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Unnecessary Spinal Surgery Will Waste Billions In 2009

2009-01-09 08:43

During 2009, millions of Americans will undergo unnecessary and costly spinal surgeries and injections or be given mind-altering drugs that fail to eliminate their back pain -- unless their physicians recognize and treat the actual source of most back pain, says pioneering pain specialist, Norman Marcus, M.D.

It's muscles, not the spine, says Dr. Marcus.

Back pain is the most common disabling pain experienced by Americans, and, according to the National Institutes of Health, eight out of ten people will suffer from it during their lifetime.

Dr. Marcus is Clinical Associate Professor in Anesthesiology and Psychiatry and Director of Muscle Pain Research at the N.Y.U. School of Medicine, a past president of the American Academy of Pain Medicine and founder and medical director of the Norman Marcus Pain Institute, which is dedicated to pain elimination, rather than pain management.

He says that despite more healthcare dollars than ever being spent on back pain ($86 billion yearly, almost equal to what is spent on cancer, according to a study published in the Journal of the American Medical Association), treatments are failing, more people are suffering and the number who report that their pain is limiting their ability to function is increasing. The study makes it clear that the battle against back pain is being lost.

In addition, the annual productivity loss from chronic back pain is approaching $30 billion.

The reality is that most back pain originates in weak, stressed or damaged muscles, not in the spine, says Dr. Marcus, who has shown that muscle pain can be successfully treated without surgery or drugs.

Although muscles constitute 50 percent of the body, they are rarely even considered as a possible factor in low back pain, neck pain and headaches, says Dr. Marcus, who has found muscle involvement in over 75 percent of the more than 10,000 pain patients he has treated.

With the assistance of New Jersey's Stevens Institute of Technology, Dr. Marcus has developed a muscle pain detection instrument that enables physicians to identify and then treat the specific muscle (or muscles) causing low back, shoulder or neck pain. The device is considered revolutionary because it provides a standardized method for accurately diagnosing muscle pain.

The clear superiority of the instrument in detecting the muscles that may be contributing to back pain was demonstrated in a double-blind, randomized, controlled trial at the NYU School of Medicine and will be presented January 28-31 at the American Academy of Pain Medicine's 25th annual meeting, in Honolulu.

After his device identifies the muscle (or muscles) among the 25 or more muscles that could be causing the patient's pain, his treatment includes a program of simple exercises and, when indicated, injections that soften the muscles and make them flexible -- and pain free.

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Dr. Marcus believes that a large percent of all spinal surgeries are unnecessary (spinal fusions are being performed as many as 20 times more often in some parts of the United States as in others) and finds it "disturbing" that the number continues to grow yearly.

An estimated 1.2 million spinal surgeries are performed in the U.S. each year, and, according to the National Center for Health Statistics, more than 300,000 of them are spinal fusions, at an average cost of approximately $60,000 each.

And the spinal products industry is experiencing meteoric growth. Worldwide sales went from less than $100 million in 1990 to $3.5 billion in 2004 and more than $6 billion in 2007.

Recent studies show that the failure rate for back surgeries is extremely high (50% in some studies), prompting a new diagnostic category for the failures: Failed Back Syndrome, the only such diagnosis in medicine.

Dr. Marcus notes that most MRIs of the low back are read as abnormal, frequently with herniated or bulging disks, and that as many as 50 percent of people with herniated disks have no back pain, while as many as 70 percent of those with degenerated lumbar disks have no pain. He cautions that, conversely, discovering herniated or degenerated disks in the spine of a patient in pain should never automatically lead to the assumption that the pain is originating from those disks.

"Reliance on invasive techniques, such as spinal fusions, and implanting spinal cord stimulators and morphine pumps without even determining if there is a muscle component can result in surgeries that are doomed to fail and to prolonged suffering," says Dr. Marcus.

Dr. Marcus says he owes both his recognition that muscle weakness, stiffness, tension and hardened knots (trigger points) are the primary causes of back pain, and his non-surgical pain elimination treatments to the five years he spent working alongside the late and legendary Dr. Hans Kraus.

Dr. Kraus was the physician and rehabilitation specialist who eliminated most of President John F. Kennedy's crippling back pain, is recognized as the father of sports medicine in America, developed landmark tests that evaluate muscle strength and flexibility and a series of exercises to correct muscle weakness and stiffness, and was responsible for the largest and most successful back treatment program ever conducted.

Dr. Marcus says he is not "a surgical nihilist" and has prescribed back surgery when it was clearly indicated.

He says he believes that sharing his new approaches to the evaluation and treatment of muscles with his medical colleagues could lead to more effective treatments for the majority of back pain patients.