muscle pain posts Archives

How we perceive pain – nociceptors

Wednesday, February 5th, 2014 at 10:34 AM  

We generally don’t think of muscles as a cause of pain. Sure, we know that after exercise or playing ball we can have muscle soreness, but when pain persists we often think it is coming from nerves, joints or the spine.  Believe it or not, muscles (and other soft tissue) are the most common reason for pains such as lower back pain, neck pain and shoulder pain.  The brain gets information from the body about pain from specialized nerves called nociceptors that respond to tissue damage. Trauma, overwork, and over-exercising cause low oxygen and too much acidity in the muscle. These changes, along with other chemicals that are produced when the muscle is damaged in any way, stimulate the nociceptor.  When a stimulus as strong enough it causes the nerve cell to produce an electrical impulse that is sent into the spinal cord and then up to the cortex, the part of the brain where we perceive pain.

There are actually more nociceptors in the muscle attachment sites (the ends of the muscle where it attaches to the tendon and the tendon attaches to the bone) than in the muscle tissue. That is why if you have pain originating in muscles you may be more aware of the pain close to a bone than in the middle of the muscle.

Any kind of injury releases substances from damaged muscle and surrounding tissue that stimulates the nociceptor. If the nociceptor gets enough stimulation it creates an electrical discharge which travels down the nerve and ends up in the spinal cord. Muscle nerves that have been stimulated repeatedly become more sensitive to additional stimulation. They are called sensitized nerves and they will more easily produce electrical activity with even non painful events such as any contraction to move the muscle. That is why when an injured muscle is used it may cause pain.  That is why if you have strained muscles for any reason you may feel pain from every day movement.  Nociceptors are key structures in the perception of pain.

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Muscles as the source of pain

Monday, February 3rd, 2014 at 1:03 PM  

Muscles are the largest organ system in the body, accounting for approximately 50% of our body weight.  We have different ways of categorizing muscles: how they look, how they move, and where they’re located. We are going to focus on muscles that move voluntarily, which means we tell the muscles to move, as opposed to involuntary muscles, which automatically move on their own (like our heart and blood vessels). There are 641 muscles in the body – 340 pairs (meaning we have one on the right, and one on the left), and one unpaired (which is the transverse arytenoid for those who must know).

Back Pain

70% of lower back pain is diagnosed as idiopathic or non-specific[1], which means we are not sure what caused the pain. However, most investigators believe that sprains and strains of the soft tissue are the source of pain. Soft tissue refers to muscles, tendons, and ligaments. So it may be surprising that the emphasis in evaluating and treating lower back pain, neck pain, and shoulder pain, is on the spine and the nerves coming out of the spine. In fact, from 1997 to 2005, the prevalence of the diagnosis of spine-related issues has increased 100% while the diagnosis of strains and sprains of soft tissue has gone down by 40%[2].

This is generally attributed to the increase in the use of high-tech imaging studies, such as MRI and CT scans.  However, just because we have a clearer image of what’s going on inside of your body doesn’t mean that we have a clearer understanding of what’s causing your pain. More than 90% of lower spine MRIs exams in adults are abnormal[3]. Studies have found that up to 40% of people have herniated discs and as many as 70% have degenerated discs with no pain. If people can walk around with abnormal spines without pain, then this means that abnormalities in the spine aren’t always the cause of pain. Your diagnosis of a herniated disc, spinal stenosis, or spondylosisthesis may actually be unrelated to your source of pain.

Muscles are often ignored when it comes to diagnosing pain. I believe the reason is that we rarely evaluate muscles as a source of pain. We generally don’t learn about or understand how they work, what chemical changes take place inside, and how they produce pain (the pathophysiology). I would like to take the next few blogs to discuss how muscles contribute to your chronic pain.


[1] Deyo, RA., et al. Low Back Pain. NEJM. 2001; 344(5):363-370

[2] Martin, B., et al. Expenditures and health status among adults with back and neck problems. JAMA. 299(6):656-64, Feb 2008.

[3] Zimmerman, Robert D. “A Review of Utilization of Diagnostic Imaging in the Evaluation of Patients with Back Pain: The When and What of Back Pain Imaging.” Journal of Back and Musculoskeletal Rehabilitation 8 (1997): 125-33.

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Pain relief following a motor vehicle accident

Friday, December 13th, 2013 at 3:57 PM  

Dean was a 41-year-old, married executive when he was involved in a motor vehicle accident where his car was totally wrecked. X-rays revealed no fractures. Over the next five years he experienced progressively increasing aching and tightness in his low back which sometimes radiated into his buttocks and down into both legs to the soles of his feet. He also reported pain in his neck and shoulders, which was made worse by bending over.

Therapeutic exercises, medications, psychotherapy, epidural steroids and nerve blocks were given without success. Radiofrequency lesioning of nerves innervating the facet joints in his cervical and lumbar spines provided six months of minor relief.

His pain became unbearable and he attempted suicide twice. When he consulted me five years after the accident, he was no longer working and rarely left his house. Physical examination revealed 16 muscles that appeared to be a source of pain. He lived out of state so his treatment was not continuous. Over the course of 4 months, he received muscle-tendon injections to each muscle identified followed by 3 days of a physical therapy protocol after each injection which included teaching Dean an exercise program that had been given at the YMCA . No muscle was re-injected. His pain was eliminated. Four years later, he continues to contact us to let us know he is still pain free and working as a corporate executive.

 

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Back pain relief achieved when soft tissue was addressed

Tuesday, December 10th, 2013 at 9:19 AM  

Oliver is an 84-year-old publisher who came to see me for pain in the middle of his low back, which sometimes radiated to his right hip and down his right thigh.  He described this pain as an intermittent aching, stabbing, shooting sensation, made worse by sitting for more than 30 minutes, standing for more than 15 minutes, and walking.  His pain made it difficult for him to stand erect.  Though his pain began 8 years before he came to see me, it was exacerbated by an automobile accident 5 years prior to treatment.  He had been to a physical therapist and a neurologist, and was diagnosed with postpolio syndrome.  Imaging studies revealed severe degenerative changes throughout the lumbar spine.Back Pain

His physical examination revealed that although he had adequate strength in his trunk and no trigger points, his hamstrings were very tight and he had atrophied muscles in his lower extremities. I suggested that he learn the exercises that were created at the Columbia University School of Medicine in the early 1960s by my mentor Hans Kraus.  These exercises were later given at the YMCA to over 300,000 people with an 80% success rate in diminishing or eliminating low back pain.  The exercises are created to produce relaxation, limbering, stretching and strengthening of key postural muscles.  Oliver also began to gradually increase the amount of walking he did each day until he reached 2-3 miles.

By addressing the deconditioned muscles in his legs, buttocks and low back, Oliver was able to find relief for the discomfort in his low back, and stand erect.  Even with a diagnosis of Post-polio syndrome and  imaging studies showing degenerative changes in his spine, Oliver found relief when the soft tissue component of his pain was addressed.

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Over 90% of spine MRIs are interpreted as abnormal.

Tuesday, November 26th, 2013 at 4:38 PM  

Fusion x64 TIFF FileNearly all individuals experience degenerative changes in the spine as they age, with nearly 20% of the population exhibiting disc herniations without any symptoms or pain by the age of 50(1).  This means that even though your X-ray or MRI shows an abnormality, it doesn’t mean that this is what is causing your pain.  Though imaging studies can be valuable tools, they are not equipped to show the nuances of the muscles and soft tissue.

In 2001, a study(2) of more than twenty thousand patients at outpatient medical clinics in the United States found that sprains and strains of muscles and other soft tissue accounted for 70-80% of all back pain.  Since muscles play such a large role in pain, and imaging studies cannot give us enough information about the state of the muscles, a thorough physical examination is necessary to evaluate the soft tissue as a source of pain.

Even if you are diagnosed with a separate condition, like spinal stenosis or fibromyalgia, if soft tissue has not been examined not only for tenderness or spasm but in addition as a source of pain, it is possible that muscles are contributing to your pain.  Over the next few blogs, I will talk about different patients who came to me with a variety of diagnoses that were thought to be the cause of their pain, who were able to reduce or eliminate their pain by treating their muscles.

 

 

1 Zimmerman, Robert D. “A Review of Utilization of Diagnostic Imaging in the Evaluation of Patients with Back Pain: The When and What of Back Pain Imaging.” Journal of Back and Musculoskeletal Rehabilitation 8 (1997): 125-33. Print.

2 Weinstein, Deyo NEJM

 

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Increased risk of neck pain from extensive computer use

Tuesday, November 5th, 2013 at 2:48 PM  

There has been an increase in the number of hours we sit in front of a computer for leisure and work. Does your job require you to stare at a computer for hours at a time? One study found that workers sitting for 95% of the day, and/or worked with their neck at 20˚ or more in flexion for more than 70% of their working time, had a significantly increased risk of neck pain  (http://oem.bmj.com/content/58/3/200.short).

An ergonomically designed workstation would help reduce the strain on your muscles. Here are a few suggestions:neck pain-NMPI blog

  • Place your monitor so you are looking at it straight ahead or down at no more than a 15˚ angle.
  • The monitor should be 18-24 inches away.
  • The angle of your elbows when typing on the keyboard should be > 90 degrees.
  • An ergonomic mouse or keyboard may also help.
  • A laptop is always non-ergonomic; because the monitor and keyboard cannot be separated one or the other is in the wrong position.  If you always use a laptop think about getting an auxiliary keyboard.
  • Footrests should be used if your feet do not rest flat on the floor.
  • If you use a phone frequently get a headset so you will not have to hold the handset to your ear.

Aside from these changes, you may also consider doing limbering activities such as small stretches throughout the day – shrug your shoulders a few times, move your arms above your head, or get up and walk around your chair.

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Physiological and biological mechanisms do not address all the variables contributing to persistent pain.

Monday, October 21st, 2013 at 4:51 PM  

One of our colleagues, Ronnie Gonzalez, a bereavement counselor, sent us a comment about her clients, who often felt physical pain while struggling with the loss of a loved one.

Very often, emotional stress and negative thoughts can manifest physically as tension in the muscles, which is one of the most common causes of pain. Constant exposure to stressors can cause the development of musculoskeletal pain in even healthy individuals (http://psycnet.apa.org/journals/ocp/15/4/399/, http://iospress.metapress.com/content/w8147125250687x5/) and is therefore considered a risk factor associated with the onset of pain.

fMRI (functional magnetic resonance imaging) studies of pain patients demonstrate that negative thoughts can excite areas of the brain associated with pain perceptions and intensify the sensation of pain. Studies have shown that painful muscles which are tense, especially during times of stress, can stay contracted and tight even after the stress or negative feelings are long gone. This causes the body to be more susceptible to pain.

Breathing and stress are also linked. When we suppress our feelings, we generally hold our breath. Depriving our muscles of oxygen will cause it to hurt. The advice of taking deep breaths when we’re stressed or anxious is not unfounded.

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Spine surgery and exercise

Tuesday, July 23rd, 2013 at 8:42 AM  

I was interviewed, on Doctor Radio on Sirius XM. One of the callers told us that after she had spine fusion her pain was eliminated but if she didn’t do exercises at least every other day her muscles above and below the surgical site would tighten up and  pain would begin to return. Even when surgery is indicated for back pain, proper conditioning of the postural muscles is still important.

If she didn’t have a good physical therapist and she wasn’t motivated to doing her exercises her surgery might have been considered a failure, another Failed Back Syndrome. Too often the need to address muscle health is overlooked in the treatment of persistent pain problems. As I emphasize in End Back Pain Forever, exercise and physical conditioning should be taught in grade school and encouraged throughout our life.

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Many Back Surgeries Unnecessary

Monday, July 1st, 2013 at 11:05 AM  

In the United States we are faced with the highest per capita health costs in the world. One would think that massive expenditures could provide the best care and treatment outcomes, but this is not the case. In many aspects the US is worse or no better than countries spending 50% of what we do on health care. One reason is that we often inappropriately provide costly evaluation and treatment interventions. We provide surgery too frequently on conditions that could be treated more cost-effectively. Having a step- care model (using the least invasive and potentially harmful, and most cost-effective approaches first) for various conditions would offer models of care for the majority of problems whilst still allowing for modifications in unusual circumstances. —Dr. Norman Marcus

 

By Ryan Sabalow

Some doctors estimate the national rates of unnecessary hysterectomies and back surgeries are even higher than the 25 percent cited by state health officials questioning the Redding area’s high rates of the procedures.

Dr. Ernst Bartsich, a clinical associate professor of obstetrics and gynecology at Weill Cornell Medical College in Manhattan, N.Y., said as many as one in three women in the U.S. has had her uterus removed by the time she’s 60. That number increases to one in two by 65.

Bartsich, an outspoken critic of what he calls the overuse of hysterectomies, said he believes that 85 percent of such procedures could have been avoided through less invasive methods, such as removing painful fibroid tumors from the uterine wall or through medication.
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How can we know what back pain treatments make sense?

Monday, July 1st, 2013 at 10:32 AM  

If the cost of health care is to be reduced in the US, new methods should be established to pay clinicians, pharmaceutical companies and device manufacturers. If graduating medical students are so laden with debt that paying it off is more important than the possibility of ongoing study and academic pursuit, we must lower the cost to the student of medical education. If the cost of drug development is so high that huge prices must be charged for pills, we must find ways to reduce the cost of development of new pharmaceuticals. These fundamental issues in health care have an impact on the standard of care of back pain in the USA. Read the rest of this entry

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Bedside Manner and the power of suggestion in back pain

Sunday, June 30th, 2013 at 6:30 PM  

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.

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A discussion about back pain

Friday, May 31st, 2013 at 5:55 PM  

Back PainWhere to begin? In the first two chapters of my book, End Back Pain Forever,  I explore a variety of issues related to the difficulties in evaluating and treating patients with back pain. I am posting these chapters as a means to share my perspective which developed over more than 40 years as a pain medicine physician in the US and the UK. I encourage the members of my LinkedIn Group, Let’s Talk About Pain to agree, disagree, or share your own experience as a patient, family member of a patient, or clinician.

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The cost of evaluating and treating lower back pain and neck pain is rising. From 1997-2005 it went up from $54 to $86 billion/year. Unfortunately, advances in spine surgery techniques, nerve blocks, and pain medication have not translated into more successful treatment – from 1997-2005, 25% more patients reported difficulties functioning because of neck pain or back pain.

Although 70-80% of back pain is diagnosed as non-specific lower back pain, referring to sprains and strains of muscles, ligaments and tendons, the current guidelines do not mention muscle as a possible source of persistent back pain. This leads to an overemphasis on the spine and the nerves leaving the spine.

We need a treatment model (step-care) that addresses the most common reason for back pain first. Protocols that provide soft tissue treatments that are least costly with minimal chance of harm, should produce better, more cost-effective outcomes.

Spending more money to do the same kinds of treatment is not working. This discussion group will explore possible reasons for sub-optimal pain treatment outcomes. How can we change the way we evaluate and treat persistent pain to improve our results and lower the costs of care?

A search for back pain on the internet finds almost 600 million sites. With so many different ideas on how to address this problem, we will attempt to narrow the discussion to concepts that have been studied and published in scientific journals. One obvious issue is the absence of a muscle evaluation and treatment protocol.

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Epidural Steroids- Are they worth the downside risk?

Thursday, October 11th, 2012 at 12:47 PM  

The tragic occurrence of meningitis, stroke and death following use of infected steroids used for spine injections should make us more aware that this very common treatment for back pain may not be worth the risks. The use of epidural steroid injections (ESIs) to shrink an inflamed nerve thought to be causing back pain has not been shown to consistently reduce pain and even when it does the benefit is frequently short-lived. Aside from infection, other rare but serious side effects include bleeding that can cause  nerve damage with possble weakness and paralysis, and additional pain. Steroids themselves have been the cause of bone  (aseptic necrosis) and tendon  damage.

Multiple medical professional organizations have suggested that ESIs should not be used for long standing back or neck pain or for pain in the back or neck that does not radiate to the arms or legs. Despite the evidence that even when ESIs reduce or eliminate pain, at best they are useful for 3 months or less. Other countries i.e. Denmark, rarely use ESIs. 

As long as a thorough physical examination does not take place with all patients complaining of back or neck pain, with the purpose of determining if muscles are a source of pain, we will continue to rely on imaging studies that lead us to mistakenly believe that all back pain comes from the spine and the nerves leaving the spine. Continuing to provide unnecessary and ineffective treatments not only squanders our limited resources but could cause irreparable harm.

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End Back Pain Forever: Chapter 2, part 5 #endbackpain

Thursday, May 31st, 2012 at 10:00 AM  

In this next segment, I take Hans up on his offer to examine one of my patients. Read what happens next!

Click here for the Part 4 segment.

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 5)

     Dr. Kraus and I met a week later at Lenox Hill. I had chosen a patient whom I shall call Beth. She was a forty-five year-old woman so defeated by pain after three unsuccessful spinal operations that she could no longer hold a job. Her life had revolved around her work, which was at the core of her sense of self. She was devastated. No one had found a truly successful treatment for her, and I did not believe that anyone could. She was on high doses of morphine, 60 milligrams orally five to six times a day, to relieve her pain.

After reviewing her case history, Dr. Kraus gave her a comprehensive and thoughtful mental and physical examination. Starting with her neck, he used his fingertips to palpate her muscles to distinguish between those that were supple and pain free and those that were stiff and painful. He found five pairs of painful muscles on both sides of the lower back, buttocks, and thighs.  “If these muscles are treated properly,” he told me, “it should reduce or eliminate her pain.” Read the rest of this entry

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End Back Pain Forever: Chapter 2, part 4 #endbackpain

Monday, May 28th, 2012 at 10:10 AM  

This excerpt from my book End Back Pain Forever,  is about my mentor and friend, Dr. Hans Kraus. He changed the way I viewed pain and the treatment of pain, and enhanced my life and ultimately my patients’ lives for the better.

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 4)

     Then, in 1993, I met Dr. Hans Kraus. He was to transform my life and the life of my patients. He was eighty-five years old and had just retired from his practice as a specialist in physical medicine and rehabilitation. He had also given up mountaineering and rock climbing. In all those pursuits, he had won international acclaim. Originally trained as an orthopedic surgeon at the University of Vienna, Dr. Kraus was well known for having successfully treated President John F. Kennedy’s back after all prior treatments had failed. Yet his nonsurgical approach to treating patients with muscle pain, especially low back pain, was not accepted by other doctors, including some of the very doctors who referred their own patients to him for what proved to be successful treatment.

For example, one prominent orthopedic surgeon at the Columbia University School of Medicine, Dr. Frank Stinchfield, who routinely sent many of his back pain patients to Dr. Kraus, underwent spinal surgery rather than consult him for his own back pain after a herniated disk was diagnosed. The surgery failed, and Dr. Stinchfield was never able to work again because of unrelenting pain.

Another disappointing example was that of Dr. Jonas Salk, best known for developing the first safe and effective polio vaccine. Dr. Salk did consult Dr. Kraus for back pain, and the treatment was successful. It eliminated Dr. Salk’s pain and allowed him to avoid surgery. Yet when Dr. Kraus needed Dr. Salk’s help to obtain research support, the famed medical researcher declined. He said that muscle pain didn’t have a “scientific foundation.” That has since changed, and we will look at the basic research explaining the mechanisms of muscle pain in Chapter 4.

In our first meeting, Dr. Kraus asked what I did. I told him that I treated patients with chronic pain.

“How do you do that?” he asked.

“I teach them how to manage their pain, how to deal with it, live with it.”

“Why not get rid of their pain?”

“Because it’s chronic pain,” I said. “You can sometimes reduce it, but you can’t get rid of it.”

He persisted. “Have you treated the muscles?”

“We treat the muscles with aerobic exercises.”

“Aerobic exercises? Really? Muscle pain caused by muscle spasm, tension, stiffness, and trigger points does not respond to aerobics. But it will respond to other types of exercises: prescribed exercises designed to treat the specific source of pain. That’s what I’ve done.”

“Low-impact aerobics are the standard way,” I said.

“They may be the standard way,” he replied. “But they are sure to make many of your patients feel worse.”

He asked if I had “very difficult cases,” and I told him that I did. “Some,” I added, “are impossible to treat.”

“Would you mind if I were to examine one of them?”

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End Back Pain Forever: Chapter 2, part 3 #endbackpain

Thursday, May 24th, 2012 at 10:00 AM  

This excerpt from my book End Back Pain Forever, provides a small summary of my early involvement in pain medicine.

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 3)

     In 1975, I became a staff physician in the Montefiore Department of Neurology’s Headache Unit, founded by Dr. Arnold Friedman. Two years later, with Dr. Edith Kepes, an anesthesiologist at the hospital, we started the first outpatient pain center in New York City, effectively following the lead of Dr. John J. Bonica, a medical giant to whom we owe the study of pain as a recognized discipline. As a young army anesthesiologist during World War II, he pioneered pain-relieving techniques and treated ten thousand wounded soldiers. Dr. Bonica went on to write a 1,500-page medical classic, The Management of Pain, Dr. Kepes and I began a team approach with practitioners from different fields – including colleagues from anesthesiology, neurology, orthopedic surgery, neurosurgery, physiatry, psychiatry, and psychology – all of whom were interested in what could be done for patients tormented by chronic pain.

I subsequently expanded on this concept by starting the New York Pain Treatment Program at Lenox Hill Hospital in 1983. It was considered a state-of-the-art treatment center in a hospital setting, with an integrated team that involved not only doctors but also physical and occupational therapists, psychologists, and pain rehabilitation nurses. We used a variety of treatments: biofeedback and relaxation training; physical therapy to increase strength, mobility, and endurance; hypnosis to help control pain; stress management to provide coping skills for handling daily upsets that may increase muscle tension; occupational therapy  to teach patients how to complete their routine tasks effectively through proper time management; individual, family, and group psychotherapy to resolve personal difficulties related to living with chronic pain; and medication management to eliminate many ineffective drugs that patients were taking in their journeys from doctor to doctor.

But our program had a basic flaw. We were convinced that teaching people how to live with their pain was usually the best we could do. We didn’t believe that we could eliminate their pain. Many of our patients remained on strong medication indefinitely. If a patient had a 35 percent decrease in pain, I considered that good. If we got it down to 50 percent, it was considered a success.

Along with the vast majority of physicians, I was committed to the fallacy that most chronic pain couldn’t be cured. Then, in 1993, I met Dr. Hans Kraus. He was to transform my life and the life of my patients.

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End Back Pain Forever: Chapter 2, part 2 #endbackpain

Tuesday, May 22nd, 2012 at 10:00 AM  

I wrote End Back Pain Forever  to open up a discussion on back pain and provide insights on effective treatments. I have posted the first two chapters of the book on my blog.

 Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 2)

As a physician specializing in pain medicine, I know how intimately mind and muscles interact. I can literally see a patient’s mental stress in tense, taut muscles. Early on in my training at Montefiore Medical Center in psychosomatic medicine, which is the study of how the mind and body interact, I could see that the separation of mind and body in medical practice made little sense. This drew me to a newly introduced technology, biofeedback, which enabled me to integrate my medical education with my psychiatric practice at the time.

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End Back Pain Forever: Excerpts from Chapter 2 #endbackpain

Monday, May 21st, 2012 at 3:05 PM  

Chapter 2 of End Back Pain Forever delves into the ever-increasing problem of the back pain epidemic. Please review this blog for Chapters 1 and 2 from my book.

Chapter 2

You Are Not Alone: The Back Pain Epidemic

     If you suffer from back pain, you are not alone. The widespread failure by doctors to recognize muscles as the primary source of back pain is helping to fuel an epidemic. Back pain is now the most common disability in the United States. Every year twelve million Americans make new-patient visits to physicians for back pain and a reported one hundred million visits to chiropractors. At the current rate, eight out of ten Americans will experience back pain sometime during their lives.

In addition to the human suffering, medical costs are soaring. The cost of back pain, together with related neck pain, came to $86 billion in 2005, the most recent year for which figures were available. That was an increase of $34 billion from 1997. More amazingly, 25 percent of patients reported being significantly impaired, compared with 20 percent eight years earlier. Spending on back pain now equals the amount spent on cancer and is largely the result of failed surgeries, various nerve block procedures, and the cost of pain medications. We are spending more and getting worse results.

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Why do we over-prescribe strong pain medication?

Tuesday, April 10th, 2012 at 10:01 AM  

The NY Times on 4/9/2012 ran a story about the overuse and unintended negative consequences of strong (opioid) pain medication. They mentioned opposing views concerning the liberal use of opioids. I participated in a debate in 1995 about the inappropriate use of the diagnosis “Chronic Pain Syndrome”(CPS) in patients whose muscles had not been assessed as a cause of their persistent pain, which resulted in the justification to put some of these patients on opioids for the rest of their lives.   

Since then one of the largest growth industries in medicine is the evaluation and treatment of back and neck pain, currently accounting for ~$100 billion in direct medical costs. The pain juggernaut is fueled in part by ignoring muscles which are the most common reason for pain complaints. Addressing the incorrect causes of pain leads to inappropriate, expensive and potentially harmful treatments with poor outcomes, persisitent pain, and overuse of opioids. CPS is a license to prescribe life-long medication. Chronic use of opioids has not been studied for its overall impact on patients with CPS but neither have any of the other medications that we are now using. Does the marginal reduction in pain in many of the patients taking these medications justify their costs and side effects? As the Times reports, for some patients the treatment is actually making them worse.

Imagine if some of these patients had pain that could be eliminated. Many do; it’s from muscles that are not evaluated or treated in a systematic way.  My new book, End Back Pain Forever, to be released by Atria on June 5, 2012 is a wakeup call to change the way we are treating common pain problems.

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How do I know if kinesiophobia is a factor in my pain?

Wednesday, April 4th, 2012 at 11:06 AM  

There may be more to your pain than you think. Pain affects how you feel and how you move your body. More often than not, these changes happen without you even realizing it.  Consider a concept known as kinesiophobia, defined as a fear of movement associated with anxiety related to an injury. Just as stress and anxiety can make pain worse, kinesiophobia can prevent a patient from recovering to their full extent and achieving relief from muscle pain.

 

An example….

Consider the case of a 50-year-old woman who was visiting the Norman Marcus Pain Institute for the treatment of her foot and ankle pain. The pain started two weeks after a fall, and had plagued her for five months. Because she felt that she was unable to walk without support, she used a walker or a cane. She complained of pain in her heel and ankle and in her Achilles tendon.   Her foot was cold and clammy. Attempting to move her foot up and down and applying pressure to the painful areas caused the pain to become much worse. Read the rest of this entry

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