I just read a medical report and felt the need to educate the population, as this is discouraging and sad! Ready?
AUTO INSURERS - READ THIS. This is why your claim closure rates are terrible, your having to approve Psychology Assessments and Treatments, and your clients are reporting worsening injuries as the claim progresses.
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LAWYERS - READ THIS. This is why your clients are progressively worsening over the course of the 5-7 years that you represent them and Most/All of their special imaging reports and specialist reports come back negative.
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INJURED PATIENTS - READ THIS. This is why YOU will say, (most likely), I feel better after treatment for a few hours and the pain returns/the pain is worse. This is why you have a responsibility to research the provider you are going to, to ensure that they have specific training in the injury you need treatment for, in this case WHIPLASH. You would not go to a Hip Surgeon if you needed Brain Surgery, would you? Or a Neurologist if you have Bunions?
Report regarding Motor Vehicle Accident Patient with a WHIPLASH INJURY. REVIEWED TODAY, 12/20/2023.
Family Doctor response to Whiplash Injury Pain Patient in Ontario Canada: Gabapentin 100 mg- 5 capsules 3 times a day. This medication was prescribed for (500 tablets) filled on November 23, 2023.
*** This is a prescription for nerve pain for 166 2/3 days, that is 5 1/2 months of Pills for a Whiplash Injury that should recover, with appropriate treatment in 20-24 visits.***
Insured Statement: "The pain comes and goes but at night I have a lot of pain. I have a lot of back pain. When I start walking the pain increases. I cannot walk a faraway distance."
This is NOT nerve pain. This is Ligament Instability with Muscle Guarding. Gabapentin will NOT work in this case!
Something to think about, this is a whiplash injury, an injury that causes loss of stability of the spine, a functional injury with neurological symptoms that can progressively worsen over time if appropriate treatment is not provided.
Think Gabapentin is the appropriate treatment and I am wrong, this client's accident was 13 months ago! It hasn't worked in 13 month's, it probably will not work!
"Whiplash is a progressive disease, due to functional loss of the spine, which will progressively worsen over time if not correctly treated. Research shows that you have 3 weeks post injury to receive appropriate care, otherwise the likelihood of chronic pain increases exponential."
Dr. Jason Mazzarella, DC, DAAPM, DCAPM, DAAETS, DqEEG (c), DWTT (D), FIAMA, MVC-FRA, CATSM, CBIS, CMVT, CPM, CDRSC, CDAAC, BSc Kin, BSc HPA
Client statement: "My stomach hurts from the medications."
Background Gabapentin:
Gabapentin was first approved by the Food and Drug Administration (FDA) in 1993 as an adjunctive treatment for partial seizures. In 2002, the medication was approved for the treatment of postherpetic neuralgia, a painful complication of shingles.
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In 2004, the manufacturer of Neurontin, Pfizer, pleaded guilty to multiple counts of illegally promoting the off-label use of gabapentin, resulting in nearly $430 million in fines.
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What are the signs of gabapentin addiction?
Signs that you may be misusing or becoming addicted to gabapentin include:
Taking larger doses or using this medicine more frequently than prescribed by your doctor.
Experiencing withdrawal symptoms when you try to stop using gabapentin.
You are having strong cravings to use gabapentin.
It is interfering with your ability at work, school or home-related activities.
Seeing multiple doctors to obtain gabapentin prescriptions.
Trying to stop use of gabapentin without success, even though you want to.
Spending too much time trying to get gabapentin
What are the most common gabapentin withdrawal symptoms?
agitation - (Psy/Concussion diagnosis?)
anxiety - (Psy diagnosis?)
inability to remain still, restlessness (akathisia)
disorientation - (Concussion diagnosis?)
headaches - (Margarine diagnosis?)
dizziness - (ENT/Vestibular Referral?)
excessive sweating (diaphoresis)
confusion - (Concussion diagnosis?)
trouble sleeping - (Psy Diagnosis?)
nausea - (Concussion diagnosis?)
fast or abnormal heart rate
seizures (possibly severe)
Why this wont work for Whiplash Injuries. Because pain medication is designed to assist with Acute Pain, when pain becomes Chronic secondary factors occurr such as:
Impaired Sleep - (Depression and Anxiety diagnosis.)
Catastrophizing
Altered Biomechanics - Key with Whiplash Injury.
Myofascial Dysfunction.
Overuse Injury.
Reflexive Guarding.
Nerve Entrapment.
Metabolic Dysfunction - HPA Axis.
Immune Dysfunction.
Overall Reduced Quality of Life!
***The primary cause of Neurological Symptoms post Whiplash Injury is associated with A Beta Nerve Fibers, Gabapentin will work on A Delta and C - Fibers. This is the PATHOPHYSIOLOGY OF WHIPLASH!***
This list of Chronic Pain Consequences is from Dr. Ming Kao of Stanford Pain Medicine Lab.
This is why a SOFT TISSUE INJURY does not resolve.
It is NOT a soft tissue injury, this is from 1983, take my post graduate class!
Whiplash is progressive, and pain increases due to neurophysiological changes that occur if proper treatment is not provided.
Pain = Cognitive changes (concussion diagnosis?)
Pain = HPA Axis changes (Depression/Anxiety diagnosis?)
Pain = Catastrophizing (AC and IRB Benefits?)
Pain = Social Isolation (Psy Benefits ?)
Pain = Activity Avoidance = Deconditioning (PSW/OT Benefits ?)
Pain = Altered Biomechanics = Myofascial Pain = Overuse Injury = Nerve Entrapment = Reflexive Guarding.
Key Takeaway!!!
It does not matter if the Doctor is an MD, MD specialist, DC, DPT or some secondary provider - Nurse practitioner, PA, etc. Understanding of the health concern, in this case WHIPLASH, is what will determine if the person, if truly injured, gets better.
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If you are going to treat Whiplash Injury, at a minimum, understand its Pathophysiology!
Lawyers - Stop looking at the ending credentials of providers for opinions, look at the post graduate training! As a lawyer YOU should know the QTF. The QTF is what the SABs is based off of. The QTF states No Medical Program (MD, DC, PT) teaches Whiplash Pathophysiology and specific, voluntary, post graduate training is required! Do your Experts have this?
Insurers - Use PPN's that understand the injury so you are not throwing your money away! Want to know if you are? Read the IME reports or Treatment Facility CNR's, what improvement is the client reporting. Usually none or minimal over an extended period of time. Appropriate Treatment Gets People Better! Generic Treatment increases claim duration and costs, and makes you send files out to secondary adjusting companies due to high adjuster pending!
Patients - Make the doctor you choose explain why you have pain, if you don't believe them, or if it doesn't sound like the pain you have or reason, DO NOT listen to OTHERS that sent you to the doctor/clinic, TAKE CONTROL OF YOUR HEALTH, and find a doctor that can help you get better, Find a Doctor with Specific Whiplash Training!
Want to Learn More?
Let me know your Whiplash Questions?
Thank you
Dr. Jason Mazzarella, DC
