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Mon, Dec 22, 2014

Referred pain can often be misdiagnosed

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In recent years it seems that I have spent a good part of my weekly study time on understanding pain.

Fortunately that is because over the past decade a tremendous amount of research has emerged on the topic of pain.

Because of advanced imaging and enhanced communication between researchers through the internet and other opportunities, more is known now about the origins of pain than ever in the history of medicine.

Although there is still much to be done to understand what causes pain and how it can be resolved, today there are many more options available than in previous years.

One of the most fascinating topics in pain research of late has been that of referred pain. Specifically, researchers continue to try to pin down how the body’s neurological system works when pain is actually originating from an anatomical site other than where it is felt.

Because the origin of pain can often be elusive, it is possible that pain can be misdiagnosed, often for years. For example, when a patient complains of pain in the shoulder area, the clinician usually examines the shoulder. That makes sense and is often all that is necessary to determine the cause of the pain.

However, in many cases the actual origin of the pain may be somewhere other than where the patient feels the pain. This is especially true for chronic pain.

Let’s go back to the person with shoulder pain. If that person has recently injured the shoulder in a specific trauma, incident or accident, it is often a very straightforward process to do routine examination testing on the affected shoulder and immediately find the problem. However, for some patients that feel pain in the shoulder, the shoulder is not the source of the pain. Therefore all treatment directed to the shoulder will be ineffective.

In the case of shoulder pain, often the pain is the result of problem in the neck.  This is not a newly discovered possibility but it is one that is often overlooked. As far back as 1938 a medical researcher named Kellgren published studies in which he experimentally injected 6 percent saline (salt water) into the joints of the lower neck and the patient felt pain that seemed to be coming from the shoulder muscle.  This experimental evidence was repeated multiple times with identical outcomes.

Kellgren also experimented by injecting the saline solution into each joint of the spine and the subject responded that they felt the pain in a different body part than near the spine. For example, in the middle back the patient would feel the pain in the side or flanks and if the solution was injected into the lower back the subject would feel pain in the legs.

It is important to note the subject did not report any pain in the back or neck, just in the referral zones.

This type of research confirms that spinal problems can cause pain in areas other than the back and that the spine should be evaluated in all cases of chronic pain.

More recently, a medical researcher named Chan Gunn reported treating 50 cases of elbow tendinitis with complete resolution of symptoms without treating the elbow. In each case he treated the spine.

Dr. Gunn’s theory is that all cases of chronic pain involve spinal nerve roots. In his case, he used a type of treatment similar to acupuncture to resolve the pain.

Because of Dr. Gunn’s approach focusing on the spine one might imagine him to be a chiropractor. Actually he is a medical doctor that was working and teaching at the University of Washington in Seattle. He is considered to be a world renowned medical expert on pain.

In 2001, Dr Gunn was awarded the Order of British Columbia, and in 2002 he became a member of the Order of Canada, the Nation’s highest honor. In 2007, Dr. Gunn was also admitted as a Companion of the Guild of Cambridge Benefactors and elected as a Fellow of the Royal College of Physicians.

In the seminars that I teach to doctors regarding pain I focus considerable attention on Dr. Gunn’s research. In our clinic we have used this approach to resolve difficult pain for many patients.

If you know someone with chronic pain, it may be in their best interest for you to suggest that they seek a second (or third) opinion. For many patients, alternative solutions can be helpful, but not all clinicians are up to familiar with these approaches.

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chiropractic, doctor, dr., kellgren, mark kestner, pain
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