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Norman Marcus, MD - Exercise and Low Back Pain, Carpal Tunnel Syndrome and Nerve Conduction Velocity

Mon, 28 Nov 2011 00:00:00 -0500

“For every complex problem there is an answer that is clear, simple, and wrong.” HL Mencken

Exercise has been suggested as an important part of any treatment program for chronic non-specific low back pain (NSLBP)-the kind of low back pain that most people get, where there is no obvious reason for the pain and therefore no obvious treatment. A thorough review of the literature (a systematic review) on exercise for NSLBP, was published in October of 2011. It found that there was no or only a weak correlation with changes in disability following exercise programs and improvements in pain, mobility, strength, or endurance.

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Norman Marcus, MD - Obesity, poverty, and community influence

Wed, 16 Nov 2011 00:00:00 -0500

Obesity is more prevalent in neighborhoods with high incidence of poverty. A study in the New England Journal of Medicine showed that encouraging families to relocate to higher income neighborhoods could lower the rate of obesity and signs of diabetes. This finding may lead to a better understanding of how we can combat the obesity epidemic.

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Norman Marcus, MD - Osteoporosis Prevention and Treatment

Tue, 20 Sep 2011 00:00:00 -0500

Osteoporosis in women is a growing public health challenge with an aging population. New approaches are needed to prevent and treat decreases in bone density and strength. Two recent articles present different and potentially complementary approaches.

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Norman Marcus, MD - How can we know what pain treatments make sense?

Thu, 04 Aug 2011 00:00:00 -0500

Guidelines for care of specific conditions, produced by professional medical organizations, should be based on a rigorous analysis of all existing literature about the treatment of the condition. Guidelines for Low Back Pain were published by the American Pain Society advising that many pain treatments were not clearly effective. Another organization not liking these guidelines offered two systematic critiques (1), (2). The APS responded addressing the need for unbiased assessments of treatments offered by healthcare providers. If you make your living doing a procedure, it may be difficult to admitt that what you do doesn't work well. The results for treatment of low back pain in the US (and elsewhere) are generally not good.

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Norman Marcus, MD - How to decrease headache frequency

Thu, 23 Jun 2011 00:00:00 -0500

A recent study of a simple resistance exercise program for the neck and shoulders, in office workers who complained of weekly headaches (HAs), showed an approximately 50% reduction in HA frequency vs. a weekly health education control group. The exercise groups were 2 minutes or 12 minutes of daily exercise. The remaining HAs were no different in terms of intensity or duration of pain.

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Norman Marcus, MD - New possibilities for painful knees

Thu, 16 Jun 2011 00:00:00 -0500

The body can sometimes heal itself in painful conditions. A study of patients with painful osteoarthritis of the knee showed that by mechanically separating the bones in the knee that were touching and causing pain, cartilage regrew and pain and function improved.

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Norman Marcus, MD - Above all else, do no harm!

Thu, 09 Jun 2011 00:00:00 -0500

In our desperate wish to relieve our pain we sometimes receive treatment that is harmful. One of those treatments may be botulinum toxin, frequently provided as Botox injections to tender muscles. A recent article showed how Botox could produce permanent damage in muscles with normal muscle fibers being replaced with fat cells.

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Norman Marcus, MD - Knee pain, back pain, and muscles

Thu, 26 May 2011 00:00:00 -0500

A large study of army recruits demonstrated the protective effect of exercise on the development of knee pain. Male and female recruits who performed 4 stretching and 4 strengthening exercises for 7 weeks, were 75% less likely to develop anterior knee pain.

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Norman Marcus, MD - Years of pain relief in neck and shoulder with muscle injections

Wed, 18 May 2011 00:00:00 -0500

Years of pain relief in neck and shoulder with muscle injections, when the correct muscle(s) is injected properly.

A patient was seen in 2002 with years of neck pain that radiated into the back of the head and the upper part of the arm. He had failed at attempts of physical therapy. An MRI had shown that there were signs of arthritis in his neck and narrowing of the holes through which the nerves in his neck travelled as they left the spinal cord.

Male Upper Body Exposing Muscles of the Neck

Norman Marcus, MD - Neck and Shoulder Pain - Can an MRI do damage?

Tue, 10 May 2011 00:00:00 -0500

I saw a 56 year old office manager, who I will call Roger, with a 5 year history of neck, shoulder and head pain, which had become much worse in the past year. This is the pain diagram he drew. The darkened lines on the shoulder and upper back are where the pain was experienced.

Norman Marcus, MD - Follow-up to recent Failed Spinal Fusion post

Tue, 26 Apr 2011 00:00:00 -0500

The patient mentioned in the blog posted in March, 2011 copied me on an email he sent:

Norman Marcus, MD - Failed Back Surgery Syndrome

Fri, 25 Mar 2011 00:00:00 -0500

A recent article looks at the problem of persistent back pain after surgery. If you have back surgery and it doesn't work, you are given a new diagnosis, Failed Back Surgery Syndrome (FBSS), occurring according to this article, 30% of the time, but in some studies it is reported as much as 50% of the time. The article goes on to suggest Spinal Cord Stimulation (SCS) to treat the pain, where an electrical device is implanted into your body that stimulates your spinal cord producing a sensation to mask your pain. Another usual option for FBSS is life-long use of strong morphine like medications taken orally or delivered through a pump implanted in your body.

Norman Marcus, MD - MRI, CT, and X-rays may mistake the cause of your pain

Thu, 03 Feb 2011 00:00:00 -0500

MRI, CT and X-rays may fool us. A recent article concluded that the amount of constriction of the nerves exiting the lower spine thought to be the reason for back and leg pain was not correlated with the amount of relief a patient experienced with steroid injections around that nerve(s).

Norman Marcus, MD - Why do you still have pain?

Wed, 19 Jan 2011 00:00:00 -0500

We believe that the medical community and particularly the pain treatment discipline is misguided. The almost complete ignoring of muscle as an important and frequent source of common pain problems has contributed to the growing numbers of chronic pain patients unnecessarily sentenced to a life of pain and medication.

Norman Marcus, MD - Obesity and Understanding BMI

Tue, 21 Dec 2010 00:00:00 -0500

People in all industrialized countries are being harmed by a world-wide obesity epidemic. We generally determine if we are the proper weight by calculating the BMI (Body Mass Index): dividing your weight in pounds x 703 by your height in inches squared. If you weigh 140 pounds and are 5 feet, 8 inches, your BMI would be 21.28-

Norman Marcus, MD - Painless injections.

Fri, 10 Dec 2010 00:00:00 -0500

Pain is a deterrent to many patients when offered a therapeutic injection. There is some encouraging news on ways to make injections more comfortable.

Norman Marcus, MD - Misinformed medical advice may be harmful.

Thu, 09 Dec 2010 00:00:00 -0500

A word in the mouth of a physician is as dangerous as a scalpel in the hand of the surgeon, Eugene Bauer, M.D. 1931

Norman Marcus, MD - Spinal Cord Stimulators- How well do they work?

Mon, 06 Dec 2010 00:00:00 -0500

Results of a 2 year study on Spinal Cord Stimulation (SCS), sponsored by St Jude’s Medical, Inc., found that 70 % of patients reported 50% or better pain relief at their final two-year visit. In addition 88% of these patients reported that their quality of life was improved or greatly improved. No specifics were reported concerning measures of success aside from pain reduction.

Norman Marcus, MD - Vagueness of myofascial pain concepts confuses treatment of non-cancer pain in adolescents.

Mon, 29 Nov 2010 00:00:00 -0500

Persistent pain in childhood and adolescence, as in adults, may be caused by muscles.
Overlooking muscle pain may lead to alternative diagnoses and treatments with sub optimal results. Looking for and identifying specific muscles causing pain in younger patients may allow early successful interventions and prevent chronic impairment.

Norman Marcus, MD - Darvon banned by FDA- Methadone spared

Wed, 24 Nov 2010 00:00:00 -0500

The painkilling drug Darvon (propoxyphene) was banned this week by the FDA because it can cause potentially fatal arrhythmias (abnormal heart rhythms). But other pain medications, like methadone, can also cause dangerous arrhythmias. I have been asked a few times why was Darvon banned, but not methadone?

Norman Marcus, MD - Pain relief, motion, and function after rotator cuff repair may not last.

Fri, 15 Oct 2010 00:00:00 -0500

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:

Norman Marcus, MD - Golfers with pain

Tue, 28 Sep 2010 00:00:00 -0500

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 .

Norman Marcus, MD - Measuring Low Back Pain Treatment Outcomes

Thu, 24 Jun 2010 00:00:00 -0500

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.

Norman Marcus, MD - Is chronic pain adequately treated?

Tue, 25 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - Neck Pain from arthritis? Maybe not

Fri, 21 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - Activity and quality of life

Tue, 18 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - If I get back pain will it go away?

Tue, 11 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - Pain in the Military- Facet arthropathy or muscle pain?

Thu, 06 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - Pain in the Military

Mon, 03 May 2010 00:00:00 -0500

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.

Norman Marcus, MD - Chronic Low Back Pain and Fibromayalgia

Fri, 23 Apr 2010 00:00:00 -0500

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

Norman Marcus, MD - Pain Treatment in 2010

Thu, 22 Apr 2010 00:00:00 -0500

Please refer back to the past two blogs to find the background material for todays blog. Although the number of CARF approved pain centers in the US halved, the number of outpatient pain centers mushroomed. The services provided however focused on two areas-1.Medication management, 2. Nerve blocks and other invasive procedures. Although many patients could be helped with one or both of these approaches, many patients in need of physical therapy and psychological services that were integrated with the overall treatment plan, would no longer receive optimal treatment.

Norman Marcus, MD - Multi-disciplinary Pain Centers rise and fall

Wed, 21 Apr 2010 00:00:00 -0500

John Bonica, M.D. a world renowned anesthesiologist at the University of Washington in Seattle was the individual most responsible for the creation of a new specialty, Pain Medicine. In 1977 The American Pain Society was founded and became the United States national chapter in the International Association for the Study of Pain. Complicated difficult to treat pain patients were usually not successfully treated by a physician representing one medical discipline and thus the multi-disciplinary pain treatment model was created.

Norman Marcus, MD - History of the concept of the spine as the cause of back pain

Tue, 13 Apr 2010 00:00:00 -0500

Back pain can be found in the medical literature as far back as 1500 B.C. in Egypt.

Norman Marcus, MD - History of Back Pain- Don't believe that the newest approach is the best!

Sun, 11 Apr 2010 00:00:00 -0500

Spinal fusion surgery for back pain was reviewed in three articles in the Journal of the American Medical Association this week http://cot.ag/bjDgWW . The sobering conclusions were that we are spending up to 10 times more for complicated new surgical procedures and frequently getting worse outcomes and up to twice as many complications.

Norman Marcus, MD - CBS Early News on MPDD

Mon, 05 Apr 2010 00:00:00 -0500

CBS Newswatch distributed a story on the MPDD to CBS affiliate stations around the country. It showed two patients-one who had an unsuccessful spinal fusion in her lower back and one who had been told he needed a spinal fusion in his neck. Both were better after muscles causing their pain were identified with the MPDD and then treated.

Norman Marcus, MD - History of Muscle Pain

Mon, 22 Mar 2010 00:00:00 -0500

A review of comprehensive pain treatment textbooks finds no chapters dealing with muscle pain aside from sections on "Myofascial Pain Syndrome” discussing “trigger points” as the defining characteristic of syndromes with painful muscles. This points up a fundamental problem in discussing and understanding clinical muscle pain- the lack of agreed terminology to describe what is found when a painful muscle is examined.

Norman Marcus, MD - Spinal Fusion

Sat, 13 Mar 2010 00:00:00 -0500

Norman Marcus, MD - Herniated Discs may not explain your back pain.

Thu, 04 Mar 2010 00:00:00 -0500

In my last blog I told you about the MPDD, an instrument to tell you which muscle causes your pain. But you might have said that doesn’t help me- I have a herniated disc!
My patient this morning said that- his MRI showed the disc and he felt the pain exactly where he thought the disc would be. He didn’t know that in some studies 40% of patients have herniated discs and 70% have degenerated discs and No Pain.

Norman Marcus, MD - MPDD- An instrument to find what causes your pain.

Sun, 28 Feb 2010 00:00:00 -0500

In order to move a muscle and see if it is painful, I developed an instrument with the cooperation of the Stevens Institute of Technology that can move one muscle at a time and find which muscle in a region of the body is the cause of your pain. It is called the Muscle Pain Detection Device (MPDD). It works by being able to stimulate the nerve fibers that produce muscle pain in the area where they are most often found, the parts of the muscle that attach to the tendon and the tendon to the bone as well as stimulating the trigger points.

Norman Marcus, MD - The problem with finding the reason for your pain.

Fri, 19 Feb 2010 00:00:00 -0500

Muscle pain has confused physicians for centuries. Muscles account for half the weight of your body but they are strangely absent from the examination and treatment that you generally get from your doctors. There are many reasons for this, including:
1.    Physicians don't agree on what to call muscle pain,
2.    They don't teach about muscles in medical school,
3.    We don't have a standardized examination for muscle pain, and

Norman Marcus, MD - Why We Don't Do Trigger Point Injections

Tue, 08 Dec 2009 00:00:00 -0500

We believe that the current use of Trigger Point Injections leads to limited results based on problems identifying the proper source of the pain as well as the lack of a uniform approach to treat the identified painful region. Instead, at NMPI we perform muscle-tendon injections, which target the true source of the patient's pain, thereby eliminating that pain and allowing the patient to return to a normal, healthy, active and pain-free life.

What is a Trigger Point Injection?

Norman Marcus, MD - How the Wrong Diagnosis Can Hurt You

Thu, 03 Dec 2009 00:00:00 -0500

"Kathy" is a 50-year-old woman who more than five years ago developed severe pain in her foot and lower leg following fractures to her leg bones. She was diagnosed with Reflex Sympathetic Dystrophy, now called Complex Regional Pain Syndrome. This is a very severe and poorly understood pain syndrome that generally follows some damage to an area of the body. The painful area is very sensitive to even light touch. The skin changes color and may become warmer or colder than the opposite side of the body.

Norman Marcus, MD - Migraine Free After 31 Years of Pain

Wed, 02 Dec 2009 00:00:00 -0500

"Jane" is a 48-year-old woman who came to the office with a 31-year history of migraine-like headaches. These crippling headaches happened at least once a week and could last for up to three days, severely impairing her ability to function.

Norman Marcus, MD - Which Muscle is Causing Your Pain?

Mon, 30 Nov 2009 00:00:00 -0500

A muscle causing pain in your body will often produce pain in an adjacent muscle.

Norman Marcus, MD - Why does pain sometimes appear to move to another region or change intensity?

Fri, 31 Jul 2009 00:00:00 -0500

There are three different mechanisms that affect your pain when it is related to muscles- and that means most of the pain you will experience in your life.

1. Referred pain patterns- Pain may be referred from one muscle to another when the nerves carrying painful sensations in a muscle stimulates the same area in the spinal cord as an adjacent muscle.

Norman Marcus, MD - Pain Medications in the News

Wed, 08 Jul 2009 00:00:00 -0500

Pain that never goes away completely can undermine your quality of life. It can prevent you from particiapting in activities that bring you pleasure and security. The medications that we use to deal with the pain, while being life-savers in terms of providing relief from the suffering, expose us to potential harm.

Norman Marcus, MD - Why Are Muscles Ignored If They Are So Important

Fri, 29 May 2009 00:00:00 -0500

Muscles are thought to be the cause of low back and other common pain problems by some clinicians. Myofascial pain (syndrome), which actually means pain that originates in the muscles and connective tissue (i.e. tendons, ligaments and fascia) is the diagnosis that is frequently used and it is often considered to be the same as trigger point pain. Trigger points are small nodules or knots in the muscle that when pressed produce pain locally and often at a distant area, i.e. a trigger point in the trapezius muscle may radiate pain to the upper arm.

Norman Marcus, MD - What causes my back pain?

Sun, 03 May 2009 00:00:00 -0500

With severe back pain we frequently worry about having a herniated disc. If you have back pain and get an MRI chances are you'll find something. At NY Hospital/Weill-Cornell, 90% of the MRIs of the low back are read as abnormal. But most back pain is diagnosed as "Idiopathic /Non-specific", referring to sprains and strains of soft tissue such as muscle.

Norman Marcus, MD - The Blog to Illuminate and Eliminate Chronic Pain

Mon, 27 Apr 2009 00:00:00 -0500

It is my wish to inform patients and colleagues about the possibilities of eliminating pain even when it is thought to be permanent (chronic) or require an invasive proceedure such as surgery, nerve injections, spinal cord stimulation or a morphine pump to achieve any relief. Our story begins with the recogniton that the current standard of care doesn't work very well. An article in the Jouranl of the American Medical Association (JAMA), in February, 2008, by Martin, Deyo, et al..