ArizonaBackInstitute

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

I find it very ironic, that many spine doctors are skeptical about certain procedures, yet run with something unproven because it fits into their little specialty box. I see every day in  my practice the poor people who’ve been caught in the trap of the current medical approach to back and neck pain. I can tell you with certainty that the typical treatment plan for back or neck pain includes the following; medication, physical therapy, spinal injection then surgery. That is as scientific as it gets, and you know what? This approach is a horrible failure.

Treatments like spinal decompression, manipulation under anesthesia and MedX spinal rehabilitation have all been proven more effective then any of those mentioned above, yet many pain sufferers know nothing about them. Why? Because their doctor was taught the above formula and breaking out of that paradigm is a difficult thing to do. It’s much easier to send a back pain patient elsewhere by writing a prescription, and let’s face it, most doctors don’t have time to educate themselves on the newest treatments on back pain, so they do what they’ve always done. Which is why we have a 90 billion dollar per year price tag on the treatment of back pain and more people are reporting severe functional limitations then ever.

Which brings me to the topic of this particular blog post, complications with neck surgery. You see very often new techniques or instruments are introduced into the spinal surgery world without adequate testing. For example two recent studies highlight this problem, referring to the inability of the current research and regulatory systems to monitor and restrain the spread of new technologies and avoid unnecessary safety problems related to their use.  These two studies found significant growth in the use of bone-morphogenetic proteins (BMP’s) in spinal fusion surgery. And the rapid uptake of the new technology has led to a rash of complications related to their premature use in anterior cervical spine surgeries. In fact one of the studies found  an approximately 50% higher complication rate after BMP use in anterior cervical fusion.

My point to all of this, is that technologies are used everyday in the spine world that unfortunately are unproven and even worse can lead to severe complications. Spinal decompression on the other hand, is safe and proven effective. It is beyond me why anyone would have spinal surgery without at least going through spinal decompression. My practice routinely saves patients from surgery and often gets people better after surgery has failed. So my advice, ask questions, look at the rationale behind treatments offered to you and look at the long term benefits as well as the potential complications.

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

In my practice it is rare to see a patient with lower back pain or neck pain, not exhibit some other condition. Whether it be knee pain, shoulder pain or some other type of joint or muscle pain. However most doctors are so narrow in their focus that they rarely look past the body part wherein they specialize.

This is unfortunate for many reasons. Usually as the back or neck pain improves the other area will begin to affect the person much more significantly and a referral to another specialist is usually made. This can be a source of frustration for most people because who wants to go to an endless series of doctors and specialists when their problem could have been taken care of in one place?

A recent study by Michael Korff PhD and colleagues found that about 20% of the population of the United States has chronic spinal pain at any given time. And of this population 87% reported at least one other musculoskeletal condition. However, these problems are not only an accessory condition but, create about 1/3rd of the persons disability in conjunction with the spinal pain.

Another article written in the journal Pain by Peter Croft MD states that humans are vulnerable to multiple forms of pain, and common conditions will inevitably occur together.

Because of this common thread my team here at the Arizona Back Institute is very well trained in the treatment of a variety of musculoskeletal conditions, injuries to the knee, the rotator cuff and conditions like carpal tunnel syndrome and neuropathy just to name a few. Of course our main focus is on chronic spinal conditions, but my philosophy is that their affect on other areas should be treated as part of the total injury and not as a separate case, requiring a referral.

If you have suffered from lower back or neck pain for any length of time, you may have been given facet joint injections as a part of your treatment. Facet joint injections, are injections into the joints of the spine with a steroid to relieve pain. The theory behind these injections appears sound, since these joints are highly innervated with pain sensitive nerves, it would appear that injections would help. The second step in the injection process is to then ablate or deaden the nerves in the joint to prolong the pain relief. These nerves do however, grow back usually within 3-6 months.

While the rationale behind these injections makes some sense the medical research shows them to be ineffective. In fact several studies have come to the same conclusion, that essentially these injections are no better than a sham injection and do not give the patient any semblance of a long term result.

The problem however with any study is that the treatment is often applied to a more generalized group, lower back pain in this example. What needs to happen in order to give us better clinical indications is to break down the patients by diagnosis and treat only those who fit the criteria. that way the true success rate can be established.

In my own practice we are very meticulous in our selection process and patients are not accepted into any program unless we have been able to establish very specific clinical findings. That is why our success rate is so high, we only accept those we feel very strongly that we can help. Unlike many medical studies published apparently disproving individual treatments, where the study population is a mixed bag.

The truth is no one treatment has all the answers. In my experience the best treatment approach is one that addresses all of the various components of back and neck pain and treats them simultaneously, giving the patient the best possible chance of a successful outcome. That is what we strive for everyday at the Arizona Back Institute.

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

With the unemployment rate at record numbers more and more people are out of work and willing to do whatever they can to make money to support their families. With that said there is not a day that goes by that I don’t give thanks to my choice of careers and the impact that choice has on so many others.

Everyone wants to hear that they have done a good job, no matter what the vocation or job description. It gives you a sense of satisfaction and pride to know that others see your hard work and dedication. My job as a back pain doctor is no different. My acknowledgment of a job well done is a patient responding to my care, someone who has suffered, but now is pain free.

I have had this conversation many times with my employees when they comment on the complete 180 degree turnaround of a particular patient. Often we’ll see someone literally become a different person, they are cheerful, friendly and really happy in sharp contrast to the miserable, edgy, skeptical person they came in here as.

Just today Francesca my front office coordinator told me about a patient of ours who after 20+ years in pain turned around as he was leaving the office and said to her ” You guys have no idea how much you have changed my life”. This patient went through our manipulation under anesthesia program and I can’t tell you how satisfying it is to hear a patient say that. With the programs we offer, treatments like manipulation under anesthesia and spinal decompression we hear comments like that a lot. Our programs have helped those that everything else has failed. In fact our average patient has been in pain for 7.8 months and has tried no less than 3 other treatments and we get them better!

And that is why I love my job…

Pain is a much more complex issue then we think. No one likes to be in pain and back pain can really affect your life in so many ways. The problem with pain is that not only does it affect the areas of your body involved (like your back) but it also has a very significant impact on your brain making it a much more difficult issue to deal with.

Research done by A. Vania Apkarian, PhD and colleagues showed that chronic back pain has a strong effect on the prefrontal cortex in humans. The newest research reveals that this connection is much more powerful then we once thought. Evidence shows that chronic pain alters the structure of the brain leading to destructive atrophy of regions involved in memory, rational thinking, and the processing of emotions. They’ve also showed that long term neurological changes associated with chronic low back pain may result in impairments in thinking and decision making.

So as you can see, back pain is much more debilitating then you may have thought. It affects not only function, but also emotional well-being, concentration and decision making. Dealing with the pain, needs to be done through restoring the structures of the spine, not masking the perception of pain with drugs. Also if pain has this type of effect on the brain, imagine what affect the surgical removal of tissues from spine or a fusion of the spinal segments has on the brain.

Just look at the example of a person losing a limb. That limb had a connection to the brain and information from that limb activated brain centers and wired the brain a certain way, depending on the skills that the person could perform with that limb (ie like playing the piano). Remove the limb and the brain immediately undergoes dramatic change, and at times the person may still get the perception that the limb is still there (phantom limb pain). The spinal joints and muscles are rich in receptors and have a large influence on brain function. Damage or alteration of these structures leads to more and more dysfunction as these studies have shown.

Treatments like neurologically based spinal rehabilitation, spinal decompression and MedX rehabilitation address chronic back pain from the structural perspective and allow functional restoration of the problem. This leads to changes ultimately at the brain level and an improvement in the deficits that the chronic pain may have caused. Drugs and invasive treatments don’t do this.