Pushing MRI and Pain

The real question is, are you certain that particular finding on an MRI is new? You can differentiate between an old or recent injury by the changes around it, which will tell you that it had been there for years. You can see the lack of edema, or lack of swelling around it. It may be at the wrong level or may be on the wrong side, but the doc went ahead and operated on it anyway, because that’s what they do.

The question has to come down to causality. Did that herniation result in that problem, or did that accident cause that herniation? Then comes the next question, is that if it did, how do you prove it? And there are ways to do that. There are provocative tests that you can do. My favorite’s called an NCV. You can do something called an SSEP, or you can do an NCV. These are all electrical tests, and what you look for is irritation of the nerve routes that bounce off those spots. And if you can identify a single location or a pair of locations on one side, then you know pretty well that that might be the issue. If it has the right age markers attached to the signals, otherwise you’re looking at something that had been there forever and God help you, because you pulled a muscle in your hip, and now your back’s going to get operated on. And when it’s all said and done, you’re going to have two problems–one that you had before, the second one that we caused, and then if you’re, if you’re like everybody else, two or three years down the line you get the next surgery and then the next surgery, and then the next one. That’s predictable.

When I was at Duke, we were taught general surgery, where we were taught two things. We were taught one, you can train a monkey to do surgery—but what you trained a surgeon to do is judgment. We all thought, “Oh, everybody has good judgment.” Not so true. And the second thing, is that you never operate on a back or neck for pain alone. You have to have loss of muscle, bladder or bowel function. If you do that, then your odds of improvement increase, but if it’s just for pain, you’re cannon fodder.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.