In this next segment, I take Hans up on his offer to examine one of my patients. Read what happens next!
Click here for the Part 4 segment.
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.”
I couldn’t believe that this would be the case. Her diagnosis was arachnoiditis, inflammation of the deep layer of the membranous tissue surrounding the spinal cord. In Beth’s case, it was caused by the dye that radiologists use to outline the spinal cord when performing a special X-ray called a myelogram. The oil-based dye used in the past sometimes irritated the tissue, producing scarring that could squeeze nerves and bring about pain in the back and legs. (Today a nonirritating water-based dye is used instead.) I had done my best to help her live with the pain in my pain management program. Even though she reported a 50 percent improvement, she was still taking large doses of morphine and couldn’t return to work.
Beth and I had nothing to lose by trying. She demonstrated all of the reasons for muscle pain that I will explore with you as you get further into End Back Pain Forever. Beth was tense, weak, and stiff (deconditioned). She had areas of persistent painful contractions, or spasming, and tender spots in her muscles that Dr. Kraus knew from experience would respond to injections of lidocaine, a numbing solution. Beth would need prescribed exercises, but because her pain was so severe that all movement hurt, Dr. Kraus decided to start her treatment with injections into the identified painful muscles and then quickly add exercises.
The injection technique – different from the trigger point injections popular among other pain physicians – concentrated on the areas where the muscles attached to the tendon and the bone, in contrast to the tender nodules in the muscle tissue. (More on this later.) Only one muscle could be treated per day, and each injected muscle received three days of a special physical therapy protocol to restore its flexibility.
Four weeks later, the patient that I had considered “impossible to treat” returned to work free of pain. This was the most important medial awakening in my career.
Beth’s arachnoiditis was a bona fide diagnosis. I had seen her CT scan following a myelogram. In fact, it had shown severe arachnoiditis. But her pain at that moment came from her muscles, not from her arachnoiditis. If we had not examined and found the painful muscles, she never could have been treated properly for the pain, and she would have been on the same medication, getting marginal results, for the rest of her life. It forced me to wonder how many other patients of mine were suffering needlessly because I had reflexively attributed their pain to their existing diagnoses, and whether they too were not receiving the proper treatment that could eliminate or diminish their suffering.
The successful resolution of Beth’s case was such a revelation that I asked Dr. Kraus if he would be good enough to come to the Lenox Hill clinic for two hours once a week. He agreed, although that soon changed to one full day a week. He would come in at nine in the morning and leave at six. He did this for five years and quickly became a close friend and mentor.
I learned an extraordinary amount from Hans, all to the benefit of our patients, who began returning to normal lives following successful treatments that relieved their pain.
The number of back surgeries continues to rise. Today, in fact, back operations are by far the fastest-growing surgery in the country. There are now on the order of 400,000 back operations annually; 150,000 to 200,000 are spinal fusions. Additional studies have shown as many as half the operations are failures. A more measured, thoughtful approach than spine surgery could help patients suffering with back pain. But even many of the competing interventions, such as nerve blocks and nerve stimulation techniques, are bound to fail because they too are aimed at the wrong target.
The history of medicine is replete with examples of significant advances that were met with opposition, even ridicule, by the reigning authorities. Some were as sophisticated as the discovery of blood circulation, others as simple as the need for doctors to wash their hands. We can add to the list the fact that muscles, not spinal deformations, are the cause of most common back pain.
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My book (which can be found here) will cover what you have read so far and more, such as a more in-depth look at the role of stress in pain, the anatomy of the spine and muscles, tips about daily living, and therapeutic exercises that you can do at home. Thank you again for reading! #endbackpain
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