Back Pain Case Studies and Testimonials (8-13)

Case 8 – Back pain in a mail again 73 years
Mr Clifford Jones
Mornington, VIC

Mr Jones had experienced ten years of lumbar pain which had spread to his right hip and leg. He was told he had arthritis and that nothing could be done for his pain. Tablets made no difference.
The procedure was performed on one occasion only and led to the reduction of his pain. He was virtually pain free for the following three years.

Mr Jones comments:
This has made the world of difference. I now have no pain whatsoever.
Case 9 – Lower back pain in a male patient aged 55 years
Mr George Webber
Hollywell, QLD

Chronic lumbar pain had dogged George’s existence for most of his life. He had always done heavy manual work and was an ex-boxer. All conventional treatments had made no difference. His pain was across his low back and was present every day. It had been much worse over the last 5-10 years.
Within two days of a single treatment all his pain had gone. Minor recurrences of pain led to further treatments but he was largely pain free for the next four years.

Mr Webber comments:
Marked improvement, although not a cure. I had some pain recurrence when walking 70 km per week so have reduced that by half.

Case 10 – Lower back pain in a male aged 33 years
Mr Graeme Deeth
Currumbin, QLD

Mr Deeth is a veterinary surgeon who had low back pain for fifteen years. Although he could continue working with relatively mild discomfort, heavy physical exercise resulted in severe right-side low back pain. Previous treatments had resulted in only temporary improvement.
The treatment was performed only once and led to a dramatic reduction in his pain level, enabling him to elevate his standing as az martial arts expert. Heavy exercise does not produce the pain it did previously.

 
Mr Deeth comments:
Having had chronic pain for numerous years, relief was almost immediate and near complete. Despite strenuous exercise, no further serious pain has occurred.

Case 11 – Neck pain in female aged 59 years
Ms Delma Cook
Tweed Heads, NSW

Ms Cook had had severe right side neck pains for four years. Cortisone injections had produced temporary lessening of her pain. Other treatments had no effect. She was told that she had neuralgia and that nothing could be done about it except an operation that might not work.
Trigger points were easy to feel on the right side of her neck and the procedure was performed on two occasions. She was free from neck pain four years later.

Ms Cook comments:
A hundred per cent relief. I would have been in an asylum by now if I had not received pain relief.

Case 12 – lower back pain in a male aged 68 years
Mr Alan Manterfield
Burleigh Waters, QLD

Alan had suffered low back pain for four years. In the eighteen months prior to seeing me the pain had become much worse and had localised mainly to the right side. He was a keen golfer and found his pain far worse after a round of golf.
Treatment led to rapid resolution of all his pain. He was pain free four years later and playing golf without any discomfort.

Mr Manterfield comments:
I am no longer ‘killed’ by pain. I can bend easier and can work in the garden or on my car without pain. My golf has improved considerably since the pain and stiffness has gone.

Case 13 – Lower back pain in a female aged 32 years
Mrs Sharyn Ellis
Coolangatta, QLD

Sharyn’s back pain had been present for about ten years. The pain fluctuated considerably and had been generally worse over the last year. Her pain was aggravated by vacuuming, making beds and physical exercise. She also had some pain in her thigh. Previous treatments had produced no substantial improvement. Computed tomography (CAT) scan showed no surgical pathology; she had been told she had a ‘bad back’.
The treatment was performed once and most of her pain resolved. She is now more mobile, and twelve months later had no acute relapse.

Sharyn comments:
Before I had this treatment, I couldn’t do any housework – even making the bed was difficult. I had trouble lifting my daughter up for a cuddle. Driving my car was a nightmare and exercise was a dirty word. After Dr Stuckey treated my back, I can now do housework, make beds and even scrub the floors. I have no trouble driving and I can exercise without feeling pain. I can pick up my daughter without the anticipation of pain. My quality of life has improved 100 per cent.

Back Pain Relief Case Studies 3 - 7

From "Say Goodbye to Back Pain"...

Case 3 – Lower back pain in a female aged 30 years
Mrs Leanne Edwick
Tweed Heads, NSW

Leanne had experienced low back pain for twelve years. She had presented for chiropractic treatment each time the back became bad. The treatment was performed only once and she had no episodes of pain over the following two years.

Mrs Edwick comments:
I am now seven months pregnant with my second child and have not had the back pains I had when carrying my first child. My life has improved overall now that I have no pain.

Case 4 – Lumbar and neck pain in a male aged 56 years
Mr Mervyn Christie
Palm Beach, QLD

Mr Christie had a fall 8-9 years before seeing me. During that time he suffered constant severe low back pain. The tablets prescribed had aggravated his stomach ulcer. Other treatments had given only temporary help. Over the previous six months, his neck had been continually painful and this produced severe head-aches. Various doctors and specialists had told him that his spine was degenerating and the ‘degenerative nerves were rubbing’, producing his pain.
Trigger points were easy to find and the procedure was done four times for his low back pain and twice for his neck pain.
Mervyn estimated that his overall pain was reduced by about 85 per cent. Thus, while he was not cured, his life is now tolerable. He seldom takes pain-killing medication.
Mr Christie comments:
Dramatic difference is to the cervical area after the treatment enabling myself to discontinue using neck brace. The pain in my right shoulder and right arm has resolved. My low back pain has reduced dramatically and my intake of pain relieving medications is only fraction what is used to be.

Case 5 – neck pain in a female aged 38 years
Mrs Meryl Fray
South Tweed Heads, NSW

Meryl had suffered severe neck pain and head-aches for 25 years. The pain was present every day and radiated to the back of her head, causing severe head-aches. She was given a number of possible diagnoses including ’arthritis’ and ‘tension head-aches’. Multiple treatments had made no difference.
The procedure was performed on one occasion only and she did not experience head or neck pain for the following four years.

Mrs Fray comments:
I have no neck pain and no headaches. I wish I had been told about this twenty years ago and saved suffering terribly for half my life. As far as I am concerned the treatment is bloody brilliant!!

Case 6 – thorax pain in a female aged 67 years
Mrs Catherine Jaworski
Maroochydore, QLD

For five years Catherine had been tormented by excruciating pain in her right shoulder blade area. The pain was present constantly and often radiated to her neck and arm. A multitude of treatments, many specialists’ opinions and admissions to a pain clinic had made no difference. She had been told that a bone was pressing on a nerve.
Following the procedure, all her pain was eliminated. She had a total of three treatments, and three years later had virtually no pain and took no tablets.

Mrs Jaworski comments:
The pain in my shoulder blade, which had tortured me for five years, has gone.

Case 7 – neck pain in a male 63 years
Mr Tony Allen
Lyons, ACT

Mr Allen had experienced neck pain for more than thirty years. The neck pain fluctuated in intensity but was particularly bad after long drives, or sitting at a typewriter. He believed he would have to live with his pain.

He had two trigger points at the base of his neck and was treated at these points. His neck pain subsided rapidly and over the next three years hardly bothered him at all.

Mr Allen comments:
I have had no further problem with that severe pain that I had endured for many years. There is still no sign whatsoever of recurrence of that pain for which I must add that I am eternally grateful to you.

Back Pain Case Studies

The history of human kind is sprinkled with bad backs, many of them belonging to famous people. Elizabeth Taylor has one of the most publicised bad backs of the century. Prince Charles has a bad back; John F. Kennedy had a terrible back and so, too, did the actors Sir Laurence Olivier and Rex Harrison.

Almost weekly, there are reports of famous sportsmen succumbing to bad backs. The case of the Australian Test cricketer, Bruce Reid is a good example, along with Mick Dittmann, the jockey. Personally, I find it frustrating to read that some of these sportsmen are subjected to traumatic and sometimes unproductive surgery to cure their pain. I am almost certain none of them has even been told about Nesfield’s Treatment.
There are two notable exceptions, so far as I know. The American golfer, Lee Trevino, suffered a bad back during the 1970’s and was unable to play golf properly. He was cured after receiving facet rhizotomy (a variation of Nesfield’s Treatment) and went straight back on to the winning list.  The colourful Australian rugby footballer and broadcaster Rex Mossop, according to Dr Rees, was in a great deal of trouble with the pain before he was treated by Dr Rees at the age of 40 (nearly 26 years ago). Subsequent to the treatment he has been able to maintain an exercise and training regime which persisted until his recent passing.
But the silence about the procedure continues. Back pain sufferers learn about it mainly from patients who have received the treatment themselves. It is kind of bush telegraph in the wilderness of pain sufferers. Sadly, many learn about it after years of excruciating pain, and often after their lives have been irrevocably changed for the worse. Many, upon successfully undergoing the procedure, become justifiably angry that such vital information seems to have been deliberately withheld from them.

As I have stated, many back pain sufferers appear in my surgery, believing that Nesfield’s Treatment is a last option. Their optimism levels are low and their desperation high. They have been to a plethora of specialists and practitioners who have failed to alleviate their pain. I might even be a witch doctor to some, but by then they will try anything to get rid of their wretched pain.

A number of my patients have kindly assisted me in the course of writing this book by allowing details of their own cases to be revealed. For the following case histories, I have approached each patient and obtained permission to publish their file. I am grateful for their consent.
The following case studies represent a diverse number of ages and occupations and include both male and female patients living in various parts of Australia and their conditions as at March 1993.

Case 1 – Lower back and cervical pain in a male aged 59 years

Mr John Gardner
Tweed Heads South, NSW   

At the time of his motor accident (1968) John was a fit, 39 year old, high ranking Victoria Police officer. Following the accident he developed severe neck and back pain. Conventional back pain treatments made no difference. He subsequently had the following operations:
1973    Neck fusion
1974    Enzyme injection to lumbar disc
1974    laminectomy
1975    Lumbar fusion
It was thirteen years later when I first met John. During those thirteen years he had been in constant pain, with crippling head-aches and severe low back pain. John would usually take in excess of ten pain-relieving tables each day (more on a bad day). He was assessed as untreatable and pensioned out of the police force.
He had once been a serious contender for the Deputy Commissioner’s job.
In 1988 I performed five treatments on his neck and one in his lower back.

He describes the subsequent four years as the best over the last twenty years. His head-aches have gone, his lumbar pain has virtually vanished, he takes no pain-relieving tablets and he has resumed playing golf.
He remained pain free until his death from other causes, some 15 years later.

Mr Gardner comments:
I have achieved an 80 per cent reduction in pain and a 100 per cent reduction in analgesic intake. I believe that if I had been offered this treatment 16 or 20 years earlier, I would not have been forced to retire and may in fact still be working. Fifteen years of superannuation money could have been saved.

Case 2 – Neck pain in a male patient aged 59 years

Mr Don Allen
Mermaid Beach, QLD

Don had suffered neck pain for twenty years. The pain was at the base of the neck and fluctuated markedly. When very bad, he needed to wear a collar and when he was ‘good’ the neck felt stiff. Trigger points were easily located and the procedure was performed twice. In the 3 ½ years following this treatment he had no pain and minimal tenderness in his neck.

Mr Allen comments:
More than pleased. I now have no neck pain, take no tablets and do not wear the neck collar.

Trigger points as a cause of back pain

Progress and growth are impossible if you always do things the same way you’ve always done them.
Backs are among the trickiest things in the world, especially when they start playing up. There are many, many different theories about what causes back pain. Logically, this clearly demonstrates that no-one really knows whether they are right or wrong in diagnosing its causes. They cannot all be right but neither can they all be wrong. But no-one knows for certain.

In my work as a general practitioner administering Nesfield’s Treatment, I see a wide variety of people of both sexes suffering the agonies of back pain. They represent a broad assortment of ages, with differing pain levels, pain locations and physical signs; disc prolapsed and bone degeneration. I am also able to examine their X-rays, CAT and MRI scans, and learn about their various previous diagnoses, or medical opinions, and treatments.

This information services mainly to confirm my opinion that the cause of back pain constitutes one of the great unsolved mysteries of the medical world. It has also guided me down my own path seeking an answer, or answers, to the causes of the affliction and, of equal importance, to find out why Nesfield’s Treatment works.

Soon after I started using the treatment, I became aware that Dr Rees’ procedure was controversial and that there had been a powerful backlash against it by mainstream Australian medicine. I had never heard of it during my medical training and in my subsequent work as a general practitioner. Yet, here I was, actively performing the procedure and achieving an exciting degree of success.
In tracing the backlash against the procedure, and reading, or hearing, what its critics had to say, I began to suspect that the reasons quoted by Dr Rees as to the mechanism of pain relief may well have been incorrect. From the time he first performed the treatment, Dr Rees had stated that he ‘cut the nerve supply to the zygapophyseal joint’ in effect a denervation, or nerve-cutting process. I concluded that, although the procedure was undoubtedly a highly effective treatment for some types of back pain, Dr Rees was wrong about why it worked; the scalpel he used was simply not long enough to reach the nerve supply to the zygapophyseal joints at the back of the vertebra.

Most patients I see have had many different opinions as to the diagnosis of their back pain and many different recommendations as to the treatment of their pain. Each practitioner believes that their advice is appropriate and that their treatment will help the patient. However, these recommendations often vary enormously. With such a diversity of opinion, it is likely that all theories have some fundamental flaws and that, in most cases, we do not know the cause of pain.
In short, I believe the critics of the procedure were right not to believe Dr Rees’ theory why the procedure was successful. But they were wrong to believe that it did not work.
In accepting this, and setting out to find my own answers, I arrived at one simple question.  Was there something that most patients with chronic back pain had in common? If I could answer that, I might begin to understand why the procedure worked.

To my pleasant surprise, after studying my files, the answer was yes. I found that the vast majority of my patients suffering chronic back pain had tender areas in muscles around the vicinity of their pain – trigger points. Most patients are well aware of the location of these trigger points. More significantly, they know that if the points are massaged hard enough, some temporary pain relief usually follows.

My theory would best describe trigger points as clusters of sensory fibres. They are akin to outposts from major nerves within the body, just as capillaries are end branches of arteries. These nerves are not vital to the effective functioning of the central nervous system. Although trigger points are not visible to the naked eye and look identical to surrounding tissue (except under intense magnification) they are recognised medically. They are known variously as Points of Travell, Distil Points of Russell and Points Apopysaire. They have been listed in medical text books for a good number of years.
In recognising the commonality of trigger points in back pain sufferers, I realised that most non-surgical back pain treatments also target these trigger points e.g. physiotherapy, chiropractic, osteopathy, massage, acupuncture, injection and traction.
Most of the above treatments target these fiery little trigger points and apply diverse forms of stimuli to them to obtain varying degrees of pain relief. Most of the other methods, however, obtain only temporary alleviation whereas my method, when successful, appears to be permanent.
Recognising that trigger points are the common factor in chronic back pain and also the target of virtually all non-surgical back pain treatments, I concluded that trigger points were somehow intimately involved in the production of back pain. I also concluded that, in any given patient, there seemed to be two possible sources of pain. One pain, in my opinion, certainly emanated from the vertebral column complex – bones, discs, ligaments and nerves. The other pain came from the trigger points. Further, I concluded there was probably a connection between the vertebrae and the trigger points, with pain transmission from the trigger points to the central nervous system.

Again I compared my trigger point treatment with other forms of therapy – massaging, puncturing, stretching, pressure, ice, needling or injecting. I realised that, in reality, I was merely taking all of those treatments one significant step further. By surgically invading the painful trigger points and sweeping through them with a fine scalpel, I was physically entering a pain transmission or generation zone and probably short-circuiting it – permanently. It was logical to assume that I was dividing, or separating, sensory fibres. That, I believed, was why it worked.

Thus my own theory about why Nesfield’s Treatment worked was born.
In repeating my assertion that in the majority of cases the causes of back pain are unknown, I can almost hear various back pain experts howling me down. That, of course, is the problem. Everyone has their own different theory about what causes back pain – from orthopaedic and neurosurgeons; general practitioners, physiotherapists, acupuncturists, chiropractors, masseurs, iridologists and homeopaths.

Seeking the answer to the cause or causes of back pain is a little like trying to discover the meaning of life. Everyone has an opinion but no-one really knows.

By the time most patients reach me, my research shows they have been given an average of at least six entirely different diagnoses and six totally different treatment recommendations by at least six different experts. Understandably they are often totally confused. I ask every patient:
“What have other doctors told you is the cause of your pain?”

In order, the five most common replies are:
1. Osteoarthritis
2. No diagnosis
3. Degenerated disc
4. Degenerating bones
5. Pinched nerve

Note that the second most common reply given to patients after many years of suffering back pain is ‘no diagnosis’.

Many other diagnoses given to patients are both pathologically unsound and quite ridiculous:
Curved coccyx
No marrow from the lower spine down
It’s just a hell of a mess
It was caused by an accident
Tension
Neuralgia
Your bones are worn
You’re neurotic
Your pelvis is misaligned
Something’s out of place
Inflamed sinews
Strained ligament
Five nerves caught, one nerve dying
You need surgery
You’ll just have to live with it
Previously surgery has caused the pain
Your back’s buggered
It’s all in your mind

See what I mean?

No doubt each opinion has been given by a practitioner who sincerely believes that the advice is valid. Moreover, the diagnosis has been pronounced by a person, who in the patient’s eyes, often has an almost god-like aura of medical credibility and invincibility.

Back pain sufferers are extremely vulnerable human beings. They hobble, limp and crawl, or are wheeled, grim-faced into surgeries by their hundreds every day seeking expert help and advice – alleviation from their pain. Their condition is invisible and virtually indescribable. They are frequently at low ebb when they present themselves for treatment. It is not uncommon for patients to be depressed and even suicidal when they reach that stage.  Many have been told they will have to live with their pain for good.

Many patients come away highly disgruntled and inappropriately treated – or not treated at all. Patients frequently feel that practitioners either do not believe their degree of pain or appear to have no concept of it. Worse, medical practitioners often appear unsympathetic to the patient’s condition, especially if the doctor suspects a malingerer seeking a compensation pay-out.
Over a period of years most chronic back pain sufferers will seek a variety of opinions and treatments until they get some degree of pain relief. Whilst most achieve pain relief at some stage, a small percentage do not and end up back where they started. They feel like they have been on a merry-go-round and the many opinions and treatments have achieved nothing. It is this group of patients that I usually see and the majority get some degree of relief following ‘Nesfield’s Treatment’.

Patients arriving in my surgery often have a less than glowing impression of doctors. I certainly try to be as understanding as possible, and as truthful. In some cases, I do not advise the patient to undertake Nesfield’s Treatment because I feel it will not benefit them, especially in cases where there are no trigger points. In many of these instances, I believe surgery may be a viable option for them and advise the patient accordingly. I seldom tell them they must live with their pain.

Conversely, where there are trigger points, I advise patients that if they undertake the treatment, they will have a 70 per cent chance of some reduction of their pain. I try not to build their expectations unrealistically and definitely not to expect a miracle cure. Nesfield’s Treatment is a more gradual process; it is usually at least a day or so, and sometimes three or four, before the patient realises the degree of pain relief gained from the treatment.

I find the initial reaction of patients curious, to say the least. Because their expectations are high, many simply expect to be cured by me, much as they would expect me to cure their respiratory infections by prescribing antibiotics, or if I was a dentist, by pulling out an infected tooth. It is a very simple approach – you are a doctor, fix me. Some expect a 100 per cent miracle cure.
I ask every patient to call me a week after I have performed the procedure on them. When they do, I inquire whether they have achieved a reduction of pain and if so, to what degree. Although a 100 per cent reduction of pain is uncommon, about 70 per cent of patients report a marked improvement in their condition. But – this is the curious part – their reactions are usually low key, or muted. Rather than yell down the line, euphorically telling me they are cured, it is usually just a matter-of-fact description of what has taken place, end of conversation.

Joy at their liberation from back pain usually comes much later, long after the treatment. I am told it often happens in private moments when people find themselves enjoying a long bushwalk, or playing tennis, or activities that were that were impossible during their regime of pain. The realisation suddenly comes to them that their lives have returned to normal and that they are free again; they feel joy then. When I hear my patient’s good news I also feel a sensation of happiness.

Facts and Fallacies about Back Pain

Nothing begins, and nothing ends
That is not paid in moan;
For we are born in other’s pain,
And perish in our own.
(Francis Thompson 1859 – 1907)

Pain is a hugely complicated subject and, in all sincerity, I profess no greater knowledge of it than the next doctor. There are, however, new ideas, or theories, surfacing about pain, some of which may well replace the old ones. These included what appears to be the important role sensory fibres play in the central nervous system and how they function in transmitting pain to and from the brain.  This is of particular interest to me because I believe, until someone shows me better, that these sensory fibres are central to my work in treating back pain.

Some facts and fallacies about back pain; while many aspects of diagnosing and treating back pain are uncertain, there are some observations that are factual.

• Recent onset – or new – back pain almost always reduces quickly. A common situation is when a person (of any age) is doing something that they may do every day when suddenly they develop severe back pain. The pain is often excruciating. If no active treatment is sought, the majority of these cases (95 per cent) resolve within 3-4 weeks.

• X-rays are not the most accurate way of diagnosing causes of back pain. It has been shown many times that there is no correlation between degeneration on X-ray and the severity of pain. People who have extremely bad-looking spines on X-ray may experience no back pain at all. Conversely, people who have perfectly ‘normal’ X-rays may experience severe back pain. This applies similarly to CAT scan or MRI investigation. Abnormalities that are detected do not necessarily cause the pain. A number of trials have been carried out where MRI scans are taken on people who have never had back pain. Sixty percent of these were shown to have a significant disc protrusion and yet experience no pain.

• In my opinion the most common misdiagnoses of back pain sufferers over forty years of age, include arthritis, joint degeneration, osteoporosis, spondylitis and ‘wear & tear’. But no matter what investigations are performed, no-one can ever be 100 per cent sure of the cause of pain. My belief that vertebral degeneration as shown on X-ray, in the absence of trigger points, is not a cause of back pain will probably be strongly criticised by some colleagues.

• It is not necessarily true that there is nothing that can be done for back pain and that sufferers will ‘have to live with it’.

Here is a list of treatment options that may be considered and explored by back pain sufferers and their doctors. Some of these treatments are well-known, others are not. They are listed alphabetically, not in order of importance – there are no doubt various other methods of back pain treatment, which are commonly practised in some parts of the world, and not known to the author.

Acupuncture
Acupuncture is believed to work on the principle that the production of brief, moderate pain will cure severe, chronic pain. Stimulation, by placing small needles in various charted parts of the body, i.e. ear, calves, ankles, causes the release of pain-killing endorphins.

There has been a recent trend in acupuncture to specifically target the trigger points instead os set reference points and needle  the same point on a number of occasions. This is thought to lead to localised muscle lengthening and to decrease pain that was due to muscle spasm. Although mainstream medicine has gradually embraced the theory of acupuncture and its effectiveness, it is still considered only an adjunct to conservative treatments and does not necessarily produce long-term relief from pain.

Analgesic/anti-inflammatory Drugs
Use of these is common treatment for back pain. Research suggests that, while the drugs are frequently prescribed, their actual cure rate is insignificant and often cause a lack of well-being in patients, although they do help temporarily to alleviate pain.

Bed rest
Bed rest is the most common and successful (95 per cent success rate) form of treatment for the onset of new back pain. Generally, patients are advised to lie on their sides with their hips and knees slightly flexed. More than a few days in bed is not recommended.

Electrotherapy (transcutaneous electrical nerve stimulation – TENS)
The principle of electrotherapy is that by electrically stimulating nerves, pain will decrease, although how it works is unknown. Interestingly, electrical current passes more easily though painful tissue and non-painful tissue. It is thought that the electrical current produces endorphins, like acupuncture. It is a medically respected treatment and does help patients become more functional. (NB it is an accepted medical practice even though it is not understood).

Enzyme injection (chemonucleolysis)
This is a comparatively recent method where the damaged disc is injected with an enzyme (from papaya). It dissolves the disc, thereby relieving the pressure it is applying to the nerve roots. The procedure has a relatively high long-term success rate. Studies after two years show a 77 per cent success rate in the reduction of pain, with 45 per cent of patients enjoying a pain-free status. Very few people however are suitable for this treatment. The procedure is not without its risks and requires hospitalisation. Three per cent of patients suffer complications, and 40 per cent suffer back spasms in the immediate post-operative period. Patient assessment is crucial for this treatment; a handful of patients have died from allergic reaction.

Epidural
This is often used where more conservative forms of treatment have failed. The theory is that injecting cortisone into the epidural space in the spine reduces inflammation on the damaged nerve root and surrounding tissue. The procedure requires hospitalisation, and is safe as long as meticulous technique is used to administer it. It has been known to cause tuberculous meningitis and other complications if not properly performed. Note that the procedure currently being carried out is considered medically ‘not proven’.

Exercise
This is a common treatment designed to strengthen muscles surrounding back injuries, or to increase the patient’s flexibility and mobility as well as improving fitness levels to prevent further injury.  In some cases, exercise appears to decrease pain levels; in others, it may u increase the pain. Exercise programmes have a mixed success rate and in some cases are impractical because of the pain of movement experienced by the patient.

External supports
These include braces and corsets. They are designed to take pressure off injured areas in the back and neck during recovery, although some patients wear them permanently. In themselves, these supports do not cure back pain, but may assist in the recovery process.  Many feel that external supports actually weaken back muscles and worsen the problem.

Hypnosis
This can be a successful treatment, at least in the short term. Because pain is thought by some not to be a purely physical phenomenon, but associated with thoughts, emotions and perceptions, it is possible to alter the state of awareness in a patient in a way that reduces, or changes their pain.

Injection therapy
Many substances have been injected into people’s backs with varying degrees of success. Different compounds can be placed in one of three areas:

I. Trigger Points: by merely needling these tender points some pain relief can be achieved. This technique is called ‘dry needling’ but would seldom produce more than six month’s relief. These points can also be injected with local anaesthetic or cortisone. Pain relief is often longer than needling alone but seldom longer than six months.

II. Ligaments: The ligaments at the base of the spine can be injected with irritant (sclerosant) solutions. This is thought to set up an inflammatory reaction within the ligaments and, when this settles, the ligament will become thicker, shorter and stronger thus better supporting the vertebral bones. In well conducted trials, it would seem that many people get pain relief where they have not responded to other treatments.

III. Intravenous: In some countries the use of intravenous colchicines is a popular method of back pain treatment. Colchicine is a powerful anti-inflammatory agent and in various trials (some controlled) it has been shown to produce significant pain relief in a large percentage of patients.

Manipulation
Mainstream medicine still considers spinal manipulation a controversial therapy. It is mainly performed by chiropractors. Although studies have shown there is probably no relationship between vertebral misalignment and low back pain, there is no doubt that manipulation does provide relief, often permanent relief. It is considered appropriate for some types of low back pain, including sciatica, spondylitis and stenosis but not for osteomyelitis, osteoporosis, and fractures, ruptured ligaments, acute arthritis and should not be undertaken during pregnancy.
My own belief is that the benefit from manipulation may well be due to stretching the trigger points and not due to ‘re-aligning the bones’.


Massage
This, too, is a common treatment for back pain and usually works well on a temporary basis.  Massage is used by physiotherapists and other professionals trained in the art, and others who have developed their own forms of massage i.e. Swedish, Japanese etc.
All forms of massage target the trigger points and the main stimulus is directed there.

Muscle relaxants
Although these have been used as treatments for low back pain and muscle spasms for many years, their use is still considered controversial, particularly because some forms are addictive and others may cause depression.  They appear to reduce back pain in carefully selected patients and should not be condemned outright.

Psychological support
This treatment is specifically targeted at restoring psychological balance in the back-pain sufferer, particularly overcoming depression. Clinical trials have produced mixed results, but the technique has been successful in improving patient attitudes and decreasing anxiety and stress levels. This technique is used extensively in pain clinics helping people to ‘live with their pain’.

Surgery
Surgery can be considered for those suffering; pressure on nerve roots (most commonly by herniated discs); spinal stenosis (narrowing of the spinal canal); vertebral instability.
Unfortunately, if surgery is performed for other reasons, the results are usually poor. There are three main forms of surgery:

I. Laminectomy – this is performed in hospital under general anaesthetic and is the less complicated and safer of these procedures. Essentially, the injured disc is removed along with surrounding bone. The nerve root, upon which the disc had been pushing, is thus liberated. Surgery takes between 1-2 hours. There is a minimum of blood loss and the patient is encouraged to stand and walk soon after surgery. Laminectomy works very well for leg pain and numbness but no so well for back pain. New techniques are being developed to surgically remove herniated discs without removing any bone. These techniques are far less traumatic for the patient but suitable for only a narrow spectrum of people.
II. Fusion – This operation is performed under general anaesthesia. The object of the operation is first to remove the injured disc and any other material pressing on the spinal cord or nerve roots. The two vertebrae are then fused together by one of a number of techniques. One is using a bone graft (usually taken from the pelvic bone). Another is to join the vertebrae by screwing steel rods across them. New techniques are being developed to use a flexible material (Dacron) to stabilise the vertebrae but not to fuse them in a rigid fashion. Different techniques will suit different cases.
Post-operatively, patients experience a great deal of pain and need to be monitored closely for the first 48 hours and may remain in hospital for two weeks. It may take 12 months before normal activities can be resumed. The results vary enormously. Some claim 90% success whilst others claim 50% success. This variance may reflect different criteria to gauge success and failure.
Long term studies show that the success rate for laminectomy and fusion drops considerably after five years and may reduce to as low as 50 per cent.
III. The newer procedure of disc replacement is emerging as a means of correcting damaged discs without fusing the vertebrae.
Temperature therapy
There are three kinds of temperature therapies:
I. Cold (cryotherapy)  This can be an effective treatment. It uses ice or cold packs. Studies show that two thirds of patients who undergo it will experience approximately a 33 per cent reduction in their pain, although it is usually only temporary. It should not be used on patients with sensitive skin and can sometimes produce muscle spasm. It usually only cools the skin over the injured area rather than the tissue under the skin.
II. Heat (thermotherapy) although this can be used to ease pain and reduce muscle spasm, it should not be used where patients suffer decreased circulation or sensation loss because it can cause damage to the skin i.e. burning.
III. Deep heat (shortwave diathermy/ultrasound) penetrates below soft tissue near the skin, delivering heat to bone, muscle and ligament. Should not be used in areas where the pain is acute or recent. Ultrasound delivers heat more deeply than diathermy.

Traction
This treatment has been used in one form or another for several hundred years. The basic theory of traction is that it stretches the vertebrae and surrounding muscles in order to provide relief and to return the spine to its original form. There are several types of traction, ranging from stretching patients on a bed either manually, or using mechanical devices that apply continuous stretching or sporadic stretching. Another form of traction is to hand the patient upside down by the ankles from a frame, using gravity to stretch the spine and surrounding muscles. Although it is a common treatment, traction does not have a high success rate in permanently alleviating back pain. In some cases it can make it worse.

I believe back pain relief occurs from this form of treatment more from stretching of trigger points rather than the bones.

Different treatments for back pain

What is benign, intractable back pain? Medically it is not life threatening, not surgically treatable, and does not respond to forms of therapy. It is very frustrating to doctors because they feel they have an obligation to assess, diagnose and treat their patients. Non-medically it is an affliction which affects families, jobs, self-esteem and quality of life.

A more colourful description, however, comes from a back patient:

It is as though a fiendish torturer has plunged a pair of sharp pliers through the flesh at the top of the buttocks, located the sciatic nerve deep in the hip, grabbed hold of it and twisted it, pulling it taut. The pain is excruciating; you can’t stand and you can’t walk, or sometimes make even the slightest movement, because of a white-hot lava of pain that runs in a fiery seam down from your lower back and hip, into your thigh, down your leg, right to the tip of your big toe. At the height of its intensity, you wish to vomit, burst your bowels, faint or die – and sometimes all four at once.

This account sounds awful and I hope I never experience it, and certainly not to that degree. It is the most useless, meaningless, tiresome and debilitating form of pain known to mankind. It appears to serve no real purpose, except to continue torturing those poor souls who experience it.

Traditionally, pain is recognised as a warning sign that something is wrong in the body.  Benign, intractable pain defies that comparison. It seems merely to create pain for pain’s sake – like vandalism – and usually signals nothing other than the troublesome fact that more pain of an identical nature will immediately follow. In its most perverse form, it can be likened to a car horn that suddenly goes off in the middle of the night for no good reason and then continues to blare away, keeping the whole neighbourhood awake – until someone disconnects the battery.

That is not such a bad analogy, especially when related to some forms of back pain and the treatment I prescribe for it.

Pain is nebulous, very personal and subjective. There are some medical experts who say quite seriously that pain, as we know it, does not exist; that it is purely an individual interpretation of some sort of stimulus that varies enormously from person to person. I do not accept that and neither do most medical schools.
There is an amusing, apocryphal story about two doctors fiercely arguing about pain. The first doctor argued strongly that there was no such thing as pain, the second argued there was. The second doctor suddenly punched the first one and sent him to the ground, screaming and clutching at his bloodied nose, ‘What’s that .....?’ cried the first doctor in agony. ‘That’s pain’ replied the other.

Certainly pain cannot be measured medically. The only people who can measure it are the pain sufferers themselves.  Click here to find out more about back pain relief.

Vincent Nesfield, Dr Rees and the history of the treatment

The originator of what I have named Nesfield’s Treatment was a brilliant English surgeon, Mr Vincent Nesfield. Among many achievements in his life, he invented chlorinated water. I have, therefore, taken the liberty of calling the procedure Nesfield’s Treatment in this book because I believe it accords Mr Nesfield the recognition he merits. People can also easily remember a non-medical name instead of the various tongue-twisting medical names it is known by; e.g. percutaneous neurotomy, percutaneous rhizotomy, rhizolysis and others. I would like to think that other medical practitioners will begin calling it Nesfield’s Treatment as well.

 

Vincent Nesfield was a Harley Street specialist. He worked in a broad range of medical fields; from cancer, ophthalmology, deafness, blood pressure, bubonic plague, tuberculosis, rheumatism and eczema, to diets for infants. Although he was a qualified surgeon at the tender age of 21, he had to wait until he was 25 before the Royal College of Surgeons would accept him as a fellow – he was too young.

Those who knew him described him as a deeply spiritual man and a dreamer, a man who lived ‘out there’ in a figurative sense. By all accounts he was not a personally ambitious man. He died in 1972 at the age of 92. At the time he was working on a serum for cancer.

Nesfield, incidentally, did not believe there was such a thing as a slipped disc (although I disagree with him). He wrote ‘The agonising pain in the back which may continue for months and is usually diagnosed as a slipped intervertebral disc, has never in my experience of very many cases over 30 years, been due to a slipped disc; but has been due to a sensory nerve caught up in a muscle or tendon fibres. This not only gives pain in the back, but referred pain in the hip, thigh and the leg, and indeed in the sciatic nerve itself’.

Nesfield developed his procedure in 1918. He used it on soldiers returned from the First World War for what he described as ‘trench back’. He performed it on an average of six patients a week during his working career.

In December 1959, a prominent London journalist, Horace Hughes, who had suffered debilitating back pain since 1945 and whose career was threatened by his affliction, because none of the many treatments he undertook had worked, noticed an article in the now defunct Daily Sketch.

THE SLIP THAT ISN’T

Ever had backache? Suffered agony when you moved, stood, sat or lay down?

And then said to yourself: “I’ve got a slipped disc”

Well, you’ve had your worry for nothing. For in a new pamphlet to-day called ‘Backache and Slipped Disc’ a Harley Street specialist says THERE’S NO SUCH THING AS A SLIPPED DISC.

‘The slipped disc theory has been evolved during the last few years,’ he says ‘due perhaps to post-mortem findings after a crush from buildings falling on people during the bombing’.

He points out that in the vertebrae the intervertebral discs are extremely firmly attached.

‘In fact’ he says ‘it is impossible to move a disc without cutting the ligaments and using a chisel’.

So how could it slip?

The cause of that excruciating pain, says the specialist, is damage to a muscle fibre, muscle sheath or ligament.

It could be in the thigh, the muscles between the shoulder blades, the shoulder and the neck, or the muscles of the chest.

The cure? So simple and uncomplicated it’s almost ridiculous in comparison to the long drawn out business of plaster casts and painful operations. Just a tiny incision one-eighth of an inch wide and about half an inch deep. The relief is immediate, the cure complete.

It’s so quick that when the specialist treated a daughter while her mother momentarily left the room, the mother returned to find that her daughter could stoop, sit, lie down without pain, things the girl hadn’t been able to do as nine months before she’d got a ‘slipped disc’ when she’d fallen from a horse.

The specialist sums up:

‘The agonising pain in the back which may continue for months or years, usually diagnosed as a slipped intervertebral disc, has never in my experience over a period of 30 years been due to a slipped disc.’

‘It has been due to a muscle or fibre caught up with a sensory nerve’

‘The recognition of the simple fact that a so-called slipped disc is NOT A REALITY would release many thousands of people from plaster jackets and relieve a very great deal of pain and suffering’.

Hughes wasted little time in following up on the article but perhaps it is better that he recount the story in his own words, in a letter he kindly wrote to me on 23 March 1993.

                                                                                                  Horace Hughes

                                                                                                  9 Trewithan Parc

                                                                                                  Lostwithiel

                                                                                                  Cornwall PL22 OBD

                                                                                                  United Kingdom

I had had fourteen years of unmitigated pain and disability and things were indeed desperate as there was a real possibility of having to give up work, leaving my wife to become the breadwinner. My right leg had lost all feeling; the foot had turned in and dragged. Then, miraculously, appeared the article in the Daily Sketch. I was able to obtain the name of the doctor, Mr Vincent Nesfield. (Mr Hughes then obtained a referral from his doctor and made an appointment with Mr Nesfield).

I crawled into his consulting room. He performed a simple but brilliant operation under local anaesthetic which took ten minutes. The feeling returned to the leg, the foot turned back to its normal position and the (sensation of) blood could be felt rushing down the leg. A period of six further visits, one a month, dealt with residual (pain) spots ending on the right hip. To this day, 36 years on, there has never been a day’s pain or disability of any kind. At 80 year of age I can walk miles and garden for hours.  He had no back pain up until his death in his late eighties.

A short time after Horace Hughes’ treatment, a woman friend of his told a Welsh renal surgeon, Mr W. Skyrme Rees, about Hughes’ miraculous recovery at the hands of Nesfield. Rees was highly sceptical and doubted it was true. At the insistence of the woman, Mr Rees eventually made an appointment to meet Nesfield and watch for himself the procedure being performed. To his astonishment, he witnessed a male patient enter the surgery suffering acute back pain and walk out afterwards, apparently fully cured. Nesfield seemed to place no great importance upon the value of his innovation. In fact he did not even have a name for the procedure; it was merely something he did to alleviate back pain.

The effect upon Rees, however, was profound; it caught his imagination. It was to change his life.

As a renal specialist, bad backs were not something he usually encountered in the course of his work. Nonetheless he set about conducting his own research, including considerable anatomical research on monkeys and various birds. Rees, like Nesfield, concluded that the majority of back pain was not caused by what are called ‘slipped discs’ at the front of the spine but by derangement of the zygapophyseal*  joints at the back of the vertebra. Rees believe that by cutting the nerve supply to these joints he had discovered a way of safely switching off back pain.

Rees performed this operation for the first time on a Mrs Sally Jones-Davis, aged 59, at Llandudno General Hospital, North Wales after the house physician sent him a request for consultation.

*  Apophysis is a protuberance (process) coming out of a vertebra. Zygapophyses are processes on the side of each vertebra that move in co-ordination (articulate) with the corresponding process on the next vertebra. The zygapophyseal joints are the small joints at the back of the vertebral body and spinal cord.

Mrs Jones-Davis was described as having right-side severe sciatic pain. By then she had been bedridden in agony for four weeks.

Dr Rees describes what followed:

 On arriving at the hospital on 16 June 1960, I found a frail lady lying in a high bed in the general ward. The ward sister explained that Mrs Jones-Davis had been placed in this high bed because there were problems of nursing.

The patient’s sciatic pain was triggered off by the slightest movement and the high bed minimised her discomfort. Her history was of very severe right side sciatica of sudden onset four weeks previously. She told a long history of minor pain in the back, not amounting to disability, before the present attack struck her suddenly, making all movement impossible. She had been in bed at home for one month.

I performed the described operation at the level of the 4^th lumbar vertebra, using a von Graefe cataract knife.

At the completion of the operation Mrs Jones-Davis climbed out of her high bed at my behest and took tea with us and her fellow patients, free from all pain.  She walked out of hospital the next day. This freedom from pain remained for 15 years until her death in 1975 from heart failure.

Later, in 1960 as consultant surgeon to the hospitals of Caernarvonshire and Anglesey, which were going through a period of great difficulty from hospital cross-infection, Rees was given a grant by the Welsh Hospital Board to travel to the United States to report on methods used there to control the problem.

He decided to combine this visit with his own investigation into the treatment of back pain as practised in America. In the course of his visit, he met with a Dr Hackett in New York and found that he had been treating lumbago and sciatica by injecting a sclerosing (hardening) solution into the ligaments of the zygapophyseal joints. Dr Hackett called his treatment Pro-Lan therapy. Rees concluded that Pro-Lan therapy was, in some ways, similar to his own work.

Dr Hackett thought that by placing the sclerosing fluid around the weakened ligaments in the spine, a stronger ligament was produced by scarring and that after three weeks, when the ligament was firm again, the pain would be relieved permanently. Dr Hackett did not demonstrate this treatment to Rees but gave him the address of a Dr Peterson in Boston, whom Dr Hacket had trained and who was performing Pro-Lan therapy successfully. Rees met Dr Peterson and watched the procedure being performed. Although he was impressed at first by the theory of it and its apparent success rate, he was concerned about the amount of pain it caused patients, so much in some cases that even morphine failed to alleviate it. Later, before leaving America, Rees was disturbed to discover that at least two patients who underwent Pro-Lan therapy had become paraplegics. He immediately excluded it as a treatment.

Upon his return to Britain, Rees decided to continue his research into treatment of back pain and to modify the treatment he had learned from Nesfield. In the next five years, Rees says he performed the operation successfully on 88 patients disabled by lumbago and sciatica.

However, in 1965 Rees attracted national attention for his views about the hygiene standards of British hospitals. As experts in cross-infection, he and five other doctors accused British hospitals of being ‘The dirtiest hospitals in the world’. In the ensuing uproar the five others backed down and withdrew their accusations. Rees refused and was suspended from duty. As a direct result of that, Rees resigned, sold up his possessions, took a refresher course in general medicine in order to become a general practitioner again, and vanished.

He re-appeared a few months later on the other side of the world in Tocumwal, New South Wales, a small town in the Australian bush. There, as plain Dr W Rees, GP at the age of 53, he introduced his startling surgical innovation (which he called rhizolysis), to the back pain sufferers of the bush. Rees chose to become a general practitioner in Tocumwal with great deliberateness, because it was a place of sheep shearers and fencers, a great number of whom suffered bad backs.

Now, as a general practitioner, he was able to gain direct access to large numbers of them. It was an amazing transition for a consultant surgeon and highly successful one; he began curing bad backs by the hundred. As news spread of his extraordinary success, people began flocking to see him from all over Australia.

Along with a rapidly burgeoning patient base, Dr Rees attracted national attention from both the media and a somewhat sceptical medical fraternity. In 1972, Rees was the subject of a (then) Australian Broadcasting Commission documentary “Four Corners”. The report included interviews with a number of orthopaedic surgeons who voiced their reservations about his work after watching the procedure being performed.

Nonetheless Dr Rees’ medical career flourished and he was soon invited to the United States and other countries to give lecturers about rhizolysis. At home, he was so much in demand that he opened clinics in Shepparton, Melbourne, Sydney and Wellington, New Zealand.

For reasons that will become clear, interest in rhizolysis began to dwindle by the mid-1980’s. By then an old man, Dr Rees closed the last of his consultancies, in Macquarie Street, Sydney and went into semi-retirement at his home in Woollahra to look after his ailing wife, Marjorie. Privately, he was embittered that his remarkable surgical innovation had not gained the world-wide acceptance from orthodox medicine he had hoped for it. Nor had he been recognised for his work in this field. Indeed, while he had been handsomely financially rewarded, he concluded there had been a ‘conspiracy of silence’  - a backlash – against it.

Dr Rees was only partially right. There was a backlash, and a powerful one, against rhizolysis but there was one of equal intensity against Dr Rees himself. I know of cases where orthopaedic surgeons refused to treat patients any further if they dared to go and see Dr Rees.

Dr Rees was a colourful man with total confidence in himself and his innovation; an articulate, superior, flamboyant Welsh gent, who is elegantly disdainful of his Australian medical peers and highly zealous in promoting the virtues of rhizolysis. He admits to ‘cocking a snook’ at them and flaunting his financial successes, ‘laughing all the way to the bank’ as he would put it. His personality, his extroverted ways – a chauffeur-driven white Rolls Royce with red leather seats, presidential suites at hotels, silver-knobbed walking canes – went down badly with the conservative medical mainstream.

They turned their backs on him and successfully vilified a man of impeccable medical credentials, accomplishments and great personal charm.

Personally, I consider Dr Rees a gifted physician and a valued personal friend. I will always be grateful to him for what he has taught me, just as I will always recognise the great work he carried on from Vincent Nesfield in the treatment of back pain. Until his retirement in March 1993, he enhanced the lives of many thousands of suffering people, and he has enhanced my own. I believe he has been unfairly denied the recognition he surely deserves for his work in this field. He has been badly wronged, although he is outwardly philosophical about it. ‘It is better to be wronged than to do wrong’ he says quoting Socrates.

On balance, though, I also believe that Dr Rees ‘sold’ the treatment badly. In my opinion, the explanation as to the mechanism of pain relief was incorrect and his selection criteria for who he treated was in-precise; he used it as a cure-all. Thus, he stepped away from mainstream medicine and was perceived badly by conservative practitioners. He compounded his problems by being seen to have become wealthy as a result of it – and then flaunting it.

In many ways the backlash against him was fairly understandable. But the tragedy, so far as back pain sufferers were concerned, was that mainstream medicine tried to bury the procedure with Rees. To me it seems they – the specialists – were shooting the messenger because they did not like him. Nor, of course, did they like his message; it could be performed by general practitioners in their own surgeries.

By 1988 the demise of this demonstrably viable option for pain sufferers was virtually a fait accompli. There was every reason to believe that it might eventually die with Dr Rees.

There was a small of doctors quietly, and persistently practising the procedure in Australia. But, by and large, no-one in mainstream medicine spoke of it, and it certainly was not included int eh curricula of any medical schools in Australia. Opponents had adopted a policy of silence, like a family refusing to speak of a black sheep or ignoring something in the hope that it will go away. It was highly effective; officially, Nesfield’s Treatment had ceased to exist.

In that year, of course, my patient Ken and his miraculous cure led me to meet Dr Rees and learn the procedure. It has taken me on a fascinating, privileged medical journey, or quest, and has caught me up in the lives of hundreds of back pain sufferers. It has taken me so far to two continents to express my views on, and my knowledge of, the subject of my international peers. It has been an enlightening experience.

More importantly, Nesfield’s Treatment is alive and well again. I have been asked whether I have taken up the banner once held by Dr Rees? My answer is a qualified yes. While I have taken up the banner I have also changed it because I do not accept the reasons Dr Rees gave for the treatment’s success. I acknowledge his enormous contribution in enhancing the lives of many of the 16,000 patients he treated in the course of his extraordinary career. I applaud his work, and Nesfield’s, in shifting the emphasis away from the slipped disc theory as the major cause of back pain. Dr Rees, however, like many practitioners, did not place any great emphasis on follow-up research after patients left his surgery. This gave his critics further ammunition, which they used to try to shoot him down, especially his claim that he cured 99.8 per cent of his patients.

I decided at the outset of my work to carry out appropriate follow-up with all of my patients and to monitor the long-term effects of the treatment with a view to determining a statistically reliable success rate. If Dr Rees had made mistakes, I was going to try to avoid them where possible.

There is little doubt that, despite my caution, I will stir up a hornets’ nest among my medical peers as a result of writing a book like this. Many of the older specialists still remember Dr Rees and it is likely they will lump me in with him in their opinion of me and the procedure.

In the pecking order of the medical world, it should be borne in mind that I am a general practitioner, not a specialist who has passed a multitude of examinations to achieve a higher medical status. Some specialists look down on general practitioners like myself, especially when we enter their specialised areas e.g. treatment of back pain.

The specialists are correct in part, but it seems to make little difference to their former patients who come to me and experience a great reduction in their back pain.

As you will read in a later chapter, I have tried to publicise Nesfield’s Treatment or percutaneous neurotomy as it is called medically, through official channels – medical journals – here in Australia but have met with stern and, in more than one case, vehement resistance.

By writing a book like this aimed primarily at a non-medical audience, and hopefully for as many back pain sufferers as possible, I acknowledge that I run a great risk of backlash from my colleagues. Although I doubt whether I would make much of a martyr, I sincerely believe the greater good lies in the opportunity for back pain sufferers to benefit from this treatment.

I often look back on that moment when Ken hobbled into my surgery, and wonder what would have happened if he had not returned to me with his revelation, or how I would have felt if my first patient failed to improve after the treatment? Quite likely, I would have dismissed the technique out of hand and carried on with my practice exactly as before. Little doubt, I too would have been sceptic.

In taking up the banner of Nesfield’s Treatment and changing it, and acknowledging that I run some of the risks of Dr Rees, I also decided I would try to minimise these wherever possible. I promised myself that I would do whatever was required to place the procedure on a better, more credible medical footing with a view to it gaining greater acceptance among doctors everywhere – and their patients.

In keeping accurate follow-up records, I believe I have made some progress in this. If this book provides further assistance in my quest, then my role as a medical practitioner will offer more relief for back pain sufferers.

The Procedure of Nesfield's Treatment

Nesfield’s Treatment is not a panacea for all back pain. There are many back and neck pain sufferers who are not suitable for this treatment. I treat only patients who fulfil the following criteria:

1. Have suffered back or neck pain for more than six months

2. Have not responded to other forms of treatment

3. Problem is not surgically correctable

4. Have tender spots (trigger points) in the vicinity of their pain

5. Pain is getting worse

Before making a final decision, I interview the patient at length to decide those who are suitable for the treatment.

Nesfield’s Treatment is a very simple procedure. This is what I do:

1. Locate and mark the painful trigger points in tissue on the patient’s back

2. Inject local anaesthetic into each point

3. When the local anaesthetic has worked, I make a small incision into the muscle through a puncture in the skin. The depth of the incision is about 2 cm.

4. I then apply a pressure dressing. No sutures are required.

5. I allow the patient to go home, or back to work, immediately.

Observations:

1. The average number of treatments is two per patient, preferably no less than three weeks apart

2. The treatment takes about five minutes, does not require hospitalisation, has no adverse side effects, does not require expensive equipment and need be done only once or twice

3. Following this very simple procedure, many people (70 per cent) obtain a significant degree of pain reduction.

Here is a patient’s description of Nesfield’s Treatment:

“The doctor asks you to remove your upper garments and to lie face down on the examination couch. Pressing firmly with his fingers, the doctor then locates tender areas in soft tissue, or muscle, usually an inch or more away from the middle of the back. These points are easy to find; you know their exact location only too well. They are fiery spots where the pain comes from. The doctor describes them as trigger points. These, he explains, contain tiny sensory fibres which are thought to transmit back pain.”

“The doctor marks the trigger points with coloured dye and then injects a local anaesthetic into each of them. This causes no more discomfort than a normal injection. Approximately two minutes later, when the anaesthetic has taken effect, the doctor inserts a small scalpel into the anaesthetised points. There is no sensation as this is done. Each insertion lasts four to five seconds.”

“Sticking plaster dressings are applied; you get up, dress, walk out of the surgery and carry on with your normal daily activities. 

The anaesthetic wears off after approximately one hour. There is only a minimal amount of spot bleeding shown when the dressings are taken off the next day. You feel some tenderness for three or four days. If the procedure has been successful, you may be aware of it within 24 hours or, at the most, by the time the soreness has gone. There is no scarring.”

• Equipment needed – blades, blade holding handle, local anaesthetic, syringe, needles, adhesive tape
• Trigger points are marked
• Local anaesthetic being given
• Then blade just prior to incision
• Depth of incision
• Dressing is then applied

It really is as simple as that, both from my point of view as a doctor and from the patient’s.

Now, some 20 years later, my career has changed as a direct result of my consultation with Ken. That led to my ongoing almost daily involvement with Chronic back pain.

 

As a busy general practitioner, I still carry out my daily consultations, treating a wide range of complaints like any other doctor. But I have also become committed to the treatment of back and neck pain; it is an absorbing and personally satisfying field. Patients from all over Australia, and even from New Zealand, arrive in my surgery regularly for treatment of this debilitating affliction.

More recently, I have also received visits from medical practitioners who have heard about my work and are keen to see it at first hand. They include doctors from Europe and the United States. I know of at least one specialist medical centre in the United States, where Nesfield’s Treatment is being performed with great success (also 70 per cent on early indications) as a result of a visit by one of their team to Dr Rees and myself.

 

I find it gratifying that I have been able to help people who suffer back pain and that my work has generated interest from some members of the medical fraternity.

 

I know Nesfield’s Treatment as a worthy, safe and inexpensive alternative for the treatment of back pain. I call on my fellow medical practitioners and strongly urge them, after careful examination of the procedure, its effectiveness and safety, and after reading this book, to present Nesfield’s Treatment as an option to back pain sufferers, especially before more radical and traumatic forms of treatment are undertaken.

 

 

Facts About Back Pain

* Three out of four people experience back problems at some point in their lives. One of every three people over the age of 40 will experience major, long-term lifestyle difficulties resulting from back pain. Some will even lose their jobs because of it.

* Back pain is among the most common health problems confronting general practitioners every day.

* Indeed, it is third only in volume to respiratory infection and heart disease. Bad backs are rife, these invisible, agonising destroyers of the ideally painless human state. There are as many as two million Australians suffering the complaint in one form or another as I write.

* In Australia, back pain is an extremely costly medical problem. Fifty to sixty per cent of the work force will suffer from back pain at some time during their careers. It directly affects some 100,000 workers every year at a cost to the economy of at least $1 billion - $4 million per day – by way of workers’ compensation, medical, legal and hospital costs and lost production. In America, the cost may now be as high as $US30 billion annually.

* There are, therefore, also profound economic reasons why more attention should be given to the successful treatment of back pain.

* At present, the overall cost of a laminectomy or spinal fusion in Australia (which is widely perceived to be the only permanent solution for acute back and neck pain), is between $15,000 - $20,000 per patient. Yet statistics reveal that this radical, painful and time-consuming treatment may have a less than 50 per cent chance of permanent success.

* Nesfield’s Treatment is only a tiny fraction of the cost of other surgical treatments. There is no prolonged post-operative recovery period at hospital or at home. The patient is able to return to work immediately after treatment and the treatment offers a strong chance of permanent recovery.

The Miracle of Nesfield Treatment for Chronic Back Pain

The twenty-ninth of March 1988 was a day that would change my life. It started much the same as any other busy day. Ahead of me lay the usual number of consultations at my surgery and then, later, three home visits that would complete a 10 hour day for me. About mid-morning, a patient named Ken hobbled through my door. I knew Ken well by then; he was a frequent visitor to my surgery.

He had chronic back and neck pain and at the age of 52, was a cripple leading a miserable life. His condition had begun in his youth when he was a rodeo rider and worsened during his working life as a cane cutter and banana grower. He estimated that he had suffered back or neck pain daily for 25 years. Ken had tried virtually every known treatment for his pain. He had seen a multitude of specialists over the years and undergone three major operations (two laminectomies and one spinal fusion). He was then told that nothing could be done for him and he would just have to ‘live with his pain’.

My role in assisting Ken to do this was mainly one of support and of prescribing appropriate pain relievers (often pethidine), muscle relaxants and sleeping preparations to enable him to endure his life – albeit in a medicated haze. Every day was continuous hell for him, there was no doubt of that; he was utterly miserable. On this day, however, the consultation took a different direction. Ken asked if I would give him a referral to see a Dr Rees who worked in Sydney. One of his friends, he said, had been treated by Dr Rees with a simple surgical procedure and been given great relief from his back pain. Because I had never heard of this doctor, nor of his treatment, I felt the whole exercise would be a waste of time and money and I voiced this opinion to Ken; doctors can, of course, be among the best sceptics in the world. Nonetheless, I gave him the referral, in addition to his usual prescriptions, and wished him well.

Two weeks later, when Ken returned to see him, he was a different man. He walked briskly through my door with a bright smile on his face (I had never seen him walk properly and only rarely smile) and announced, standing up perfectly straight before me, that all of his pain had gone! He had even resumed playing lawn bowls and had taken no medication for one week. It was astonishing news. I had no doubt Ken was telling me the truth; it was obvious the man was entirely free of pain.

In 15 years of full-time general practice, it was the most remarkable and rapid transformation that I had ever witnessed in any branch of medicine; it seemed almost too good to be true. My curiosity well and truly aroused, and my former scepticism retreating, I questioned Ken closely about the treatment he had received from Dr Rees. I then called Dr Rees himself in Sydney several times and questioned him at length about the procedure, which he called rhizolysis. During our discussions I noted he pronounced it ‘rees-o-lysis’, which cleverly, and with some humour, incorporated his own name into it. Although still harbouring some doubts, I decided to travel to Sydney during my annual holidays and learn the technique myself from Dr Rees. It was a decision that would change the direction of my career. Dr Rees, I learned, was a Welsh surgeon and had been a Fellow of the Royal College of Surgeons in England since 1948. He was a beautifully spoken man who sounded like the BBC broadcaster Wilfrid Thomas, another Welshman.

Naturally, I had formed a mental picture of Dr Rees following my telephone conversations with him. But it was nothing like the extraordinary vision he presented when he greeted me at the door of his Woollahra home at 8.40am on a Monday morning as I arrived to start my training. Opposite me stood an extremely dapper man of about 77, of slight stature and wearing, of all things, a bowler hat. He had the most piercing blue eyes, one of which, the left, sported a monocle. He wore a black pinstripe suit that was immaculately pressed, with a gold chain from a fob watch neatly crossing his waistcoat. His black boots were polished in military fashion and they shone so much that I could see my own reflection in them when I glanced down. Dr Rees looked as though he had stepped straight out of 1930. ‘Do come in, Dr Stuckey, it’s lovely to meet you’ he said in an impeccable upper-class British accent, extending his right hand to shake mine while beckoning me inside with his left. Dr Rees was working from his home, after retiring from the hurly-burly of Macquarie Street some years earlier. We sat down and discussed my patient, Ken, and his treatment at some length before Dr Rees’ scheduled patients arrived. It was a fascinating discussion and during it I learned more about the old man’s extraordinary career.

When his first patient arrived in the waiting room, Dr Rees removed his suit coat, hung it up neatly and put on a long, white doctor’s gown, a practice I had long since discarded. Almost as though he was reading my thoughts he insisted I do likewise. Initially I sat in, observing Dr Rees perform the treatment on what seemed like an endless queue of patients outside his door. During the first two days I talked to patient after patient during their treatment and I quickly realised that Ken was only one of many who had benefited from this apparently miraculous treatment. On the third day, Dr Rees informed me the time was right for me to perform my first treatment. The first patient that I treated was a woman in her early sixties who had suffered severe neck pain for more than ten years. I located her trigger points (specific, medically recognised spots from where her pain emanated), injected local anaesthetic into them and, watched carefully by Dr Rees, carried out the treatment with a small surgical scalpel. The entire procedure took five minutes and seemed not to bother the woman at all. She left the surgery, promising to return the following day. The next morning she arrived and was ushered in by the nurse. “How do you feel?” I tentatively asked her. She looked at me with a serious expression on her face and for a moment I was afraid she was going to give me an answer I did not particularly want to hear. She stayed silent, staring at me. Then suddenly she began rotating her head, around and around. Then she stopped and smiled at me. “I haven’t been able to do that for ten years” she replied brightly. “Thank you, doctor”. I had turned off her pain. I felt as though I had performed a small miracle on her, and judging by the grateful expression on her face, she thought so, too.

Upon my return from Dr Rees’ training course in Sydney I was, as usual kept busy. Apart from my usual medical appointments there were also a number of back pain sufferers eager to hear what I had learned. The first patient that I treated was a petite woman in her sixties who had endured two decades of crippling back pain. She used to attend the surgery on a weekly basis because she required a cocktail of about twenty tables per day to control her pain. “How do you feel?” I asked, one week after treating her. To my amazement she bent down and touched her toes, then stood up and gave me a broad, cheeky grin. “I’ve been out boogieing, doctor” she replied enthusiastically. “I haven’t been able to dance a step in years”. She has taken virtually no pain relieving tablets since. Two small miracles in a row; it was astonishing, at the least, and very encouraging.

At the time of writing, I have treated more than a thousand patients using the technique I now call Nesfield’s Treatment. Dr Rees had treated thousands of patients more before me – and there are a small number of doctors throughout Australasia and overseas also practising it. Surprisingly, the procedure is unknown to most back and neck pain sufferers throughout the world. The procedure’s anonymity, the lack of knowledge about it, is an extraordinary situation; I can only liken it to an information blackout. (I will refer to the affliction only as back pain from this point but it does include neck pain as well.)

Why I specialise in Back Pain Treatment

Three out of every four people will be troubled by back pain at some stage in their life. In most cases the cause is unknown despite many different theories.  Most people find that their pain diminishes with the passage of time. Many seek and find effective treatment for their pain. There remains, however, a large group of back pain sufferers who are left to live in daily agony with seemingly no relief available.

It was one of this latter group of back pain sufferers who was to change the course of my career. This man had suffered crippling back and neck pain for twenty years. Multiple treatments and three major operations had made no difference to his pain. He required daily narcotic pain relieving tablets and often needed to rely on a walking stick to get around. He told me that he wished to travel interstate to see Dr Skyrme Rees who used a procedure called Nesfield’s Treatment (medically called percutaneous neurotomy) to treat back pain. Despite the fact that I had never heard of this doctor, nor of the treatment, I advised my patient that I felt he would be wasting his money. Two weeks later, he returned to see me as a different man: NO PAIN, NO TABLETS, NO WALKING STICK AND PLAYING LAWN BOWLS. It appeared as though a miracle had been performed and certainly it was the most remarkable and dramatic improvement in any patient that I had seen in my fifteen years as a doctor.

My fascination was such that I flew to Sydney and was trained to perform Nesfield’s Treatment. Straight away I realised my patient was not the only person to find relief. This kind of ‘miracle’ happened daily in Dr Rees’ surgery.

It amazed me that a treatment which takes five minutes, performed in the doctor’s surgery and produces such dramatic pain relief was not better known and more widely used. Why had I not heard of percutaneous neurotomy? Why was it not taught in medical schools or hospitals? Why was it not offered to more people? My search for the answers to these, and many more questions had just begun.

Imagine my sense of satisfaction when the patients I treat can reduce their tablet intake from twenty per day to nothing because they have no pain.

It seemed incredible to me that this patient of mine who used to spend his day lying down in agony or hobbling around on two walking sticks, now works full time as a security guard.

I felt incredible joy when a patient who was suicidal because of his daily head and neck pain, received total pain relief from this treatment. He has since resumed work with appositive outlook on life.

Over the last five years, I have observed thousands of similar cases. Nesfield’s Treatment, a five minute procedure performed in my surgery, provides significant and lasting relief in the majority of cases.

My interest in this work has led me to publish articles in a number of different medical journals and to present this subject to medical conferences in Australia, USA and Europe.

Despite all this, the reaction of me medical colleagues is enormously varied. Some are supportive of my work, most are tight-lipped and sceptical while some are openly critical.

The purpose of this book is to present an extremely safe, effective and very simple method of treating many cases of back and neck pain. It is not a criticism of any of the currently practised methods of treatment, rather it is written for the large group of patients who have had no relief of their pain despite many different treatments.

The book is a statement of opinion supported by thousands of well documented case histories. I fully accept that my theories differ from current medical thinking. It is my firm conviction that our current medical model for back pain is inadequate and leaves many patients undiagnosed and poorly treated.

You DONT have to live with your pain, as you will discover in Say Goodbye to Back Pain.