Concussion, Chronic Pain & Diagnosis

Given MACRA and outcome assessment based compensation it is important for doctors to understand reasons for delayed recovery and justify treatment outcomes. Studies show that more than 50 percent of people suffer from chronic pain disorders in the years following a brain injury. Headaches and neuropathic (nerve-related) pain is most commonly from injury to the head and neck.

According to the ICD10 criteria, at least three symptoms, which may include headache, dizziness, fatigue, depression, irritability, difficulty in concentration, and memory problems, are required for a diagnosis of postconcussion syndrome [7].  

The study shows that patients with injury-related pain often reported post concussion symptoms several years after injury. Although more women than men participated in the study, few differences between genders were found. A significant relationship was found between postconcussion symptoms and posttraumatic stress and between postconcussion symptoms and depression and anxiety. As whiplash is reported as the most common traffic injury, it was not surprising that most patients related their chronic pain condition to a previous whiplash trauma.

Although patients reported high frequencies of symptoms, these are seldom assessed in patients with chronic injury-related pain. The results in the present study agree with Smith-Seemiller et al.; they demonstrated that post-concussion symptoms were common in patients with chronic pain [19]. Since several studies have shown a lack of specificity of PCS [1528], the challenge is to establish a causal link between MTBI and PCS and to the diagnosis post-concussion disorder. According to our findings, the optimization of treatment for PCS requires clinicians to assess postconcussion symptoms, to investigate causes for each patient, and to account for factors such as posttraumatic stress and depression.

*See Post Concussion Chronic Pain below.

Diagnosing Ligament Instability

Early and correct diagnosis of ligament instability is very important. This information can also greatly affect the final outcome of a personal injury case including permanent disability and future medical care awards. Most importantly, if not properly diagnosed it can seriously affect the accident victim’s long-term health and quality of life. Ligaments are not seen directly on x-ray and are often not properly visualized on standard supine MRI. Unfortunately, this can result in improper diagnoses leaving the patient in life-affecting pain for what appears to be no known reason.

We use software specifically for the detection of Ligament Injury called Symverta.  Our experience since using this software is that 50% of ligament injuries are missed by the treating doctor and/or radiologist using x-ray and MRI.  Using computerized software specifically for ligament instability allows the doctor to render the proper diagnosis, prognosis, and treatment plan. 

We can digitize x-rays via the internet upon uploading them, very simple to perform.

Click here to see a sample report 

Feel free to contact us should you need this for your case or clinic.

Concussion Diagnosis

The final decision on diagnosis and coding is up to the doctor. Chiropractors should check with their state licensing board regarding making these types of diagnosis.

TBI Diagnosis

Chiropractors should be particularly interested in a patient’s potential TBI status as manipulation and exercise have been shown to be contraindicated in the very acute concussion stage but can be part of a successful recovery program for whiplash associated disorders (WAD) thereafter. Learn more here.

Differential Diagnosis