DrLamb.com

Up

Email Dr. Lamb

Click on this 3 minute movie link for an overview of the Lamb Program For Stretching

Dr. Blair Lamb, MD recommends

Get Healthy!

Stay Healthy!

Many of our readers have asked for my opinion about the effect of thermal burns and chronic pain.

Temperature fluctuations have a definitive effect upon the human body. Cold temperatures seem to be associated with muscle shortening (part of the shivering effect), but are also associated with reduction of inflammation. Warm temperatures are associated with muscle relaxation, but can also enhance inflammation of bone and even soft tissue.

More extreme temperature changes can have more severe effects. Specifically, burn patients have a variety of effects upon their physical body. Burns can be chemical, electrical, radiation and of course thermal, or direct heat. Thermal burns can cause severe scarring of the soft tissues involving skin, muscle and tendon. The superficial skin is of course the most visible of changes and can restrict joint range of motion quite significantly. This, in turn can contribute to other soft tissue restriction, such as muscle and tendon. Similarly, shortened, or scarred skeletal muscle will have a direct joint range of motion effect and can contribute to an increase in compressive forces of a join, thereby increasing the risk of osteoarthritis (I commonly use the term compression arthritis) of that and other nearby joints.

As well, chronic pain of a limb will commonly contribute to changes in the muscle length of the intrinsic spinal muscles represented by that joint. For instance, a foot disorder can contribute to a chronic low back disorder, and a hand disorder to a neck disorder. The exact mechanism is not clear; however, in my opinion, I believe that there is ascending information up the leg (or arm) that contributes to abnormal shortening of the intrinsic spinal muscles and then a spinal radiculopathy can occur. This may lead to sciatica, hip pain, knee pain and even a reflex sympathetic dystrophy (RSD). Of course similar effects can occur in a hand and neck. Other contributing reasons for the "ascending" pain disorder can be a change in joint posture of the foot or hand leading to an abnormal strain position that over time acts much like an RSI or repetitive strain injury. This will contribute to deep spinal muscle injury, which can then lead to disk compression, "spinal subluxation."

Although my practice is not concentrated upon burn victims, I do see various burn patients. Electrical burns are quite unusual, and can cause not only local tissue problems, but seem to have the ability to contribute to serious and progressive neurological injury of the spine and brain. Thermal burns seem to be more direct, but can contribute to spinal dysfunction that can lead to chronic fatigue, and progressive limb dysfunction and pain.

The treatment of a burn victim involves several areas of medicine. The initial therapy is performed by trauma teams who strive to keep the person alive, and minimize permanence of injury of tissue. Surgeons are needed to repair and debride (remove) damaged tissue. Therapy plays a role as soon as possible to help minimize contractures of skin and muscle. Skin contractures sometimes have to be surgically revised, and some injections can help. With respect to skeletal muscle, similar approaches can be attempted as with classical myofascial neuropathic disorders. That is, one can use IMS (intramuscular stimulation-see IMS description) to help release spinal and limb muscles such that an improvement in range of motion and strength can be achieved. This can be accompanied by a reduction in pain, improved function and improvement of the overall pain disorder. Using combination therapies such as IMS and other injections such as BOTOX™, stretching (personal and assisted), spinal and limb traction, surgery, NSAIDS, microcurrent TENS (Alpha Stim), muscle relaxants (Zanaflex), massage therapy and machines, chiropractic, pain medication, sleep enhancing medications (preferably non-addictive such as Elavil, Melatonin), improvement can be made in most chronic pain sufferers whether a burn is related or not.

As always, keep long and strong.

G. Blair Lamb MD, C.C.F.P.

Pain and Rehabilitation Consultant

Created by ViaVoice 10