The real cost of neglect

I wish I had a dollar for every time I was told by a patient: “My doctor said that there was nothing that could be done for my problem, so they gave me these pills for the pain.” I consider this to be neglect of the highest form. To me, when someone tells their patient that, it often means that they were too lazy or poorly informed to look for other choices.

Having said this, I certainly acknowledge that there are circumstances where use of medications for the control of pain is the last alternative, but it should always be just that - the last alternative. I suggest that for the number of patients coming into our offices regularly taking medications for their aches and pains, for the most part, their use essentially serves to mask the discomfort. It provides symptomatic relief with little evidence of regard for the long term consequences of failing to deal with the offending cause. Let me explain!

What actually is the purpose of pain? The International Association for the Study of Pain's widely used definition defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage; however, due to it being a complex, subjective phenomenon, defining pain has been a challenge. In medical diagnosis, pain is regarded as a symptom of an underlying condition.” In essence what this means is that pain is the body’s way of telling us that there is something wrong. It is a neurological sensation, warning us that if a particular offending activity or cause of the insult is not dealt with, there is a real risk of serious or potentially life threatening damage.

So, what happens when we take medications for pain but fail to address the underlying cause of the discomfort? The simple logic here is that it will inevitably get worse. Now I am not talking about taking the occasional drug to deal with a headache or random transient injury. I am dialling in on the people using medications to dull the pain associated with longstanding mechanical insult involving weight bearing joints and their related tissues with the belief that what they are doing is helping their problem. Nothing could be further from the truth. In fact, this is akin to putting a piece of tape over the engine warning light on your dashboard hoping because you no longer see the problem indicator that the issue is no longer there. It is insanity.

Here is an example of what inevitably happens when you take a symptom based rather than corrective approach to your health. Mr. X hurts his knee rounding first base while playing slow pitch. Initially the joint got a little swollen, after the game he went home, puts some ice on it and took some ibuprofen for the pain and went to bed. The next day, he is still suffering so he continues to ice and take more meds. After a few days, the swelling starts to go down and the pain is just there with activity and at night. Over the next few weeks the condition appears to be getting better except when he plays ball. After playing, the knee again swells a bit and is sore the next day. After about 6 weeks, he makes an appointment with his physician who looks at it, takes some x-rays which come back negative and prescribes stronger medications for the pain and swelling. This seems to aid with the symptoms and Mr. X carries on with life. Six weeks later he is rounding first again, and this time experiences a lance-like pain on the inside of his same knee and immediately drops to the ground. On this occasion it is crutches for 3 weeks and more meds. Over the next few months the condition again improves but he can no longer run and even walking up stairs causes some discomfort. The knee aches at night requiring more medication to allow him to sleep. Fast forward and it has now been over a year on and off with the injury. More diagnostic studies are done of the knee demonstrating emerging arthritic changes and a course of therapy is prescribed. The condition again appears to resolve, but the knee pain persists especially after activity. Mr. X decides to explore other alternatives for his problem and approaches our office.

During the course of the consultation, Mr. X noted, that prior to the initial knee injury, he had experienced some minor discomfort in his lower back on that same side. He noticed it more after prolonged sitting and since it never seemed to affect him with activity, he just chalked it up to “one of life’s aches and pains.” This led us to examine the whole mechanical chain (low back to foot) for underlying mechanical distortions which may potentially involve his affected knee. What we found was not only fascinating but ultimately proved to be life changing for Mr. X. 

As we examined his affected knee, we noticed a minor lateral shift of the knee cap which led us to examine his hip and pelvis. This revealed a significant pelvic shift involving the sacro-iliac joint on the affected side. The nature of this dysfunction is to create an internal rotation of the lower leg, predisposing the knee to strain and injury. Further examination of the foot and ankle revealed a dropped arch on the affected side which again would precipitate a shift in knee mechanics.  In essence reflecting the old saying: “the knee bone’s connected to the thigh bone…” At the end of the day, we worked to stabilize the pelvis and arranged for a certified pedorthist to build corrective arch supports for Mr. X and low and behold, the knee stabilized. The next spring he was back playing ball without issue. My question to you the reader would be: Where do you think Mr. X would be if he continued his original treatment path?

The purpose here is not to bash the use of pharmaceuticals, but rather to help readers understand that the use of pain medications as a stand-alone treatment is a dangerous course of action. Drugs for pain, used in conjunction with the appropriate therapy is reasonable, but without a corrective approach to deal with what actually precipitates the discomfort will inevitably lead to bigger and more life altering problems. This is just logic.