Dental Care & Serious Illnesses

Thomas Varga, DDS
 
 

Arab Family Web Site & Directory

Arab Health Directory

Arab Kidney Transplant Directory

Arab Neurosurgery

Arab Orthopedic Surgery

Arab Obstetrics And Gynecology Directory

Arab Physicians And Scientists Directory

Arabic Cancer Patient Publications

World Specialists Directory

Exceptional Arab Family:
How To Care For Children 
With Special Needs 

Arab American Seniors Association
 

Orange County 
Care Providers Directory

2nd Opinion Specialists Directory

Advances In
Physical Medicine & Rehabilitation Directory

Women Doctors Directory

Workers Compensation Directory
.

Chronic Pain 

When reviewing a chart, a great deal of confusion can arise, confronted with a claimant, who seems to have a valid claim, but does not have supporting medical evidence. There are several diagnoses such as “chronic pain syndrome,” or "low back pain," which are not diagnoses but rather are descriptions. Likewise, “lumbo-sacral strain,” or "cervical strain” should be reserved for an acute problem, but are not applicable for a chronic problem, since sprain last only four to six weeks by definition. When a physician is using these poor descriptions or faulty diagnoses rather than specific diagnoses, there is a 40% to 67% chance that the claimant will really have a definable organic lesion, that is real, and probably could respond to appropriate treatment (Hendler et al., Psychosomatics, ’93, and ’96). The implications for the insurance industry, especially in the area of return to work, is obvious.

First and foremost, the reviewer should look for warning signs that include (a) vague diagnosis, such as "low back sprain,” or “cervical strain," that have lasted longer than two months. A sprain or strain is nothing more than stretching a muscle or ligament, and with the rest and reduced weight bearing or reduced use, use, the muscle or ligament should recover function within two to three weeks. Obviously, any "sprain” or “strain" that has lasted more than three or four weeks, has to be something more than just a sprain or strain.

The second warning sign, for which an reviewer should be concerned is the presence of normal MRIs, or CT scans or myelograms, or MRIs, CT scans or myelograms showing either degenerative disc disease or bulging disc, in association with a patient who has persistent neck or back pain. The reviewer should realize that a disc can be pathological, without being herniated. Think of a normal disc, which resembles a jelly doughnut, with the outside, doughnut portion of the disc, or the annulus, being intact, and the nucleus pulposi being a jelly like substance, in the center of the disc. This disc actually serves as a cushion, between vertebral bodies. It prevents the two vertebral bodies from rubbing against each other, and cushions any shock from jumping or excessive bending. Also, the disc, in effect, exerts forces up and down, from the center of the disc, just as a piece of compressed sponge rubber exerts forces up and down, in response to its compression. The anatomical components of the vertebral bodies that keep the disc from pushing the vertebral bodies further apart, are the ligaments, which hold the bones in place. Very simply, bones hold the body up, ligaments hold the bones in place, and muscles move the bones.
(More Information)
 

Nelson Hendler, M.D.

• Professional Profile
• Arabic Web Page
• Web site