I reread my blog on misleading diagnoses and central sensitization, and it confused me, so it must have confused some of you. The point was that if so many of us have different interpretations of pain and how to treat it, we can’t all be right. I want to discuss specific pain syndromes where it […]
When treating chronic back pain, over-reliance on imaging studies frequently suggest arthritis, disc herniations, spinal stenosis, degenerative disc disease, and spondylolisthesis as the underlying diagnoses. Unsuccessful treatment often results if muscles, tendons, and fascia are not considered in the differential diagnosis. Widespread pain is often diagnosed as Fibromyalgia Syndrome (FMS). In 1990 the American College
I Googled back pain and got 649,000,000 hits. I am sure that the opinions of all those who posted their successful approaches were in there. Overall I would say the consensus, based on cost and outcomes analysis, is that we do too much treatment of low back pain. Back pain is a symptom that may
Do you believe that long acting opioids should be used routinely when patients are taking round the clock meds? A recently published study http://bit.ly/18y6RXL concluded that long acting but not short acting opioids were associated with hypogonadism in men. Boxed warnings on long acting opioids now read that if short acting opioids are effective they
I have heard from a number of group members who have been diagnosed with spinal stenosis. The diagnosis is often made based on what is found on a CT scan or MRI without the expected corresponding signs and symptoms. It is important to understand what any diagnosis means in relationship to your back or leg
An example of the importance of a multi-disciplinary approach to persistent pain is the patient with Kinesiophobia (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….
The importance of a multi-disciplinary approach to persistent pain Read Post »
The emphasis on procedures vs. cognitive and non-interventional approaches is a driving force in producing unsustainable costs of care in all areas of American Medicine. A recent study in JAMA Internal Medicine revealed that some procedures are reimbursed 3-5X more than cognitive services. The insurance industry appears to have inadvertently affected the delivery of care
One reason for the closing of many centers was the pull back by insurance carriers for payments for non-interventional pain treatment services. Doing a procedure seemed to be considered more valid and worthy of payment than a non-invasive service even if it was effective in reducing pain, improving function and lowering future cost of care.
The cost of services for the treatment of back and neck pain has continued to rise Read Post »
John Bonica, M.D. a world renowned anesthesiologist at the University of Washington in Seattle was the individual most responsible for the creation of a new specialty, Pain Medicine. In 1977 The American Pain Society was founded and became the United States national chapter in the International Association for the Study of Pain. Complicated difficult to
A number of my patients who have been struggling with pain management for more than a year may report that although their pain began in one specific spot, over time, it began to spread. Sometimes, over time, neck pain would involve the lower back pain as well. Many of these patients were thought to possibly
The study published in JAMA today demonstrated that from 1999-2010 in 3 key areas, guidelines for the treatment of back pain are being ignored: Use of recommended NSAIDs and APAP as first line drugs decreased by ~35% whilst not recommended opioid use increased by ~50%. Not recommended referral from PCPs to specialists for back pain
Flouting guidelines: Worsening Trends in The Management and Treatment of Back Pain Read Post »
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
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
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
How can we know what back pain treatments make sense? Read Post »
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
Bedside Manner and the power of suggestion in back pain Read Post »
Obesity is more prevalent in neighborhoods with a high incidence of poverty. A study in the New England Journal of Medicine showed that encouraging families to relocate to higher income neighborhoods could lower the rate of obesity and signs of diabetes. This finding may lead to a better understanding of how we can combat the
Obesity, poverty, and community influence- back pain Read Post »
In the last part of Chapter 1 from End Back Pain Forever, we turn to the story of “Stephanie”. Please review this blog for the complete chapters 1 and 2 from my book. “Doctor, My Back is Killing Me!”, Part 3 Take the case of a patient whom I shall call Stephanie. She is
“Doctor, My Back is Killing Me!” – Chapter 1, Part 3 (#endbackpain) Read Post »
Here is Part 2 of Chapter 1 from my book, End Back Pain Forever. Click here for Part 1. Chapter 1 “Doctor, My Back is Killing Me!”, Part 2 “I can put you on strong medication to dull the pain,” says the doctor. “It may be that your spine is the problem.” “Does that mean
“Doctor, My Back is Killing Me!” – Chapter 1, Part 2 (#endbackpain) Read Post »
Where to begin? In the first two chapters of my book 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
“Doctor, My Back is Killing Me!” – Chapter 1, Part 1 (#endbackpain) Read Post »
Dr. Marcus and his colleagues just published a 2 part long-term muscle treatment outcome study of lower back pain patients who were originally diagnosed as having pain in the spine and nerves exiting the spine (i.e. herniated disc, facet arthropathy, spinal stenosis, lumbar radiculopathy). The first large group of patients had been treated unsuccessfully with
Newly published study showing positive muscle treatment results Read Post »
