Norman Marcus, MD
Please refer back to the past two blogs to find the background material for todays blog. Although the number of CARF approved pain centers in the US halved, the number of outpatient pain centers mushroomed. The services provided however focused on two areas-1.Medication management, 2. Nerve blocks and other invasive procedures. Although many patients could be helped with one or both of these approaches, many patients in need of physical therapy and psychological services that were integrated with the overall treatment plan, would no longer receive optimal treatment.
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 treat pain patients were usually not successfully treated by a physician representing one medical discipline and thus the multi-disciplinary pain treatment model was created.
Back pain can be found in the medical literature as far back as 1500 B.C. in Egypt.
Spinal fusion surgery for back pain was reviewed in three articles in the Journal of the American Medical Association this week http://cot.ag/bjDgWW . The sobering conclusions were that we are spending up to 10 times more for complicated new surgical procedures and frequently getting worse outcomes and up to twice as many complications.
CBS Newswatch distributed a story on the MPDD to CBS affiliate stations around the country. It showed two patients-one who had an unsuccessful spinal fusion in her lower back and one who had been told he needed a spinal fusion in his neck. Both were better after muscles causing their pain were identified with the MPDD and then treated.
A review of comprehensive pain treatment textbooks finds no chapters dealing with muscle pain aside from sections on "Myofascial Pain Syndrome” discussing “trigger points” as the defining characteristic of syndromes with painful muscles. This points up a fundamental problem in discussing and understanding clinical muscle pain- the lack of agreed terminology to describe what is found when a painful muscle is examined.
In my last blog I told you about the MPDD, an instrument to tell you which muscle causes your pain. But you might have said that doesn’t help me- I have a herniated disc!
My patient this morning said that- his MRI showed the disc and he felt the pain exactly where he thought the disc would be. He didn’t know that in some studies 40% of patients have herniated discs and 70% have degenerated discs and No Pain.
In order to move a muscle and see if it is painful, I developed an instrument with the cooperation of the Stevens Institute of Technology that can move one muscle at a time and find which muscle in a region of the body is the cause of your pain. It is called the Muscle Pain Detection Device (MPDD). It works by being able to stimulate the nerve fibers that produce muscle pain in the area where they are most often found, the parts of the muscle that attach to the tendon and the tendon to the bone as well as stimulating the trigger points.
Muscle pain has confused physicians for centuries. Muscles account for half the weight of your body but they are strangely absent from the examination and treatment that you generally get from your doctors. There are many reasons for this, including:
1. Physicians don't agree on what to call muscle pain,
2. They don't teach about muscles in medical school,
3. We don't have a standardized examination for muscle pain, and