I see many patients that come to me every day with pain and lots of it. Often they have pain in several similar global areas. These seem to occur in groups like neck, upper back and shoulder pain some with arm pain some without; or low back, sacrum and hip pain as a group some with leg and some without leg involvement just to name a few. I have talked in the past to Drs. Spurlock, Matz and Hadley of the UAB Dept of Neurosurgery, as well as our doctors about this phenomena. They too have seen this in their practices. Over the years I have concluded that Pain is often not of a single source genesis or origin. Meaning that pain often comes from more than one cause. Further pain seems to begot pain. In that once the body is in pain the second or third pain seems to combine with the other pains to make the global area painful.
We the patients, want our pain to be from a single origin or cause as we feel that in someway it might be easier to stop or turn off the pain. However, I now believe in the multi genesis pain origin theory. This theory says that pain is often cumulative in the body. I often compare this to lighting a book of matches. If one were to light one match, one would have a small fire. Light the whole book and you get a much bigger fire composed of many smaller fires.
I find the same is true for the body. Let us take the low back pain for example. The origin of low back pain can often be traced to several pain generators. Say for example, a patient presents with low back pain radiating into the hip. How many times have we found that the patient did indeed have a disc problem, a same side facet problem, sacroiliacs, and bursitis of the hip or similar findings. This perhaps, is part of the reason for so many failed low back surgeries. Yes the surgeon dutifully decompresses the disc but does nothing to treat the co-concomitant conditions(other problems).
I often tell my doctors that if you can't find the problems you can't fix the problems. This can only be done through examination, treatment, re-examination and continued treatment. I often find it necessary to bring in other doctors or specialist in their respective areas to confirm diagnosis or treat. I find by accurately diagnosing the multi genesis pain and its several pain generators we can often separate and treat the overall pain putting out several of the pain fires and then determining the extent of the core problem. Kind of like turn off the background noise and see what is left.
Patients like this kind of treatment as they feel the progress. This progress gives them hope that their pain may be treatable. Surprisingly it is. Often the average doctor does not take the time or have the inclination to tease out the many pain generators. It is far easier to just say you have a bulging or herniated disc and treat only that problem. We encourage our doctors to look globally at our patients, diagnosing multi genesis pain generators and then treat them all.
Dr Greg
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