Our Practice

Non-Surgical Pain Relief

Our Unique Approach

We do the best for our patients by following the basic principles that we were taught in medical school. Primarily, that the key to diagnosis is in the history and physical examination. The answer for the cause of a patient’s problem almost always lies in what the patient tells the doctor and what the doctor finds when the examine the patient’s body.  By following these principles, we are often able to find the source of pain, even when others have not.

After that, we employ a systematic approach based on the scientific method, identifying and treating individual components of the patient’s pain. Most spine specialists focus on the intervertebral disc, presuming that a torn, bulging or herniated disc is the main source of the patient’s symptoms.

Too often, an MRI is treated as a perfect test.  However, the accuracy of MRI–like any other test–is limited.  While disk pathology is very common, just because a patient has a disk bulge or herniation, that doesn’t mean that’s what’s causing the pain.  For example, in ‘normal’ patients with no back pain, studies have shown that about 50% will have a ‘significant abnormality’ on MRI.

When it comes to spinal fractures, MRI isn’t any better.  About half of moderate and severe vertebral compression fractures are missed on radiology reports (Hurxthal, 1968).  While we may think that radiologists would be the best doctors to pick these fractures up, a study in 2006 (Casez et al) showed that general internists actually recognized more fractures than radiologists after a short training program.

For the patients we see, the pain is usually caused by multiple problems that may include the facet joints, the vertebral bodies, posterior elements, sacroiliac joints, muscles and other soft tissues in addition to the disc. Since all of these structures are stacked in the spine like an accordion, they can all be affected when muscle spasm puts pressure on the back (a process known as “axial loading”).  We don’t just treat the disc, we treat the patient after doing our best to determine the main source of the pain using our training and expertise.

We believe that treating a patient should start with arriving at an accurate diagnosis. Since spinal pain is complex, this isn’t always possible.  However, by analyzing all the available data from the history, the exam, imaging studies and synthesizing it into a cohesive, logical explanation for the patient’s problem, we can start a process of elimination. Once a rational diagnosis is made, treatment can begin.

Many times, when a patient has back pain, the question is “does this patient need spine surgery?”  What we try to do is get to the root cause of the patient’s pain and find out what is most likely wrong with them – not to focus whether or not they are a candidate for a particular procedure.

Back pain is a leading cause of disability. Back surgery takes months to recover from, leaves a huge scar and metal in your back. While there are many patients who need and benefit from a surgeon’s procedure, try to help patients avoid surgery when we can.  That comes from years of helping patients with pain who still had pain after back surgery and those who couldn’t have surgery because of age or other medical problems.

References

Casez P et al.  “Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists.”  Osteoporos Int. 2006; 17(7):965-70.

Williams AL et al.  Under-reporting of osteoporotic vertebral fractures on computed tomography.  Eur J Radiol. 2009 Jan; 69(1):179-83.