Letter from Scott Greenberg, MD

Scott Greenberg MD practices Prolotherapy in Cheery Hill, New Jersey

Why can’t conventional medicine find your pain? Pain is often misunderstood and mismanaged in traditional medical settings.

While many of us hurt or have hurt to various degrees during our lifetime, there is no traditional test to ‘quantify’ our pain, nor does the series of happy and sad faces to describe our pain level aid in finding adequate relief from our symptoms.

What we have lost in medicine is our ability to examine the patient, correlate the examination with the patient’s symptoms, and lastly consider the diagnostic tests. Instead, we as patients enter the system of pain treatment, done almost as a mass production protocol involving first a trial of anti-inflammatory medication and then physical therapy. If these ‘conservative’ measures fail to provide relief, it’s off to see the surgeon, where the decision is made to have either surgery or pain management.

As a physician, I never wanted to manage pain, nor would want, as a patient, to have my pain managed. Having suffered with pain myself, I could not even imagine living the rest of my life in chronic pain. So why are we so far off the mark with treatment of pain? I think that the answer lies in two important factors. First, we are overly reliant on diagnostic tests. Secondly, we have lost the art of physical examination.

Take, for instance, the case of lower back pain. It is one of the most common causes of pain and disability in the world, but often misunderstood. Why? Because most cases are due to musculoskeletal conditions such as sacroiliac joint dysfunction, pyriformis syndrome, or facet joint arthropathy. Such problems are not seen on MRI, CT, or X-rays, thus a clinician without expertise in curing these conditions will not be able to effectively manage them.

Even though we have access to the greatest diagnostic tests in the world, we as physicians need to use our clinical judgment to determine their significance. For example, the majority of healthy people who do not have any back pain at all will have degenerative, bulging, or herniated discs in their lumbar spine. But if you do have pain, the job of your physician is to determine the relevance of your test results. It is not a black and white issue in what may be causing your pain.

So how do we determine what the best treatment courses are for our patients? First we must listen to our patients and ask the right questions—where is the pain, where does it travel, is there any numbness or weakness? What makes it better and what makes it worse? Are there any ominous signs like loss of bowel and bladder function, fever, chills, weight loss, and so on.  From our questions alone, the skilled physician should be able to determine 85% of the diagnosis, and then confirm it with physical examination.

The examination is key to determine and confirm the root cause of pain, and unfortunately it is becoming a lost art. Many of my patients have told me they were recommended to undergo surgery with either a very brief exam or no exam at all. I find this to be a disservice to patient care that can only lead to bad outcomes. The physical exam is not without its faults, and to be reliable must be performed with experienced hands. Palpation of ligaments, tendons, and joints is a skill and an innate gift to those that possess the ability to acquire its skill. Skilled hands have the ability to determine damaged, weak, and painful joints from those that are normal. This critical tool allows us to incorporate all of the information about a patient’s condition and formulate a treatment plan.

There is no one size fits all formula to treat a pain condition. However, most pain and sports injury conditions are curable, in the right hands, with reconstructive and regenerative treatments such as Prolotherapy. I found my way to a complete cure after suffering for over 10 years, and I wish you the best in finding your solution, as it exists. If not then hold on tight as we are working on new solutions and treatment options to cure pain and arthritis, all without ever going under the knife.

Scott Greenberg, MD

JOP Comments

Well said Dr. Greenberg!

Obviously, one of the messages we are trying to promote here at JOP is that pain can be resolved, whereas just managing the pain by other methods will leave the underlying disease process untouched, free to continue to worsen. Prolotherapy is one method of treatment that has the potential to stop and reverse the underlying degenerative process. The net result is pain resolution, not pain management!