Pain Research and Management

Biography

Biography: Nelson Hendler

Abstract

Chronic pain patients are misdiagnosed 40%-80% of the time, according to research from Johns Hopkins Hospital physicians. The most common of these misdiagnoses is sprains or strains, which are listed in medical textbooks as self-limited disorders, which resolve in less than three weeks without treatment. Yet these diagnoses account for over 50% of diagnoses in patients with pain for more than three months. On the other hand, certain diagnoses are overused, and misapplied without attention to published diagnostic criteria. Therefore, complex regional pain syndrome (CRPS) formerly called reflex sympathetic dystrophy (RSD), and fibromyalgia, are over diagnosed 71% to 97% of the time, to the detriment of the patients. The leading causes of these errors in diagnoses are: failure to take a complete history and using the wrong medical tests. As an example, MRIs fail to detect damaged discs 78% of the time compared to a provocative discogram, and CT fail to detect bony lesions 56% of the time compared to 3D-CT. Two expert system internet questionnaires are discussed. The pain validity test predicts the presence of abnormal medical testing with 95% accuracy, which validates the complaint of pain, and detects drug seeking behavior. Another internet based expert system the diagnostic paradigm, provides diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital physicians. The associated treatment algorithm recommends the appropriate tests to use for confirm the correct diagnosis. The value of these two systems is documented by published outcome studies, which demonstrate patient improvement rates far higher than other methods. These publications report cost savings $20,000 to $175,000 a case, with an 89% reduction in narcotic use, and a 45% reduction in doctor visits. Between 50%-63% of patients need surgery to improve.