Two days ago I reported on a study that showed we are frequently doing a disservice to patients in inappropriately ordering imaging studies such as MRIs. Yesterday I saw a patient who could be the poster person for the study. This patient had a back injury one year ago when a fall onto the buttock produced lasting severe low back pain. The pain doesn’t radiate-it is only in a discrete area on the buttock. She felt a tender sensation when the area was pressed.
Despite the obvious findings suggesting the cause of her pain was muscle and not spine and nerves coming from the spine, an MRI was ordered and it showed a bulging disc and she was told this was the cause of her back pain. She has had a variety of physical therapy interventions and injections without relief.
Her physical examination showed that she could touch her toes and her straight leg raising was 90 degrees, rarely if ever seen with a patient whose pain was the result of a disc. She did have two muscles, the Gluteus Maximus and Piriformis, which were tender when stimulated by the Muscle Pain Detection Device. This showed that these muscles were the probable cause of her pain. A ketamine based cream was applied to the skin over these muscles and her pain was gone, further supporting the connection between the muscles identified and her long-standing back pain.
The pain relief from the cream may last for minutes to 4 or more hours. The definitive treatment to eliminate the pain permanently however is injections into the muscle tissue and its attachment points (the beginning and the end of the muscle), with follow-up neuromuscular stimulation for 3 days. This is followed by exercises that were developed @ Columbia University School of Medicine in the 1960s and later given to 300,000 participants at the YMCA. End Back Pain Forever, my new book from Atria Press/Simon and Schuster, available in May 2012, will provide all the details of how the evaluation and treatment protocol was developed.
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