http://www.nytimes.com/2008/12/09/health....html?_r=1
"And so, in what is often an irresistible feedback loop, patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it is common for doctors and patients to assume that any abnormalities found are the reason for the pain.
But in many cases it is just not known whether what is seen on a scan is the cause of the pain. The problem is that all too often, no one knows what is normal."
1171 Very interesting reading.
I think the phenomenom has a lot to do with the interaction of the legal and insurance systems with medicine. the drive for "proof" and "cause" as a pre-requisite to payment and coverage has forced this.
lawyers and claims people play as big a role as the patient.
Hopefully a reformed Health care system will reduce such practices.
One of the more interesting recent developments that lends credence to the work coming out of the Cleveland Clinic referenced in the NYT has to do with a japanese study that shows a strong relationship between two particular DNA expressions ( abnormalities ? ) and back pain in the face of degenerative disc disease. Those with a particular haplotype get chronic back pain and those with another do not.
I read an editorial by Alf Nachemson, MD, the world's foremost spine research scientist for 30 years until his death in 2007, that he knows less about the cause of back pain at age 70 than he did at age 35.
As a person who can read x-rays a little bit, I always stand next to my surgeon to read my x-rays & scans...I absolutely hate MRI's...x-rays I'm pretty good at finding the artifacts...
Thanks for the article!
a discogram is the best way of finding out if its truely a disc causing the pain and witch one or ones are the problem.seeing they inflicked pain to find pain and they know what to do from there.just my thoughts as i have had a discogram done and it found the problemed discs.
Hurt:
Literature search on the comparison of MRI and discography,or specificity of discography and it's role on back pain will yield the usual conflicting studies but there is agreement that overall specificity , the opposite of sensitivity, is no better than MRI is MOST studies although there is a role in certain types of spine pathology.
In particular, a number of studies commented on the significant false positive rate; i.e. patients with no history of back pain who report pain on provacative discography.
For those who are not familiar with a good web site for back pain, Spine Universe, here is a link ( that's allowed right ? a certain other site doesn't like factual.data references ? ) that is a summary with commentary on this topic.
http://www.spineuniverse.com/displayarti...e1920.html
Much of what is going on in the back pain literature lately is a discussion of the general failure of early surgery, the tremendous escalation in costs for back pain with no improvement in outcomes over the last 25 years and prevention of needless disability by NOT operating but encouraging life style changes.
my surgery went well and i had fusion taking early.its the scar tissue that wrapped around the S-1 nerve that put me were im at today,it destroyed my S-1 nerve and theres nothing that can be dont,so i cant say my surgery didnt go well.my dr will now find out what its like to be fused as he had to have the same surgery i did,we will see what he thinks of fusion now.
my surgery went well and i had fusion taking early.its the scar tissue that wrapped around the S-1 nerve that put me were im at today,it destroyed my S-1 nerve and theres nothing that can be dont,so i cant say my surgery didnt go well.my dr will now find out what its like to be fused as he had to have the same surgery i did,we will see what he thinks of fusion now.
Hey hurt,
When you see him and if he's in pain make sure you laugh, then tell him it's all in his head.
this was one of the best drs i had he listened and tries to help with meds and so on.but this will be a real eye opener for him and he will see what we say we mean about pain and the other issues we went through.