Hidden Drivers of Chronic Pain – We Have Been Thinking About Pain All Wrong

 

What if what we always knew about chronic pain was wrong? 🤔

We are conditioned to think about pain as a direct product of injury. Because of this, we have strong, but incorrect assumption that the severity of pain correlates with the severity of injury.

These beliefs may be true for acute pain or injury, but they have poor carry over to chronic pain conditions. In fact, taking these beliefs into a chronic pain condition likely promotes nocebo and likely worsens outcomes in painful conditions.

As patients and health providers, we put most of our collective energy into the biological factors in pain.

  • structural issues
  • Inflammation

But we have a strong tendency to discount the psychological and social factors that contribute to pain.
– Fear and avoidance of movement
– False beliefs about the nature of pain
– The role of depression and anxiety in magnifying pain conditions
– How our friends and family deal with pain (walk it off vs rest till it’s better)


.
While addressing the biological factors is important, the psychological and social factors behind pain might be most important in having enduring results.

Without addressing the psycho and social aspects of pain, patients are often in a roller coaster of temporary relief going from doctor to doctor or treatment to treatment never satisfied.

This starts in our office with a change in belief. A belief that your body is strong and anti-fragile. A belief that the body is self-healing and is always striving to maintain homeostasis.

 

In a perfect world, we hope that our patients start feeling better before we even put our hands on them because they are starting to embrace a stronger, brain-centric view of life and health.

Keystone Brain Bytes Episode 4 – The Vestibular System in Memory and Cognition

Keystone Brain Bytes Episode 4 – The Vestibular System in Memory and Cognition

 

On this episode of Keystone Brain Bytes, Dr. Chung talks about the impact that the vestibular system has on memory and cognition.

  • Did you know?
    • Scientists used to destroy the vestibular nerve in rats, and rats struggled to get through mazes. They also had difficulty finding their home and places where food was left
    • Patients with vestibular loss have problems with spatial intelligence and spatial memory
    • Vestibular loss is associated with specific forms of Alzheimer’s disease

Learn more by checking out our latest episode. Make sure you like and subscribe to the channel if you like the content

 

Left Brain Vs. Right Brain: Myths and Facts

There’s some confusion about the functions of the two sides of the brain, so let’s talk about some myths and facts about brain hemisphericity.⁣

We know that the the brain is organized into right and left hemispheres, but do these hemispheres have unique functions?⁣

One of the most common beliefs is that personality traits are left or right brained. It’s typically thought that the left brain is for logic and problem solving, while the right brain is for creativity and spontaneity. Therefore people can train their left Brain by doing math, and train their right brain by doing art.⁣

Verdict: 𝗙𝗮𝗹𝘀𝗲⁣



A number of studies have found that logic and creativity tasks tend to light up both sides of the brain. Additionally, the brains of very creative or very logical people don’t tend to show much difference from one side to the other.⁣

Now in #functionalneurology we do look for differences in right vs left Brain, but it’s not based on behavior or personality traits. ⁣

There are some brain functions that are organized by left and right brain predominance.⁣

For example, we know that contracting a muscle on the left side uses mostly the right motor cortex. We know that perceiving touch on the right side is mostly perceived by the left sensory cortex. We also know that when strokes hit these parts of the brain, we can have a paresis or loss of sensation on the opposite side of the body. ⁣



What might be less known outside of a neurology office is that language and speech is a very left brain dominant function, while visuospatial awareness and attention is a very right brain biased function.⁣

This was also born out of studies on stroke patients who develop bizarre presentations. Where specific strokes in the left brain can leave some patients with severe speech and language deficits, while some right sided strokes can leave a patient ignoring the whole left side of their body!⁣



The stories on these cases documented in “Phantoms in the Brain” by Ramachandran are really incredible.⁣

As always, #neurology and #neuroscience are endlessly fascinating!

Can Bad Sleep Increase Your Risk of Dementia?

Adapted with links from an article written for The Brain Health Magazine

Sleep is arguably the most powerful and least expensive treatment that we have in our arsenal that can help support brain health. We all know this intrinsically, and most of us really do want to get more sleep. For most of us, getting a good night’s sleep helps us feel better throughout the day, but the latest research in neuroscience is showing us that patients who were sleep deprived had 1.68 times the risk for developing cognitive impairment or Alzheimer’s Disease.

 

In order to understand how sleep can impact our risk of dementia, we have to understand an important piece of anatomy called cerebrospinal fluid (CSF). CSF is a water-like substance that acts as a cushion inside of our head that serves to protect the brain from the jagged edges inside of the skull. CSF also plays a role in the transportation of nutrients and waste that can build up in the brain and spinal cord. From a clinician’s stand point, procedures like spinal taps are an important diagnostic tool because we can see if there’s evidence of infection of degeneration that has entered the brain.

 

The role of CSF in brain disease has gotten stronger recognition in the last decade and more recent neuroscience studies are pointing to a massive role of deep sleep. A groundbreaking study published in 2013 by Xie et al. showed that sleep increases the flow of CSF through a mouse brain, and that this increased flow cleaned removed the toxic protein clumps that are associated with Alzheimer’s disease. This system wasn’t working during the mouse’s awake phase.

 

Said another way, the system responsible for cleaning our brains of a toxic protein that causes Alzheimer’s Disease works primarily in sleep.

 

This was a massive finding that changed our understanding of why it feels like sleep is a powerful contributor to recovery. But does this effect happen in humans? So far, studies are saying yes. Three major papers corroborate some of the early findings that were seen in mice.

 

  1. A PET scan study by Shokri-Kojori et al on healthy patients showed that just one night of sleep deprivation increased the build up of beta-amyloid by 5%.

 

  1. A study by Fultz et al using functional MRI, EEG, and CSF flow measurements have identified an electrical signal that precedes a rush of increased spinal fluid movement during sleep.

 

  1. Finally, a longitudinal study by Lucey et al studied patients with Alzheimer’s disease and used sleep tracking data. They showed that there was a strong relationship between loss of deep sleep and greater Alzheimer’s pathology.

 

So what does this mean for patients with brain injury?

 

We know that a history of brain injury puts some patients at higher risk of neurodegenerative disease. While the big suspicion is that the brain damage itself contributes to the disease process, there’s also a possibility that other physiologic processes from brain injury could be drivers of dementia.

 

A well known phenomenon after concussion is an increased prevalence of sleep disorders following the injury. Patients with concussion have poorer sleep quality and feel worse on waking than patients without a concussion. There is also a variety of sleep disorders associated with concussion including sleep apnea, insomnia, circadian rhythm disruption, and narcolepsy. No matter what the disorder is, the end result is a loss of the healing potential of deep sleep.

 

This has become such an important issue in my clinic, that if any concussion patients have any reported problems with sleep, then I consider referring for a sleep study right away. Prevention of dementia and neurodegenerative disease is certainly a consideration, but a loss of sleep is also going to impair the results patients can get from post-concussion syndrome.

 

We can do some amazing things in rehabilitating the brain in patients with persistent concussion problems, but there will be barriers to cognition and pain improvement if the patient continues to sleep poorly.

Keystone Brain Bytes Episode 3 – Our Approach to Dysautonomia

Keystone Brain Bytes Episode 3 – Our Approach to Dysautonomia

Dysautonomia is becoming a more common complaint in our office and one that we have had a good amount of success in treating. It will likely become a more prevalent issue in the coming years. In this episode of Brain Bytes, Dr. Chung explains our approach to dysautonomia and the neurological reasons why we use the cervical spine and vestibular system as our window into the autonomic nervous system.

 

 

 

Gait Testing Can Predict Future Post Concussion Syndrome

A recent study in the journal Gait and Posture looked at various biomarkers in posture and walking in athletes who suffered a #concussion.⁣

⁣Prognosis for Persistent Post Concussion Symptoms using a Multifaceted Objective Gait and Balance Assessment Approach


They wanted to see if any specific findings on balance or gait testing could predict which patients would have a worse recovery.⁣

The study found that out of all of the balance and walking parameters, 2 metrics were associated with the development of persistent symptoms or #postconcussionsyndrome


𝗗𝘂𝗮𝗹 𝗧𝗮𝘀𝗸 𝗮𝗻𝗱 𝗚𝗮𝗶𝘁⁣
The study found that when concussion patients had to perform a cognitive task while walking, there were changes in their walk that predicted future symptoms.⁣

Patients that were more likely to have future symptoms showed 𝙞𝙣𝙘𝙧𝙚𝙖𝙨𝙚𝙙 𝙢𝙤𝙫𝙚𝙢𝙚𝙣𝙩 𝙤𝙛 𝙩𝙝𝙚𝙞𝙧 𝙡𝙤𝙬𝙚𝙧 𝙗𝙖𝙘𝙠 when walking, and also 𝘀𝗵𝗼𝘄𝗲𝗱 𝗺𝗼𝗿𝗲 𝗿𝗮𝗻𝗱𝗼𝗺 𝗳𝗼𝗼𝘁 𝗽𝗹𝗮𝗰𝗲𝗺𝗲𝗻𝘁 when landing when they were engaged in a cognitive task.⁣

This might not seem like a big deal, but this may be a subtle sign that the brain is struggling to compartmentalize basic movement patterns, so it is using important resources from the frontal lobe to do something as simple as walking straight.⁣

This is why we have all of our patients perform a walking test with and without a cognitive challenge.⁣

The dual task paradigm gives us insight into brain function, and it also lets us know if we can use dual task exercises like the Fitlight to enhance our rehab.⁣

#neuroscience#neuroplasticity#tbi

Occipital Neuralgia – Migraine-like Pain without the Migraine

A sharp and sometimes electric nerve pain coming from the back of the head that can radiate over the top of the skull or into the eyes.⁣

The pain from occipital neuralgia can be severe, and is often misdiagnosed as a #migraine.⁣

While occipital neuralgia is common after a head injury like #concussion, it can come out of nowhere from tight neck muscles or inflammation to a nerve called the greater occipital nerve.⁣

These types of headaches can be resistant to most medications, but can be alleviated by addressing mechanical factors in the neck, especially in the #atlas of the upper cervical spine.⁣
While there is no definitive test to diagnose occipital neuralgia, we can often find a tender point in the back of the head/neck that can reproduce the pain. That along with a detailed health history can help us identify the source of the head pain so it can be treated properly.⁣

The Dangers of Stroke

This post hits close to home, but it’s so important that lay people understand the signs and risk factors for stroke.

As a chiropractor trained heavily in neurology, I’ve spent years understanding and training to recognize when someone may be having a stroke. Despite my training, my wife suffered multiple strokes over the course of 3-4 days, and I was only able to catch the largest and most recent one.

Survival and recovery from stroke heavily depend on early recognition and treatment, and depending on the location of the stroke, a matter of minutes can mean the difference between life and death.

Signs of Stroke
The most common signs involve looking for facial dropping, arm weakness, and speech issues.

However, other serious signs include alterations in consciousness/awareness, nystagmus, and unsteadiness in walking and balance.

What makes stroke unique from other problems is that these signs will present suddenly and out of nowhere.

You can also combine the signs and symptoms with a patient history of risk factors.

Big risk factors are any history of high blood pressure, artery disease, and heart disease.

Important risk factors for stroke

Also be aware if someone is taking medications like blood thinners or birth control which can contribute to stroke risk.

Lastly, a recent history of infection or a recent autoimmune flare up can increase risk of stroke.

Strokes can be scary, and it can be terrifying to see a loved one show these signs. However, it is survivable and can be treated when recognized and treated early.

After the acute threat of stroke is over, a plan for comprehensive neurological rehabilitation can drastically improve a survivor’s life.

Is Your Neck Muscle Connected to Your Heart Muscle?

Is Your Neck Muscle Connected to Your Heart Muscle?

A 2015 study suggests that it might be the case. At least in rats.

Neck muscle afferents influence oromotor and cardiorespiratory brainstem neural circuits

The authors of the study were evaluating the anatomic mechanisms for how whiplash disorders and dystonia could cause problems with facial, oral, and cardiorespiratory issues.

To do that, they applied electrical stimulation to the upper neck muscles of rats and used molecular tracing techniques to identify what areas of the brain were stimulated.

They found that stimulating the upper neck muscles had unique pathways into an area in the brainstem called the nucleus intermedius, which had a direct impact on breathing and heart rate in the mice.

Even more interesting was that stimulating the neck muscles had as strong an effect as stimulating that area of the brain stem directly!

This effect was also specific to neck muscle stimulation, as pure sensory fibers didn’t produce the same effect. The effect was also not reproduced when stimulating nerves from the lower neck.

Obviously we don’t know for sure if this happens in humans because this was a rat study after all.

But studies like these might help explain why doing an adjustment to the upper neck seems to elevate vagus nerve function as measured by heart rate variability. It might also explain why many of our patients with #potssyndrome and other forms of #dysautonomia have had success with NUCCA.

The science on this is still very young, but it’s exciting to see the anatomical connections that make the upper neck such an important area to work on.