Monday, December 7, 2009

Back to the basics

This past month, we have seen an increase in the number of patients with pain or parathesia that travels into the lower extremity. Back in 1990, a study was published “The centralization phenomenon: It’s usefulness in evaluating and treating referred pain”. In this study of 87 patients, 87% of all acute, sub- acute and chronic patients exhibited centralization. 81% of the centralizers and even 33% of the non-centralizers had good or excellent outcomes. Of this group, only 4 were surgical patients and were also non-centralizers and did quite well with surgery as well. The conclusion is that centralization is that it occurred commonly and its present or absence was a strong predictor of treatment outcome and present or absence of surgical disk pathology.

Very often our patients in these times are very eager to obtain an MRI study of their spine which will indicate a history of what condition their spine has been in and is not always conclusive to the source of pain. Centralization has proven to be a very valid predictor of treatment and outcomes and should still be considered the gold standard before more invasive procedures are tried. We will be compiling studies which have supported the importance of mechanical diagnosis and therapy and the issue of centralization in hope educational white paper or pamphlet which will help guide decision making for diagnostic decision making among our patients.

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