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Sources of Chronic Pain Are Often Hidden From Standard Tests
 

Many of our readers have asked for my opinion about testing and chronic pain.

The story of chronic pain for most sufferers is that the source of their pain is often not recognized by the treating physician(s) or the standard tests that are ordered. Many who suffer chronic back pain have negative, or borderline abnormal X-ray, CT, or MRI scans. Traditionally, much of the medical profession, but more significantly, insurance companies have given little credence to those that say they have pain when in fact, they probably do. Pain is what law suits can be made of; however, more importantly, it is important to find the source of the pain, and acquire an appropriate treatment for the pain syndrome.

I estimate that 40% of herniated disks in the spine are not recognizable by conventional scanning methods. This means we are actually punishing many who have pain that is missed. For almost ten years I have recommended that someone make an MRI or CT that is standing, as a supine MRI will miss the effects of gravity upon the spine and disks, and probably miss many spinal abnormalities. One of my comments that I frequently say to my patients is that there is always more spinal (and joint) disease than is seen on any scan or X-ray. It is dangerous to assume you see everything in any scan. At the root of all scans and X-rays is the fact that we are "shadow gazing", as I call it.

The good news is that technology is always advancing; and it is my opinion that a day of reckoning is coming for those in chronic pain. The ability to demonstrate soft tissue injury with little error is coming. The ability to diagnose neuropathy and demonstrate the source is coming. Two new examples are the addition of "stand-up MRI", and thermography scanning. In stand-up MRI, the application of gravity is applied to the scan recreating the more "lifelike" events of a spinal pain sufferer.

My "guesstimate" is that the stand-up MRI will demonstrate an increase in disk disease by at least 40%, or higher. I recognize that almost all adults have some spinal muscle dysfunction with the probability of a disk always lurking. There are no stand-up MRI's in Canada, but there are a few in the United States. A Company known as FONAR Corporation has produced this device.

Thermography scanning was created initially for Military applications (like many new medical technologies) to see the enemy in the dark using heat released from their bodies. People who have chronic pain have changes in their color flow scanning with thermography, and it can be used to help demonstrate chronic pain, find missed fractures, tendon injuries, myofascial pain syndromes, etc. Conditions such as fibromyalgia, regional pain syndromes, Carpal tunnel, ulnar neuritis, chronic spinal pain, and more will ultimately benefit from these new pain-finding technologies. The big loser will be insurance companies, Workman's compensation, National pension and disability plans, as the percentage of workers that will qualify for disability will rise. Expect insurance costs to rise even more!

The big winners will be law firms, and legitimate sufferers of pain. As this technology gets better, the accuracy of diagnosis, and ultimately treatment will improve.