The article in the European Spine Journal highlights a major difficulty in assessing the effectiveness of various back pain treatments. No two studies used the same criteria to measure improvement. The lack of uniformity appears to be present in every aspect of the enigma of low back pain. Recent studies demonstrated that the tests a family physician uses to establish probability of a disc herniation may not be valid. There are inconsistent criteria for fusion vs. a simple laminectomy or foraminotomy for back pain. Injection techniques vary widely for back pain thought to be from nerve or muscle.

It is no wonder that with no widely adopted standards of care the overall results of treatment are suboptimal. We propose a step care model where before anything else is offered, an assessment of muscle strength, flexibility and tenderness be done so that simple inexpensive and safe treatment of muscles occurs before any other interventions. In light of our success in reducing or eliminating pain in patients with years of back pain that has not yielded to surgery, injections and spinal cord stimulation, we know that needless suffering and wasted resources could be avoided.

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

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