Cervical Disc Disease encountered in physiatric practice include herniated nucleus pulposus (HNP), degenerative disc disease (DDD), and internal disc disruption (IDD). HNP implies extension of disc material beyond the posterior margin of the vertebral body. Most of the herniation is made up of the annulus fibrosus. DDD involves degenerative annular tears, loss of disc height, and nuclear degradation. IDD describes annular fissuring of the disc without external disc deformation. Cervical radiculopathy (disease of the spinal nerve roots) can result from nerve root injury in the presence of disc herniation or stenosis (narrowing of the spinal canal), most commonly foraminal (openings in the vertebrae for the nerve bundles to enter) stenosis, leading to sensory, motor, or reflex abnormalities in the affected nerve root distribution.

Understanding cervical disc disease requires basic knowledge of anatomy and biomechanics. The intervertebral disc absorbs shock, accommodates movement, provides support, and separates vertebral bodies to lend height to intervertebral foramina.  No disc exists between C1 and C2, and only ligaments and joint capsules resist excessive motion. Disc degeneration and/or herniation can injure the spinal cord or nerve roots and result in stenosis and/or myofascial pain.

Spine-health – http://www.spine-health.com/conditions/degenerative-disc-disease/cervical-degenerative-disc-disease

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Back Pain Causes of mechanical back pain (BP) generally are attributed to an acute traumatic event, but they may also include cumulative trauma.  The severity of an acute traumatic event varies widely, from twisting one's back to being involved in a motor vehicle collision.  Mechanical BP due to cumulative trauma tends to occur more commonly in the workplace.

The pathophysiology of mechanical BP remains complex and multifaceted. Multiple anatomic structures and elements of the spine (eg, bones, ligaments, tendons, disks, muscle) are all suspected to have a role. Many of these components of the spine have sensory innervation that can generate nociceptive (a sensory receptor that responds to pain) signals representing responses to tissue-damaging stimuli. Other causes could be neuropathic (dysfunction of the nervous system--e.g, sciatica). Most chronic BP cases most likely involve mixed nociceptive and neuropathic etiologies.

The concept of a biomechanical degenerative spiral has an appealing quality and is gaining wider acceptance. This concept postulates the breakdown of the annular fibers and allows PLA2 and glutamate, and possibly other as-yet unknown compounds, to leak into the epidural space. The weakened vertebra and disk segment become more susceptible to vibration and physical overload, resulting in compression and stimulating release of substance P. Substance P, in turn, stimulates histamine and leukotriene release, leading to an altering of nerve impulse transmission. The neurons become sensitized further to mechanical stimulation, possibly causing ischemia, which attracts polymorphonuclear cells and monocytes to areas that facilitate further disk degeneration and produce more pain.

The National Pain Foundation – http://www.nationalpainfoundation.org/cat/862/back-and-neck

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Anxiety Disorders such as panic disorder described above, are far more common than most people think. In fact, recent estimates from the National Institute of Mental Health (NIMH) show they are the most common mental illness in the United States.

Approximately 40 million American adults ages 18 and older—or 18.1 percent of the adult population—suffer from an anxiety disorder. Anxiety disorders are a unique group of illnesses marked by persistent, irrational, uncontrollable anxiety. These include generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder, social phobia and specific phobias.

Researchers have found that anxiety disorders and chronic pain often occur together. In some patients, the stress associated with living with chronic pain may exacerbate conditions such as anxiety disorders and depression. Feelings of helplessness, loss of control and interference with daily activities from chronic pain can trigger mental health disorders in some pain patients. In some cases, the symptoms of an anxiety disorder may be similar to those of chronic pain and go undiagnosed. It is important to get a correct diagnosis since anxiety disorders are treatable.

The Most Common Anxiety Disorders:
Generalized Anxiety Disorder (GAD) involves excessive and uncontrollable worry about everyday things, such as health, money or work. It is accompanied by physical symptoms such as restlessness, irritability, muscle tension, fatigue and difficulty sleeping or concentrating.
Obsessive-Compulsive Disorder (OCD) entails persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears. Someone with OCD often will practice repetitive behaviors or rituals (compulsions). For instance, obsessing about germs may lead someone with OCD to compulsively washing hands—perhaps 50 times or more per day.
Panic Disorder includes severe attacks of terror or sudden rushes of intense anxiety and discomfort. Symptoms can mimic those found in heart disease, respiratory problems or thyroid problems, and individuals often fear they are dying, having a heart attack or about to faint. The symptoms experienced during a panic attack are real and overwhelming, but not life threatening.
Posttraumatic Stress Disorder (PTSD) can follow exposure to a traumatic event, such as a car accident, rape, a terrorist attack or other violence. Symptoms include reliving the traumatic event, avoidance, detachment or difficulty sleeping and concentrating. Though it is commonly associated with veterans, any traumatic event can trigger PTSD.
Social Anxiety Disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. People who have SAD have what feels like exaggerated stage fright all the time. SAD is also called social phobia.

Specific phobias are intense fear reactions that lead a person to avoid specific objects, places or situations, such as flying, heights or highway driving. The level of fear is excessive and unreasonable. Although the person with a phobia recognizes the fear as being irrational, even simply thinking about it can cause extreme anxiety.

Visit http://www.adaa.org for more information or contact ADAA at 240-485-1001.

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