with chemotherapy and mantle field radiotherapy. DHS can occur in patients with Hodgkin’s lymphoma but this patient did not develop these symptoms until well after he had recovered from cancer.

Is Exercise Therapy Cost Effective for Whiplash?

Exercise therapies have proven beneficial for patients suffering from neck pain and whiplash-associated disorders. But how do these approaches compare to usual care in terms of reducing disability and limiting cost? Is providing education and advice to stay active enough to enhance recovery or is guided physiotherapy essential?

To answer these questions, researchers from the UK compared four different approaches for treating whiplash injury in a new study. The data included 3,851 whiplash patients who were admitted to 15 emergency departments across England.  Patients were divided into two groups: those that had improved within a week (Step 1) and those that had persistent symptoms after three weeks (Step 2). Within Step 1, patients were randomly assigned to receive either usual care in an emergency department or a psycho-educational intervention. For the Step 2 group, patients were assigned to receive either one physiotherapy session or a package of six sessions.

For patients in Step 1, psycho-educational interventions in emergency departments were no more effective than usual care for reducing the burden of whiplash. For patients in Step 2, more physiotherapy sessions resulted in slightly more improvements in disability. The patients receiving more physiotherapy also had significantly reduced work absence.

Despite these improvements, having more physiotherapy sessions was not considered cost-effective “at current levels of willingness to pay.” However researchers pointed out that having missed less work days could make the intervention more cost-effective “at a societal level.”

Previous studies show that fear avoidant beliefs can worsen whiplash symptoms, and that staying active can improve long-term treatment outcomes.

Reference

Lamb S, Williams M, Gates S, et al. Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries. Health Technology Assessment 2012;16(49):1-141.

MRIs Reveal Brain Injuries Not Seen in CT Scans

MRI scans could help doctors diagnose brain injuries previously undetected with CT scans, according to a new study published in the Annals of Neurology.

The study included 135 patients who were admitted to the emergency room for suspected brain injuries. All patients received a CT scan at their initial visit and an MRI scan one week later. Although most of them had no detectable signs of brain injuries on CT scans, more than a quarter of patients with “normal” CT results did show signs of a brain injury on MRIs. Using the different imaging technique, doctors were able to identify signs of microscopic brain bleeding in the form of focal lesions.

This study demonstrates that having a “normal” CT scan doesn’t rule out the possibility of a mild traumatic brain injury.

Brain Injured Solider May Face Death Penalty for Mass Shooting

Commanders at Joint-Based Louis McChord announced that they will refer the case of Sgt. Robert Bales for general court martial, reported The LA Times. Army officials also announced that they will seek the death penalty for Bales on charges that he killed 16 Afghan civialians in March.

Bales’ defense lawyers have argued he wasn’t in his right mind during his shooting rampage since he suffered from posttraumatic stress and the lasting effects of a brain injury. Some observers have suggested these claims are overblown. Traumatic brain injuries, now considered the signature wounds of the Iraq and Afghan Wars, can range in symptoms from short-term confusion to life-altering cognitive deficits and behavioral changes.

Whether or not a brain injury played a role in Bales’ behavior, the incident adds to growing awareness of TBIs in the military, and raises questions about the best approaches for helping soldiers recover from the invisible wounds of war.

Hillary Clinton Recovering from Concussion

Most Secretaries of State won’t take time off for illness. But that’s exactly what Hilary Clinton has been forced to do after fainting and hitting her head. Clinton is currently recovering from a concussion and has been for several days. Although she will continue working from home for the next week and staying in contact with the State Department, doctors say it’s important for her to allow enough time to heal.

In light of Clinton’s concussion, a recent article from the Huffington Post outlines the most common causes and symptoms of mild traumatic brain injuries.  Incidences like these present an opportunity to raise awareness about the seriousness of concussions.