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ORTHOPEDIC
MEDICINE: A NON-SURGICAL APPROACH TO CHRONIC PAIN
Lawrence
Cohen, M.D.
When asked what I do,
I hate to say "I'm in pain management," because the focus of my
practice is really pain resolution. By the time someone reaches a pain
specialist, they have failed standard interventions such as physical therapy,
medication and even more invasive procedures such as epidural steroids. They
have persisting pain that leaves them less effective in the home, at work, and
in their personal relationships. I was trained with a physical medicine
education to utilize medications, physical or occupational therapies,
psychology, and a few injection techniques for tendons, bursae or muscle
trigger points. This approach proved inadequate for so many of my patients. I
began searching the alternative medicine world for treatments that worked.
This led me to the
field of Orthopedic Medicine, a group of physicians who are utilizing
alternative techniques to deal with complex pain problems. The direct cost
savings can be tremendous; just think of the cost of one back or neck surgery
that might be avoided or the cost of years of chiropractic, physical therapy,
or physician and emergency room care. Indirect savings can be greater when
adding the return to work someone who otherwise might be out on disability or
worker's compensation for life.
The focus of this
therapy is on the structural component. This might be the sprained or strained
ligament, tendon or muscle- or the "somatic dysfunction" of the
chiropractor or osteopath. One of the most important lessons regarding
structure is that the underlying problem may not be where the pain is. The
injured area is typically tender only to careful examination, and may be quite
distant from the area where pain is actually felt.
I see many patients
involved in car accidents with persistent neck pain and headaches who have
undergone expensive and unnecessary MRIs, EMGs, physical therapy and
chiropractic treatment aimed at the cervical spine, when careful examination
might have focused treatment at the real source of their pain elsewhere.
In some instances the
perpetuating problem results when the head is whipped to the side, the scalene
muscles yank on their insertion into the first rib and pull it up out of
alignment. This results in a super sensitive spot where the first rib attaches
to the T1 spine, and muscles around it remain severely triggered, referring
pain up the neck to the head, down the medial scapula and down the arm. In
this case, osteopath mobilization followed by prolotherapy to the ligament
that joins rib to spine and trigger point injections of the remaining
triggered muscles, will resolve the head, neck and shoulder girdle complaints.
For others, the
problem occurs following an accident in which they bounce back into the car
seat at their mid thoracic spine. This can depress one or two segments of the
thoracic spine, reversing the normal kyphotic curve. Here, the posture changes
to compensate, straightening out the cervical curve and shortening the
paraspinal muscles. Restriction and triggering at mid-thorax refer pain up to
the skull and neck. The pain is felt in the neck and head-not in the back!
When asked to flex their neck, patients typically cannot reach their chin to
their chest. Osteopathic mobilization, often facilitated by neural therapy
block to the paraspinal musculature, will allow resolution.
In another common
accident scenario , the person is jamming on the brake with the right foot
while the left foot is hanging loose and the seat is tethering the pelvis.
This may displace the right cuboid (a small bone in the foot) or, worse, may
cause a torsion that shifts the pelvis out of alignment with respect to the
two iliac bones, or to the sacrum that sits between. The low back may be
painful with either one of these conditions, yet the foot, where the injury
really occurred, rarely is. Either one of these conditions can alter the
patient's posture, gait and stance, resulting in chronic head or neck pain.
Osteopathic mobilization and occasionally prolotherapy is necessary to obtain
correction and relief.
Finally, there are
pain patients where the structural problem is in the neck. These patients
typically are okay as long as they keep seeing the chiropractor or physical
therapist every few days, but they can't resolve the pain. X-rays may show
some arthritis, spondylosis, and degenerative disc changes, which frequently
get the blame for the pain.
Here the structural
problem involves the ligament and tendon attachments to bone. There may be a
strain or sprain (micro avulsion or rupture of fibers as the insert into
bone), with local tenderness on palpitation, causing reactive muscle
triggering, which generates much of the pain a patient feels. In addition,
recurring somatic dysfunction in the cervical spine returns within hours or
days after each chiropractic or PT treatment.
The most effective
treatment is prolotherapy, a way of repairing the ligament and tendon injuries
and shutting down the "C" pain fiber irritation present. In
prolotherapy, a hyperosmotic 12 percent dextrose and lidocaine solution (which
may be combines with a chemical irritant as well) is injected in small amounts
at the attachments of tendon and ligament to bone. This induces the body's
healing inflammatory response to repair strained and frayed ligament, or
merely tighten existing ligaments, made lax by narrowing of disc or joint
spaces through degenerative processes. Through repeated injections, the
treated ligaments can have as much as 140 percent the strength of controls (in
animal studies). Prolotherapy can be used at the neck, low back, knee,
shoulder, or any joint to prevent progression of arthritis and eliminate pain.
Introduction to Prolotherapy
Why Get Prolotherapy? Donna Alderman, D.O.
What is Prolotherapy?
Alvin
Stein, M.D.
Introduction to Prolotherapy
Ross
Hauser, M.D.
How
Safe Is Prolotherapy? Ross
Hauser, M.D.
The
Importance of an Experienced Prolotherapist Ross
Hauser, M.D.
Non-Surgical
Tendon, Ligament and Joint Reconstruction William J. Faber, D.O.
How Does Prolotherapy Work? Marc
Darrow, M.D.
When Prolotherapy May Not Work David Harris, M.D.
Twenty
Common Questions About Prolotherapy
David
Harris, M.D.
The History of Prolotherapy Ross
Hauser, M.D.
Curing Chronic Pain with Prolotherapy Scott
Greenberg, M.D.
Why So Many Turn To Prolotherapy
David Harris, M.D.
Prolotherapy
and Chronic Pain Ross Hauser, M.D.
Peripheral Joints
& Prolotherapy
Jay W. Nielsen, M.D.
Orthopedic Medicine: A
Non-Surgical Approach to Chronic Pain Lawrence
Cohen, M.D.
The Difference
Between Prolotherapy, Trigger Points, and Acupuncture Marc Darrow,
M.D.J.D.
Prolotherapy: Creating
Inflammation in an Area that is Already Inflamed Marc Darrow,
M.D.J.D.
Growth Factor Basis of
Prolotherapy
David Harris, M.D.
What
Does It Take To Heal Connective Tissue?
Dave
Harris, M.D.
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