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| |  Many Americans With Chronic Pain Misdiagnosed NEW YORK -- July 17, 1997 -- New treatments are being developed to alleviate pain, but many Americans may never be diagnosed properly in the first place, according to Nelson H. Hendler, M.D., M.S., clinical director of Mensana Clinic in Stevenson, Md. Dr. Hendler also says misdiagnosis may occur in one-third to two-thirds of all cases, based on existing medical research and research he and a colleague performed by following the course of 180 chronic pain patients involved in litigation. The results showed the overall rate of inaccurate or incomplete diagnosis at referral was 40 to 66.7 percent. Dr. Hendler spoke today at an American Medical Association (AMA) briefing on pain. He is also a part-time faculty member at The Johns Hopkins Hospital, Baltimore, Md. "What some patients receive from their physicians are descriptions of the problem, rather than diagnoses -- descriptions such as 'chronic pain,' 'muscle spasms' and 'low back pain.' This happens when the physician is unable to identify the reason for the cause of the problem. Other diagnoses ascribe the pain entirely to the patient's mind, such as psychogenic pain, dismissing the possibility that there could be a legitimate cause," he explains. Dr. Hendler says physicians too often rely on tests for determining the cause of chronic pain. "A lot of doctors are using MRIs or CT scans to make a diagnosis instead of using clinical judgment." Dr. Hendler says an equally disturbing fact is that anatomical tests are often favoured by physicians over physiological tests, which are more likely to pinpoint chronic pain. "As an example, an electrocardiogram (ECG) is used to check the pathology of the heart rather than an MRI or CT scan,” he said. “This is because there are electrical abnormalities in the heart, not anatomical ones. “Now, let's use this analogy and compare it to some types of chronic pain,” he added. “If you damage a nerve going down your leg and you take an anatomical picture of it with an MRI, you can't necessarily tell if the nerve is damaged. You'll see disc damage, but not nerve damage. Instead, you have to use a physiological electromyogram nerve conduction study. This can locate the actual site of nerve damage. Facet blocks and provocative discometry may provide more valuable information." New Treatments for Chronic Pain Dr. Hendler says 55 percent of the patients he sees are referred to surgery because appropriate testing has pinpointed a correctable problem. "For those who don't go on for surgery, there are a variety of techniques for dealing with the pain,” he said. “It is a matter of matching the appropriate treatment with the cause of the pain. But you can't do that until you have accurately diagnosed the cause of pain." The latest therapies to treat chronic pain include a variety of methods to block the perception of pain in the brain, ranging from group therapy and biofeedback, in some minor cases, to heavy medications such as anticonvulsants or vasodilating drugs, depending on the source of the pain. He tells of one promising solution -- conotoxins -- that come from sea snails, "It is fairly specific and has been used in clinical trials for blocking the message of pain to the brain. All types of pain seem to respond to this. So far, only implantable devices work for this, but other forms may become available." "For certain disc problems, eventual fusion using a titanium cage can be done laparascopically with incredibly fast healing times versus the three to six month healing time of conventional fusion surgery,” he said. “The surgeon comes in from the front of the patient and puts a little titanium plug, similar to a hollow screw, in between the disc space. This is packed with bone and it grows in place and provides a fusion." For those with severe untreatable diseases, Dr. Hendler says, a radical but effective pain blocker called epidural stimulators are used. These wires are implanted over the covering of the spinal cords and electrical stimulation is delivered across the skin.
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