Pain is inherently subjective, and a greater awareness of the need for taking pain seriously is growing among the health community as well as the public at large. This is particularly true for Osteo-arthritis Knee joint, chronic neck and back pain sufferers. Great majorities of cases are self-limiting and resolve on their own. The risk of recurrence and development of chronic disease is significant. Chronic back pain tends to be very difficult to treat. In these cases if the patient is subjected to surgical treatment it may become a dilemma if patient does not recover completely after that, as the anatomy of the affected area is now completely disturbed and patient looses any chance of recovery through conservative methods. This is just because of the reason of a wrong diagnoses that can be prevented by “Unmasking the underlying problem” through this new technique before deciding for the treatment (discussed in detail in individual chapters of Osteo-arthritis Knee joint, chronic low back pain and others).
It is learnt through our clinical experience that the Patient may report of continuing pain in the absence of an apparent definitive pathology. They have all too often been dismissed by health professionals who traditionally expect to find an organic cause for pain. Often such patient may be labeled as functional and physicians often think that reassurance will help the patient to cope with the problem. Even in the absence of such an organic cause, it is clinically observed that these chronic pains can lead to neurological feedback processes that only serve to worsen the pain and make it more difficult to treat. Thus this point cannot be ignored that there may be an organic cause that we are not knowing about. It is specifically true about the chronic low back pain and Neck Pain. This organic cause has been unmasked by the new technique and underlying lesions have been identified as the cause of pain. These lesion may be ligamentous or of tendon origin and are mostly fibrositis, tendonitis, or myositis.
Since long Pain management has been considered as a subspecialty of Anesthesia. It is appropriate here to discuss this aspect with a revolutionary concept so as to find new venues for answering the problem of treating chronic pain conditions. In a medical set up all the patients who are ill consult their appropriate specialty. Sizeable number of cases recover while selected pain cases out of these are referred to the physiotherapy department for management. Sizeable number of cases recover with physiotherapy techniques while still others remain having problem.
These cases are then traditionally the cases for the department of Pain Management. If we look at the fall out cases from physiotherapy department they are varied. Neuralgic pain cases are managed by the department of anesthesia. However OA Knee joint cases, Low back pain cases that do not respond to conservative techniques of physiotherapy, cases of frozen shoulder, neck pain (commonly labeled as cervical spondylosis on the base of radiological findings) are the cases that cannot be helped to any extent. Thus these cases then enter the classification of becoming chronic problems. They keep on shuffling between the clinicians, physiotherapy and the department of anesthesia. Thus a gray area is created that harbor these cases. None of the three departments can own them, as none can treat them.
These are the cases that we are talking about in our discussion of pain management. These cases have in fact been ill understood and academic and clinical evidence tell us that their etiology has till date been not ascertained by the medicine. It is just because that this concept has remained hidden from the eyes of the physicians and it has not yet become a part of the medical knowledge. “Unmasking the underlying problem” in all these cases gives us knowledge of their etiology that is very much curable and these patients can be well treated within days to complete cure. Thus large group of chronic problems will shrink down to a little, once this technique is understood and brought to medical practice.
In Osteoarthritis Knee joint the conventional concept that the narrowing of the joint space, reduction of the surface cartilage, drying of the synovial fluid are the cause of pain, is negated by this new concept. All these finding may radiological be very much there but these would not be causing the pain to the patient.
In fact there are two major lesions that are causing the pain knee joint and this technique has identified these to be outside the joint proper. Clinical results of the patients treated with this technique tell us that these two points are manageable and the patient becomes completely free of pain knee within a fortnight. Thus these findings tell us that despite the fact that there is radiological evidence of osteoarthritic changes it may be inappropriate to call these cases clinically as Osteoarthritis Knee Joint and they shall be termed as cases of “PAIN KNEE” rather.
Similarly in chronic low back pain majority of cases with marginal degree of disc prolapse, read on advanced radiological examination (CT scan and MRI) respond well to this conservative treatment. It seems that radiological finding in these cases were not the true indicators, of the cause of clinical presentation of symptoms. “Unmasking the underlying problem” in them, revealed the lesions that were pinpointed to an error of 2-4 mm and were possibly fibrositis, Myositis or facet joint pain. These are then accurately injected giving rapid recovery in two days time and complete recovery after healing in two weeks.
Same is true about the cases of neck pain termed as cases of cervical spondylosis. Radiologically these patients may be having lipping of the cervical vertebrae or even narrowing of spaces between one odd vertebrae, but unmasking the problem reveals, that their pain was because of trigger spots, that were lesions in the muscles in the cervical and scapular region and their clinical symptoms completely recovered except some neurological deficit in certain cases in whom there would have been a real nerve irritation in the cervical region. This is discussed in detail in the section of cervical spondylosis.