We believe that the medical community and particularly the pain treatment discipline is misguided. The almost complete ignoring of muscle as an important and frequent source of common pain problems has contributed to the growing numbers of chronic pain patients unnecessarily sentenced to a life of pain and medication.
Patients who have persistent pain for any reason may be helped. Those who believe that their spine and the nerves exiting the spine are the reason but nothing can be done because surgery and nerve blocks have failed may still be helped. If you have achieved partial relief from your back pain through surgery, injections or medication, you may be able to eliminate most of your back pain if muscles possibly causing your pain have been overlooked. The patient presented today is an example of wasted resources, unnecessary suffering, and failure to challenge irrational concepts of care.

A herniated disc does not explain your back pain.

A 50 year old administrator saw me this week. He had severe back pain in 1990 and his MRI showed a herniated disc in his lumbar spine. he had spine surgery but he had no decrease in his pain. A repeat MRI showed no evidence of the disc or nerve compression. The suspected reason for his pain was eliminated but it turns out that the surgery did not address the reason for the pain. He had a herniated disc and it wasn’t the cause of the pain!

He continued to have back pain for 19 years. It would get better with rest, ice and over the counter pain pills such as ibuprofen. In 2009 the pain increased without any obvious reason and radiated down his thigh to his knee. He was advised to see another spine surgeon by his internist in the event that this time he may actually need surgery. He had another MRI and it showed a herniated disc, but at the wrong level to explain his pain. Nevertheless the surgeon suggested that he have a spine fusion.

Having had no  pain relief with the first surgery he was reluctant to have another and sought out another approach. His physical examination showed us where his pain originated. In addition to having stiffness in his thigh muscles and his low back, he had more than 10 muscles I could identify as causing his pain with the MPDD. I was fortunate to discover that if I applied a ketamine cream to the skin over the muscles I identified as the probable cause of pain in a region of the body, I could frequently eliminate or significantly diminish the pain. A ketamine cream applied to his identified muscles eliminated his pain minutes after application. This is not a permanent pain relief. It does show that there is a good chance that the muscles identified actually are causing the  back pain and if treated properly pain relief could be achieved..

Have you been told that your back or neck pain was the result of the changes seen on an x-ray or an MRI? If you did not have a thorough examination of your muscles, it is almost impossible to know if the findings on the imaging studies actually explained your problem. This is true of almost any pain problem that you may have. Unless you have been examined for the possibility that muscles contribute to the pain, you may get the wrong treatment and not get all better. I say all better because the wrong treatment can give you partial pain relief and then you are left to believe that is all you can hope to achieve.

Future blogs will present other patient histories of pain in other parts of the body that were thought to be the result of difficult to treat conditions but actually were caused by easily treated muscles. If you don’t think of muscles as a possible common cause of pain you will never find and treat them. If we do not begin to incorporate muscle assessment and treatment into our common pain syndrome protocols, we will miss the opportunity to help contain the run away costs of our broken health care system.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY

Tagged with: • • •

Filed under: back pain • Failed back surgery • Failed spine surgery

Like this post? Subscribe to my RSS feed and get loads more!