BuildingNY – New York Stories with Michael Stoler
June 14th, 2012
Dr. Marcus discusses his background and how he developed, with the help of Hans Kraus, MD, his approach to evaluate and treat chronic pain.
Dr. Marcus is an Associate Professor at NYU Langone School of Medicine and Director of Muscle Pain Research. After starting the first pain center in New York City at Montefiore Hospital, he developed and directed the NY Pain Treatment Program at Lenox Hill Hospital and the Pain Treatment and Functional Restoration Centre at Princess Margaret Hospital in Windsor, England. He has published with Simon and Schuster two books, Freedom from Pain and End Back Pain Forever. He is the author of numerous academic chapters and articles.
Chronic pain treatment often assumes that the pain is the problem and an underlying cause cannot be found or treated. The approach used is a combination of interventions from various disciplines, ie physical therapy, occupational therapy, physiatry, neurology, anesthesiology, psychiatry, psychology, orthopedic surgery, and neurosurgery. The goal is to improve function and reduce pain but even if pain cannot be reduced or eliminated, a patient can still have a meaningful, productive life.
Dr. Hans Kraus taught Dr. Marcus that many patients with chronic pain could be successfully treated if muscles were considered as an unidentified cause. The first patient they saw together was diagnosed with arachnoiditis. After having two spine surgeries for herniated discs and spondylolisthesis, she had persistent low back pain and sciatica. Her CT scan showed scarring of the tissue surrounding her lower spinal cord (arachnoiditis). Her diagnosis was also Failed Back Surgery Syndrome – the diagnosis you may receive if your spine surgery doesn’t relieve your pain.
After examining the patient, Dr. Kraus concluded that eight muscles were causing the pain. When these muscles were treated with injections that included the tendons as well as the muscle tissue, the patient’s pain was almost gone. She stopped taking morphine that she had been taking around the clock, and returned to work.
Even though her CT scan showed arachnoiditis and she had Failed Back Surgery Syndrome (both with poor prognoses), much of her pain was being caused by muscles. By not even considering that muscles were a possible source of her pain, she could never get better.
Dr. Marcus now understood that unless every patient was evaluated for possible muscle pain, it was impossible to know if all or even some of the patients’ pain was caused by what was seen on an MRI, CT scan, or x-ray. Patients who had multiple failed treatments such as spine surgery, laminectomy, spine fusion, epidural steroid injections, facet blocks, radiofrequency ablations, spinal cord stimulators, morphine pumps, rotator cuff repair, and impingement syndrome decompression, could be found to have painful muscles that were causing some or all of their pain.