Dr. Glenn Frisch

March comes in like a lion with this newsletter!  I have included only 'meat and potatoes' information that is all supported by research data!

If this newsletter seems to be slightly more 'matter-of-fact' than other newsletters that I have written, there is a good reason why.  I have been inundated recently with questions and solicitations regarding internet trash and infomercial claims.

People too easily forget that infomercials are designed for one thing....to make money!!! 

We want to believe that all people are good and honest and that they really do have our best interest in mind.  Unfortunately, that is not the case when they are trying to sell you something.

One of the fastest ways to tell if there is a catch or to recognize a sales pitch is to look for a simple target lines like these:

• "Secrets that your doctor doesn't want you to know about!"

• "A 100 year old miracle cure found."

• "Look and feel 20 years younger."

• "What your doctor won't tell you."

• "A new 'cure' for back pain."

• "Secrets that insurance companies don't want you to know."

(These dishonest titles are all in actual print.)

Sensationalism that includes 'hidden secrets', miracle cures, and a promise of the fountain of youth are designed to trigger an emotion that pulls you in so that you may be sold something.  

Real research does not use sensationalism to sell you!  It just is what it is.  Unfortunately, real research can be tedious and boring to wade through and in our society we want fast answers and fixes to the problems we create.  This demand for immediacy sets us up for the hucksters to sell us anything.  Don't get fooled with your health!

There is important information in each article this month and I hope that you take the time to read each one closely.  

Dr. Frisch

Dizziness After Whiplash Due to Neck Trauma

Many people who have sustained neck injuries as the result of accidents, crashes and even home injuries report that they suffer with dizziness (vertigo), nausea and balance problems for long periods after the injury.  These findings are clinically supported. 

Due to the duration of their complaints, family members, friends and even co-workers do not believe that they are telling the truth because there is no blood, broken bones or other outward appearances of disability.  The problem, however, is very real and can be quite dangerous and debilitating.  

Imagine driving your car, turning your head quickly and becoming so dizzy that you lose control of your car, become nauseated and begin vomiting immediately, or lose complete consciousness only to wake up on the side of the road.  All of these scenarios are real and have been reported to me by different patients on many occasions.  The effects of neck trauma do impact people's daily lives long after the original injury.

A recent study published in the Journal of Neurotrauma (2005) supports the clinical findings of dizziness as the result of neck injury.  They tested subjects with and without whiplash injury by placing them in a rigid seat while holding the neck steady.  The seat was then rotated at different speeds in a dark room and the eye movements were recorded using a laser camera.  The reason that the eye movement was measured relates to the cervico-ocular reflex (COR), which I have described in earlier newsletters.  The COR is a measure of eye, neck and brain function as they work independently and together.  This reflex stabilizes eye motion in relation to neck motion and it is impaired as the result of a 'true whiplash' trauma to the neck.  Without care, it rarely returns to proper function.

The findings of the study indicate that there is a large difference in eye compensation in whiplash sufferers when compared to normal people.  There also seemed to be no difference in the length of time since the injury.  In other words, a three year old injury showed the same impairment as a two week old injury. 

The significance of these findings is threefold:

1. Dizziness is real after an auto crash, and other accidents in which the neck is accelerated forward and backward rapidly resulting in injury to the cervical spine.

2. Since the dizziness, nausea and headaches are a result of trauma to the cervical spine, the treatment should revolve around stabilizing the cervical spine.

3. Vertigo after trauma should have an initial evaluation to rule out additional trauma to the brain and not just the neck. 

This is exciting!  This was a medical study and not a chiropractic study.  They are now beginning to understand what patients have been describing for decades.  They also valid that Chiropractic care is the appropriate care for whiplash injuries....period!

Kelders WPA, Kleinrensink GJ, Van Der Geest JN, et al.  The cervico-ocular reflex is increased in whiplash injury patients. Journal of Neurotrauma, 2005; 22(1):133-137.

Forgiveness and Back Pain

What is it about forgiving someone that makes us feel better?  We all do it in one capacity or another.  Sometimes we forgive the mailman for not bagging the paper when it rains, we forgive the person who cuts us off in traffic, and let's not forget about forgiving our spouses when we get on each other's nerves.  One thing that each of these things have in common is that you feel better when you do it! (Even if you didn't want to.)

It has long been accepted that people who harbor feelings of hate and anger heal slower and have more episodes of chronic pain than people who don't hate the person who wronged them in some fashion.  It has even been noted that people who have anger or negative emotions regarding trauma will look for anyone or anything to blame for their problem, even if it or they had nothing to do with it.  This displacement of anger serves a purpose.  It diffuses personal responsibility, while at the same time allows them to accentuate their feelings of pain and garner attention. 

A recent article published in the Journal Pain (2005) describes a research study performed at Duke University, which examines the relationship of forgiveness to pain, anger, and psychological distress.

The study used 61 people with chronic low back pain.  Standardized measures were used to assess each individual's levels of forgiveness, forgiveness self-efficacy, pain, anger, and psychological distress.

Results

The results were quite interesting in that forgiveness is usually not associated with low back pain as a physical entity.  Most people with back pain talk about the trauma and aggravations, but they fail to recognize, or possibly admit to their doctor, that there may be other issues that are involved with their symptoms of pain.

This study exposed forgiveness as a real tool in chronic pain!

First, the results showed that forgiveness can be measured in relationship to pain and that the extent of the pain is attributable to the level of forgiveness.

Secondly, correlational analysis revealed that patients with higher scored levels of forgiveness had lower levels of pain, anger and psychological distress.

Added analyses indicated that anger was a 'trigger' for the relationship between forgiveness and pain and forgiveness and mental anguish.

Moral of the Story

 Chronic pain may have a direct physical relationship to anger and the inability to forgive.

Endearing anger is never good. 

Carson JW, Keefe FJ, Goli V, Fras AM, Lynch TR, Thorp SR, Buechler JL. Forgiveness and chronic low back pain: A preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. Journal Pain. Feb, 2005. 6(2):84-91.

New Medical Treatment of Low Back Pain

Medicine is constantly searching for new and improved ways to fix DISC PAIN.  I applaud their continued efforts to help the sick and injured, but this article finds truth in the old adage that history which is not learned and remembered will repeat itself!

The 'New Wave' of medical care for low back discal treatment involves techniques like enzyme injections to dissolve parts of the disc, heating the disc to try and remodel (melt) it, and even withdrawing parts of the disc to try and lower discal pressure.  None of these are very effective.  

Any basic physics student who understands how a gyroscope works will understand the basic workings of a disc, with the exception that the disc is gravity dependant.  For the non-scientist, the disc works much like placing a marble on the floor and then placing a piece of wood over it.  The disc can move 'slightly' in many different directions.  The disc has a function in weight-bearing and support, and the rings of the disc help to tighten and strengthen the vertebral column.  All of these functions of a disc are dependant on the Recurrent Meningeal Nerve (and others), that penetrate the disc and give the brain information on what is happening within the disc's environment.  Sound complicated?  That's because it really is!

Those of us old enough to remember the 1970's will recall a medical procedure that injected injured discs with a papaya enzyme to dissolve the nucleus (center marble) of the disc and lessen the pressure.  The technique was very ineffective and led to a lifetime of pain for many who received it.  Unfortunately, one of the 'new' procedures is simply a take on the old enzyme injection.  It doesn't work!

A recent study collected data from John Hopkins Medical Institution (Baltimore) and Walter Reed Army Medical Center (Washington) in the treatment of low back discal trauma.  16 people with multiple levels of discal trauma (32 total) were treated with 2 invasive techniques.  9 people had discal material (nucleus) removed along with a thermal molding (heating) of the disc.  7 of the people had only discal material removed.

Nine months after the procedures a follow-up was performed with very dismal results:

• Pain scale ratings in both groups only reduced from 6.7 to 5.6 on a ten point scale, with 10 being the worst.

• In the 7 patients who underwent the discal removal there was only a drop from 6.0 to 4.8.

The researchers determined that the removal of discal material, with or without heating the disc was ineffective in reducing long-term discal pain or disability.

Cohen SP, Williams S, Kurihara C, Griffith S, Larkin TM. Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment fro lumbar herniated disc. Journal Spinal Discord Tech. Feb. 2005. 18:S119-S124.

NOTE: To invade an injured disc that isn't 'fragmented' (broken) before attempting conservative chiropractic care with the Activator Technique is irresponsible at best.  The Activator Technique has extensive research on 'fixing' injured discs without surgery.  

Rule

Never invade the gyroscope (disc) unless it is an emergency or life-threatening.  Leave it alone and treat it properly. It has a job to do that will be impaired once the capsule is invaded!

Eileen's Corner

This month celebrates St. Patrick's Day.  I thought that this wonderful treat would be appropriate!

Note

This bread dish is so versatile that it could be considered a morning coffee cake, an afternoon tea cake, or an evening dessert.  This is one that your family will love!  Glenn likes it with raisins, but they are optional. 

Whiplash and Illness

In case you haven't gotten enough information about whiplash and the weird symptoms that can accompany it, here is another study that objectively evaluates how someone's overall health can be impaired as a result of trauma to you neck.

The University of Alberta, Canada recently published article in the Annals of Rheumatological Disease, which describe how whiplash-associated disorders (WAD) can be considered systemic illness to the individual.

7,462 people were evaluated and determined to have sustained 'true' whiplash with lingering symptoms of pain, nausea, headaches, jaw pain, etc.  45% of these people actually were able to fill out a form that determines mental and physical functioning right after their accident.  This form is called SF-36.

Re-examination of these people one month after the accident still showed that they had lower than normal mental function and physical functioning.  This test is not one in which someone could 'cheat' if they wanted to give false answers.  It is fairly indicative of mental and physical functioning.

Conclusion

The researchers concluded that WAD is actually a Syndrome that can be considered a systemic illness.  The symptoms and physical impairment project past what could simply be considered a physical problem alone.  Their recommendations are that added research focus on the systemic illness aspect associated with a whiplash injury and not just on the injury itself.  

Assessment

I believe that medicine is beginning to understand what Chiropractic has been dealing with for decades.  In treating whiplash-related injuries, there is more to the problem than just treating the initial pain, giving the injured patient a few exercises, and then sending them home to fare for themselves.  The long-term picture for whiplash patients is excellent with care, but predictably poor without care.  

The degeneration of the spine and systemic problems that will occur with time, if left untreated, is 'ugly to treat' at best!  The patient wants to believe that the acute pain just began rather than being the result of neglect for many years.  It saddens me when I have to tell a patient that their injuries are now permanent in nature and that the best that I can hope to do is stabilize their problem, and without stabilization, their condition will worsen.  Whiplash, initially, got a bad image because the patients were thought to be faking their problems in an attempt to 'get rich'.  Unfortunately, there is not enough money in the world to compensate for the pain and systemic illness that a patient with an 'old, untreated whiplash' experiences  (GF)

*Bonus Article*

Acupuncture and Low Back Pain

I wasn't going to write about acupuncture and low back pain in this issue, but since I was disclosing so many other types of effective and ineffective treatments regarding neck and  back pain, I decided that it would be unfair to exclude acupuncture from the microscope of effectiveness.

I first began using acupuncture as a therapy over 20 years ago.  Long before it was popular and 'in fashion'.  I learned from experience that acupuncture had benefits in treating pain, but not for the same reasons that most people would think.  First, let us put the whole idea of miracle points, meridians and chi energy to bed for a while. 

When was the last time that you saw Chi Energy?  Neither have I!

Chi energy is an attempt to explain body actions or reactions when someone doesn't understand neurology, physiology and neuropeptide release within the brain..  There is no magical force in your body called Chi Energy.  There is a neurological response to stimuli that is predictable and reproducible, but no magical Chi button.  I know that I am bursting the bubbles of some people out there who make their living by keeping things 'mystical and magical' so that you don't try to understand, let alone question, what they tell you.  They are probably not sure what they are actually doing either!

In conjunction with a formal training in traditional Chinese acupuncture, I was instructed for a brief time by a Chinese Neurosurgeon who was in this country doing research at the University of Minnesota.  I will never forget what he told me in very broken English when I tried to blend multiple meridians according to traditional 'Earth, Water, Fire, etc.  He looked at me quizzically and said "Hurt there. Put there."  He repeated this several times in spite of my protests because I was sure that I knew what I was doing!  He never wavered in his emphatic, "Hurt there. Put there".  It wasn't until many years later that I understood what he was really trying to tell me (He was right, by the way!).  

Acupuncture meridians were established thousands of years ago by people trying to explain what they were seeing.  They did not understand nerves or brain function.  It was illegal and immoral to even think about performing autopsies on the dead or performing dissection to understand what made them tick.  The best explanation that the Chinese had to explain body function and ways to stimulate the body was by tracking things over time.  The acupuncture meridians that they describe are in close proximity to nerve tracks and tender points are often where nerves enter muscles or penetrate bone.  These nerve points, then, are simply points of irritation or sedation in the body.  Stimulating these points doesn't release magic energy, but it does send a signal to the brain which then either responds with neurotransmitters or if it doesn't feel that the stimulus is enough of an irritation to worry about, the signal is ignored!

Who thought that a honey bee or a mosquito knew how to release Chi energy?   

When you get stung by a mosquito or a bee, you can notice a red 'welt' where you were stung.  That is due to the toxins stimulating a mast cell to degranulate and release Histamine.  Local scavengers like macrophages begin to clean up the area, but not before the brain begins to release its own neurotransmitters to help to negate the toxic invader and stimulate a response or sedate the area.  When you 'stick an area' with an acupuncture wire, what do you think happens?  That's right!!!!  If your eyes were closed, your brain couldn't tell the difference between a pinch, sting or stick.  It responds the same way every time!

When an acupuncture wire is inserted, it is a stimulus-by-irritation to the brain, which responds whether we want it to or not.  The trickling of neuropeptides is small and several wires may be used to make the stimulus greater.  If a series of wires is left in an area, a numbing effect can be generated because of continuous irritation and response.  It is the same process as when you slam your hand in a door and it begins to quickly numb.

If you have noticed, I have talked about stimulation and sedation, but I never once mentioned 'structure and function' while discussing acupuncture.  That is because acupuncture will not change 'structure and function' due to trauma.  It merely sends a signal to the brain that an irritation is occurring and the brain responds.  It doesn't, however, tell the brain how to respond.  Its a lot like ringing a door bell and having someone open the door and walk in.  That person won't build your house or fix a fallen wall or replace a broken window or put out a fire or paint or do the laundry or cook dinner; all things that occur in a house.  The ringing of the door bell merely let someone in to talk.  In the initial stages of a crisis (tornado, flood, etc) we often need someone to talk to, but they also need to get out of the way when the clean up and reconstruction begins.  

This is similar to using acupuncture as a therapeutic tool.  During the initial stages of trauma it may have benefits of stimulating a localized response, but after that the usefulness is limited. I know that I may be condemned by acupuncture 'purists' as an anarchist, but the lack of credible research supports my conclusions by experience.

In a search and collection of databases around the world from 1996-2003, Cochrane Database Systems found only 35 randomized clinical trials regarding acupuncture that were available and only 3 of those trials were attributed to acute low back pain!  That's right!  The real evidence supporting success of treatment using acupuncture is very small.  Due to small sample sizes and poor methodology (technique allowing reproducibility) no firm conclusions were able to be gathered.  What they did determine was that acupuncture may have benefits in the acute stage of pain for the same reasons that I described above, but they also stated that those benefits only lasted a very short time before returning to prior levels.  They suggested that acupuncture may work best when combined with other forms of care, but that acupuncture was not more effective than other forms of conventional and 'alternative' treatments.

As I have stated in prior Newsletters, I love acupuncture as a therapeutic tool, but it has limitations and to ignore those limitations and not relay it to 'potential or current patients' is irresponsible behavior on the part of the Practitioner.  Unfortunately, when economics is involved, ethical standards may suffer!

I hope that you have enjoyed this month's ENews!

See you next month,

Dr. Frisch

P.S. Next month there will be exciting news regarding the success of our HABITACK^® smoking cessation program.  I can't wait to bring it to you!