Orthoapedic Medicine is a branch of Physiatry aiming at diagnosing and treating skeleton related disorders, acute or chronic, which may not be eligible for surgery.
Still today, many people suffering from vertebral and articular pains often undertake a sort of pilgrimage seeking the advice of specialists in search of a solution to their problems which, if not of surgical competence, will often be disregarded as being of arthro-rheumatic, fybromialgic or even psychosomatic origin.
These people, mainly elderly, are almost abandoned to themselves, too often tricked into a downward spiral of drugs such as anti-inflammatory, antirheumatic, antineuralgic, antiepileptic, anti-depressive drugs, in search of a miracle cure. By doing so, unfortunately, the only result will be to further enlarge the ranks of people suffering from chronic pain. As evidence of this we should look no further than the queues of patients filling our practices.
The major problem behind these painful skeleton related disorders for a long time defined as arthritic, is that this generalist definition really hides within a multi-factorial origin concerning, in 70% of cases, the connective structures of our organism represented by muscles, tendons and ligaments.
So then, what do these people really suffer from, which are the structures affected, is there a solution?
These are just some of the question we must seek when facing our patients to objectively identify the disorders and find a possible solution.
Nowadays we can avail ourselves of many diagnostic tools which help us to investigate the soft tissues. New diagnostic technologies which not so long ago seemed belonging only to science fiction. We must, however, bear in mind that the first and foremost important tool is the clinical diagnosis since instrumental diagnosis is not a valid substitute of our brain, eyes and hands.
New diagnostic technologies help us to better define the anatomy of the soft tissues but, if on one hand we can now better outline some pathologies, on the other they may also evidence pathological issues sometime silent or not directly involved in the pathological state under examination. This has often led to highlighting false targets which, if unproperly treated or approached in a fierce manner, may further aggravate the real pathology.
All painful disorders have their own cause, pathogenesis and a specific medical history thus a proper anamnestic evaluation, clinical overview and accurate palpation exam apt to collect enough useful elements, must be sought to draw up a proper therapeutic programme.
Physicians have always tried, well before the advent of technology, to localize the structure responsible for pain by trying to interpret the pain itself through palpation and appropriate semeiological maneuvers.
Traditionally rehabilitation medicine, when facing muscular-skeletal pathologies, always embraced a quite minimalistic approach considering the degenerative arthritic condition just as an inevitable event due to the normal ageing process hence to be treated with suppressive therapies.
Rehabilitation Medicine has always been concerned with treating these disorders with conventional drugs aimed at reducing the symptoms rather than treating the origin of the problem: anti-inflammatory steroids, muscle relaxants and chondro-protecting drugs.
The real problem facing us when confronted with patients suffering of muscular-skeletal pain, is to identify in which structure the problem originates to enable us to conceive a targeted treatment, according to our therapeutic knowledge, which considering the somatopsychic characteristics of the patient, will ensure pain relief and minimize future recurrences.
During my medical career as a Physiatrist, more than 30 years long, I have found it useful and necessary to combine clinical diagnostic methods aimed at localizing the true origin of pain together with therapeutic methods apt to specifically treat the area concerned.
The diagnostic path, when facing such patients, may begin by an in-depth study by the way they walk, the whey they speak, how they describe their concerns. An accurate medical history can give us a hint of the current difficulty and a palpation examination, and eventual instrumental diagnostic exams, may bring to a more accurate clarification of the given problem.
In industrialised and developing countries, chronic pain caused by postural deficit, articular degeneration, ligament, tendon and cartilage disorders, produces social disparity, emotional instability and depression, more than any other degenerative or infective pathology. Chronic lumbosacral pain, for example, may be responsible for a serious restriction in social life which may cause serious depression affecting quality of life which in turn will significantly increase costs in health management.
Lumbar sacral, back and cervical pain, hip, knee, head whiplash, carpal tunnel, Morton Neuroma, post-surgical pains, are pathologies too often not properly treated and highly debilitating.
Who, then, really benefits from these chronic pains?
Easily explained: The Pharmaceutical companies. Thanks to their false advertising campaigns they trick people into believing that there is some miraculous drug which will dissolve the pain. Not forgetting some unscrupulous surgeons who, by offering easy surgery, may seriously and irreversibly damage their patients.
Scientific information abounds of similar publications. Surgical techniques once mainly concerned with post-traumatic operations now focus on to the treatment of chronic pain. In this flourishing of new scientific findings, the patient is no longer the protagonist, instead he is often left alone or left disillusioned by useless or highly invasive treatments. Patients, and often also the general practitioners, are deluded by the power of the multinational pharmaceutical companies, not concerned with medical investigation, offering easy and quick false solutions. Nowadays, unfortunately, traditional academic medicine strongly grips onto “evidence based medicine”, which aims at conforming every symptom of any given disease, but does not consider the most important thing: the uniqueness of the individual who rarely resembles another.
The research of symptoms, or of symptoms perfectly suited to all individuals, can only exist in the mind of those who still haven’t comprehended, or better still who do not wish to comprehend, that the human being is a very complex entity governed by a Nervous System which reacts differently to environment, culture, habits and the singular way a patient will perceive any given pain. From these observations, it follows that an efficacious treatment for a patient may result totally ineffective for another. Furthermore, we can state that the more knowledgeable we are in different treatments, greater will be the opportunity of finding the right cure for the ill.
Thus, if on one hand we have the traditional academic medicine often deaf to integrated therapeutic solutions, on the other we have false practitioners without proper preparation, or indeed none, who exploit patients and mislead them with useless therapies which at best will give some results only because they have a placebo effect on people.
Dr. Luciano Cesare Bassani
Specialist in Physical Medicine, Rehabilitation & Physiatrist