A Message from Dr. Lasich

A new high tech era for the LIFE Letter has begun. A few years back, I mailed the newsletters to colleagues, now they are electronic and prettier. The content should appeal to both professional and laywomen who are interested to hear the latest in spine and pain rehabilitation.

This year marks an exciting time with the release of my first book, High Heels to Hormones: A Woman’s Guide to Spine Care. Please visit www.christinalasich.com to read more about this mold breaking book which is available on Amazon, Barnes & Noble.com, and at the Book Seller in Grass Valley.

Recently, a handful of practitioners and I attended an addiction medicine class in order to obtain waivers (known as the DEA “X” numbers) for prescribing schedule III medications like Suboxone to treat opioid dependence. The exponential rise in opioid abuse is frightening; but, remembering that pain is still undertreated, I hope that the bad apples will not prevent the appropriate candidates from obtaining responsible pain management. Pain management can save lives. Addiction treatment can save lives. Now, a few of us are better equipped to manage both.

I hope that you will share this newsletter with others who might also enjoy it. Have a momentous day!

On the Journal Frontline: Neck Pain
by Christina Lasich, M.D.

At times, it becomes necessary for the medical community to reflect before proceeding further. Not many people realize that 2000-2010 has been designated the “Bone and Joint Decade” to focus our attention on a healthcare crisis which is “seriously impacting the economic viability of society and draining health resources”. Reviewing the medical evidence related to musculoskeletal pain was delegated to multiple task forces. The Neck Pain Task Force has just released their report on the prevention, risk and determinants of neck pain; its assessment and diagnosis; effectiveness of intervention; and its prognosis. This information does not pertain to neck pain associated with tumors, infection, rheumatoid arthritis, fractures or other serious disease. This information relates to “soft tissue” neck pain found with whiplash injuries and occupational injuries or common neck pain found in 15% of the general population. This momentous evaluation should reshape the way doctors and patients regard neck pain and reshape the way we use newer technology and alternative treatments.

One of the most widely utilized technologies for assessing neck pain is the MRI. The Neck Pain Task Force very clearly outlines the limitations of the MRI for identifying the cause of neck pain. The positive MRI findings of degenerative disease do not correlate with neck pain. Additionally, the MRI does not accurately detect minor trauma. Ultimately, in the absence of suspected major trauma or nerve damage, the MRI is a costly technology that is unnecessary.

Electrodiagnostic testing is another diagnostic tool that should only be used under when nerve damage is evident with a thorough exam. Discography is another newer technology that poorly predicts the pain generator and does not improve the outcomes. The Neck Pain Task Force also states that “there is no evidence supporting the validity of diagnostic facet joint or medial branch blocks in diagnosing cervical facet joint pain as the primary cause of disabling neck pain”. Discounting new technology is not the goal of this comprehensive review; but its message is clear. This panel of experts urges clinicians to primarily assess with a good history and physical examination and diagnose using descriptive categories instead of trying to find the exact cause of pain. Appropriate care does not rely on an exact diagnosis in many non-emergent types of neck pain.

The Neck Pain Task Force report evaluates neck pain treatments and these findings could shake traditional medicine to its core. Some alternative treatments for neck pain have very good scientific evidence supporting their use while other more traditional treatments have weak evidence. Both acupuncture and laser therapy have reliably outperformed the placebo effect, other treatments that are recommended by the Task Force include exercise, mobilization, manipulation and reassurance. Surgery and epidurals are only recommended for those with definite signs of nerve damage or major structural damage. Much money has been wasted on Botox injections, magnets, collars, radiofrequency ablation, and neck joint injections. If scientific studies do not find a treatment effective, our precious healthcare dollars should not be spent on that treatment.

The Bone and Joint Decade Task Forces are taking the common practices for assessing and treating musculoskeletal disorders to task. Doctors and patients are lured by the promise of technology and the hope of alternatives. Medicine then becomes a bottomless pit without scientific evidence supporting the practice. Good scientific principles, beyond the reaches of politics and profits, will help save healthcare from going down the drain.

LIFE Quotes

“Dying is easy... Life is an athletic event that you need to train for.”
– Jack LeLanne, age 93"

In the News

jacklalanne.com

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An Exercise Old-Timer Shares Some Of His Secrets With Sunday Morning's Emily Senay

(CBS) Forget frail old age: A growing number of aging baby boomers have discovered the world of serious weight-training. From overweight folks who just want to feel better to dedicated 60-plus bodybuilders, the weight machine has become the new rocking chair. In a report by Sunday Morning correspondent Dr. Emily Senay, we meet the current senior National Bodybuilding Champion, a Manhattan gerontologist who preached a healthy lifestyle for years and is now taking her own medicine, and the legendary figure behind the modern fitness industry, Jack LaLanne. read article

Apothecary Corner