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Identifying Pain Generators

June 21, 2019

So let’s talk about a little bit about the past, a little bit about the future of low back pain. And is there something right now that’s marvelous on the horizon that’s going to make everybody’s low back pain better? If there is, I’d certainly like to see it because right now there is a lot of research going on. There’s a lot of interest in terms of the neat things that we have in terms of screws and rods and X staples and things like that that we can put into spines. But remembering the nodal back pain is surgical. So ultimately there probably two avenues that are going to be of interest. The first avenue is imaging and identifying pain generators. A pain generator is the thing that’s causing the pain. And when someone has a rupture disc our MRI shows, ooh, that’s the pain generator. When someone has that pain that goes down the leg with walking, that’s the Lumbar stenosis. CT or MR show us that. Ooh gee, that patient had pain lying at night in bed. The EMG shows us that it’s their peripheral neuropathy from their diabetes. So those are that we can identify those pain generators in gross waves, but we’ll get better and better. We’ll have more and more things that can identify things that are in soft tissues and think back 15 years people were very interested in something called thermography, which was to take photos as it were or images on a screen and see what the various temperatures were in various portions of the body and try to then postulate if those areas were sick. And those images, of course were very gross because you were looking at surface temperatures and to some degree temperatures that were further in, but you really weren’t getting to the heart of that. But think if you can use the same MRI technology that we now exploit water molecules, but somehow we can figure out places that hurt or maybe we can do an MRI and we can give somebody something in their veins that goes to only places where inflammation has taken place and we can identify those. So we might be able to identify places that we have our low back pain from the arthritis that’s in the actual joints of the low back. I mean, you see that it’s on the left at L3-4 but it’s not on the left at L4-5. So imaging and identification of the pain generators is one avenue.

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