Vikas Agarwal, MD, Cert. MDT, FACP
Mosaic Life Care
Saint Joseph, MO
In my practice, the use of opioids and other pain pills has been drastically reduced in two ways: first, appreciation of mechanical pain. Second, the ability to make patients’ understand the mechanisms and science behind their pain better.
Mechanical pain is a common source of both acute and chronic pain in our patients. It occurs when a joint between the two bones anywhere in the body is placed in an abnormal position that stretches the surrounding ligament and connective tissue, creating a mechanical disturbance and thereby triggering the mechanical pain. For example, slouched sitting posture and frequency of flexion are two common lifestyle factors predisposing to abnormal position in one of the lumbar intervertebral joints causing the mechanical low back pain.
The McKenzie Method (Mechanical Diagnosis and Therapy) helps in identifying the particular movement needed to remove the mechanical distress. The patient is advised to do active single, directional repeated movements and posture correction to correct the underlying abnormal mechanics causing the pain.
To overcome the time constraints of a primary care practice, I employ the use of patient education videos, written materials, and help of my nurse to get the job done. Here is an example, from my practice, mechanical low back pain and elbow pain (coming from mechanical disturbance of intervertebral lumbar and cervical joint respectively). The patient removes the mechanical pain by single directional repeated movement of lumbar and cervical spine and posture correction.
Addressing the underlying cause rather than suppressing the symptom avoids medicalization of the problem and dependency on opioids. Self treatment fosters patient empowerment, increases satisfaction, and is highly cost-effective.