Wednesday, April 28, 2010

Research Published - August 31, 2010 at International Meeting

Below is a summary of our research presented at the 13th World Congress on Pain for presentation in Montreal, Canada, August 31, 2010. The study was done jointly by Dr. Campa and Dr. Larison over the last two years. Both physicians will be on-site to present our findings. This research is a follow-up, expanded study to our prior investigation, Median Nerve H-reflex and Pain Diagnosis, and should continue to help other physicians to more accurately and timely diagnose those individuals who present with neck and upper extremity pain.

John A. Campa III, MD
Tom C. Larison, DC
October 10, 2010
Research Summary

The Usefulness Of The Median Nerve H-reflex, Median Nerve F-wave And Radial Nerve F-wave In Pain Diagnosis Of Multilevel Degenerative Disc Disease Of The Cervical Spine

J. A. Campa III, MD, T. C. Larison, DC, Neurology, Pain Diagnosis Consultants, LLC, Albuquerque, NM, Faculty, School of Medicine, University of New Mexico, Albuquerque, NM, Electrodiagnostic Medicine, Pain Diagnosis Consultants, LLC, Albuquerque, NM

We have previously reported the value of the Flexor Carpi Radialis Median nerve H-reflex study (FCR-HR; root derivation: C6, C7) in assessing patients with neck and upper extremity pain and underlying multilevel cervical disc disease (C5-6, C6-7). These lesions present special problems in the diagnosis and management of the primary pain generator, as they are commonly diagnosed on X-ray, CT and MRI as degenerative, and not usually considered as a legitimate source for the patient's pain complaints, resulting in undertreatment and delay in improving the baseline pain control. The FCR-HR, Median nerve F-wave (MNF; root derivation: C6, C7, C8, T1) and Radial nerve F-wave (RNF; root derivation: C5, C6, C7, C8) in their assessment of the functional impact of these lesions, would help clinicians resolve the primary source of the patient’s pain, and permit a focused and directed approach to more definitive management.

To assess the usefulness of the MNF and RNF, when correlated with an abnormal FCR-HR, in identifying cervical degenerative discs as potential pain generators.

A 24-month retrospective chart review was performed of patients with neck and upper extremity pain, who underwent electromyography/nerve conduction velocity studies (EMG), where Median nerve neuropathy above the wrist was excluded, and the FCR-HR was abnormal. Results were correlated with MNF, RNF, EMG paraspinal, X-ray, CT, MRI, and clinical findings.

68 cases underwent EMG for neck and extremity pain; Abnormal FCR-HR: 43/68 (63%); Abnormal FCR-HR and correlating X-ray/CT/MR (C5-6/C6-7): 31/43 (72%); Abnormal FCR-HR and C6, C7 correlating EMG paraspinals: 28/43 (65%); Abnormal FCR-HR and Abnormal MFW: 9/43 (21%); Abnormal FCR-HR and Abnormal RFW: 5/43 (12%); Correlating imaging lesions: DDD, disc bulge, protrusion, extrusion, listhesis, foraminal narrowing, cord impingement, thecal sac effacement, osteophytic ridging, Modic Type I, central canal stenosis.

We conclude that the MNF (21%), when combined with the FCR-HR (63%), is a useful diagnostic tool in the assessment of C5-6, C6-7 cervical disc disease as a primary pain generator. We recommend its routine use in the evaluation of patients with neck and upper extremity pain, who present with multilevel cervical disc disease. The RNF (12%) was less helpful.