Track 3: Pain Management
Thursday, July 27
Patients with arthritis usually receive treatment at the point of their pain, but the source of the arthritis symptoms often can be traced to distant factors, including lower extremity dysfunction and spinal nerve hypersensitivity. The theory of “pseudo-stenosis” will be explained by its creator during the Pain Management track.
Pseudo-stenosis is the dysfunction of the spine that mimics spinal stenosis. It can result from biomechanical dysfunction, which is also one of three components of arthritis pain, said Stuart Goldman, DPM, who will present “Lower Extremity Arthritis and Spinal Stenosis/Pseudo-Stenosis: Understanding and Managing the Three Factors of Arthritic Pain.” Dr. Goldman is the author of Walking Well Again: Neutralize the Hidden Causes of Pain.
“There are three common factors that affect arthritic pain, and we must deal with two of them—and sometimes all three—to have success,” Dr. Goldman said.
The first of the factors is the local pathology of the pain, which can be bone, soft tissue, inflammation, or degenerative arthritis.
“If someone has arthritis in the knee, hip, or ankle, the doctor appreciates it, but does not necessarily investigate what causes it," Dr. Goldman said.
The second factor—biomechanical dysfunction—is linked to the way a person walks, and is usually associated with the seven causes of pseudo-stenosis.
“Even minor biomechanical dysfunction can cause exacerbation of arthritic pain, which one can confirm by treating the distant biomechanical dysfunction properly,” Dr. Goldman said.
The third factor is related to spinal nerve compression.
“Both spinal stenosis and pseudo-stenosis can cause nerve compression in the back, which mimics or exacerbates lower extremity symptoms. That exacerbation can include any kind of arthritic presentation.”
The key to managing arthritic pain is to consider all three factors, diagnose which are involved, and treat them.
“We should be questioning patients about arthritis and arthritic symptoms of the entire body, not just the feet,” Dr. Goldman said.