The problems of pain and addiction are rampant in the U.S. Often, they go hand-in-hand. Pain is a symptom of something wrong in the body and can be debilitating. Low back pain is the second most common complaint for which patients go to the doctor and a major cost to the healthcare system. Arising out of the problem of pain is the epidemic of opiate addiction. Pain can be alleviated by finding out what the specific problem causing the pain is, and then treating it effectively.
Pain is often due to inflammation in tissues. Inflammation can result from infection, autoimmune and degenerative conditions, overuse, or injury from sports or accidents. If all pain were due to inflammation, it would be logical that taking some anti-inflammatory medication would get rid of it. How often have you taken ibuprofen, steroid, or something else for your pain with minimal or no relief? Or a “muscle relaxant”? It happens a lot.
In osteopathic medical school, we attempt to emphasize to our students the importance of understanding and KNOWING the anatomy of the person with specific focus on the neuromusculoskeletal system (NMS). Not only knowing it from a didactic perspective, but learning as much about the palpatory characteristics of normal and abnormal tissues. So much can be learned about a patient’s condition through intelligent palpation. Telemedicine has its place but does not help in hands-on diagnosis of a patient’s problem.
The NMS system comprises over 60% of the mass of the human being. It is what allows us to function, move, balance, express ourselves, play sports, exercise, drive, type…whatever. Muscles, bones, joints, ligaments, discs, cartilage, blood vessels, lymphatics, and nerves all can and do contribute to pain syndromes. Much of the time, the core NMS problem causing pain cannot be seen on an x-ray, MRI or CT scan. Organ dysfunctions can also cause NMS pain through nerve reflexes to the body wall. Of course, psychological stressors can enhance the sensation of pain. And there may be the occasional malingerer with ulterior motives.
In my patient populations over the years, rarely did I see psychological issues as the true primary pain inciting factor. I believe too many diagnoses of “it’s all in their head” or “they are just depressed” or “they are crazy” are made because the clinician lacks the expertise, time, or incentive to really figure out what the problem is.
I believe the most important step in helping a patient to heal from pain is finding and fixing what is known as the “Key Lesion”. This osteopathic concept has to do with sorting out what the underlying problem or problems is/are that are truly causing the symptoms. Key lesions can be summarized as follows:
- Somatic (NMS)
- Visceral (organ)
- Some or all of the above
The fine art of medicine is being able to find the key lesion(s) and treat them appropriately and as conservatively as possible to enhance the patient’s inherent healing system/health. Of course, this includes using all the non-surgical, surgical and medication tools that are appropriate. Being able to offer appropriate education in prevention, stress reduction and self-help options are key to the patient’s maintenance.
Great options for pain include an in-depth osteopathic evaluation with appropriate hands-on treatment combined with acupuncture, exercise/physical therapy, and stress reduction. BFA and NADA protocols would be key players in therapy. I have seen it work many times before my eyes and hands. I firmly believe that this could save everyone a whole lot of money and aggravation, except for maybe the pharmaceutical industry.
What do you think?