The December 2014 National Institutes of Health (NIH) Task Force report on chronic low back pain conveyed:
“Chronic low-back pain (cLBP) is common and has a major societal impact. Despite rapidly increasing use of medications, injections, and surgery, functional disability has increased in recent decades.”
“Given the current state of knowledge, classifying cLBP by its impact is more feasible and potentially useful than attempting classification solely by pathoanatomy or physiology. Impact of cLBP will tentatively be defined in terms of pain intensity, interference with activities, and physical function.”
The NIH has now announced to the American healthcare system and the American public that current overreliance on “objective” spinal imaging and neurological test results does not provide useful “diagnostic” information. The current strategy does not allow patients complaining of neck or back pain to be accurately classified into the subtypes needed for proper treatment decisions. The results of this strategy have been and will continue to be that far too many lives are damaged needlessly with devastating human and social consequences from unnecessary surgical intervention and damaging prescriptions.
The implications are profound for stakeholders dealing with the epidemic of musculoskeletal pain. All medical treatment and subsequent outcomes are founded on the idea that the person’s condition should be accurately “diagnosed” [or in other words ‘classified’]. Like most patients going to their physician with a painful condition, I want my problem properly classified, accurately treated, and cured if possible. Unlike the NIH recommendations, I don’t want to suffer waiting until my life becomes severely disrupted with intense pain, lost function, and diminished activity before my condition is classified or diagnosed. I want my treating physician to guide me back to health and physical independence as quickly as possible.
By publicly acknowledging that spinal pain [and by extension many other musculoskeletal conditions] cannot be classified/diagnosed by “pathoanatomy,” the US government’s most distinguished scientific medical body has once again informed physicians and patients that MRI and CT scan results do not provide “the diagnostic answers” for musculoskeletal pain. You do not hurt just because you have bulging/herniated discs or facet arthritis (as physicians have been telling patients for several decades). Looking back, it is not surprising that increased use of spinal surgery, spinal anesthetist injections, and opioids have created increasing disability and suffering. Physicians have been heavily relying on these “compasses”, now proven inadequate to help patients correctly navigate the musculoskeletal ocean of pain.
There is an interesting analogy to this complex situation in a book, Longitude by Dava Sobel. The technique for monitoring latitude [how far north/south of the equator] was available for a thousand years. Until only a few centuries ago, ocean ship captains had no method to measure their longitude [how far east/west]. The inability to accurately know the east/west location caused thousands of ship wrecks, lost lives, and lost fortunes. Longitude described how a watch maker invented an elegant but straightforward technology allowing the proper assessment of longitude at sea. This new technology, when combined with the modern compass, permitted a ship’s captain to know his location in mid-ocean and steer his ship and cargo safely to its destination. It was far safer than blindly navigating, hoping to reach one’s destination. Once a shipped hit the rocks and sank, it was too late to develop new strategies, and useless to assess the outcome.
This sea-faring comparison is applicable to dealing with chronic pain. Ocean navigation is multidimensional. One needs first and most importantly to classify a ship’s location in terms of latitude and longitude. Thereafter one 4330 West Broward Blvd., Suite F, Plantation, FL 33317 954-584-4996 (O) 954-587-4018 (F) www.neuropasglobal.com must analyze other influences such as the ship’s origin and destination, the ocean currents, the prevailing winds, and what weather lies ahead. Similarly, the physician must have a reliable “compass” that enables him to understand the patient’s needs and select the right course toward the best outcome.
Pain is multidimensional. By scientific definition, pain is “an unpleasant sensory, emotional experience associated with actual or potential tissue damage or described in terms of such damage. The three dimensions include the “physical sensory;” the “emotional [or psychobiological];” and the “sociodynamic”, the factors that may influence the specific pain patient’s safe journey back to health. These factors are like the currents, winds and tides that influence direction. The first goal is to diagnose [or classify] the patient’s pain experience and how it is affected by these three factors. Then the best course toward a safe and effective outcome can be plotted and navigated.
Rather than classifying pain patients according to how lost they are [pain intensity] and their outcomes [lost function and diminished activity], it is essential to start using a more complete “compass” to guide physicians and patients through the foggy ocean of refractory musculoskeletal pain treatments. Until then, too many lives will be damaged by the uncertain advice provided by physician captains who are deprived the necessary information. Performing research on the outcomes of such damaged lives may be expedient but is unlikely to help the individual patient when it is most needed – now. Einstein said “insanity [is] doing the same thing over and over again and expecting different results.”
Fortunately a reliable compass now exists. The Neurophysiologic Pain Profile [NP1 and NP3] technology is an extensively vetted, award-winning, non-invasive and objective pain assessment tool. Test results allow the physician to better classify the chronic pain patient within the three dimensions of chronic pain. The results locate the lost pain patient and allow the healthcare system to better guide them back safely and effectively to recovery.
Implementing these assessments and then refining treatment paradigms based on the results is a more logical and rapid method to improve outcomes. The NP1 is designed for use early in cases to prevent individuals from going in the wrong direction and becoming lost in the foggy ocean of musculoskeletal treatments. The NP3 is designed to help lost individuals find more effective and safer ways to stabilize and navigate towards resolution of their pain.
In summary, the NIH has confirmed the problem. Chronic spinal pain [and by extension, most chronic musculoskeletal pains] cannot be adequately classified [or diagnosed] by “pathoanatomy.” i.e., imaging tests. If patients are not to become lost and damaged within the ocean of aggressive treatment options currently used, health care providers need to adopt the NP1 and NP3 as the new compass that better identifies an individual patient’s treatment and rehabilitative needs. NeuroPAS Global’s NP1 and NP3 are valid assessment tools that provide a more complete and accurate compass to help physicians navigate their patients back to health and more functional lives. It determines a more definitive course heading (direction) to assist claims’ adjusters, nurse case managers, and corporate claims and risk managers in ensuring physicians’ medical treatment plans are steered on a proper course towards case resolution.
NueroPAS Global, LLC