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Health & Wellness Doctors

Our Whiplash Seminar Blog

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Pain

Posted by Toronto Pain Doctors: Chronic Pain, Whiplash and Concussion Therapy on April 13, 2013 at 8:35 PM

This Blog will provide updates on Pain Management research

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251 Comments

fMRI research has shown that pain can be visualized.  Research shows that pain as a result of social or physical factors can now be distinguished with fMRI imagining. 
Reply Jason Mazzarella
2:38 PM on April 23, 2013 
Research published by the American Academy of Pain Management indicates that multidisciplinary pain therapy is more beneficial than interventional, prescription or any other therapy options.

http://www.ncbi.nlm.nih.gov/pubmed/23462285
Reply Dr. Jason Mazzarella
12:04 PM on May 22, 2013 
Chronic Pain and IME assessments.

Today, there is a great deal of controversy over who can complete these assessments and what needs to be incorporated to avoid bad faith. The controversy continues due to current Ontario court rulings stating the chronic pain is subjective with no objective findings, even though research has shown the ability to test for neuropathic and nociceptive pain. Further to this fMRI testing has shown to indicate specific active brain area?s with pain response and just recently biomarkers have been found to confirm the presence of pain.

Dr. Mazzarella?s suggestions for choosing a Chronic Pain IME doctor

The doctor must have specific pain management post graduate training. Research has shown that approximately 40-71% of chronic pain patients are miss-diagnosed by GP?s or specialists acting in a pain management function. (Research varies dependent on institutions)
Look for qualifications. Currently in Ontario there is not a specific Board Recognition. Thus many doctors blend into the gray area of their scopes. Currently the Canadian Academy of Pain Management offers a Diplomat. In my opinion this is the best option to ensure a pain management background, as achievement of this Diplomat (not just a member) requires a review of education, board approval to sit for testing and passage of a comprehensive multi-disciplinary test. Most importantly, it also requires obtainment of 100 hours of continuing pain management education to maintain status.
Ensure all concepts of pain are considered - Multidisciplinary Consideration. The World Health Organization has stated pain management is a universal human right. If a doctor only evaluates for 1 type of pain (nociceptive, neuropathic, inflammatory, or mechanical / compressive) they are denying that basic human right and opening the door to a liability claim.

Pain research has come along way since the inception of the IASP in the 70?s. By utilizing doctors with specific pain management training, expenditures can be reduced and quality of life can be significantly increased in those suffering from this condition. For an example of this please check out the IASP June 2013 newsletter which will present an example case study from my clinic.
Inflammation and Chronic Pain.

Research has shown that even after long-term treatment with opioids, inflammation persists in many chronic pain patients as evidenced by C-reactive protein levels and erythrocyte sedimentation rate. http://www.medpagetoday.com/MeetingCoverage/APS/39026

Research has also shown the possible benefit of physical medicine therapy in the treatment of chronic pain. An fMRI study showed that that trigger point therapy when concentrated on the primary trigger point can reduce inflammatory markers surrounding the trigger point. However this same therapy when applied to satellite or secondary trigger points did not reduce inflammatory markers surrounding the tissue.
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