riday, July 20th, 2012 at 9:00 am “Thank

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steelerfan7 Vikingzskillz #96

“Thank you for treating me as someone struggling with pain and not as a former drug addict who could not be trusted with strong pain medication”  – a note I recently received from one of my patients.

A patient with a history of drug abuse may be fearful that their past will prevent adequate treatment for a serious painful condition. My patient imagined that I would not be respectful of his suffering and his commitment to sober living. He received the pain medication that allowed him to go through a series of medical and dental procedures without suffering. He was grateful.

Concerns about opioid misuse have made physicians wary of  prescribing potentially habit-forming pain medication. Illicit prescription drug use is a growing problem in the USA and is actually the preferred street drug aside from marijuana. However in treating patients in pain, two basic American traditions should be the guiding principles with patients who have a history, or who test positive on a written test to determine the risk, of drug abuse:

1.  Innocent until proven guilty ; and

2. in the words of Ronald Reagan,  Trust but verify . Those patients who have problems properly using pain medication need extra attention, not condemnation. They may be more difficult to treat, but that is why there are specialists to deal with complex pain problems.

Spine surgery and exercise

I was interviewed on 7/16, on Doctor Radio on Sirius XM. One of the callers told us that after she had spine fusion her pain was eliminated but if she didn’t do exercises at least every other day her muscles above and below the surgical site would tighten up and  pain would begin to return. Even when surgery is indicated for back pain, proper conditioning of the postural muscles is still important.

If she didn’t have a good physical therapist and she wasn’t motivated to doing her exercises her surgery might have been considered a failure, another Failed Back Syndrome. Too often the need to address muscle health is overlooked in the treatment of persistent pain problems. As I emphasize in  End Back Pain Forever, e xercise and physical conditioning should be taught in grade school and encouraged throughout our life.

End Back Pain Forever: Chapter 2, part 5 #endbackpain

In this next segment, I take Hans up on his offer to examine one of my patients. Read what happens next!

Countdown: 5 days until the release of   End Back Pain Forever ! #endbackpain

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 5)

Dr. Kraus and I met a week later at Lenox Hill. I had chosen a patient whom I shall call Beth. She was a forty-five year-old woman so defeated by pain after three unsuccessful spinal operations that she could no longer hold a job. Her life had revolved around her work, which was at the core of her sense of self. She was devastated. No one had found a truly successful treatment for her, and I did not believe that anyone could. She was on high doses of morphine, 60 milligrams orally five to six times a day, to relieve her pain.

After reviewing her case history, Dr. Kraus gave her a comprehensive and thoughtful mental and physical examination. Starting with her neck, he used his fingertips to palpate her muscles to distinguish between those that were supple and pain free and those that were stiff and painful. He found five pairs of painful muscles on both sides of the lower back, buttocks, and thighs.  “If these muscles are treated properly,” he told me, “it should reduce or eliminate her pain.” Read the rest of this entry

This excerpt is about my mentor and friend, Dr. Hans Kraus. He changed the way I viewed pain and the treatment of pain, and enhanced my life and ultimately my patients’ lives for the better.

Countdown: 8 days until the release of   End Back Pain Forever ! #endbackpain

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 4)

Then, in 1993, I met Dr. Hans Kraus. He was to transform my life and the life of my patients. He was eighty-five years old and had just retired from his practice as a specialist in physical medicine and rehabilitation. He had also given up mountaineering and rock climbing. In all those pursuits, he had won international acclaim. Originally trained as an orthopedic surgeon at the University of Vienna, Dr. Kraus was well known for having successfully treated President John F. Kennedy’s back after all prior treatments had failed. Yet his nonsurgical approach to treating patients with muscle pain, especially low back pain, was not accepted by other doctors, including some of the very doctors who referred their own patients to him for what proved to be successful treatment.

For example, one prominent orthopedic surgeon at the Columbia University School of Medicine, Dr. Frank Stinchfield, who routinely sent many of his back pain patients to Dr. Kraus, underwent spinal surgery rather than consult him for his own back pain after a herniated disk was diagnosed. The surgery failed, and Dr. Stinchfield was never able to work again because of unrelenting pain.

Another disappointing example was that of Dr. Jonas Salk, best known for developing the first safe and effective polio vaccine. Dr. Salk  did consult Dr. Kraus for back pain, and the treatment  was successful. It eliminated Dr. Salk’s pain and allowed him to avoid surgery. Yet when Dr. Kraus needed Dr. Salk’s help to obtain research support, the famed medical researcher declined. He said that muscle pain didn’t have a “scientific foundation.” That has since changed, and we will look at the basic research explaining the mechanisms of muscle pain in Chapter 4.

In our first meeting, Dr. Kraus asked what I did. I told him that I treated patients with chronic pain.

“How do you do that?” he asked.

“I teach them how to manage their pain, how to deal with it, live with it.”

“Why not get rid of their pain?”

“Because it’s chronic pain,” I said. “You can sometimes reduce it, but you can’t get rid of it.”

He persisted. “Have you treated the muscles?”

“We treat the muscles with aerobic exercises.”

“Aerobic exercises? Really? Muscle pain caused by muscle spasm, tension, stiffness, and trigger points does not respond to aerobics. But it will respond to other types of exercises: prescribed exercises designed to treat the specific source of pain. That’s what I’ve done.”

“Low-impact aerobics are the standard way,” I said.

“They may be the standard way,” he replied. “But they are sure to make many of your patients feel worse.”

He asked if I had “very difficult cases,” and I told him that I did. “Some,” I added, “are impossible to treat.”

“Would you mind if I were to examine one of them?”

——————————————————————————————————————————————–

Tune in on Thursday, 5/31, to read about what happened next! Thank you for following along.

End Back Pain Forever: Chapter 2, part 3 #endbackpain

This next excerpt provides a small summary of my early involvement in pain medicine.

Thanks for following!  Countdown: 12 days until the release of  End Back Pain Forever ! #endbackpain

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 3)

In 1975, I became a staff physician in the Montefiore Department of Neurology’s Headache Unit, founded by Dr. Arnold Friedman. Two years later, with Dr. Edith Kepes, an anesthesiologist at the hospital, we started the first outpatient pain center in New York City, effectively following the lead of Dr. John J. Bonica, a medical giant to whom we owe the study of pain as a recognized discipline. As a young army anesthesiologist during World War II, he pioneered pain-relieving techniques and treated ten thousand wounded soldiers. Dr. Bonica went on to write a 1,500-page medical classic,  The Management of Pain , Dr. Kepes and I began a team approach with practitioners from different fields – including colleagues from anesthesiology, neurology, orthopedic surgery, neurosurgery, physiatry, psychiatry, and psychology – all of whom were interested in what could be done for patients tormented by chronic pain.

Read the rest of this entry

Good morning! As promised, an explanation on the technology of biofeedback.

End Back Pain Forever will hit the shelves June 5, 2012. Countdown: 2 WEEKS to go!#endbackpain

Chapter 2

You Are Not Alone: The Back Pain Epidemic (Part 2)

As a physician specializing in pain medicine, I know how intimately mind and muscles interact. I can literally see a patient’s mental stress in tense, taut muscles. Early on in my training at Montefiore Medical Center in psychosomatic medicine, which is the study of how the mind and body interact, I could see that the separation of mind and body in medical practice made little sense. This drew me to a newly introduced technology, biofeedback, which enabled me to integrate my medical education with my psychiatric practice at the time.

Read the rest of this entry

Happy Monday! My apologies to those of you that tuned in last Thursday to read up on the epidemic of low back pain. As a bonus to those of you that have following along, I am posting today in addition to the usual Tuesday and Thursday. Chapter 2 of End Back Pain Forever delves into the ever-increasing problem of the back pain epidemic .

End Back Pain Forever will hit the shelves June 5, 2012. 15 days to go!#endbackpain

Chapter 2

You Are Not Alone: The Back Pain Epidemic

If you suffer from back pain, you are not alone. The widespread failure by doctors to recognize muscles as the primary source of back pain is helping to fuel an epidemic. Back pain is now the most common disability in the United States. Every year twelve million Americans make new-patient visits to physicians for back pain and a reported one hundred million visits to chiropractors. At the current rate, eight out of ten Americans will experience back pain sometime during their lives.

In addition to the human suffering, medical costs are soaring. The cost of back pain, together with related neck pain, came to $86 billion in 2005, the most recent year for which figures were available. That was an increase of $34 billion from 1997. More amazingly, 25 percent of patients reported being significantly impaired, compared with 20 percent eight years earlier. Spending on back pain now equals the amount spent on cancer and is largely the result of failed surgeries, various nerve block procedures, and the cost of pain medications. We are spending more and getting worse results.

Read the rest of this entry

And now, in the last part of Chapter 1 from  End Back Pain Forever , we turn to the story of “Stephanie”.  End Back Pain Forever to be released June 5, 2010.

Chapter 1

“Doctor, My Back is Killing Me!”, Part 3

Take the case of a patient whom I shall call Stephanie. She is a married attorney who in 2004 began to experience stiffness whenever she she got up out of a chair. She also had problems straightening up if she bent over. This was bothersome, but it was nothing compared to her first attack of spasms in her low back, on the right side. The spasms were incapacitating. She couldn’t walk and had to lie in bed for four days, taking painkillers and muscle relaxants. When the spasms broke, she still felt an inkling of discomfort that would frequently and unexpectedly morph into repeat episodes of painful spasms.

Read the rest of this entry

…and now, the second part of the first chapter of my upcoming book,  End Back Pain Forever , to be released June 5, 2010.

Chapter 1

“Doctor, My Back is Killing Me!”, Part 2

“I can put you on strong medication to dull the pain,” says the doctor. “It may be that your spine is the problem.”

“Does that mean surgery?”

“It could. Surgeons do a million spinal operations a year.”

Surgery on your spine is the last thing you want to do, but your back pain is horrendous. And, of course, you want to get better. So you say, “Can’t we do an MRI or a CT scan to see if there’s anything wrong with the spine?” MRI, or Magnetic Resonance Imaging, is a picture generated by magnetic fields, while a CT (computed tomography) scan is a picture generated by X-rays.

When you are shown the test results, the doctor points out that the images of your spine show that you have, say, a herniated disc (in which the cushion between two bony vertebrae is either protruding or has ruptured) or spinal stenosis (narrowing of the spinal column that houses your spinal cord), or some other spinal anomaly–and that, apparently, is the cause of your pain.

But if it were true that the abnormality on the MRI or CT scan was indeed the cause of your pain, I wouldn’t have written this book–because almost no one has a “normal” MRI or CT scan of the lower spine, and what is read as abnormal is frequently not the cause of your pain.

Read the rest of this entry

End Back Pain Forever (#endbackpain)

End Back Pain Forever will be published on June 5, 2102. I will be posting sections of the book beginning 5/8 and on every Tuesday and Thursday in May. This is how it begins:

Chapter 1

“Doctor, My Back is Killing Me!”

You felt a twitch in your low back, then a heaviness and a sudden stab of pain.  It struck without warning — when you were crossing the street, stacking the dishwasher, jogging, whacking a golf ball, lifting a baby, swatting a fly, carrying groceries, bending over, getting out of a car, or just turning on a faucet.

Now you’re afraid to move. You’re locked in place. You feel a belt of pain pulsing across your back from hip to hip.  You wonder, what’s happening?  What did I do to get this?  You feel as though you’re cut in half as the pain seems to separate you from your legs.  Will the pain go away?  Will it stay?  Gingerly you start to move, but the pain only strikes harder.  No, it’s not going away, not at all.  And if — this is a big “if” — the pain does not ease off in a few days or go away in a couple of weeks, without proper treatment it is certain to return because your back is a target waiting to get hit again.

Read the rest of this entry http://www.nmpi.com/nmpi-blog

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