“Round up the Usual Suspects” is a line made famous by Claude Rains in the 1942 movie Casablanca. This is also true in medicine where we look for usual suspects in order to diagnose a disorder.
In my practice, however, the usual suspects should have been “rounded up” before the patient sees me. Most of my patients have already seen their doctors, specialists, physical therapists, and chiropractors. They have had X-Rays, MRI’s, CAT scans and other procedures and still no help. I am sure that most people find relief with this course of action. However, a small number don’t get help and are in pain for years. In these cases, I suspect, the problem continues because “usual suspects” have hid themselves either in misdiagnosis, or excess pain. In some cases the pain is something else altogether and the usual suspects are in the clear.
Misdiagnosis. The “usual” case of misdiagnosis comes from “chasing the pain”. Those following my blog know that the upper back is often treated in upper back pain. Unfortunately, this treatment does not address the source of the pain and is often unsuccessful. The usual suspect is left untreated. When the correct suspect is rounded up, treatment dramatically reduces the pain.
Excess Pain. Sometimes the usual suspect is so stressed that treating it does not elicit the desired relief. The practitioner then looks elsewhere. However, other signs do point to the usual suspect. When a patient who complained of pain for 10 years came to me in desperation I was greatly puzzled by her situation. After application of a general treatment the area of pain calmed down enough so that I could determine that the usual suspect was indeed involved. This usual suspect did not respond to initial treatment because the pain level was too high. Once the pain was somewhat reduced a treatment plan could be developed.
Unusual Suspect. A patient complained of sciatica and was diagnosed with piriformis syndrome. As the patient was not responding to treatment, her MD suggested removing the piriformis altogether. She was assured she could live without it. When I treated the patient, I too thought that the piriformis was involved since that was the usual suspect. Again the patient did not respond my treatment. That is, the relief experienced was temporary where I usually got a better response to this type of treatment. The patient’s other complaints were caused by damp heat aggravated at the time of ovulation. I then suspected that in addition to her main complaint, she also suffered from endometriosis and that this actually was involved in her sciatica. She was eventually told that she had severe endometriosis which has spread to the posterior pelvis and was pressing on her spine and causing the pain. A true unusual suspect.You can leave a response, or trackback from your own site.