Monthly ArchiveMay 2009
Neck Pain 18 May 2009 03:40 pm
We’ve all known since the beginning of time that the application of heat appears to sooth away aches and pains, but up until now that so-called “knowledge” has been strictly anecdotal. We could demonstrate it and experience it for ourselves, but there was no real proof that the phenomenon was anything more than just the result of the placebo effect.
That is until I came across a press release this summer from London’s University College stating that researchers there have discovered scientific proof that heat alleviates pain.
Dr Brian King, of the UCL Department of Physiology, led the research that found the molecular basis for the long-standing theory that heat, such as that from a hot-water bottle applied to the skin, provides relief from internal pains, such as stomach aches, for up to an hour. 
Dr. King goes on to explain:
“The heat doesn’t just provide comfort and have a placebo effect – it actually deactivates the pain at a molecular level in much the same way as pharmaceutical painkillers work. We have discovered how this molecular process works.”
If heat over 40 degrees Celsius (104F) is applied to the skin near to where internal pain is felt, it switches on heat receptors located at the site of injury. These heat receptors in turn block the effect of chemical messengers that cause pain to be detected by the body. 
In the past it was easy to speculate that heat therapy seemed to work simply because it made us feel good and thus made the pain more bearable.
Add to the fact that the pain relief was only temporary, furthered the assumption that the effect was merely psychological and not really real. However, Dr. King’s research gives us physiological evidence that supports our past personal observations.
The team found that the heat receptor, known as TRPV1, can block P2X3 pain receptors. These pain receptors are activated by ATP, the body’s source of energy, when it is released from damaged and dying cells. By blocking the pain receptors, TRPV1 is able to stop the pain being sensed by the body.
Scientists made this discovery using recombinant DNA technology to make both heat and pain receptor proteins in the same host cell and watching the molecular interactions between the TRPV1 protein and the P2X3 protein, switched on by capsaicin, the active ingredient in chili, and ATP, respectively. 
And so we see that even the temporary aspect can be demonstrated at the molecular level.
What does this all mean for the future of pain research? Dr. King goes on to give his opinion on the matter…
“The problem with heat is that it can only provide temporary relief. The focus of future research will continue to be the discovery and development of pain relief drugs that will block P2X3 pain receptors. Our research adds to a body of work showing that P2X3 receptors are key to the development of drugs that will alleviate debilitating internal pain.” 
Not Just Anecdotal Any More
This, of course, means the physical therapists have been correct all along in their use of modalities such as heat and ice when treating back and neck pain. It also confirms what you and I have observed time and time again, that the relief only lasts a short while.
For those of us who prefer not to use pharmaceuticals if they can be avoided — and don’t mind settling for a temporary solution — this is interesting research and a chance to finally point to something other than anecdotal evidence.
So, if you don’t want to take a pill and all you’re looking for is something to help you get to sleep at night. Try applying a hot water bottle or one of those commercial heat packs just before bed.
It may just do the trick.
Till next time,
1. Press Release: Heat Halts Pain Inside The Body, University College London, July 5, 2006
2. BBC News: Heat ‘blocks body’s pain signals’
Neck Pain 18 May 2009 03:32 pm
Looks like Kittums is feeling no pain… neck or otherwise.
I received a rather lengthy email this week from a reader who asked a number of really good questions about neck pain, his symptoms, and various treatment options. It would take too long to attempt to address them all in a single post so I’ve decided to just focus on one of them this time. I’ll cover the rest in future posts.
I followed your advice and went to see my doctor today about the pain in my neck and arm. I thought I had sciatica, but he said sciatica was only in the legs and then he called it something different. I should have written it down because we talked about several things after that and now I can’t remember what he said it was.
[Then proceeds with the rest of his questions.]
Guy Who Writes Really Long emails
The term you’re searching for is probably radiculopathy.
Radiculopathy is a condition that gets its name from the fact that the symptoms radiate into the extremities along the path of the affected nerve root. For example, cervical radiculopathy is when a pinched nerve in the neck causes pain, numbness and tingling to radiate into the shoulder, down the arm and possibly even into the hand and fingers.
Radiculopathy that starts in the lower back and radiates down through the legs is often referred to as sciatica. It gets its name from the fact that it follows the sciatic nerve, which exits the spine in the lumbar region and travels all the way from there to your toes.
For lack of a better term, I refer to this as a phantom pain because the injury is actually in the neck or back even though it’s felt at some distant location. There is nothing really wrong with your arm or leg.
These strange symptoms are caused by mechanical problems in the spine including (but not limited to) herniated discs, stenosis (narrowing of the spinal column), loss of disc height, bone spurs or a combination of these and other factors.
Pain that Radiates
Don’t feel bad about getting the term wrong. Your doctor is used to it by now.
Besides, it’s quite understandable when you’re hearing a bunch of strange new terms for the first time to start getting them confused. After all, they’re pretty closely related.
Just remember radiculopathy – the pain that radiates.
- Cervical radiculopathy is in the neck
- Lumbar radiculopathy (commonly referred to as sciatica) is from the waist down.
One Final Thought
Sometimes a bad radiator can be a pain in the neck…
Don’t you just hate it when that happens?
Neck Pain 18 May 2009 03:26 pm
Buddy here looks like he’s planning on bilking the insurance company out of some major coin.
I’m sure it comes as no surprise that every once in awhile someone will write to me and ask about those cervical collars you occasionally see people wearing. For example, here’s a letter I received about a month ago…
I’m 37 and a working Mom. I slipped and fell at home about a week ago and I’ve had this awful neck pain ever since. It’s worse first thing in the morning, gets better by mid-day, but by the end of the day it’s hurting again. My doctor said there was nothing seriously wrong and prescribed Motrin for the pain but I’ve been wondering if I should go back and ask him about one of those collars to support my neck while it heals. I don’t really want to wear one of those things, but maybe that would help my neck heal faster?
What do you think? Any advice would be appreciated.
There was a time when cervical collars were considered a viable option for treating neck pain. And there was a certain logic behind the practice.
After all, it made sense to try and protect the injured tissue and give it a chance to heal. The goal was to prevent repetitive injury, which would ultimately delay your recovery.
However, these days most doctors don’t prescribe cervical collars for minor neck injuries. They’ve found that it actually slows recovery time and weakens the neck if the collar is worn for any length of time.
Here’s what the American Academy of Orthopaedic Surgeons has to say on the subject…
“In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.” 
The basis for this position can be found in the current research, which indicates that a certain amount of movement actually helps the injury heal faster…
“Research has shown that whiplash patients who rest for several weeks and wear a soft collar actually recover more slowly than those who try to follow a normal routine.” 
“In the past, some people have worn a neck collar for long periods after a whiplash sprain, and have been reluctant to move their neck. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.” 
And here are a couple more quotes along the same lines…
“Mealy and associates, in a prospective randomized trial comparing use of a soft cervical collar and analgesic medications with a regimen of active therapy, found that the group treated actively had significant improvement in both neck pain and mobility compared with the group treated with a soft collar.” 
“In a third prospective randomized study… Patients encouraged to remain at their normal level of activity had a better outcome than patients treated with immobilization and time off from work.” 
So there you have it.
I think the only time cervical collars are used for minor neck injuries is if you need support at night when you’re sleeping. Since you are waking up with neck pain, your doctor may decide that support at night might be helpful in your case.
However, I suspect that he will not want you to wear it during the day. (Even if you are trying to set a new fashion trend.)
As always, be sure to check with your doctor first before acting on your own.
1. Whiplash. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. [Oct 2000]
2. Kasch H. Whiplash: What causes Whiplash? netdoctor.co.uk [Jan 2005]
3. Whiplash Neck Sprain. Patient UK. patient.uk.co [April 2005]
4. Young WF. The enigma of whiplash injury. Current management strategies and controversies. Postgrad Med Vol 109, No 3:179-86 [Mar 2001]