ArizonaBackInstitute

By Randall Pruitt, DC, DACNB, DAAPM, MUAC, FACFN, CES-NASM

If you have suffered from chronic back or neck pain for sometime there may be days when you feel like you just can’t go on any longer. I have even had patients come in who have told me that suicide is not far from their thoughts on any given day. Comments like that always concern me and they certainly bring into light the devastating effects back pain can have on ones life and the lives of their loved ones.

When I first decided to focus my practice exclusively on chronic back pain sufferers I really had no idea just how important my job as a back pain doctor really would become. I have never seen a condition lead to such devastation as chronic and unrelenting back pain. It not only ruins lifestyles from an activity stand point, but it can ruin careers, marriages and tear families apart.

My observation is that because back pain can be such a difficult thing to treat, when everything has been done and a patient still suffers, spouses, significant others and family members really have a hard time understanding why the patient is still unable to perform their daily activities. Blame becomes very harsh and depression becomes a very serious side effect. I have had burly truck drivers in my office, the kind of guy you would never want to meet in a dark alley, breakdown crying over his inability to function, work and support his family and be intimate with his wife.The psychological effects alone can become a very serious problem.

A recently published study looked at the causes of premature mortality among individuals who received a permanent disability pension in Norway from 1990 to 1996. They showed that “persons on a disability pension had a strongly increased mortality rate.” Those on permanent disability claims had roughly a three-fold increase in risk of mortality compared with those not receiving a disability pension. The summary concluded that “while permanent disability related to low back pain is likely to be associated with premature mortality in some settings, the exact nature of that relationship remains uncertain.”

Based on my experience I can say with some certainty that the relationship they have a difficult time identifying is something that may ultimately prove to be intangible. Everyone has their own experience of suffering and pain.

As we know in the field of neurology pain is a very emotional and personal event, an event that can be quite different for each person. Offering patients an alternative to this suffering is really where my passion is, I am quite certain my team has altered the course of some very serious consequences associated with back pain by intervening and helping a patient get their life back. I been told on more than one occasion in the patients own words that I saved their life. So as primarily a back pain doctor you wouldn’t think that I would be dealing with life and death issues…but that couldn’t be further from the truth.

By Randall Pruitt, DC, DACNB, DAAPM, MUAC, FACFN, CES-NASM

With thousands of patient visits a year coming through my office, I am rarely surprised or annoyed by any question my patients ask.However, there is one question I have received on a few occasions that I have to admit always gets to me just a little. That question or more specifically that comment centers around my advertising. Prospective patients are a little skeptical about how they found me, citing the fact that they were curious as to what I had to say so they came in anyway. The truth is that my advertising is very informative, something that I am very proud of, gathering the appropriate information is very time consuming, but I think my patients deserve the truth. I think that it compels people to come in for a consultation because quite frankly nothing else they have tried has worked.

When I get this question or comment it doesn’t take long to quickly point out to them that if they watch TV for no more than a mere few minutes they are no doubt going to see a drug commercial or several drug commercials in that brief span of time. And many times they are personally taking at least one of the drugs I mention , most commonly Lipitor.

I also find it very interesting that they don’t see this connection right off the bat, I am curious as to why my advertising seems unprofessional to them. Is it because I am a doctor? Doctors aren’t supposed to advertise? Look in any magazine on an airplane and there are ads from facilities like the Mayo Clinic, Baylor University Medical Center, the Brown Hand Center and the Arizona Heart Institute. Are they unprofessional? I don’t think so. The truth is you have to advertise in this day and age, to get the word out. If you have a treatment or treatments that can help a large number of people I feel it is your duty as a health care professional to advertise. Especially when dangerous drugs pushed by these huge companies receive so much air time. For example, the drug Vioxx that was pulled off the market achieved rapid market penetration in 80 countries and achieved worldwide annual sales of 2.5 billion in 2003. And that was for a drug that ultimately caused severe consequences in it’s recipients.

Offering a treatment program utilizing tools like spinal decompression, manipulation under anesthesia and MedX spinal rehabilitation that provide real lasting pain relief, you can imagine how compelled I feel in getting these highly effective treatments out to the public, especially when I know the alternative is most likely surgery.

It reminds me of an encounter that I had just last year over this issue. A gentleman brought his wife in to see me for an evaluation. This poor lady had been the recipient of not one but two unsuccessful spinal surgeries and was currently on a lot of medication. To say her quality of life was decreased was a major understatement. His background was hospital administration and he was highly skeptical of a doctor who advertised. Unfortunately, he couldn’t overcome that objection and his wife wasn’t accepted into my program, so in the end she is the one who most likely is still suffering.

My point to all this is that when there are solutions to common problems, I think it is irresponsible to not make every effort to get the word out. My program has helped over 10,000 pain sufferers and my goals is to help tens of thousands more and if advertising is what brings them in then so be it.

By Randall Pruitt, DC, DACNB, DAAPM, MUAC, FACFN, CES-NASM

Living in Arizona and being in the back pain profession I can’t help but notice any publication or advertising associated with back and neck pain. As research comes out describing the less than optimal results of spinal surgery it seems that this specialty is always on the lookout for something a little more palatable to the pain sufferer looking at surgery as an option. I have to admit, I am not a fan of spine surgery, in my practice that is exactly the opposite of what we do. We help people avoid surgery if at all possible and I am happy to say in the majority of cases we are successful. However, there are those that no matter what we do, surgery seems inevitable and being of the mindset that non-invasive is best, minimally invasive is obviously second best, or is it?

In the past I have always recommended minimally invasive surgery to my patients that needed surgery, however with what I have seen in recent years, this may change. You see all to often in my experience the rate of additional surgical intervention has increased after a minimally invasive procedure. I can recall 3 very distinct cases where I sent the patient for surgery, they had the minimally invasive procedure only to have no change in symptoms. A new MRI is ordered and the disc herniation is still there, how can that be? In my opinion working through such a small scope, you can only take out what you can see, so if the herniated disc is outside the visual field of the scope you can’t see it and therefore it isn’t removed. In every case an “open” surgical procedure was then performed to remove the additional disc material, putting the patient at additional risk.

Recently a large randomized trial evaluating minimally invasive surgery was performed and my observations were confirmed. Mark Arts MD, and a group of spine surgeons from seven hospitals in the Netherlands decided to do an independently financed randomized controlled trial comparing standard discectomy with one of the most popular minimally invasive techniques, tubular discectomy.

The results were as follows: The minimally invasive patients had a slightly worse outcome in terms of back and leg pain, function and overall recovery and they had more recurrent disc herniations requiring repeat surgery. An even larger study performed by the same researchers led to the same conclusion, the results of that study showed at one year follow-up 69% of the patients assigned to the minimally invasive procedure reported “good” recovery vs 79% of those that underwent the traditional form of discectomy. Patients in the minimally invasive group had more intraoperative and postoperative complications, a slightly higher proportion of the minimally invasive group also had a recurrent disc herniation and a greater proportion had repeat surgery within a year.

So what we can take from this? Well first of all it’s better to avoid surgery altogether and opt for a non-invasive treatment like spinal decompression. Secondly, regardless of what some of these large minimally invasive centers advertise 2 separate randomized clinical control trials have showed that this approach isn’t necessarily better and in fact can lead to more complications.

By Randall C Pruitt, DC, DACNB, DAAPM, FACFN, MUAC, CES-NASM

Here at the Arizona Back Institute we see a lot of unfortunate souls who have really been put through the ringer when it comes to their back and neck pain treatments. If you don’t know already, my practice really deals mostly with this type of patient and very rarely do we see someone who just hurt their back yesterday. We see really chronic cases that have been going on for months to years. These patients not only have a lot of pain, but they also have very weak and atrophied spinal muscles which in and of itself promotes further damage.

Therefore, a big portion of my program centers on the use of very specific and progressive exercise to restore spinal function and stability. This is an integral part of the process and one that really cannot be skipped. Most people in our society unfortunately are not big on prevention and are de-conditioned to begin with. And we go about our daily lives not really thinking of preventing things like back pain because it doesn’t seem as important as things like cholesterol and heart disease and the other conditions that can potentially kill us. But trust me many of my patients would have done things a lot differently if they only knew.

With prevention in mind let’s take a look at a review on the primary prevention of back pain by Stanley Bigos MD professor of orthopedic surgery at the University of Washington. He and his colleagues conducted a systematic review to see whether any primary prevention method found support in high quality clinic trials. And they concluded that medicine and industry may have overlooked an effective prevention strategy: exercise in both the workplace and community settings. In this review the researchers found strong and consistent evidence that exercise had a significant impact , both in terms of preventing symptoms, and reducing back pain-related work loss. They also noted that with the exception of exercise no other prevention method had strong scientific evidence to support it. Things like belts, shoe inserts even ergonomic training.

I always find it interesting that common sense things like using exercise to reduce back pain, need to be studied over and over again and proven with more and more studies. I am sure that you probably already knew you needed to exercise more and that you feel better overall when you do, not to mention your back doesn’t hurt as much or as often. But nonetheless as doctors we need to make sense of things and prove it once and for all before we can sit back and say with conviction that exercise reduces the prevalence of back pain.

Even treatments like spinal decompression make sense to people. When I go into detail with a patient about how the discs are injured or how they heal and explain the role of spinal decompression most people “get it”. It makes sense and in over 12 years of offering it and with over 10,000 people coming through my door, I am convinced it is THE best treatment for disc related back and neck pain, bar none. The problem is that by itself it can’t prevent a re-occurrence of back pain, that is where prevention comes into play and our type of prevention is utilizing MedX technology to strengthen the back and neck to a point where you are normal for your age and weight. Then it is up to you to exercise on your own to maintain good spinal health. Don’t worry we’ll give you the tools, but you have to use them.

I applaud the authors of the above study, because sometimes things need to be spelled out for us before we’ll really take them seriously.

By Randall Pruitt, DC, DACNB, DAAPM, FACFN, MUAC, CES-NASM

Over the past 12 years I have offered a program centered around spinal decompression. In those 12 years I have steadily improved on my program and have added techniques and technologies that I have found to be valid and results producing.Therefore, I can honestly say that my program works for the majority of chronic back and neck pain sufferers. So when a study comes out that inadvertently proves what I have seen in my practice for many years I get a bit excited.

To explain this,let me start with a common question I get from patients and that is “would it help if I lost weight”? Referring to their current and ongoing back pain. In the past my knee jerk reaction was always…it certainly couldn’t hurt, but I always knew intuitively that their weight really wasn’t the issue. The other question I answer routinely is, “can my disc really heal, because my doctor said it can’t” and my answer to this questions is always “of course it can, they just have yet to see what I have seen in my practice.”

Now you may not see the relationship between these two questions, but the correlation is profound, which brings me to the study I mentioned above. You see recently at the meeting of the North American Spine Society a paper was presented that came to some rather alarming conclusions. These particular researchers looked at identical twins to determine certain factors on disc degeneration and what they found was unexpected to say the least. The twins involved in this study had one very important difference, one of the twins was at least 30 pounds heavier then the other. What they were looking for was how this impact of extra weight would effect the discs in the lumbar spine. Would there be accelerated degeneration? Would there be more disc breakdown? Would the situation in general for the spines of these overweight twins be worse in comparison to their lighter sibling?

On completion of the study several finding were relayed. The overall message was that being heavier actually slowed down the process of degeneration. What??? That is precisely the opposite of what most would expect, right? Well, here is what they found…Higher body weight was associated with a 6.2% higher bone density in the lumbar spine, Disc signal results were 5.4% higher (better) in the heavier twin. The heavier twin also had a greater disc height (2.6% higher) and a higher adjusted disc signal (2.9%).

So am I advocating that you gain an extra 30 pounds to fix your back? Of course not, the take away from this study is simply that the disc is a viable structure! It can adapt and it can respond to stresses. That is why I was excited to see this study, because it clearly indicates the discs ability to heal. Something that I have seen in my practice now for over 12 years!