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Perspectives on Chronic Pain

Tuesday, January 29th, 2013

One in every five people in Canada suffers from chronic pain.

Chronic pain sufferers may find and do find relief with prescription medication. Often strong medications, such as opoids are prescribed, but many physicians are hesitant to prescribe them, or are unable to prescribe them and only specialists can prescribe them.

There is a polarization between pain and addiction. Doctors do not want to prescribe medication for pain, because of fears that patients will become addicted to the medication.

Chronic pain can develop as a result of injuries from a motor vehicle accident and can lead to the short term disability claims and long term disability claims.

Many people in Ontario who suffer from chronic pain are left floundering, struggling to find someone who will help them to manage their chronic pain. Pain specialists are in short supply in Ontario. Chronic pain sufferers are facing an uphill battle: there is a lack of understanding with respect to chronic pain among doctors and health professionals, and a growing stigma with respect to opoid medications, which the government has cracked down on- making treatment less available to those in need.

The Canadian Pain Coalition recognizes that strong medications such as Oxycodone and morphine need to be carefully monitored, but the opoids are an important part of pain management. Having a pain specialist or physician who can prescribe the medication and monitor its use is an important part to treating chronic pain, especially when physiotherapy and/or massage therapy is not an available option. When medication is difficult to get, chronic pain patients are out of luck.

Both the government of Ontario and the federal government have taken steps to oversee how painkillers such as Oxycontin, Oxycodone, morphine, methadone and codeine are dispersed in the wake of the rising number of accidental deaths. Ontario has introduced a tracking system to monitor these narcotics to identify patients who are getting multiple prescriptions, the doctors prescribing them and the pharmacists dispersing them.

Chronic pain affects not just the individual in pain, but his or her family.

 

 

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A Depression Gene, Stigma, Psychotherapy, Relationship between Concussions and Depression

Monday, January 21st, 2013

The search for a depression gene came up empty. A group of 86 researchers were hoping to discover genetic influences linked to depression while studying approximately 34,500 volunteers. Since depression runs in families, many experts believe that there must be a genetic connection. Research failed to demonstrate any specific genes that cause depression. After raising the number of study subjects to over 51,000, only one spot in the whole genome was tied to depression, but it was not close to any genes. The study had focused on patients with symptoms of depression. The study’s authors are considering trying again on a larger scale, this time focusing on patients who have a confirmed diagnosis of depression.

What prevents people from seeking treatment for depression and mental health treatment? Psychotherapy takes time and effort. There is stigma attached to seeking treatment for mental illness. People are hesitant to admit that they attend therapy sessions. Society places illogical taboos and stigmas around mental illness, therefore many people feel ashamed about their diagnoses or symptoms. Another factor that can prevent someone from seeking treatment is severity- he or she may not realize how severe the symptoms are and may feel that therapy is not warranted. The will to get started and knowing how and when to start is another factor.

Research has shown that, in some instances, there are legitimate biological scenarios that cause secondary illnesses that would not exist in individuals otherwise. Researchers in Denmark at the University of Copenhagen were able to isolate an enzyme called C-Reactive Protein (CPR), that when present in high concentrations can cause depression, using a blood test to isolate a specific protein in the bloodstream. It was through this line of research that they found a relationship between depression and arthritis. It was noted in the past patients with inflammation or arthritis may have been simply “written off” by their doctors as upset due to the physical pain and limitations.

This new research has showed that those patients with higher levels of the CPR protein (which is released by inflammation/inflammatory conditions), were 2-3 times more likely to develop depression. It is not clear though, whether inflammation causes depression or the other way around.

An article released on the Time.Com website concerning the link between concussions and depression explains how sustaining a concussion can make one more vulnerable to depression. Two studies were conducted on  retired NFL players.  The first study, which has already been released found that the former players who are depressed or cognitively impaired have abnormal findings in a specific area of the white matter of their brains.  White matter is critical for transmitting signals. The American Academy of Neurology reports that a higher number of concussions equates to a higher likelihood of depression. Neurologist, Dr. John Hart, who was active in both studies, said that these studies apply to everyone who is affected by concussions, not just professional sports players. He said anyone who has suffered a concussion should be monitored for signs of depression. Depression is manageable, but only if doctors know how to diagnose and treat it properly.

 

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm that focuses solely on the rights of injured persons. We advocate for your rights. We provide a free initial consultation.

 

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Developments in the field of Brain Injury Awareness

Monday, January 14th, 2013

When a brain injury occurs, it is crucial to go to a hospital or diagnostic imaging clinic to have a CT Scan or MRI test completed right away to assess what has happened.

A recent study found that , however, that CT scans can miss minor bleeds on the brain. Individuals with mild traumatic brain injuries may have normal CT Scans. It may take more sophisticated scans to see abnormalities. MRIs are of course, more expensive.

The study tracked patients with mild TBI for 3 months. Researchers found that over a quarter of patients with normal CT Scans on the day of injury had positive findings on their MRIs when tested a week later. Further testing showed that full recovery had not taken place after 3 months.

An MRI study is a more comprehensive study and is better able to show a comprehensive picture of damage.

This is why it is so important for patients to tell their doctors exactly how they are feeling and if they are experiencing any problems after a head injury.

The study showed that MRIs are able to show focal lesions, which are areas of microscopic bleeding in the brain.Researchers can use the presence of focal lesions to predict which patients are more likely to have ongoing neurological problems.

MRIs are better indicators of the course of injury and recovery.

A brain injury can cause long term damage to the brain. A traumatic brain injury can lead to inflammation and slow regeneration of brain cells. A study from the University of South Florida, found that even at the most chronic stage of injury, therapeutic intervention can help with the regeneration of brain cells. The study examined brain injuries to different areas of the brain and found that TBIs caused a second wave of cell death that impairs cell proliferation and impedes that brain’s ability to regenerate cells.

The study’s researchers found that microglia cells at the injury site and distant sites were activated around 8 weeks after injury. The researchers feel that therapeutic intervention may help prevent some long term damage to the brain.

According to the Centre for Disease Control and Prevention (CDC), 1.7 people sustain a traumatic brain injury per year and of that number, 75% are concussions or some other form of mild TBI.

Aaron Waxman & Associates is a Toronto Personal Injury Firm that advocates for the rights of its clients. Contact us today for a free consultation.

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Developments in the Field of Chronic Pain/Pain Management

Monday, January 7th, 2013

Yoga is not just for relaxation. Yoga breathing and relaxation techniques can ease chronic pain according to an assistant professor, Neil Pearson, at the University of British Columbia. Pearson is offering free online information sessions (webinars) for those interested in learning more. Pearson explains that pain changes everything in a person’s life from thoughts to movement to relationships.

A step forward for pain management is to move beyond finding a simple remedy for pain. By the time most people accept that their pain condition is long term, their nervous system has already become “locked in” to a pattern of pain. This pain pattern leads to shallow breathing, tight muscles and spasms. This pain pattern causes a “hyper-vigilant” nervous system.

Yoga can help reset the system and break away from stiffness. Chronic pain is common amongst Canadians of all ages and can stem from a variety of causes including car accidents, falls, sports injuries, arthritis, digestive disorders and back problems.

If you are in constant pain, you should blame your genes, says a new scientific study. Scientists have identified genes that interact with each other to regulate pain in humans. They found that differences in these genes may influence people’s sensitivity to pain. The method used to study and target these genes is called “exome sequencing”- a strategy used to sequence genetic coding.

The study notes that chronic pain is a significant burden on individuals and on the economy. Exome sequencing could be used to find important pathways in other common conditions. The results showed different patterns of genetic variants in each group, the pain sensitive people had less variation of DNA compared to those who were less sensitive to pain.

It is known that people who are most sensitive to pain in general, are those who are most likely to develop chronic pain. Understanding the underlying genetic factors of chronic pain can help researchers understand the biology of pain and new areas to target for therapy. Research for chronic pain is important because current treatments can be expensive, have limited efficacy or significant side effects.

It turns out that Morphine can actually cause pain in some people. Research from the Universite Laval in Quebec City has shown that there is a molecular pathway by which morphine can actually increase pain, but at the same time, provides insight for how morphine can be effective for more patients.

The research team includes representatives from Quebec, Ontario, the U.S. and Italy.

The research identifies a target pathway to suppress morphine-induced pain, and was able to distinguish the pain hypersensivity caused by morphine from tolerance to it. Previously it was thought that pain hypersensitivity and tolerance were caused by the same mechanisms.

The study demonstrates that cellular and signalling processes for morphine tolerance are markedly different from those of morphine-induced pain. This research is important, because the usual line of thinking is that when morphine doesn’t reduce pain, a higher dosage is needed, but sometimes increasing the dosage has a paradoxical effect.

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Global Study Reveals People Worldwide are Living Longer, but with Disabilities and Diseases of Modern World

Saturday, December 22nd, 2012

Nearly everywhere around the world, people are living longer. Increasingly, however, people are living with chronic diseases and disabilities of modern life.

The last comprehensive global study took place in the year 1990. Back in 1990, the top health problem globally was the death of children under age 5.

Currently, the biggest contributors to the global health burden is chronic diseases, injuries, mental health conditions, and bone and joint diseases. In developed countries, these account for more than half of the health problems in the population.

The research appeared in the online journal, Lancet, more than 480 researchers in 50 countries collaborated, gathering data from 1990-2010. The series of information was paid for by the Bill & Melinda Gates Foundation.

Globally, the leading causes of death are heart disease, stroke, lung cancer, liver cancer, stomach cancer, colon cancer and AIDS.

People are living longer in chronic pain and with physical and mental disabilities.

It is a time for people to consider long term disability insurance and critical illness insurance.

Critical illness insurance assists with any costs associated with facing a critical or long term illness. Critical illness insurance provides you with a one time lump sum payment upon survival of a designated waiting period (survival period) of one of several specific condition ( cancer, stroke, Alzheimer’s etc).

If you encounter a denial of your long term disability claim or critical illness claim, the lawyers at Aaron Waxman and Associates can assist you with your claim. We are a Toronto Personal Injury Law Firm that practices personal injury law. We only represent the rights of injured people.

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Brain Injury Awareness: New Developments in Research & Technology

Monday, December 17th, 2012

A portable liquid cooling helmet could be used to help treat concussions. This helmet was designed by a former NASA engineer, Bill Elkins. The helmet is a portable emergency cooling system that can help triage brain injuries like concussions. The helmet cools the brain, inducing a type of  controlled hypothermia that protects the nerve cells. This forces the nerves to “hibernate” and that encourage recovery.

A Canadian health IT start up company is launching a web based and tablet based tool called BrainFX360, which will help with assessing brain disorders. The company , BrainFX was founded by two Canadian occupational therapists who hope to have their product break into the US market place. Typically, a clinical neurological assessment can take anywhere from 15-20 hours. The idea is that an assessment tool should be available that can capture how a brain injury affects a person’s every day life and the tool should be sensitive enough to be able to detect minor impairments. The BrainFX360 tool consists of a 2 part assessment, to establish a baseline study.

The first part of the assessment is completed by the individual and is with regard to mood, history, behaviour, sleep etc and takes about 20 minutes. The second part of the assessment is administered by a health professional and the health professional has to be certified by BrainFX in order to administer the test. The tablet based assessment has the patient do different activities that measure cognitive skills.

Did you know that zebrafish are able to re-grow brain cells? Scientists have identified the mechanism that allows zebrafish  to re-grow brain cells after injury.  Scientists have long been aware that this species of fish can regenerate brain cells after injury, unlike humans, by activating stem cells. The question of how, long remained a mystery until recently.

Researchers have discovered that regeneration in the zebrafish brain is actually linked to inflammation; a side effect of brain injury that is thought to be harmful to the brain. It appears that inflammation is what ‘kick starts’ the regeneration process in the zebrafish.

In mammals, including humans, chronic brain inflammation (persistent inflammation, or inflammation that lingers) is linked to scarring and diseases such as Alzheimer’s. Acute inflammation (lasts for a short period) is usually related to a blow to the head or sports injury.

When brain trauma occur, cells tend to build up at the site of the injury, which is how scar tissue forms in mammals. In zebrafish, when trauma occurs, it triggers regeneration.

Scientists were able to identify a molecule called leukotriene C4 (LTC4) – which, when injected into the uninjured zebrafish brain, mimicked the regenerative response. The study authors and scientists noted the implications this could have for humans.

In other research news, stem cells could help in treating traumatic brain injury. Scientists from the Medical College of Wisconsin (MCW) and the Clement Zablocki VA Medical Center received a one-year, $20,000 grant from the Clinical and Translational Science Institute of Southeast Wisconsin (CTSI). Their study is with respect to how stem cells derived from bone marrow assist in the healing of traumatic brain injury (TBI).

Currently, there are no effective therapies for TBI. According to the researchers,  there is increasing evidence that bone marrow-derived mesenchymal stem cells (BMSC) have potential to migrate toward the site of trauma and stimulate recovery of the damaged brain tissue after TBI.

Aaron Waxman & Associates is a Toronto Personal Injury Law Firm. We handle personal injury cases, including claims for traumatic brain injuries and catastrophic claims.

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Chronic Pain in the News

Monday, November 19th, 2012

A small British study has shown that laughter can increase your tolerance of pain. The study, called ” Social laughter is correlated with an elevated pain threshold”, confirmed that social laughter, laughter in the presence of others release endorphins, the same feel-good brain chemicals that are released during exercise.

Laughter is useful and helpful when you are hurting because it is work for the body. The release of endorphins through the body masks pain. It is a work out for the chest and lungs. The study was led by Robin Dunbar, PhD, a professor of evolutionary psychology at Oxford University.

The Scientific American recently posted an article entitled “How Chronic Pain Affects Memory and Mood”.  Sufferers of chronic pain also experience faulty memory, depression and anxiety. According to new research from Northwestern University, the reasons for these symptoms could be that people who experience chronic pain suffer from an impaired hippocampus. The hippocampus is the region of the brain responsible for learning, memory and emotional processing.

Researchers at Northwestern University used anatomical brain scans to study the brains of people suffering from chronic back pain or complex regional pain syndrome and found that they had a smaller hippocampus than healthy people. The study turned to mice for more clues about how the hippocampus worked. Mice in chronic pain displayed greater anxiety like behaviours. The mice were unable to produce new neurons in the hippocampus, which is one of the few brain areas where adult mice and humans can grow new neurons.

The lead study researcher suspects that the hippocampal size difference seen in humans could be a reflection of the lack of neuron growth and other problems that were seen in the mice. Without the formation of new neurons, memory and emotional processes would also become impaired.

The study author believes that the study underlines the importance of treating chronic pain as a brain based disorder, in addition to targeting its perceived source in the body.

In technology news, an iPhone/iPad App called My Pain Diary has won awards and has found to be beneficial to those who suffer with chronic pain.

The app was originally released for iPhones, and is now avaialable for iPads, called My Pain Diary HD. It was created by a chronic pain sufferer. It helps patients and chronic pain sufferers track their pain and easily report it to caregivers and doctors. Features include an automatic weather tracker, the ability to attach photos, and the ability to track and compare multiple chronic conditions within one app.

Other features include the ability to create custom PDF doctor’s report to share with doctors, or to store in the app, private entries, which can be flagged as private so as not to be shared, a reminders feature, and a passcode option. There is also a Dropbox Backup option to back up data as well as iCloud syncing between devices.

 

 

 

 

 

 

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Pastore v. Aviva Canada Inc. – Definition of Catastrophic Impairment broadens, victory for the plaintiff’s bar

Thursday, October 11th, 2012

The Ontario Court of Appeal finally released its decision in Pastore v. Aviva Canada Inc. It’s been referred to as a “landmark decision on chronic pain”.

The OCA ruled that chronic pain is a psychological condition that can produce a catastrophic impairment, thereby entitling accident victims to enhanced medical benefits.

The unanimous decision of the Court means will allow claimants with severe psychological impairments to access much-needed benefits beyond standard accident benefits.

The Court of Appeal overturned the lower court’s decision that would have denied the plaintiff, Anna Pastore access to extended benefits.

Pastore v. Aviva concerns a woman who was struck as a pedestrian in November 2002 and injured and broke her left ankle, which never healed properly, leading to numerous surgeries and an eventual knee replacement.

Prior to the accident, she was the primary caregiver to her husband of over 35 years, who was receiving chemo-dialysis.  The decision states that she is almost completely dependent on others for her most basis personal care needs.

Pastore applied for catastrophic determination in May 2005.

Pastore was assessed by a team of medical assessors to determine if she was catastrophically impaired. It was found that she had catastrophic impairment due to mental or behavioural disorder. She had class 4 or ‘marked impairment’ in terms of her activities of daily living and assigned her a class 3 (moderate impairment) with respect to social functioning, concentration, persistence and pace and deterioration or decompensation in work or work-like settings.

Aviva did not accept the findings of the assessment centre and this led to mediation and arbitration.

One major issue was whether marked impairment in one category was enough to lead to a catastrophic designation.

The arbitrator and the Director’s Delegate upheld the decision of the assessment centre and found that Pastore was catastrophically impaired. Aviva appealed this decision and the Divisional Court sided with Aviva, stating that the Guides portion of the Statutory Accident Benefits Schedule (SABS)  requires all four categories to be considered as marked impairments in order for a person to be deemed as catastrophically impaired.

The Ontario Court of Appeal disagreed and overturned the Divisional Court’s decision, siding with the original decision, stating that the American Medical Association’s Guides to the Evaluation of Permanent Impairment language did not specifically require all four categories to be considered marked impairments for a catastrophic impairment designation.

The role of pain was addressed within the context of the marked impairment test. The OCA concluded that a cumulative approach should be taken where it is not possible to factor out the impact of discrete physical impairment and associated pain limitations.

What the court is saying, is that pain can be considered within the marked test in cases where the pain is not cleared related to physical causes, but may be related to a mental disorder.

Aaron Waxman & Associates is a Toronto Personal Injury Law Firm that handles personal injury claims, including catastrophic cases.

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Rakosi and State Farm – Claimant’s appeal dismissed (social media warning)

Thursday, September 13th, 2012

Eniko Rakosi was involved in a car accident on May 5, 2008. She applied for accident benefits through her accident benefits insurer, State Farm.

State Farm denied various benefits including income replacement benefits, attendant care and medical benefits. The issues failed at mediation and the claimant filed for arbitration.

At the pre-hearing, State Farm asked for productions from Ms. Rakosi’s Facebook account. The arbitrator hearing the case, Arbitrator Bujold ordered Ms. Rakosi to produce all photographs (with her in it) posted to her Facebook profile, included any limited access or private portion of her profile from the date of loss to May 5, 2010.

Arbitrator Bujold held that the test for production was a “semblance of relevance” test.

Previously, State Farm had accessed Rakosi’s Hi5 account (another social networking site) and found photographs which showed the claimant engaged in various social and recreational activities. State Farm believed that her Facebook account would show similar photographs. Since Rakosi’s claim was that she was unable to engage in employment and required help with personal care, State Farm wanted access to this information. They felt there would be a ‘semblance of relevance’.

Ms. Rakosi’s Hi5 site showed pictures of her being attached to a zipline and ziplining. State Farm was of the view that these pictures related to activities related to the disputed benefits. Since Hi5 and Facebook are both social media sites, State Farm made the argument that the Facebook content was relevant.

The Arbitrator was not persuaded by Ms. Rakosi’s counsel that there were reasons against production.

Ms. Rakosi appealed the decision, citing previous decisions that were in favour of claimants like Prete and State Farm, and  Leduc and Roman, where the appellant deemed the semblance of relevance test was correctly applied.

The appeal was heard by Director’s Delegate Blackman, who upheld the original decision that Ms. Rakosi should produce her Facebook account.

Director’s Delegate Blackman however found that the original arbitrator had erred by using the “semblance of relevance” test. This test was used in the court system, under the Rules of Civil Procedure (prior to the January 1, 2010 changes).  Relevance could be interpreted broadly. When the RCP changes came in January 2010, the rule,  Rule 30.02(1) was changed to reflect proportionality, changed from “relating to any matter in issue” to “every document relevant to any matter in issue in an action”.

The rules guiding arbitration stem from the Statutory Powers Procedure Act and instead use a test based on relevance and reasonableness.

Director’s Delegate Blackman felt that using the semblance of relevance test would undermine the alternative dispute resolution system and create a more complicated and costly system while the courts in tort matters are moving in the opposite direction.

Director’s Delegate Blackman found there was no error in extending the inference from one social media site to another and agreed it was likely that her Facebook site would likely contain similar photos.

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm. We handle various types of claims, including accident benefits claims.

If you are involved in a law suit and have social media sites, remember to inform your lawyer you have social media accounts. Do not alter, delete or remove anything from your account during the course of your lawsuit.

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In the News: Developments in Depression

Wednesday, June 27th, 2012

Depression can happen as the result of a traumatic experience. Long term depression can make it difficult to perform the duties of day to day employment and activities of daily life.

Researchers in Copenhagen have discovered that plant compounds from South African Daffodils may in time be used for treatment for depression. The plant compounds seem to be able to pass through the blood brain barrier, which is a significant finding. Typically, drugs for “diseases of the brain” are not able to pass the blood-brain barrier.

There is a new research network in Ontario attempting to boost efforts for treating depression. A former lawyer, Phil Upshall, profoundly affected by mental illness and a neuroscientist from the University of Ottawa/ Royal Ottawa Mental Health Centre have joined forces and made a pitch to the federal Conservative government with their proposal for a new research network of 80 scientists working together to find ways to help Canadians with depression. The government granted a $5 million dollar initiative, for the Canadian Depression Research and Intervention Network. This is a recognition by the government that mental illness and depression is a serious issue in Canadian society.

The network will focus on youth suicide and post traumatic stress disorder. According to Mr. Upshall, suicide is the leading cause of death in youth after motor vehicle accidents. PTSD is an anxiety disorder but it is also linked to depression, amongst other factors.

CBC.ca recently posted an article stating that teens and youth with anxiety and depression in Ontario can have faster access to mental health care and can skip doctor referrals. Up to a quarter of teens and youths experience anxiety, depression and other forms of mental illness that go undetected due to the long wait times to see specialists.  The London Health Sciences Centre is offering a program where youth between the ages of 16-26 can pick up a phone and get a mental health assessment, thereby bypassing the need for a referral or long waiting list. Early treatment can prevent mild or moderate illness from becoming more serious.

Did you know that how you use the Internet is a reflection of your mood? Internet use can be a sign of whether or not you are depressed, according to a recent study. Time Magazine recently posted an online article about this, “The Internet Knows You’re Depressed, But Can It Help You?”.  The study examined the internet use of college students and tracked their behaviours. Depressed students typically compulsively check e-mail, watch many videos, spend a lot of time playing games and chatting, and frequently switch back and forth between applications. 30% of the students had low mood, symptoms of anxiety and difficulty with concentration.

Did you know that chronic stress blocks a gene that guards your brain from depression? It turns out that chronic stress appears to block a gene that guards against brain atrophy associated with depression.  The gene is known as Neuritin and appears to be responsible for maintaining healthy connections in particular parts of the brain. The study is published in the Proceedings of the National Academy of Sciences. Rats, whose genes were suppressed, were found to be more anxious and depressed. Activating Neuritin led to an antidepressant response. This research adds evidence to the idea that depression may result from atrophy in the hippocampus, that brain’s centre responsible for mood and memory.

Aaron Waxman and Associates is a Personal Injury Law Firm in Toronto that handles only personal injury claims. We handle long term disability claims. If your claim for long-term disability has been denied, contact us today.

 

 

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