An important study in Clinical Orthopaedics & Related Research [468(10):2678-89], reports that over time the function of the shoulder deteriorates in a significant number of patients who underwent rotator cuff repair, despite continued pain relief in many of the same patients.
The conclusions published in the abstract are found in the next paragraph:

A golfing patient I treated originally came to me with low back pain and later with shoulder and neck pain- all preventing his inner champion from blossoming. Like so many golfers he had come to accept the suffering as part of the game. He was amazed to find that he could get rid of pain that had plagued him for years. He wrote about it in his blog today bit.ly/9aluAt .

The article in the European Spine Journal highlights a major difficulty in assessing the effectiveness of various back pain treatments. No two studies used the same criteria to measure improvement. The lack of uniformity appears to be present in every aspect of the enigma of low back pain. Recent studies demonstrated that the tests a family physician uses to establish probability of a disc herniation may not be valid. There are inconsistent criteria for fusion vs. a simple laminectomy or foraminotomy for back pain.

I just read an article on the under treatment of chronic pain with the most common associated disease states listed as osteoarthritis, rheumatoid arthritis, fibromyalgia, and sickle–cell anemia. Since physical deconditioning is fraught with many serious negative consequences, such as obesity, high blood pressure, stroke, heart disease and diabetes in addition to be being a cause of most common pain problems, it should probably rank as a form of disease.

I saw a 60 year old artist who had been complaining of neck pain for 2 months. The pain began without any accident and had been getting worse. He had problems moving his neck, especially extending it backwards, and found that wearing a soft collar prevented movement and diminished his pain.  The only way he could exercise on his stationary bike was to use the collar.  He was taking anti-inflammatory medication but it wasn’t helping.

A recent article showed that even gentle but regular physical activity in middle aged women reduced the incidence of hip fractures. Lack of exercise contributes to many of the health problems with which we are confronted- obesity, heart disease, diabetes, hypertension, dementia, and osteoporosis. At a time when the cost of health care is so important to each of us as Americans, awareness of inexpensive interventions and self responsibility for our well being should be foremost in our minds.

Although Low Back Pain (LBP) is thought to affect around 80% of individuals, it is also thought to be self limiting and get better quickly (within weeks). Studies of patient populations however suggest that it is actually a more serious problem. Although most patients who experience back pain do not see a doctor, 60-80% of those that do are still reporting pain one year later and in those whose pain has disappeared, 20% will have a recurrence within months.

I recently had the honor of lecturing and evaluating patients at a pain center at an army hospital. Patients’ complaints were similar to those found at my center. I found with the use of the MPDD in 5 of the 6 patients I saw, that muscles contributed to the pain. I have found that a ketamine preparation applied to the skin over the MPDD identified muscle, can diminish or eliminate the pain and in this way I was able to demonstrate to the patient, and my colleagues at the pain clinic, that these muscles were producing some or all of the pain.

I recently treated a 30 year old veteran from Iraq with severe low back and neck pain. He fractured many bones in combat, was in a coma from an IED blast and was told that his injuries, pain and MRI findings could only be addressed with spine surgery. He is one of the many wounded warriors with post traumatic stress disorder (PTSD) complicating back and neck pain. Musculoskeletal pain is the major reason for soldiers to be unable to perform their duties and low back pain is the most common disabling complaint.

A recent article discussed the number of patients with Chronic Low Back Pain (CLBP) who also had Fibromyalgia syndrome (FMS). This article is an example of the confusion in medicine about both conditions. Believe it or not although the most common diagnosis for low back pain is non-specific low back pain, referring to sprains and strains of muscles and other soft tissue, there is no agreed method to look for and treat muscle generated low back pain. Patients with