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    Spine Care Made Easy

    Excerpted from
    A Consultation With the Back Doctor
    By Hamilton Hall, M.D.

    Phineas T. Barnum, often regarded as America's greatest showman, lived by his own maxim, "There's a sucker born every minute" I am always disappointed when his words ring true in the world of spine care. Our technology is constantly opening doors to avenues that will lead us forward in our conquest of back and neck pain. But it also opens doors onto blind alleys where charlatans wait to prey upon the unsuspecting, eating their time and money. If you have chosen to begin our consultation here, looking for the shortcut to spine care, I've caught you. Spine care is not easy, but it is simple. And it is a partnership. Caring for your back or neck is your responsibility, and anyone who says otherwise is probably trying to sell you something.

    I can't lay all the blame on those who offer magic solutions. Any successful confidence scheme must have a mark: someone who is willing to suspend rational thought in the hope that, this time, it will really work. Because back and neck pain are nearly universal, and because they apparently respond to so many different things, fraudulent claims are easy to make and difficult to disprove. All the more so because patients want to believe.

    I recall a patient who came to see me two or three times with uncomplicated mechanical low back pain. His symptoms responded to a simple program for a Pattern 1 fast responder. I provided the necessary education, offered my support, and prescribed the appropriate series of treatment sessions. But that is not what he wanted. He had heard from a friend that injecting an anaesthetic into the painful lump he felt in his back at the top of his buttock would solve his problem. It had worked for her, so why wouldn't it work for him?

    I explained that the lump (doctors call them fibrocytic nodules) was one of the body's non-specific responses to his underlying structural pain. Anaesthetizing the lump would be like blowing the smoke away from a fire. It would produce some temporary comfort, but it couldn't last. My patient's mind was made up, though. He had no interest in my other options, and so he demanded that I give him what he wanted.

    Trigger-point injection, as the technique is called, is a safe, well-established procedure. I use it occasionally to give patients with those tender lumps the temporary relief they need to embark on a more lasting solution. I am reluctant to resort to trigger-point injections when I believe the needle is all the patient wants.

    Recognizing that I was not going to change his mind, and to escape from his repeated demands, I agreed to give him the injection. I promised him nothing more than a short, pain-free interlude, but I was wrong. The injection worked, and it worked dramatically. His pain was gone and, with no further effort, his life returned to normal. I have no idea how the injection could have worked so well. Did it break a pain cycle that relieved other areas of muscle tension? Had it affected the gates to his pain-sensing system in the spinal cord? Whatever the reason, there was no doubt of its success. We parted company on the best of terms.

    About a year later, I received a telephone call from a physician in Florida. He had recently seen a patient from Canada who came to his office complaining of low back pain and, in particular, a very painful lump at the top of his buttock. It was my former patient, and he had told the doctor of my injection and its miraculous result. The doctor hadn't heard of any drug available in the United States that could produce such a dramatic effect. He had called to inquire what I had used and whether there was any way he could obtain a sample. I could feel his disappointment, or perhaps it was his embarrassment, when I told him that my injection had been nothing but a long-acting local anaesthetic available all over the world.

    For every patient who gets a good result from a trigger-point injection, there are dozens more who gain relief only for the time it takes for the local anaesthetic to dissipate, or who gain no benefit at all. One of the keys to a durable spine program is reliability. Mechanical spine pain will respond predictably to a physical treatment selected on the basis of the correct pattern. This obvious and open approach is more certain, efficient, and cost-effective than most of the highly publicized medicinal options or the mysterious secret remedies.

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