Statin Use Increases Odds of Back Disorder: Cohort Study

This is not new news, however this is further evidence that statin drugs (cholesterol lowering drugs) are associated with back pain.  The article goes on to state that statins have now been shown to be related to a greater risk of "spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis,"  whereas before, the use of statins were associated with back pain without arthritis.  

Chiropractors, don't overlook the use of cholesterol lowering drugs when trying to find the cause of your patient's back pain.  

Dr. Alan Himmel

Statin Use Increases Odds of Back Disorder: Cohort Study

Marlene Busko

May 08, 2017

DALLAS, TX — In a large observational study of insured individuals in the military and their family members, statin use was associated with increased odds of having a back disorder, including spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis^[1].

Specifically, for every 17 individuals who were prescribed a statin, one person had a diagnosed back disorder, in this study published online May 1, 2017 as a research letter in JAMA Internal Medicine.

"Some of these adverse effects [from statins] can greatly impact day-to-day quality of life for our patients," especially in those who are physically active, lead author Dr Una E Makris (VA North Texas Health Care System and UT Southwestern Medical Center, Dallas) told heartwire from Medscape in an email. "We hope that musculoskeletal adverse events will be part of the patient-provider discussion on the risk/benefit ratio" of these drugs.

"Our results provide additional motivation to further investigate the overall influence of statin therapy on musculoskeletal health, specifically if prescribed for primary prevention in physically active individuals," the researchers summarize.

 Can Statins Cause Back Pain?

Two previous studies based on NHANES data reported that statin use was associated with musculoskeletal pain including back pain among individuals without arthritis^[2,3].

Severe back pain is both debilitating and costly. In 2005, it was estimated that back pain cost the healthcare system more than $100 billion, Makris noted.

The researchers retrieved data from 60,455 individuals who were at least 30 years old, lived in the San Antonio area, and were enrolled in the TRICARE health insurance system from 2003 to 2012. Of these, 17% were active military personnel and the rest were family members and veterans.

About one in six individuals (10,910) had been prescribed a statin, usually simvastatin (in 72% of prescriptions), and on average, they had been taking this drug for 3.7 years.

The researchers matched 6728 statin users with an equal number of statin nonusers. They had a mean age of 52 and 47% were women. A quarter were overweight or obese; 53% had hypertension; 20% had diabetes; and 40% had osteoarthritis.

Close to a third (30%) had a back disorder.

In the propensity-matched cohort, being prescribed a statin (as opposed to not being prescribed this drug) significantly raised the odds of having a back disorder (odds ratio 1.27; 95% CI 1.19–1.36).

In the overall cohort and in prespecified subgroups (such as nonobese individuals, healthy individuals, or those without musculoskeletal conditions at baseline, statin use was consistently associated with increased odds of being diagnosed with a back disorder.

In an analysis of the overall cohort, but with adjustment for propensity scores, the risk increase for a back disorder went from 30% among statin users to 47% among those taking high-intensity statins. It also increased with duration to as high as 59% with >4 years of use.

Adjusted* Odds Ratio (OR) of a Back Disorder, Statin Users vs Nonusers

Group	OR (95% CI)*
Overall cohort	1.30 (1.23–1.38)
>2 y statin use	1.47 (1.39–1.56)
>4 y statin use	1.59 (1.47–1.71)
High-intensity statin	1.47 (1.34–1.62)

*Adjusted for propensity score, medications used, and use of revascularization procedures during follow-up

"Further prospective studies are needed to better understand the mechanism of how statins can contribute to back disorder diagnoses," said Makris.

"We are not advocating for taking patients off statins if they have cardiovascular risk factors. As clinicians we should be aware of these potential associations and understand the spectrum of potential adverse effects."

The study was supported by grants and awards from the US Department of Veterans Affairs, the National Institutes of Health, the UT Southwestern Center, VA Health Services Research and Development, and the Agency for Healthcare Research and Quality. The authors report that they have no relevant financial relationships.

• 9 Comment
 
• References

Heartwire from Medscape © 2017 

Cite this article: Statin Use Increases Odds of Back Disorder: Cohort Study - Medscape - May 08, 2017.

http://www.medscape.com/viewarticle/879387?nlid=114770_4502&src=wnl_dne_170509_mscpedit&uac=5165DT&impID=1344127&faf=1

I hear THIS complaint about lawyers virtually EVERY DAY.

Biggest Complaint Clients Have About Their Lawyer...

The biggest complaint I hear from patients regarding their attorney is lack of communication. Multiple calls with no response.  The response from the lawyer's office is that the "lawyer is in court." Could be true or maybe it's not true, but either way, most clients can handle that, as long as they get a call back at some point.

But many times, the call never comes.

Now, I know that if you asked most lawyers, they would tell you that the number one question they get when a client calls, is "How is my case doing?"  And, I get it.  It's the same question over and over again, and its exhausting to have to be bothered with the redundancy of answering the same question over and over again.

But, come on.  As an attorney, you are getting paid very well to answer a few stupid questions.  It's not like it's that difficult.  What I am trying to say in a nice way, is that it could be worse, and for what fees that your client's are going to pay you, at least give them good customer service.   It's not so bad and it okay to take a few minutes out of your day to reach out to your clients...even if you just leave a message on voicemail.

So, I have a suggestion:  Take a little bit of time once every two or three weeks, and try and make a preemptive call out to your client.  Simply give a quick update.  For example, "Hey, its Attorney xyz, I just wanted to let you know that everything looks good on my end.  I sent out the letters of representation and requested policy information.  Just make sure you continue to take care of your injury, and I'll keep you posted in a couple of weeks if I have any updates.  But, don't worry, I'm on top of it."

If you did THAT, and that ONLY, you would be providing a great service to the client, and at the very least you will be easing their mind.  If you made a call like that one or two times a month, not only would you satisfy the client, but they would also be more inclined to stay more compliant with treatment, make referrals to you, and EVEN if the case did not turn out wonderful, at least the client would know that you were working very hard and staying on top of their case, and did the best you could do.

I have been treating accident patients in S. Florida for almost 22 years now.  If any of your client's need a treating doctor in the S. Florida area, please have them give me a call.

Thank you.

Dr. Alan Himmel
954-659-8600  

"I WANT MONEY," is not the Right Message to Send to an Insurance Company.

I WANT MONEY

The Statute of Limitations for filing suit in a personal injury case in Florida is 4 Years.  However, in the same state, here in Florida, there is a 14 DAY limit to wait, to begin treatment, after a car accident.

Think about this for a second, please.  You will see the point I am trying to make.   WHY?  Why would you first seek an attorney before a doctor?  You are injured, RIGHT?

Do you know what kind of a message that this sends to an insurance company?

PLEASE DON'T DO THIS!   You have 4 WHOLE YEARS to get the paperwork in with an attorney and file against an insurance company. This is 4 years!  The law is very clear on this topic.

And, it's very clear on this also:  You only have 14 DAYS to get under care for an auto accident in Florida.  ONLY 14 days.  And, it goes by very quick.  Injured car accident patients SHOULD seek treatment right away.  And, when you seek treatment right away, you send an entirely different message to the insurance company.

The message that you send when you seek treatment first, is "I am injured."
The message that you send when you seek an attorney first, is "I want Money."

I have been treating car accident patients for 20+ years.  I know the rules and the laws, and have a lot of experience with this.  You can contact me and I will personally explain this to you, or better yet, call me and set up your appointment.

Alan Himmel, DC PA
954-659-8600--Call me directly.

Is there such thing as a Florida PIP No-Fault Insurance Provider?

What is a Florida PIP No-Fault Insurance Provider?

Miramar Chiropractor Accident Doctor

Can a doctor be a provider of PIP No Fault Insurance?  I know there are Blue Cross Blue Shield providers, and Aetna, and Humana, for example. But what about PIP?  I say, yes.

We are a Florida No Fault PIP Provider.  I say this as IF it requires a special designation or certification to see car accident patients and communicate with PIP carriers for reimbursement.  Well, of course it turns out that it does NOT take any special certification to this.  So, why do I call myself a Florida PIP No-Fault Provider?  It is because over the years I have met many doctors, yes, chiropractors as well, who do not handle these types of patients.  When asked why, do you know what the number one reason was?  It is that they don't know how to do it, and they never get paid.  This usually results in the doctor chasing the patient around for payment.  It means sending several bills to a patient and then collections, and it usually ends up a total waste of time.  The doctor's office loses, and of course, the patient loses as well.

I have actually gotten several patients over the last 20 years because when they went to their regular doctor, they were told, "Sorry, we don't take accident patients."  That's when they were referred to me for care, and I handled not only the communication and payment from the proper insurance carrier, but also handled the intricate documentation and proper referrals that are often times needed throughout the period of care of the patient.  This is not to mention the writing of a very detailed report which outlines the details of the accident, the injuries, the diagnosis, prognosis, future costs of health care, possible loss of work which will cost the patient income in the future.

Knowing what I know, and what I have seen over the years, I would encourage anyone who has been injured in a car accident to make sure they go to a provider who is experienced and knowledgeable on dealing with PIP.  It is entirely different than HMO or PPO or medicare rules.  PIP billing, in a sense, is a specialty.  It is not well taught in billing and coding schools, and you would not expect an average insurance biller or doctor, to know how to handle it.

I have been dealing with nothing but PIP for 20 years now.  I am very experienced in the rules and correct procedures that are often changed by the Florida Legislature almost once a year.

If you have been in an accident, please call me first.  I will explain everything to you so you will be up to speed on the topic, and you don't make any mistakes which could cost you a lot of money down the road.

Dr. Alan Himmel, DC, PA.
954-659-8600

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

Dr. Alan Himmel-West Miramar Car Accident Injury Doctor

Autonomous cars are coming.  Get ready.  It is estimated that by 2025 there could be 600,000 autonomous cars on the road, and by 2035, there could be 21 million cars on the road. (1)

What is an autonomous car?  Well, it's a self driving car.  To paint the picture, this is probably what driving will be like in the future:  We will step into our cars with probably some futuristic doors which open up in  Lamborghini style in order for us to easily slide in with handfuls of carry-ons. Think of getting onto an airport shuttle bus.  We will step in, place our stuff on the side, and simply have a seat.  From there we will likely just speak our destination out loud, so that the navigation (GPS) hears us and figures out the best route.  A voice will come on and say, please buckle your seat belt, and inform us that we will be at our destination in 23 minutes and 16 seconds.  Ehh....no speeding anymore since we are not in control of the gas pedal.  And, at this point, the doors will shut, the system will make sure all passengers are safely secured, and we will be on our way.

Since we are no longer in control of our car, we could, if we want to just sit back and read the newspaper (if they still exist), do some computer work, watch a movie, or do anything else we want.
Even Sleep.

The trip will probably be very boring.  I figure it will be like being on a tour bus, with only one big difference; we have seen this city all before, since we live here.  This won't be like being on a tour bus travelling through Rome, unless you live in Rome.  There will be no reason to take your camera with you.

So, let's talk about how the autonomous car will change things, and there are plenty: The first thing that comes to mind, is that automated cars will reduce the amount of human error, since our cars will be controlled by computer software and hardware.  I know what you are thinking... GPS is very inaccurate and most of the time it sends you to the wrong place.  Believe me, this is a system which is in progress, and I would expect there to be gigantic improvements in GPS technology.  Eliminate human error and there are less injuries, and fatalities, because there are less accidents of all kinds. Car insurance companies will have to restructure the policies to account for the possibility of computer error, and those tech companies who created the system would be held liable for accidents.

And, I would expect cars with combustion engines (again, if they still exist) to be more efficient. Keeping you at a constant 45mph in a 45mph zone will save you gas.  It will also save your brakes.

How else would we expect life to change with autonomous cars?   Fewer car accidents mean fewer trips to a body shop.  Fewer car wrecks would mean fewer tow trucks on the road.  Calling a UBER driver (sorry Taxi Companies, it was good while it lasted but your days are numbered), will mean a driverless UBER car comes to you and picks you up.  There are billions of dollars going into making this happen.  Postal, UPS, and small package delivery will probably use these driverless vehicles also.

What if we don't want this?  Sorry, its coming.  Just about every car manufacturer is working on this to make it a reality, along with Apple, Google, Microsoft, just to name the obvious. (2) (3)
Let me put it to you this way:  When Google pays a billion dollars for a traffic app called Waze, do you think it is entirely for watching where the police are?  No.  Its all about the data that that app provides back to Google.  And, don't forget that just about everyone has a smart phone, which uses wifi and data, which is continuously sending information back to Apple and Google plotting your exact coordinates.  The information that these companies are gathering will one day be crucial to making these systems work.

For now, we are just starting to see a sprinkling of this new technology in our cars.  There have been self parking cars out for a few years now.  Also, blind spot monitoring in side view mirrors has been out for a while.  My 2014 Mazda has this feature.  I just saw a commercial on TV (can't remember the car company) showing a car that is available right now, that will completely avoid colliding into something.  They were demonstrating how the car automatically stops if a person walks out in front of a car which was driving straight ahead, and while the driver took his eyes off the road for a few seconds.  Pretty awesome, and that would prevent a rear end collision, too.

What if you are the type of person who likes to keep his car forever or you like the classic cars?  I doubt if these older cars would ever disappear completely, but you would expect them to be less and less common, just like we don't see many Model T's on the road very often.

In summary, we are living in some exciting times in terms of technology.  I am not sure if I am ready for it, because I still enjoy driving, and being in control of my car.  Our grandkids will likely look back and find it amusing that we actually use to drive our own cars.  

Miramar Chiropractor


References:
1. http://fortune.com/2016/06/07/autonomous-car-sales-ihs/
2. https://www.cbinsights.com/blog/autonomous-driverless-vehicles-corporations-list/
3. http://www.fastcompany.com/3024362/innovation-agents/10-autonomous-driving-companies-to-watch

The Changes to the Florida PIP law have worked to stop fraud: True or False?

The Changes to the Florida PIP law have worked to stop fraud:  True or False?

Dr. Alan Himmel

The articles are beginning to come out stating that the changes in the PIP laws that occurred in 2012 have decreased the rate of fraud, and costs to insurance companies, and ultimately to consumers.  This is a good thing if its true.  It may be that the decreases in payouts are due to the $2500 insurance cut off, or the 14 day rule, which states that you better get to a doctor within 14 days or you get $0.00 in coverage.  It may also be due to the fact that now, there is no coverage for acupuncture or massage, two effective, safe, alternatives to medications and surgery.

As a practitioner who sees accident patients in FL, doctors now have two less options to offer patients when they are suffering from painful injuries from automobile trauma.  Plus, patients have to get better with 75% less insurance coverage than they had in the past, since not all patients will have an "emergency medical condition"  (EMC) which is supposed to allow the patient to have their full benefit.

So, I ask you:  What do you think is the true reason that insurance companies are reporting savings?   Could the answer be that there is now more opportunity for the insurance carriers to deny coverage, since the payouts are capped now in many cases?  Or, could it be true that the savings is due to less fraud?   I would be one of the first to start celebrating if I was sure that the savings to insurance companies was about the reduction in crime, but I am not 100% sure about that one.

Florida PIP No-Fault Blog--This Weeks Search Queries.

Top Search queries which brought people to the Florida PIP No-Fault Blog.

Dr. Alan Himmel

June 13, 2013.  

Q:  Can an 18 year old get only PIP insurance?
A:  No.  The minimum coverage in the State of Florida is PIP and PD.  Everyone must have at least personal injury protection and property damage liability coverage.  

Q:  "EMC doctors in Pembroke Pines Florida"
A:  Right now, the way it stands, the EMC diagnosis may not be needed.  There has been a temporary injunction to parts of the no-fault law.  However, many attorneys are still recommending patients see an MD if there is a need for documenting an emergency medical condition.  The problem is that some insurance companies may try to enforce the EMC rule, and without it, the patient is left with only 1/4 the coverage that was paid for.  To be sure, however, if I were you, I would ask an attorney.  

Q:  "Car accident 14 day treatment"
A:  This person probably wasn't sure, but he heard that PIP treatment must commence by 14 days of an accident.  Correct!  You have 14 days to begin care.  If you went to the hospital, this counts.  Also, your family doctor, chiropractor.  This is one part of the no-fault law that was not contested.  It still stands.

Q:  "Florida EMC form for accidents"
A:  The Florida Department of Financial Services or any insurance company as far as I know have NOT created an EMC form.  I have googled it for months now, and not once have I seen a standard form for the EMC.  Remember, also, the EMC requirement is likely ON HOLD for the time being.  You should check with your attorney on this.

Q:  "Car accident Florida Massage therapy pain"
A:  If you are wondering if massage is covered under PIP, yes, the temporary injunction to the new PIP law is allowing massage like it always has.  However, some lawyers still recommend staying away from massage since there will be a few insurance companies that will try to deny medical claims for massage services.

Q:  "Will PIP pay my medical bills after IME" 
A:  IME stands for independent Medical Exam.  Insurance companies will send claimants to a doctor to get a second opinion.  This almost always means that the patient's coverage will be terminated after the exam, because the IME doctor almost always states that the patient can no longer benefit from care.  I have never let this exam limit my patient's access to treatment if the patient and I think it's needed.  The insurance company will usually send out a letter to the patient which states there is no more coverage, and this very often dissuades the patient from continuing even if they truly need the care.  They are afraid of being stuck with a bill they cannot pay.  Come see me at my office.  954-659-8600 Dr. Himmel

If your benefits are terminated by your insurance company, I have been very successful in getting the treatments paid for anyway.  Just call me.  I will see what I can do.

How to Survive when your car is off the road and sinking in a canal...

If You Find Yourself in a Car and Sinking Fast, You Need to be Aware of This.

Dr. Alan Himmel

In South Florida, it is not uncommon at all for a driver of a vehicle to wind up driving his car into a canal.  Whether this is due to your error as a driver, or another driver's fault,  its highly probable, since there are canals all over the place down here, that you may find yourself in a situation where you are in your car and your car is sinking fast.  As a matter of fact, often times when a person and his car go missing down here, one of the places that the police look, are the canals.  What they do is try and predict where the person was driving, e.g. to work, to church, shopping, and they look straight down using a helicopter or small airplane, and they look for the big black outline of a car in the water.  You definitely don't want to be "found" in your car at the bottom of a lake or canal.

So, the purpose of this article was to give you the necessary information, that if you were to find yourself   in your car and sinking in the water, you would have a chance of surviving.  You actually only have a minute.

I found a good video that explains this.  Its worth watching.  It could possibly save your life one day.
Dr. Gordon Giesbrecht, an expert on submerged vehicles, explains...

And here is another video from ABC news also featuring Dr. Gordon Giesbrecht.

   Unfortunately, you will not be able to practice this survival maneuver.  The first time you try this, is the one time you will be in a car and sinking.  Learn this technique.  It could be a life saver.

A day in the life of a Chiropractor in So FL. IME Doctor solicits my patient for treatment at his office.

A day in the life of a Chiropractor in So FL.  IME Doctor solicits my patient for treatment at his office.

Dr.  Alan Himmel

It was an interesting visit I had with a patient today.   Well, actually not a patient, but the patient's father.

This came only a few hours after I had received a call from my patient's insurance company, and was told that the patient's coverage had been terminated because of an IME cutoff.  Those that are not familiar with an IME should know that IME stands for Independent Medical Exam.  The IME is a cute way that insurance companies attempt to limit the amount of benefits that are paid out to medical providers.  They generally use an outside scheduling company who is supposedly not associated with the insurance company.  Its the insurance company's way of dissociating themselves from the doctor who is being paid to essentially cut the benefits off of the policy holder.  This way they can say its an "independent" doctor.

Anyway, so I was speaking with the patient's father who told me that he thought the doctor was a really nice guy.  He was in his early to mid 50's and had a regular office.  By the way, this independent doctor has been terminating the treatment of my patients for the last 10 years.  I told my patient's dad that the IME doctor will always come off as a nice person.  They don't want any confrontation in their office.  They will never give you the results of  the IME in the office, because 98% of the time, its going to be a termination of insurance coverage, and they don't want to get into an argument, or cause any kind of scene at the office.  I always joke with my patients and tell them that you could be bleeding from the ears, and still, the doctor's job is to say you are okay, and make a recommendation that no more care is either reasonable or necessary.

So, in the conversation with the patient's dad, right after he told me how nice of a guy the doctor was, he tells me that the doctor handed him one of his business cards and told him that they can both come into the office for treatment if they want.  He also told them that he has ultrasound.

Can you believe this?  On one hand, the doctor is being paid to terminate coverage because care is "no longer reasonable or necessary", and on the other hand, he is soliciting the patients for treatment at HIS office.  I am not sure if this even fits into the definition of irony, since to me it seems like this doctor has to be one of the stupidest individuals alive.

I have no choice but to call the insurance company about this matter.  And, I must say that I take no enjoyment in this at all.  I know he is going to deny it, but I feel that its just the right thing to do.  I have to make the insurance company aware of this.

WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY, Emergency Medical Condition, EMC.

          WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY.  Emergency Medical Condition.  EMC.

Dr. Alan Himmel

I thought this would be an interesting topic due to the fact that symptoms of concussion due to whiplash, many times are routinely overlooked.  Many times, a patient seeks treatment for whiplash pain due to an auto accident, only to be treated for the typical musculo-skeletal symptoms and neurological symptoms, which include but is not limited to neck pain, shoulder pain, radiating extremity pain, tingling and numbness.  These complaints are almost universal among whiplash victims.

But what about other symptoms like headache, vertigo, fatigue, irritability, impaired memory?  The more severe case includes convulsions, loss of hearing, seizures, and loss of consciousness.  (5) Over the years I have had dozens of patients tell me that ever since the accident, they feel like they are "in a fog."    They describe it as the inability to think clearly.  If you are a healthcare practitioner you should be cognizant of these post concussion symptoms as they are commonly caused by automobile accidents, and they are an indication that the patient may have a mild traumatic brain injury.  (1)  If you are a patient who is experiencing any of the above signs or symptoms, please do not ignore this potential emergency medical condition.  Misdiagnosing or ignoring this altogether could lead to serious and permanent long term disability.

It has been estimated that there are between 1.6 million and 3.8 million individual cases of injuries that cause post-concussion-symptoms. (2) And, concussions are seen in approximately 6 in every 1000 injuries. (3) I often wonder how much higher this number would be if all cases were diagnosed, because many people never seek medical care.  There are a lot of variables here.  In fact, this is an injury that is very prevalent in athletics and contact sports, like football and ice hockey, but on the amateur level, many times these mild traumatic brain injuries are simply ignored.  Time and time again, I even see the diagnosis of concussion being missed by physicians at emergency departments.

The concussion could occur when there is an impact to the head, or the head is thrown around due to  unexpected forces to the body, such as from a car crash, a serious football tackle, etc.

The image above shows how the brain which is surrounded by fluid for protection, is moved forcefully and collides with the inside of the skull.  

The image above shows the resulting bruise to the brain, which has just crashed into  the  inside of the skull.

To get an idea of the potential seriousness of these types of head injuries, you don't have to look very far.  There have been several incidents in professional sports, particularly football, where it is has been shown that repeated concussions to the brain caused very serious and chronic outcomes.  Over the long haul, patients who have had concussions suffer from depression, chronic headaches, mood swings, early dementia, memory problems and other psychological disorders.(4)

Treatment for concussion generally involves rest, including cognitive rest, by eliminating anything that requires concentration or memory, including taking time off from school.  Reducing physical activity is important and generally if the injury happened playing sports, the individual would be taken out of the game for a while, at least until all the symptoms have disappeared.  Once the patient is symptom free, he must be gradually be introduced back into the physical activity in small steps.  You don't want to just throw yourself back into the game, as symptoms could return.

You have to listen to what the patient has to say and do a thorough exam.  Be aware that there a lot of forces involved even in small impact collisions.  Don't overlook or brush it off when a patient tells you that since the accident they are having a hard time concentrating.  Put the pieces together.  You may have a case of post concussion syndrome which is an Emergency Medical Condition or EMC.



1.  Rehabil Res Pract. 2012;2012:528265. doi: 10.1155/2012/528265. Epub 2012 May 22.

Postconcussion symptoms in patients with injury-related chronic pain.

Stålnacke BM.

Source

Department of Community Medicine and Rehabilitation, Umeå University Hospital, Umeå University, Building 9A, 90185 Umeå, Sweden.  

2..Phys Sportsmed. 2012 Nov;40(4):73-87. doi: 10.3810/psm.2012.11.1990.

Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches totreatment.

Maroon JC, Lepere DB, Blaylock RL, Bost JW.

Source

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. maroonjc@upmc.edu

3.   Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. (2004). "Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury". Journal of Rehabilitation Medicine 36 (Supplement 43): 28–60. doi:10.1080/16501960410023732. PMID 15083870

4.   Cantu RC (2007). "Chronic traumatic encephalopathy in the National Football League".Neurosurgery 61 (2): 223–5.  PMID 17762733 

5.  "Information about NICE clinical guideline" (PDF). National Institute for Health and Clinical Excellence. September 2007. Retrieved 2008-01-26.