Prior to drawing blood, saying a word to patients that suggested pain increased the likelihood of them experiencing pain. You might think of this study as just another example of the importance of “Bedside manner”- the awareness of the importance of the behavior and speech of the physician or other care-takers, on the feeling of well-being of the patient. Eugene Bauer, M.D., a Viennese physician, said in 1931: “A word in the mouth of a physician is as important as the scalpel in the hands of a surgeon”. Words can cut, soothe, and rattle. How you are approached by a doctor is determined not only by their personality but also by the beliefs concerning your problem.

Teaching medical students, residents and fellows that back pain is predominantly caused by the spine, discs and the associated nerves, and telling this to a patient, contributes to the negative effect that the doctor can produce. The fact is that most back pain is not the result of abnormalities in the spine; it is from muscles, tendons and ligaments- structures that aren’t readily seen in an MRI, CT, or x-ray. What is seen on these studies, which is often shared with the patient, is a description of the spine that demonstrates the effect of wear and tear or just a variation in anatomy, but frequently has no relationship to the patient’s pain. As I said in the last post, patients who receive an MRI or CT when they have back pain, actually on the whole do worse than those who do not have an imaging study.

Costly and potentially dangerous outcomes can result from medical care that is well intentioned but misinformed. We need to change the way back pain, neck pain, and other common pain syndromes are treated. Certainly some back surgeries and nerve block procedures are helpful, but many are not. One reason for the high failure rate for pain procedures is the absence of a step care model- where the simplest, safest, and least expensive interventions are done first. A rational and cost effective standard of care for back and neck pain, after ruling out serious underlying disease, must always first consider the evaluation and treatment of pain related to muscles and other soft tissues and how treating the muscle pain can give significant and lasting pain relief and prevent unnecessary back surgery, nerve blocks or ablations.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
“Your New York City Pain Relief Doctor”

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