Archive for 'back pain'

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

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

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

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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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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Knee pain, back pain, and muscles

A large study of army recruits demonstrated the protective effect of exercise on the development of knee pain. Male and female recruits who performed 4 stretching and 4 strengthening exercises for 7 weeks, were 75% less likely to develop anterior knee pain.
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Golfers with back pain

A golfing patient I treated originally came to me with low back pain and later with shoulder pain and neck pain- all preventing his inner champion from blossoming. Like so many golfers he had come to accept the suffering as part of the game. He was amazed to find that he could get rid of the back pain that had plagued him for years. He wrote about it in his blog today bit.ly/9aluAt

Thank you for the mention in your blog.

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