Blogs – Page 5 – Accident and Injury Experts

I Am Being Told That My Pain Is Subjective, That It Is Unprovable, And Therefore I Cannot Be Compensated. If This Is So Subjective And Mild, Why Can’t I Function?

  I have been asked the above question hundreds of times, in one form or another, by patients, attorneys, or insurers. The reality is that pain symptoms are by definition subjective. They are after all symptoms, akin to the symptoms that one might experience after having a stroke. To document objective evidence of pain requires expensive testing of the central nervous system, which is not the standard of care, and in a non research setting would be considered medically unnecessary. However, the research has already been done and is readily available. Chronic back pain is one of the most frequent reasons for permanent impairment in people under age 65, and yet is considered a subjective symptom and often denigrated as unprovable by third party insurers, who seek “objective” evidence of disability. The reality is that chronic pain is associated with reduced brain gray matter and impaired cognitive ability, which is reversible with appropriate and adequate treatment. Evidence suggests that the mechanisms of chronification of pain are related to cortical reorganization, an objective functional neuroplasticity change. Brain neuro-imaging with structural MRI in patient’s experiencing chronic low back pain documents a significant decrease of gray matter in the brainstem and the somatosensory cortex which correlates with increasing intensity of pain. Interestingly an increase in gray matter bilaterally in the basal ganglia and the left thalamus, the pain transmission centers, also correlates with increasing intensity of pain. These data support the hypothesis that ongoing nociception is associated with cortical and subcortical reorganization on a structural level, which may play an important role in the process of the chronification of pain, and that the thalamic pain processing center increases in size and functionality. Appropriate and adequate treatment of chronic pain reverses many of these functional and structural brain abnormalities, and restores gray matter in the brainstem and the somatosensory cortex.

For additional information:

http://www.painjournalonline.com/article/S0304-3959(06)00255-7/abstract Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients, T. Schmidt-Wilcke, et al. May; PAIN Volume 125, Issue 1 , Pages 89-97, November 2006 http://www.jneurosci.org/content/31/20/7540.abstract Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function David A. Seminowicz, et al. The Journal of Neuroscience, 18 May 2011, 31(20): 7540-7550; doi: 10.1523/​JNEUROSCI.5280-10.2011

An electromyelogram (EMG) is a test that is used to record the electrical activity of muscles.

When muscles are active, they produce an electrical current. Typically, an EMG is given at the same time as a nerve conduction study (NCS). These tests are used to diagnose nerve injuries and muscle damage and are referred to as elctrodiagnostic testing (EDX). Very often they will be given to individuals who have suffered low back injuries or neck injuries to diagnose nerve damage which may be causing symptoms in the upper or lower extremities (arms or legs).

The EMG measures the electrical integrity of the spinal cord to the muscle, and is frequently normal at first even with severe spinal cord injury.

The NCV will measure how quickly and completely a person’s arm or leg nerve transfers “information”, or how quickly and completely they respond. If nerve damage has occurred very often the response will be delayed or incomplete. NCS will show conduction changes in carpal tunnel and tarsal tunnel syndromes. It is very important to note that most EMG/NCV tests are not 100% accurate, and have at least a 10-30% margin of error. Very often individuals with nerve damage will have normal EMG/NCV tests even though they are experiencing severe nerve damage. One of the critical elements in utilizing an EMG /NCS is the timing of the study in comparison to the onset of the injury.

Electrodiagnostic studies (EMG and NCS) examination may be most helpful when performed several weeks after the injury has occurred. However, NCSs are often useful acutely after nerve injury, for example, if there is concern that a nerve has been severed. In fact, if studies are delayed, the opportunity to precisely identify the region of injury or to intervene may be lost. In some cases, even needle EMG testing performed immediately after a nerve injury may demonstrate abnormal motor unit action potential (MUAP) recruitment and/or provide baseline information that can be helpful to document preexisting conditions, date the injury, or serve as a baseline for comparison with later studies.

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