Book Review: Why 40%-80% of Chronic Pain Patients Are Misdiagnosed and How to Correct That
This book is authored by a former faculty member of Johns Hopkins University School of Medicine and the past president of the American Academy of Pain Management, and the Reflex Sympathetic Dystrophy Association of America. He previously has authored three books, 34 medical textbook chapters, and 68 articles. The book addresses conceptual methods of problem solving as they are applied to medicine. This book is designed to be the “freakanomics” for medicine. Many research reports document that 40%-80% (or more, for certain disorders) of chronic pain patients are misdiagnosed. The leading cause of this failure is inadequate history taking and the use of the wrong medical tests. Part of this problem is the failure to recognize the specificity and sensitivity, as well as the false negative and false positive rates, of medical tests in use today. As an example, there are many articles in the literature which document that the MRI, an anatomical test, missed the detection of a damaged vertebral disc up to 78% of the time. The book explores the use of physiological tests, such as facet blocks, root blocks, peripheral nerve blocks, and provocative discograms to supplement anatomical testing. Compiled into a step-wise fashion, this book addresses the issues and provides methods to correct these problems. The techniques of history taking and the application of the correct medical tests have been proven effective, based on dramatic improvement in patients documented by outcome studies, which are validated by third parties, (not just self-reported). This book offers information based on evidence based medicine, not opinion. It provides information on how to think, not what to think.
Nelson Hendler’s newest book does an excellent job at explaining why so many people today remain confused about why they still have chronic pain after visiting so many doctors. Hendler, a Johns Hopkins Hospital-trained psychiatrist, has been writing about chronic pain since 1974, about the same time I began my work in peripheral nerve surgery. It has been my honor to help many of the patients for whom Dr. Hendler did make the correct diagnosis by listening to his patients complaints. In his new book, Hendler uses clear exposition and explanatory diagrams to explain the causes of pain, the diagnosis of pain, and the appropriate approach to pain treatment. This book will help the person in chronic pain as well as any physician trying to help understand that patient.
A. Lee Dellon, MD, PhD
Professor of Plastic Surgery and Professor of Neurosurgery
Johns Hopkins University School of Medicine
Lee Dellon, MD,PhD, professor of plastic surgery and neurosurgery at Johns Hopkins University School of Medicine. He has authored 6 books, 104 medical text book chapters, and published 498 articles in peer reviewed medical journals. He has served as a visiting professor at 75 medical school around the world, including almost every state in the United States, and Denmark, Austria, China, Rumania, Switzerland, The Netherlands, Italy, Japan, Brazil, Finland, Korea, and Canada.
I came to know Dr. Hendler as a student in the 1970’s, when accurate diagnosis and specific treatment for chronic pain were emphasized, and I thought his approach was enlightened and consistent with the goals of my new profession. As health care delivery has since evolved, however, physician survival in practice has depended increasingly on regulatory compliance, coding (to be distinguished from accurate diagnosis) and business concerns, rather than critical scientific and clinical judgment. However, the traditional professional values are not only in the best interests of patients and the public health, but also cost-effective. This new book reminds us that these ideas can and should be maintained, refined and pursued anew.
Richard B. North, MD, Professor of Neurosurgery, Anesthesiology and Critical Care Medicine (retired), Johns Hopkins University School of Medicine
At Johns Hopkins University School of Medicine, Dr. North directed the Neurosurgery Spine Service for 16 years and co-directed the Division of Functional Neurosurgery. He was Professor of Neurosurgery, Anesthesiology and Critical Care Medicine at Johns Hopkins for 10 years, and a member of the full-time faculty for 25. He also received his medical degree and post-doctoral biomedical engineering and neurosurgery training at Johns Hopkins. Dr. North holds a number of patents in the field of implanted electrical stimulation devices. The American Academy of Pain Medicine has recognized Dr. North’s research achievements and clinical expertise with the Academy’s prestigious Founder’s Award, and the North American Neuromodulation Society with its Lifetime Achievement Award. He is now president of The Neuromodulation Foundation, Inc. in Baltimore, MD. Contact Dr. North by email at: firstname.lastname@example.org,
I first learned of Dr. Hendler when I read the Spanish translation of his book “Diagnosis and Non-Surgical Management of Chronic Pain.” His simple and useful concepts about how to evaluate chronic pain patients were a resource that I used during all my clinical practice. After recognizing his experience in the field of pain, I visited him at Mensana Clinic and had the opportunity to learn from his clinical skills. Both of these events impressed me enough to invite him to be a keynote speaker, at the 9th Argentinean Congress on Pain in Rosario, Argentina, where Ron Melzack, PhD, from McGill, was the other keynote speaker. Dr. Hendler’s new book addresses the most critical concepts in pain diagnosis and management. He offers a rationale for the use of medication based on the type of tissue damage, which is a novel approach to the pharmacology of pain. It is the most logical system I have encountered. His explanation of the specificity and sensitivity of medical tests will help any physician diagnose patients more accurately. I highly recommend this book for all physicians, nurses, medical students, and anyone else in health care involved with chronic pain.
Roberto Wenk, MD, anesthesiologist, San Nicolas, Argentina
Roberto Wenk, MD is an anesthesiologist. He was Argentina´s WHO Focal Point, Cancer Pain Control Program, Member of the Board of Directors, World-Wide Palliative Care Alliance (WPCA), and President, Board of Directors, International Association for Hospice and Palliative Care (IAHP).
Pain is one of the most important manifestations of illness and is the main symptom what tends to undermine the quality of life. Its mismanagement creates very important physical, psychological and social consequences. Moreover, if we calculate the working days lost, has a relevant economic impact. If these considerations are added to the fact that the most disabling form of pain – chronic – affects about 25-30% of the population and is now considered a problem of high social impact, it is understood how the assistance of this clinical aspect is a real priority. Finding the most functional management model to ensure a cure is not easy and often the process is made more difficult by the high percentage of misdiagnosing. The need to make the notions of diagnosis and treatment of chronic pain easier, clear and easy to apply, finds in this book its perfect expression. In this book Nelson Hendler carries out a careful and scrupulous examination of all clinical-therapeutic aspects of chronic pain, making the notions easy and accessible to both the specialist and the basic physician. It was an honor for me to collaborate with him in an international study on chronic vertebral pain and this allowed me to appreciate its expertise and professionalism, which make him one of the world’s leading experts in this field.
Alessandro Landi, MD, PhD
Professor of neurosurgery, University of Rome, Sapienza, Italy
Dr. Alessandro Landi is a neurosurgeon, who also has a PhD in Neuroscience and Maxillo-Facial Surgery. He has edited a book on neurosurgical treatment of back pain, and published 30 articles in the world literature. He has lectured or presented in Switezerland, France, Austria, Germany, Canada, and the United states. He is the editor of three journal of neurosurgery and spinal surgery, and is on the editorial board of six other journals. He is a Consultant neurosurgeon for General Command of the Carabinieri Army.
If you are a plaintiff trial lawyer this book should be bought in bulk. Give it to every treating, referring, examining medical expert you know or want to know, because this book’s practical approach to how physicians should best prepare for court or deposition testimony is absolutely priceless. If you simply copy or condense Chapter 11 (“The Doctor In Court”) for your experts, you will earn their instant respect. Your clients will have a much better armed medical-legal team, and your settlements and verdicts will improve exponentially.
If you find, as I have, in more than thirty years of my professional personal injury practice, that some treating physicians tend to “overlook” and/or under-evaluate some persistent, permanent, “chronic” pain injuries, then you owe it to yourself, your clients and your experts to read and then utilize Dr. Hendler’s trial-tested and proven method of understanding “Why 40-80% of Chronic Pain Patients are MISDIAGNOSED AND HOW TO CORRECT THAT.”
If you only read one chapter of one book this year – read Chapter 13 “Why Chronic Pain Patients are Misdiagnosed.” That one chapter will instantly improve your clients’ cases, their ultimate monetary recoveries, and your bottom line.
Tom Vesper, Esq
Tom Vesper, Esq. is a trial lawyer in Atlantic City, New Jersey. He is the author of 30 books or chapters and more than 200 published articles on damages, and trial practice. Mr. Vesper is past president of the New Jersey Association of Trial Lawyers (now NJAJ). He has served an editor of the magazine Trial, and has lectured before all 50 state trial lawyer associations in the United States, as well as the National College of Trial Advocacy at Harvard and Duke University law schools, and the New Jersey Judicial Conference of Judges. He is a member of the Million Dollar Advocates Forum, and his firm has recovered over $250,000,000 in damages. He has served in the U.S. Marine Corps Reserve for 23 years.
Dr. Nelson Hendler and I have work together for many years and he has a comprehensive approach to diagnosis and treatment. I have found over the years that poor and/or missed Diagnosis is the rule not the Exception. Currently, the most common way of handling patients is time related and dealing with the major symptom. Therefore, the current mode is to diagnosis and treat as if all individuals with similar symptoms are the same. Dr. Hendler understands that this is not the case. Each individual is unique and must be Diagnosed and treated as an individual. History and examinations must take in all symptoms. All of Dr. Hendler’s books reflect this point of view and are intended to get to the bottom of the causes and find the proper treatment.
Dennis E. Spurgin, DC
Former Dean of Chiropractic Education and Clinical Training, Los Angeles College of Chiropractic (a division of Southern California University of Health Sciences)