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One thing that makes sure that chronic pain will persist is that it is much easier to prescribe painkillers including narcotics and marijuana than to examine the patient to find a cause for their pain. In my office, every day, I see between one and three people with severe low back pain, who have had x-rays, CT scans and MRIs to their lumbar spine, which show a variety of pathologies, most of which are asymptomatic. Unfortunately, no one has examined their sacroiliac joints, where I have found that most severe low back pain originates.
Many physicians are so reliant on medical imaging, that they no longer use their hands to make a diagnosis, and, unfortunately, it is very difficult to diagnose a sprained sacroiliac joint using medical imaging. I just reviewed 180 charts of patients with low-back pain, and only 16 of them presented with pain coming from their lumbar spine. In all the others, the main pain generators were the sacroiliac joints. I know that without a doubt, as correcting the alignment of sprained sacroiliac joints resulted in immediate, complete pain relief in 50% of those treated, and partial pain relief in a further 30%. The findings from this UBC ethics–sanctioned chart review will be presented as a poster at the Canadian pain Society meeting in May 2018.
https://www.youtube.com/watch?v=NXNS6PNKRPo
Neuropathic pain can also be diagnosed through palpation along the course of the affected nerves, as these nerves are much larger than normal and much more sensitive to pressure. Ultrasound can also be used to make this diagnosis.[1-10] I just finished a pilot project on 20 people with postherpetic neuralgia, where I used a mannitol-containing cream to bring them pain relief. The postherpetic neuralgia pilot project is a Master’s thesis for Tess Debelle, a fourth year student at Groningen University. I also published a paper showing mannitol’s ability to down regulate the capsaicin (TRPV1 ) receptor.[11] This cream worked for those who had allodynia, but not for those who did not and whose pain was deeper. When I injected the mannitol around the deeper nerves, the pain disappeared, yet this pain is attributed to coming from the CNS. It is much easier to tell people that their pain is coming from inside their head rather than trying to find the cause and to treat it.
In the year 2011, I followed 235 consecutive patients with pain. Their average pain when they came into the office was 7.8/10. At their last visit, it was 2.3/10 and 89% reported they had pain relief. I did this using prolotherapy, nerve blocks, corrective exercises and manipulation. I did not use narcotics stronger than Tylenol three or Tramacet, I did not need to.
Most chronic pain is not in people's head and does not need to be treated with narcotics.
References
1. Zaidman CM, Al-Lozi M, Pestronk A. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 2009; 40:960.
2. Cartwright MS, Walker FO. Neuromuscular ultrasound in common entrapment neuropathies. Muscle Nerve 2013; 48:696.
3. Suk JI, Sigur CM, Walker FO. Superficial fibular neuropathy: complementary role of ultrasound. Muscle Nerve 2013; 47:778.
4. Riazi S, Bril V, Perkins BA, et al. Can ultrasound of the tibial nerve detect diabetic peripheral neuropathy? A cross-sectional study. Diabetes Care 2012; 35:2575.
5. Liu F, Zhu J, Wei M, et al. Preliminary evaluation of the sural nerve using 22-MHz ultrasound: a new approach for evaluation of diabetic cutaneous neuropathy. PLoS One 2012; 7:e32730.
6. Breiner A, Qrimli M, Ebadi H, et al. Peripheral nerve high-resolution ultrasound in diabetes. Muscle Nerve 2017; 55:171.
7. Hobson-Webb LD, Massey JM, Juel VC. Nerve ultrasound in diabetic polyneuropathy: correlation with clinical characteristics and electrodiagnostic testing. Muscle Nerve 2013; 47:379.
8. Zaidman CM, Seelig MJ, Baker JC, et al. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80:1634.
9. Padua L, Aprile I, Pazzaglia C, et al. Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment. Clin Neurophysiol 2007; 118:1410.
10. Padua L, Di Pasquale A, Liotta G, et al. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions. Clin Neurophysiol 2013; 124:1237.
11. Bertrand H, Kyriazis M, Reeves KD, Lyftogt J, Rabago D. (2015) Topical mannitol reduces capsaicin-induced pain: results of a pilot-level, double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2015;7(1):1111-7. Refereed article