Putting Out The Pain Fire

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


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Cervical Herniated Disc

I had a 36 year old male present with a Cervical herniated disc today. He presented with neck pain rated an 8 on the 0-10 scale and radiating pain into his left arm and hand of one month duration. He felt that his wrist was beginning to get weak. He had been to his primary doctor who sent him for an MRI of the cervical spine. His medical doctor had given him a medrol dose pack and pain meds. His MRI demonstrated two herniated disc, one at C5-6 and one at C6-7. His primary then referred him to a local orthopedist who wanted to do surgery immediately. The surgeon wanted to do a two level fusion. The patient wanted another opinion.

I did a complete history and physical. After examination I concluded that he had NO neurological deficits. He had numerous positive orthopedic and neurological test but non indicated a true neurological deficit. I needed further NCV testing to differentially diagnose between radiculopathy (radiating pain from the neck) vs Carpal Tunnel Syndrome (an entrapment of the Median nerve at the wrist) both of which could produce a pain in the hand. I ordered an NCV the next day. Dr Gary Cohen our Physical Medicine doctor at Millar MultiMedical preformed the test. The test concluded that yes there was a mild radiculopathy (radiating pain) coming from the neck but also there was carpal tunnel syndrome.

I started the patient on daily CMT, Chiropractic Manipulative Therapy with the Activator and DTS - Decompression Traction of the cervical spine at 22lbs at 15 degrees for 20 min a day. I also included in his care e-stim and ultrasound treatment. I told him he would get worse before he got better and indeed he did. But after only a few pulls his pain started going down. We also started treating the carpal tunnel syndrome with e-stim, ultra sound and manipulation. He is now nearly pain free.

I think this case demonstrates always get a second and even a third opinion if surgery is the option and it's not an emergency.
Dr Greg


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.