Archive for 'pain relief'

In today’s world we are bombarded by information and ways to obtain it. Do you want to know how many steps you take a day? Just buy a device and it will calculate it for you. Care to know what your cholesterol levels are? Simply go get a kit at your nearest drug store. Is it possible we are gathering too much information for our own good?

The same question can be asked about medical testing. Is it useful or even helpful to know certain things about our bodies? Many of us have undoubtedly had the experience where we have gone to the doctor because we had pain and an imaging study was ordered. MRI, CT, and ultrasound can give us information about our bodies that would have been unimaginable in the past.

While technology in general is of course a huge benefit, at the Norman Marcus Pain Institute, we believe it is necessary to proceed with caution as we navigate through it all. At NMPI, one common problem we find in back pain, neck pain, and shoulder pain is the overuse and overreliance on imaging studies. “Abnormalities” are often found on imaging studies without any relation to one’s pain. In fact, seeing abnormalities is more common than seeing a “normal” spine!   For example, up to 40% of people without back pain can haveBack Pain herniated discs and as many as 70% may have degenerated discs. That is why the US Institute of Medicine suggests not getting an MRI too quickly since you are likely to see one of these problems and assume it is the cause of your pain. This can lead to unnecessary nerve blocks and surgery.

At NMPI, we often see patients who have a herniated disc, yet they only have pain in their back and buttock. They have not experienced any radiation into the leg(s) at all. In these patients, the pain generally has nothing to do with the disc herniation since disc herniation pain generally radiates down the leg and into the foot. Even when the patient is experiencing pain down the leg with a herniated disc found on MRI, muscles in the low back and buttocks may be the cause of the pain. If muscles are not examined as a potential cause, you may undergo an apparently reasonable surgery, without achieving relief of pain. Some studies show that up to 50% of spine surgeries fail (resulting in failed back surgery syndrome) and one of the reasons is the failure to identify muscles that were the true source of the pain.

Most back pain and neck pain is caused by soft tissue such as muscles and tendons. This is confusing because you may have been told your pain is from your spine, discs, or nerves. The problem is most people as they get older have signs of wear and tear on their x-rays and MRIs, but these common signs of aging may not explain your pain if the pain actually originates in your muscles. That’s why we say, when diagnosing persistent pain it’s not having “more” information at hand, it’s having the “right” information at hand.

At NMPI, we often see patients who experience persistent pain even after multiple spine surgeries. Our non-surgical, non-invasive treatment program has most of our patients leaving our office free of long standing back, neck, shoulder, and headache pain.


Medical Mystery

For seven years, searing pain with no relief – that was the title of The Washington Post story that peaked my interest. So I read the article and discovered that Charon Wicker had been experiencing a burning, throbbing, excruciatingly painful sensation in her index finger – for seven years – even though she had:

  • Repeatedly consulted pain specialists and orthopedic surgeons, internist and endocrinologist; and even a hand surgeon;
  • Undergone two operations to replace the herniated disks in her neck;
  • Taken all sorts of painkillers and become dependent on the sleeping pill Ambien;
  • Received X-rays, MRI scans, and a nerve conduction test all negative);
  • Spent months in physical therapy;
  • Took a variety of anti-inflammatory drugs, increasingly strong painkillers, including oxycodone.

But nothing worked. Ms. Wicker’s pain continued.

The Case of Sore Fingertip looked as if it was a case for Sherlock Holmes (or his creator Dr. Arthur Conan Doyle) or Dr Gregory House.

It made me think — Be careful whom you ask for help!

And finally, Charon did get the right help from a hand surgeon who, listened to his patient; reviewed her medical history; and then examined her fingertip – where she had been complaining of pain for seven years, carefully. He saw a “slight bluish discoloration underneath her nail,” and found the cause of her pain — a rare benign vascular growth – smaller than the head of a pin – a tumor. He removed the glomus tumor and the pain was gone.

It’s uncommon to find that persistent pain is caused by a glomus tumor – but it is common that someone with persistent pain will be offered spine surgery to help them.

It is unfortunate that in Ms. Wicker’s case, she underwent TWO aggressive spinal surgeries and the pain continued. Even though her pain was in her fingertip (something that would clearly not be caused by a faulty disk or helped with insertion of an artificial disc in her neck) and there were no signs or symptoms that pointed to spine surgery to mitigate the pain, surgeons suggested two separate operations to replace the spinal disks. Whereas drugs have to go through extensive testing to show they are safe and effective, surgical procedures do not.  When the first surgery didn’t work, the suggested solution was another surgery to replace another the disc.

In my practice, I have seen many patients over the years who come to my office complaining of chronic neck, shoulder, low back and/or leg pain that continues after “failed back spinal surgery. The herniated disc that was discovered on an MRI didn’t explain the source of their pain.

MRIs can show doctors beautiful pictures of the bones and the material separating the bones (the discs) of our spines but interestingly an MRI of the spine will usually find some “abnormality” in most adults – the majority of the time without any pain complaint. Desperation is often one of the reasons that patients undergo very invasive procedures based on an MRI and not supported by the clinical picture.

Sometimes a surgery works but how could it in The Case of Sore Fingertip? It didn’t and as Sherlock would say, “It’s elementary, my dear Watson.” It just didn’t make sense.

You can read the article in full here.


NSAIDs for pain relief

The next series of blogs is a brief discussion of different types of medications used for pain.


Non-steroidal anti-inflammatory drugs (NSAIDs) are generally one of the first line of medications used in the initial treatment of pain. They are exactly what their name means – they are not steroid medications (like cortisone or prednisone) and they reduce inflammation which is the body’s response to any damage from any cause. When inflammation occurs there is pain along with redness, swelling and heat, which are collectively known as the cardinal signs of inflammation. Examples of NSAIDs are ibuprofen (Advil/Motrin), naproxen (Naprosyn), meloxicam (Mobic), and diclofenac (Voltaren). Aspirin is similar to the NSAIDs in almost every way but curiously it helps prevent heart attacks whereas NSAIDs may cause them (see below).

PillsAlthough NSAIDs have a number of side effects, the two most common are stomach irritation and an increased tendency to bleed. That’s why you are advised to eat when taking NSAIDs and why you have to stop taking NSAIDS before any type of intervention that may cause bleeding (such as injections or surgery).  In order to decrease the side effect of stomach irritation, many have switched to a topical NSAID, most commonly diclofenac which is offered as a patch (Flector-patch) or gel (such as diclofenac or Voltaren gel). Other potentially serious side effects include kidney failure – if your kidneys are not working properly the NSAID can cause them to stop functioning, asthmatic episodes if you are prone to having asthma, and heart attacks if you have cardiovascular disease (heart disease, high blood pressure, history of stroke).



Image courtesy of anekoho/


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 pain.

Spinal stenosis is a narrowing of the space formed by the bony segments that together make up the vertebra (the bones of the spine). The space in each vertebra is connected to the vertebra above and below to form the spinal canal, through which the spinal cord passes. Narrowing of the canal in the lumbar region, called lumbar spinal stenosis, could squeeze the spinal cord. When you are standing up, the curve in the spine makes the narrowing worse and may cause pain radiating to the leg. Many patients found to have narrowing don’t have the signs and symptoms that would indicate that their back and leg pain was caused by the narrowing. Bending over when you walk, having more pain if you straighten up, and having to wait a few minutes when you sit down for the pain to go away, are all symptoms that suggest the spinal stenosis was truly the cause of the pain; just finding narrowing with imaging isn’t enough.

Other imaging diagnoses such as degenerative disc disease, degenerative osteoarthritis, bulging or herniated disc, and facet arthropathy, may also be misleading. Just because there is an anatomic finding on an image doesn’t mean it is the cause of the pain. If some form of exercise relieved the pain, the most reasonable explanation would be that much of the pain was related to soft tissue, such as muscle and tendon and not to the imaging diagnoses.



The importance of a multi-disciplinary approach to persistent pain

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….

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.

She was overwhelmed with her pain and fearful that she would never get better. With her continued pain, tenderness, stiffness, and cold and clammy feet, her doctor told her she had RSD and needed to see a pain doctor for medications and possibly nerve block injections.

When she came in to consult with Dr. Marcus, he wanted to see if he could help increase the range of motion in her ankle. He used Ethyl Chloride spray to briefly make the area cold and numb. She moved her ankle and her pain was gone! Once she felt relief from her original pain, Dr. Marcus asked her to stand. However, she couldn’t because she was too weak. Five months without walking had weakened her muscles and made her unable to walk. She needed strengthening exercises, so she was referred to a physical therapist that helped her re-learn her walking technique while strengthening her muscles. She is now without pain because she no longer holds her ankle stiffly.

Kinesiophobia created more problems than necessary

Her fear of pain and her belief that not walking or moving her ankle would protect her caused her to become disabled, relying on her walker or cane. This could have easily been mistaken for RSD and lead to unnecessary, expensive and painful treatments. She had kinesiophobia, or fear of movement. This is an important factor when a patient is trying to overcome the effects of a painful injury.


How can we know what back pain treatments make sense?

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


Bedside Manner and the power of suggestion in back pain

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.

Read the rest of this entry


Why does back pain appear to move or change intensity?

There are three different mechanisms that affect your back pain when it is related to muscles- and that means most of the pain you will experience in your life.

1. Referred back pain patterns- Pain may be referred from one muscle to another when the nerves carrying painful sensations in a muscle stimulates the same area in the spinal cord as an adjacent muscle.

2. Central sensitization- When a painful area of the body stimulates the spinal cord and makes the cord more  active, other sensations coming in to the cord that would usually not be experienced as painful are now experienced as pain- like turning up the volume on your stereo and hearing things that you don’t hear when the volume is low. So when the original area of damage causing the pain is properly treated the other scattered areas of pain may disappear.
Read the rest of this entry


Pain Facts

  • Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health.
  • Americans spend $86 billion a year on spine treatments (up 65% in a decade), about the same as we spend treating cancer, according to a major study published in the Journal of the American Medical Association, yet our backs are not getting better. The percentage of back pain suffers has increased and more of them are reporting physical, social and work limitations. (JAMA – February 13, 2008)
  • Americans spent $20 billion on drugs for back and neck pain in 2005, a 171 percent increase from 1997, while expenditures for narcotic pain relievers increased 423%. (JAMA – February 13, 2008)
  • The proportion of men and women in North Carolina suffering from impairing low back pain has more than doubled since the 1990s, according to a new University of North Carolina medical school study, which strongly suggested that the findings reflect a nationwide trend.
    “Considering the social and economic costs of chronic low back pain, these results are alarming,” said the study’s lead author. The study was published in the February 9 Archives of Internal Medicine. (HealthDay News on Medline Plus – February 10, 2009)
  • According to the National Health Interview Survey, the percentage of people with lower back pain and neck pain which could cause impairment more than doubled between 1997 and 2006. (National Center for Health Statistics)
  • More than 25% of American men and women experience daily pain and pain is estimated to cost the economy over $60 billion a year in lost productivity, according to a Stony Brook (NY) University Medical Center random survey conducted among nearly 4,000 respondents.
    (The Lancet – May 3, 2008)
  • Studies show that chronic pain causes the brain to atrophy. It actually shrinks the brain by as much as 11 percent, equal to the amount of gray matter (the region of the brain that processes information and memory) lost during 10 to 20 years of aging, according to a Northwestern University medical school study.
    Researchers at the school found that back pain lasting six months or longer results in abnormal brain chemistry, reflected in chemical changes in the area of the brain important in social behavior and decision making. (The Journal of Neuroscience – November 23, 2004)
  • More than half of American adults suffered from one or more of 30 conditions that kept them from their typical functions and activities in the workplace or at home for an average of 32.1 days a year, according to a survey analyzed by Harvard Medical School researchers.
    That translates into a total of 3.6 billion days a year, with mental disorders accounting for 1.3 billion days lost. Chronic back and neck pain led to the most days of disability (1.2 billion), followed by major depression (387 million), the researchers found. (Boston Globe – Oct. 1, 2007)
  • Chronic pain can clinically impair your memory and concentration, according to a study conducted at the University of Alberta. (ScienceDaily – May 18, 2007)
  • An estimated 1.2 million spinal surgeries are performed in the U.S. each year, and, according to the National Center for Health Statistics, more than 300,000 of them are spinal fusions, at an average cost of approximately $60,000 each.
  • The spinal products industry is experiencing meteoric growth. Worldwide sales went from less than $100 million in 1990 to $3.5 billion in 2004 and more than $6 billion in 2007. (
  • Recent studies show that the failure rate for back surgeries is extremely high (50% in some studies), prompting a new diagnostic category for the failures: Failed Back Syndrome, the only such diagnosis in medicine.

2006 Voices of Chronic Pain

This survey of chronic pain sufferers who take opoids was conducted in 2006 for the American Pain Foundation

Control Over Chronic Pain

  • More than half of respondents (51%) felt they had little or no control over their pain.
  • Six out of ten patients (60%) said they experience breakthrough pain one or more times daily, severely impacting their quality of life and overall well-being.

Impact on Quality of Life

  • Almost two-thirds (59%) reported an impact on their overall enjoyment of life.
  • More than three quarters of patients (77%) reported feeling depressed.
  • 70% said they have trouble concentrating.
  • 74% said their energy level is impacted by their pain.
  • 86% reported an inability to sleep well.

Impact on Day-to-Day Life

  • More than half (52%) said their chronic pain has put a strain on relationships with family and friends.
  • Nearly 70% said their pain has a great deal of impact on their work.
  • 50% have lost a job due to their chronic pain.
  • More than a quarter (27%) said chronic pain impacts their ability to drive a car.

This survey was conducted by ABC News, USA Today and the Stanford University Medical Center (2005):

Key Findings

  • Excluding minor annoyances, just under half of adults have experienced pain the last two weeks, and nearly four in 10 do so on a regular basis.
  • Six in 10 Americans rate their last experience with pain as moderate or worse, and for about two in 10 – about 40 million individuals – it was severe.
  • Nineteen percent suffer chronic pain, meaning ongoing pain that’s lasted three months
    or more
  • About four in 10 Americans say pain interferes with their mood, activities, sleep, ability to
    work or enjoyment of life.
  • Sixty-three percent of Americans have spoken with a doctor or other medical professional about their pain. While nine in 10 say their doctor understood the problem, many fewer, 59%, say they got a great deal or good amount of pain relief.

Chronic/Severe Pain

  • Problems peak in the chronic, severe and frequent pain populations. People in these high-pain groups are vastly more likely than others to report negative impacts of pain on their lives, and much less likely to feel in control of their pain. (These hold true even when controlled for age.)


  • A quarter of Americans say their last pain experience was with back pain, making it far and away the leading area of pain, followed by pain in the knee (12%), headaches or migraine (9%), and shoulder and leg pain (7% each.) Together these account for 60 % of all pain by location.
  • Back pain is No. 1 across most demographic groups, with the notable exception of women under age 50. It peaks among men (30% say their last pain experience was back pain, compared with 20% of women), and particularly among men age 30-49, who may run the dual risk of being a bit older but still quite active. Back pain is the most-cited pain across all pain groups, peaking slightly among chronic pain sufferers.

Patient Testimonials

Below are stories from some of our patients.
*Please note that individual results may vary due to various underlying causes of pain.

“This procedure has changed my life…”

My name is Daniel, and I suffered with back pain for nine years. I have two degenerative and bulging discs in my lower back. I had numbness in my left leg and extreme pain in my lower back. As a result, I was not able to bend at the waist in any direction without collapsing in pain.

Over the last nine years I have seen many doctors: three general practitioners, three back specialists, three pain specialists, one neurosurgeon, and two physical therapists. They all have tried to help, some with more success than others but no one was able to completely help me. They tried epidurals, facet injections, a direct disc injection, a laparoscopy, and pain management classes.

After my laparoscopy procedure in December 2006 I felt much better. I went back to work in July 2007 and a week later I felt two big pops in my back and all the back pain and leg numbness came back worse then ever before. So off to the doctors I went again. But this time it was different. Dr. P., my pain management doctor, felt that she had tried everything she knew and was thinking I needed a fusion in my back. She referred me back to my neurosurgeon, who felt that I could be suffering from degenerative disc and disc collapsing in the area of the surgery site of the laparoscopy. He wanted me to go to physical therapy for two months and come back to see him if it did not work, at which point he would recommend surgery.

The physical therapist did not feel he could help me, but he did offer to send me to Dr. Norman Marcus at the Norman Marcus Pain Institute. I thought, “Why not? I have tried most everything else.” At the time I thought there was nothing that could help me other than a fusion or disc replacement.

I showed up on a Saturday in November of 2007 in great pain with a limp and unable to bend in any direction. After the procedure the most amazing things started to happen. Within 24 hours I could touch my toes and was walking without a limp. I had two rounds of injections over the next three months and gained full mobility and 95% pain loss. I stopped taking all pain medications for the first time in nine years.

In Feb 2008 I had a relapse. I was putting on my socks and felt something move in my back and all the pain came back with numbness in my left leg, scaring my wife and me to death. Yet again the most amazing thing happened, within 24 hours the numbness was gone and with five days I was back to 90% pain free. Now it is March 6, 2008 and I still am at 85% with stiffness and some pain. But Dr. Marcus said one more round of injection and I will be at 95-100% again. This procedure has changed my life. After nine years I am working and living with the confidence that I can make it. There are so many people out there suffering in pain to the point of wanting to give up and die like I felt. I want them to know how this procedure has changed my life.


“Life is once again bliss…”

It was the morning of the first work day of the new millennium when my life was dramatically changed. I was rear-ended by a fully loaded tractor-trailer. There I was, in the middle of I-85, feeling my muscles stiffening which as time would tell was the onset of chronic pain.

Within 90 days I was on a plethora of pain medications, I had seen several specialists. I had undergone x-rays, CT scans, and hours of physical therapy. The pain had forced me to resign my position as vice president. I was unable to perform many simple activities. The pain was a constant, always present companion in whatever I was doing. All the doctors were capable of was to keep me sedated with medications and keep sending me to physical therapy. I was also becoming depressed.

Over the next seven years, I continued to seek out medical professionals to find someone specializing in muscles. I had no spine damage, no nerve damage, and no damage to my bones. I therefore had no medical specialist to help me. It seemed that there was a specialty for every part of the body except the muscle. I received all types of treatments including nerve blocks, spinal blocks, radio frequency denervations (burning the nerves) and the common trigger points. No matter what the treatment, my back and neck muscles continued to be in constant spasm. The pain kept me from leaving my house and prevented me from driving. I had resorted to wearing a back brace in order to be able to enjoy any activity. Life was dismal for me, my wife and my two young girls.

In March 2007 my life was once again dramatically changed when I was introduced to Dr. Marcus. I was fortunate enough to discover him and was off to New York City as soon as he had an opening. I was amazed with his Muscle Detection Device (I had viewed his entire web site) and patented procedure, but what impressed me the most was that Dr. Marcus is a real person. I knew right away that I was in the right hands and that I was going to be healed. I had two muscles injected on that Monday and that night I could feel that those muscles had been repaired. I was able to finally remove my back brace (I haven’t worn it since) and walk several pain free blocks after the injections. I remember being sore from the injections, but the pain was gone. I received injections in over a dozen muscles during the next two weeks and day by day, muscle by muscle, my pain was eliminated! There were no more spasms. For the first time in seven years my muscles were relaxed. At the end of two weeks I returned to Atlanta pain free.

Although this might not have been following Dr. Marcus’ advice of taking it easy, I was able to not only join my family for a vacation in Florida the following week, but I was able to drive the nine hours after not driving for five years. I was also able to ride a rollercoaster with my 9-year-old at Busch Gardens a few days later.

Life is once again bliss. It has been full of family activities with plenty of long overdue piggy back rides. I am not longer on any medications. I am once again working and being a productive member of society. Dr. Marcus is truly my hero.


“I have a life with my family that is meaningful and without pain…”

Dr. Norman Marcus truly changed the quality of my life. I had been in constant pain due to a herniated disc. After having successful neck surgery my shoulders were still in constant pain.

In November 2006 “Good Morning America” did a feature on Dr. Norman Marcus; I immediately knew that Dr. Marcus was speaking about my situation.

In March of 2007 I spent a week having several treatments in NYC. I experienced Dr. Marcus to be truly thoughtful, kind, thorough and an excellent listener. He took his time locating the source of my muscle problems. The treatment was extraordinarily successful and I have a life with my family that is meaningful and without pain.

The Marcus Institute is truly wonderful. The staff is kind and patient and I immediately felt so comfortable in this office. They truly care about you.

Once the treatment was completed my family and I saw visual changes in my upper body muscles. Besides the visual the improvement was dramatic and has been sustained. I am now approaching the one year anniversary of my treatment with Dr. Norman Marcus.

Twinker M*

Norman Marcus Pain

“I always felt the pain…”

I lived with extreme upper and lower back pain for three years. I had been a weight lifter but had to stop. Whether it was standing, sitting, walking, or even while I was sleeping, I always felt the pain (which caused mood swings). In that time period I tried many things from someone walking on my back to heating pads.

I was finally introduced to Dr Marcus and after two weeks of treatment I am pain free. I can enjoy my activities without pain (which will take getting used to). I can thank Dr. Marcus for that.

Clifford C*

“I am running again…”

Injuries are a fact of life for runners. Does that mean I have to learn how to run and live with pain? Not with Dr. Marcus’ treatment.

None of the previous doctors understood that I was suffering from pain, but gave me medication and therapy sessions. How could a doctor treat any patient without knowing the problem? Dr. Marcus pinpointed the problem and treated it. He does not teach how to live with pain, instead he eliminates the pain.

I am now back on the road and find myself running and competing again, thanks to Dr. Marcus.

Yayoi S*

“I have a much brighter outlook…”

On April 3, 1999 I was involved in a near fatal car crash while working in South Africa. Until that time I was known around the world as a very successful performer, teacher and choreographer.

After four days in a coma, I was left with brain damage as well as damage to my foot, ankle, wrist, arm, back, shoulder, ear and neck, that have presently required nine surgeries, including plates in my foot and arm and a spinal fusion. Not too fun.

After seeing many doctors and trying many therapies I was referred to the Norman Marcus Pain Institute. Following a very pleasant consultation with Dr Marcus, I began a series of treatments including injections, various forms of electrical stimulation, physical therapy and medication.

Dr. Norman Marcus never made any guarantees or spoke down to me but was confident the treatments would be beneficial. I’m glad to report his confidence was well founded. The treatments have resulted in much increased range of motion as well as lessening, and in some cases cessation, of pain.

Thanks to Dr. Marcus I have a much brighter outlook, and look forward to more improvements to come.

Alan O*

“He is an oasis in a sea of white coats…”

To say that Dr. Marcus and his institute changed my life is an understatement- they “saved my life.” I am a chronic pain patient who suffers from Marfan’s Syndrome. The day I met Dr. Marcus, I was writhing in agony after having my left knee replaced (this was my twenty-first operation in my 40 years of life). At the time, I was experiencing so much pain that I felt life itself was no longer worth it. The doctors that surrounded me didn’t understand why I was in so much pain. I yearned for someone in a white coat to listen.

I will never forget the night he walked into my hospital room. Instead of looking at me as a “clinical oddity” or a “drug addict” looking for more pills, he listened to me. Since that night three years ago, he and his staff have helped me handle three subsequent operations. If there is anything he has done for me, it is to treat me like a human being. As a chronic pain patient, one needs to feel that they are not alone; they can overcome their disability and regain the essence of life. For me, this is what Dr. Marcus symbolizes. He is an oasis in a sea of white coats who are yet to understand how to treat people like me.

Since receiving treatment from Dr. Marcus, I have been able to regain life as a professor, researcher and writer. When I look back and ask myself how this was able to come about, I realize that it was because of Dr. Marcus’s belief in the human spirit to survive pain if given the right tools, treatments and resources. The Marcus Pain Institute has the ability to provide hope, when hope seems beyond the realm of reality. Although Dr. Marcus does not have the capacity to “walk on water” yet (although many of his patients would not be surprised if it happened one day), he has the wonderful gifts of compassion, honesty and integrity. These same qualities he has passed down to his staff. Although I still live with some pain, he has taught me how to manage it and live with it.

For this, I will always be grateful.

Christopher H*


In the News – Curing back pain

Back Pain – 3 Great Exercises with Dr. Norman Marcus M.D.

29 April 2013

Tips on Healthly Living with Dr. Norman Marcus demonstrating 3 of the exercises in his book, End Back pain Forever – a groundbreaking approach to elminate your suffering. Back muscles cause pain in 4 distinct ways: tension, weakness & stiffness, spasm, and trigger points.


Curing Back Pain

07 Jan 2012

A clip from NBC’s Today Show with Dr. Norman Marcus and a pain-free patient discussing how back pain can often be cured without surgery or mind-altering medications


Alisyn Camerota reports on New Back Pain Treatment

07 Jan 2012

Alisyn Camerota, the host of Fox News’ ‘Fox & Friends 1st’, reports on a new& very promising, nonsurgical treatment for severe back pain. For more info about the treatment go to


My Aching Back

07 Jan 2012

A film clip from ABC’s Good Morning America, showing how the Muscle Pain Detection Device changed the life of two patients who were totally disabled by persistent back and leg pain and had been considered untreatable.


Easing Back Pain

07 Jan 2012

Harry Smith spoke with Dr. Norman Marcus about tips for preventing and easing back pain.


BuildingNY: Dr. Norman Marcus

14 Jun 2012

Michael Stoler speaks with Dr. Norman Marcus about his most recent book, End Back Pain Forever, as well as a look into Dr. Marcus’s history.


Hip pain and surgery

A bony abnormality of the hip called Femoral Acetabular Impingement Syndrome (FAIS), where the head of the femur (the thigh bone) is found to be irregularly shaped rather than its “normal” spherical shape, is sometimes treated with a surgical procedure to shave the head of the femur. FAIS can affect young individuals in contrast to osteoarthritis (OA) of the hip which usually occurs in older patients. It is thought that FAIS can cause pain in the hip, and can in addition if left untreated, result in OA. Read the rest of this entry


Osteoporosis Prevention and Treatment

Osteoporosis in women is a growing public health challenge with an aging population. New approaches are needed to prevent and treat decreases in bone density and strength. Two recent articles present different and potentially complementary approaches.

Diet: Lanou reviews the studies on soy diets for the prevention of osteoporosis and bone fractures. Although the results are not consistent, soy based diets that are part of a diet rich in fruits and vegetables appear to be effective. Other studies have suggested that such a diet has a wide range of health promoting effects. Although there is not yet strong enough evidence to suggest that everyone become a vegetarian, at least for women, increasing the amount of fruits and vegetables and having soy in your diet, is a good idea.
Read the rest of this entry


How to decrease headache frequency

A recent study of a simple resistance exercise program for the neck and shoulders, in office workers who complained of weekly headaches (HAs), showed an approximately 50% reduction in HA frequency vs. a weekly health education control group. The exercise groups were 2 minutes or 12 minutes of daily exercise. The remaining HAs were no different in terms of intensity or duration of pain.

HAs are the most commonly reported pain problem. If brief exercise could have such a dramatic effect on HA frequency, it should be considered as a standard intervention for all office workers who appear to have muscle tension type headaches. However it is not clear why neck and shoulder exercise reduce HA frequency. It is understandable that exercising muscles that are tense and stiff from repetitive strain, for example bending your head and neck over a desk for hours at a time, could help relax stiff and tense muscles. which can cause back and neck pain.  But just performing an action to address HAs on a daily basis may make you more aware of the circumstances surrounding a headache episode. Since headaches are frequently brought on with emotional stress, being more aware of and addressing stress has been shown to reduce HA frequency through various interventions.
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New possibilities for painful knees

The body can sometimes heal itself in painful conditions. A study of patients with painful osteoarthritis of the knee showed that by mechanically separating the bones in the knee that were touching and causing pain, cartilage regrew and pain and function improved. No other treatment is available that can produce structural change in an existing osteoarthritic joint. This is a potentially revolutionary discovery, and if shown to be effective in larger studies, may help patients with knee pain avoid or forestall knee replacement surgery. And give at least some temporary pain relief.

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


Above all else, do no harm!

In our desperate wish for pain relief, we sometimes receive treatment that is harmful. One of those treatments may be botulinum toxin, frequently provided as Botox injections to tender muscles. A recent article showed how Botox could produce permanent damage in muscles with normal muscle fibers being replaced with fat cells.
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Follow-up to recent Failed Spinal Fusion post:

The patient mentioned in the blog posted in March, 2011 copied me on an email he sent:

“I’ve been waiting for clearance from my surgeon who finally declared my fusion as failed (FBSS) in early March and offered no additional hope for pain reduction. At one-year post surgery I could be evaluated for an implanted morphine pump or spinal cord stim. Pain management started experimenting with oxymorphone and hydromorphone, which both had bad side effects and were less effective than the oxycodone. I’ve had the first two weeks of treatments with Dr. Marcus. The first week he did my left side lower back and leg, this Monday he did the right side lower and mid back. Pain reduction is at least 90%! I have much more energy, am more active and I’m beginning to feel flexible. He is also working on my mid-back and legs. I’ve been able to reduce oxycodone from ~180mg+/day to 60-80mg/day.”
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Obesity and Understanding BMI with back pain

People in all industrialized countries are being harmed by a world-wide obesity epidemic. We generally determine if we are the proper weight by calculating the BMI (Body Mass Index): dividing your weight in pounds x 703 by your height in inches squared. If you weigh 140 pounds and are 5 feet, 8 inches, your BMI would be 21.28-
(140 x 703/68 x 68). Normal is 18.5-24.9, overweight is 25-29.9 and obese is over 30. A study of patients in 30 European countries found that over 70,000 new cancer cases were attributable to excess BMI in 2002. Obesity is also associated with an increased incidence of diabetes, hypertension, arthritis, coronary artery disease and dementia.
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Painless back and muscle injections

Pain is a deterrent to many patients when offered a therapeutic injection. There is some encouraging news on ways to make injections more comfortable.

A Cochrane review found that adjusting the pH, with bicarbonate, of a lidocaine injectate for local anesthesia, reduced the discomfort for patients without reducing analgesic effectiveness. The burning sensation produced by the acidic pH of lidocaine injectable is diminished by adjusting the pH upwards from the 3.5 -7.0 usually found in commercial preparations, to approximately 7.4.
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Misinformed medical advice may be harmful

A word in the mouth of a physician is as dangerous as a scalpel in the hand of the surgeon, Eugene Bauer, M.D. 1931

Women who have had breast surgery for cancer do not have more lymphedema with exercise according to a new study published in JAMA. This is an important finding because the myth has been that exercise could cause edema in women who had lymph node excision during surgery. The study showed that not only were the women who exercised stronger, but that they had a lower incidence of edema.
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