12.08.10

Truths About Back & Neck Pain Part One

Posted in Truths About Back & Neck Pain at 9:23 PM by Dr. Greathouse

This is an introspective look at an age-old problem.
I have nothing but empathy for back pain sufferers because they are faced with an impossible decision process on what to do about their pain in a world of indefinite opinions by a multitude of health care providers (HCP) that rarely agree on a diagnosis or a treatment approach; even among same specialties. The last time I counted there were at least 22 specialties that addressed back pain.
Back pain is truly a diagnostic conundrum. Regardless of what diagnosis your doctor or therapist gives you, it’s likely not supported in the literature. It may make sense and you may even agree with it because it seems so sensible, but the truth is, 85% of all back pain has no specific diagnosis and is categorized as “non-specific” by all health care guidelines. This is not a diagnosis!
Gunnar Andersson states…  “Our treatment success rate can be no better than our diagnostic success rate.”  Gunnar Andersson, MD, PhD, Chairman, Department of Orthopaedic Surgery, Rush University Medical Center
An inaccurate diagnosis poses a big problem! Without an accurate diagnosis the prescribed treatment cannot be accurate either, thus leading to poor outcomes. The back pain sufferer unwittingly rolls the dice in high hopes that the recommended doctor or clinician will make them better. When treatment doesn’t help, ongoing doctor shopping commonly ensues, resulting in a great deal of lost time and money, not to mention the suffering in some cases.
For example, in spite of the fact that we can see arthritic changes, disc degeneration and even disc herniation on x-ray or MRI, doctors cannot reliably state that those findings are the cause of your symptoms. Chiropractors cannot find a vertebra out of place; much less put it back in place. Massage therapists can’t diagnose tight muscles as a cause and physical therapists cannot reliably prescribe exercises that will make you better. Of course, I don’t want to bore you with the entire list, but there are very few models of assessment and care that are valid and reliable.
The only way these theories can pass the muster is when specific criteria can be met, and to date (December 2010), very few qualify.
This is likely one reason why outcomes are actually worse today than in the past and cost continues to skyrocket ($90 billion in 2009 for low back pain)! Back pain is big business! One has to wonder whom the care is designed to benefit, the patient or the provider of care! This might be why providers are slow to embrace more valid & reliable methods of assessment and care.
Finding the answers has been my “Holy Grail” over the past 28 years of my career. I’ve spent over 450 post doctorate continuing education hours and countless hours online reading the literature, looking for the most valid & reliable methods and protocols to better assess and treat back pain. The best I’ve found thus far is the McKenzie method, AKA, Mechanical Diagnosis and Treatment (MDT) method. It’s unsurpassed by any other protocol available!
Let’s put things in some perspective. We know that certain forms of care do work. For example, manual therapy or manipulation or “adjustments” do work! Massage helps, physical therapy in all its forms sometimes helps. All of these forms of care work some of the time, but none of them work consistently all of the time. Science hasn’t determine when or why they work. So, these forms of care are really put forth in a global fashion; much like treating all chest pain with an antacid.
What has proven to work is subcategorization.  Most experts would agree that pain is produced either by inflammation (chemical) or mechanical means (abnormal stress on tissue), and both, in some circumstances. That might be why an anti-inflammatory helps a little, but, an adjustment or manipulation seems to help in addition to the anti-inflammatory medication.
The MDT method reliably identifies some specific mechanical subgroups (causes) of spine pain in the nonspecific group of pain sufferers. This is HUGE in the field of physical medicine because with that information we can more reliably address the 85% non-specific population and further break it down into subgroups that we know will more likely respond to mechanical forms of care, as well as those who might additionally benefit from ant-inflammatory care.
With this, two very important things happen: Ø First, once a specific mechanical fault can be reliably identified, outcomes improve dramatically.Ø Second, it identifies those who will not likely improve with mechanical means of care thus eliminating the ongoing trial & error care that we’ve grown accustom to, saving time & money.
Not only does MDT identify those who should respond to mechanical forms of care it also provides specific algorithmic means of treatment protocol to follow, which further eliminates trial & error physical medicine approaches to care.
Just remember, there’s a lot of hype out there among all disciplines (all healthcare providers). I’m offering an honest contemporary appraisal of your problem followed by a more specific treatment approach on my part with physical medicine procedures or a referral to the appropriate health care provider that best suits your needs.
Last but not least, if you or someone you know is considering spinal surgery for a disc problem please encourage them to consider this alternative. All avenues of conservative care should be exhausted before surgery. This method literally works wonders on disc problems in many cases.

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