Archive for 'back pain nyc'

Is access to your medical records a good thing?

More and more doctors are transferring their records to an electronic format. One electronic medical records software, OpenNotes, allows patients to view their medical records online as well. Does having this information mean better care for a patient?

The New York Times published an article about one patient, Steven Keating, who benefited from the ability of seeing his medical records. In fact, because of this, he was able to push his doctors to perform an MRI of his brain, which revealed a brain tumor the size of a tennis ball.

In other cases, having this unfiltered information may create unnedatacessary concern and anxiety. For example, if one of your blood levels isn’t within the “normal range,” what does this mean? Most people would probably run to their computer and search “abnormal blood level for _________” and get countless different possible diagnoses….most of them serious, and probably not related to your “abnormal” blood levels. Results of imaging studies, such as x-rays and MRIs may also appear to be serious when they are actually only reflecting the results of age and normal wear and tear.

Just having raw data and unfiltered notes is not generally useful and can be harmful. If you are going to get your notes, make sure to discuss your concerns regarding what you read with your physician.

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Spinal Surgery for Lumbar Stenosis

A recent study was published in the Journal of the American Medical Association, analyzing spinal surgeries done on Medicare patients who were diagnosed with lumbar stenosis.

Let’s rewind – what is lumbar stenosis? Lumbar refers to the lower part of the spine, where we would normally identify as low back. Stenosis refers to the narrowing of the bones in the spine, often pushing or compressing the nerves that being in the spinal cord and extend into your legs. Spinal stenosis is often associated with pain and numbness in the leg.

When a patient is diagnosed with lumbar spinal stenosis, a wide variety of treatments are offered. If the spinal stenosis is actually causing pain and difficulties functioning, such as walking, you would imagine that exercise and physical therapy would have little or no effect. However, pBack Painhysical therapy and exercise are frequently prescribed and may reduce symptoms. This means that at least some of the pain is from muscles and that the picture seen with the CT or MRI showing the nerves being compressed wasn’t accurately showing the reason for all the pain. Without a thorough examination of the muscles in the lower body, we may overlook an easily treated source of pain.

Overreliance on imaging studies can lead to unnecessary, costly, and sometimes damaging treatments, which may include various pain medications, injections (such as epidural injections), and surgery. When surgery is recommended, there are different complexities of surgeries that can be performed.

In this recent study, the surgeries were divided into three categories: 1. Decompression by itself (removing a small piece of bone from the spine to relieve pressure on the spinal cord or nerves), 2. Simple (only 1-2 levels) fusion (fusing the bones in the spine using metal and or bone that may be harvested from the hip or provided by a bone bank), or 3. Complex Fusion (more than 2 levels and/or anterior [front] and posterior [back] approach). From the years 2002 to 2007, the number of decompression and simple fusion surgeries decreased while the number of complex fusion surgeries increased 15-fold. With increasing complexity of the surgery, the odds for complications and rehospitalization significantly increase without a significant demonstrated improvement in outcomes.

We should all be concerned that the number of complex surgeries is increasing, causing more severe side effects and death. Hospital charges alone for a less complex surgery can cost around $23,000 while the complex surgeries may cost over $80,000.

 

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In today’s world we are bombarded by information and ways to obtain it. Do you want to know how many steps you take a day? Just buy a device and it will calculate it for you. Care to know what your cholesterol levels are? Simply go get a kit at your nearest drug store. Is it possible we are gathering too much information for our own good?

The same question can be asked about medical testing. Is it useful or even helpful to know certain things about our bodies? Many of us have undoubtedly had the experience where we have gone to the doctor because we had pain and an imaging study was ordered. MRI, CT, and ultrasound can give us information about our bodies that would have been unimaginable in the past.

While technology in general is of course a huge benefit, at the Norman Marcus Pain Institute, we believe it is necessary to proceed with caution as we navigate through it all. At NMPI, one common problem we find in back pain, neck pain, and shoulder pain is the overuse and overreliance on imaging studies. “Abnormalities” are often found on imaging studies without any relation to one’s pain. In fact, seeing abnormalities is more common than seeing a “normal” spine!   For example, up to 40% of people without back pain can haveBack Pain herniated discs and as many as 70% may have degenerated discs. That is why the US Institute of Medicine suggests not getting an MRI too quickly since you are likely to see one of these problems and assume it is the cause of your pain. This can lead to unnecessary nerve blocks and surgery.

At NMPI, we often see patients who have a herniated disc, yet they only have pain in their back and buttock. They have not experienced any radiation into the leg(s) at all. In these patients, the pain generally has nothing to do with the disc herniation since disc herniation pain generally radiates down the leg and into the foot. Even when the patient is experiencing pain down the leg with a herniated disc found on MRI, muscles in the low back and buttocks may be the cause of the pain. If muscles are not examined as a potential cause, you may undergo an apparently reasonable surgery, without achieving relief of pain. Some studies show that up to 50% of spine surgeries fail (resulting in failed back surgery syndrome) and one of the reasons is the failure to identify muscles that were the true source of the pain.

Most back pain and neck pain is caused by soft tissue such as muscles and tendons. This is confusing because you may have been told your pain is from your spine, discs, or nerves. The problem is most people as they get older have signs of wear and tear on their x-rays and MRIs, but these common signs of aging may not explain your pain if the pain actually originates in your muscles. That’s why we say, when diagnosing persistent pain it’s not having “more” information at hand, it’s having the “right” information at hand.

At NMPI, we often see patients who experience persistent pain even after multiple spine surgeries. Our non-surgical, non-invasive treatment program has most of our patients leaving our office free of long standing back, neck, shoulder, and headache pain.

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Is Looking Good Worth Having Back Pain?

There is an old expression, “beauty is pain.” Does it need to be? Is it worth risking your long-term health? Why do women wear high-heeled shoes when they know that looking beautiful in the moment may cause them pain down the road? Scientists from the Universite de Bretagne-Sud recently conducted experiments, which studied the effects of high-heeled women on men. Women who wore higher heels (3-4 inches vs. 2 inch heels) were able to get more men to answer survey questions on the streets and were picked up faster in bars and clubs. These studies show some type of empowerment in women with high-heeled shoes.  heelsKnowing that this empowerment exists, and as fashion has increased the height of heels from 4 inches to 5 inches, we would like to remind you that walking for extended periods in high heels can cause calf tendons to shorten and possibly result in an increase in low back pain.

Here at the Norman Marcus Pain Institute, we see patients that run the gamut of factors causing their back pain. Prevention is always the best treatment; since low back pain affects so many of us a simple intervention is being more conscious of our shoes! While those Manolo Blahniks and Jimmy Choos may be stunning, they may be causing a problem for you down the line. At NMPI, we won’t say don’t wear them, just please, wear them in moderation.

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NORMAN MARCUS PAIN INSTITUTE
30 East 40th Street - New York, NY 10016
Tel 212-532-7999 Fax 212-532-5957
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