Dr. Richard Stuckey MB.BS. DRCOG. FAANaOS "Say Goodbye to Back Pain"
Sunday, February 19, 2012
"Say Goodbye to Backpain" Table of Contents:
Say Goodbye to Back Pain, Sept 2011
Why I Specialise in Back Pain Treatment, Sept 2011
The Miracle of Nesfield Treatment for Chronic Back Pain, Oct 2011
Facts About Back Pain, Oct 2011
The Procedure of Nesfield's Treatment, October 2011
Different Treatments for Back Pain, November 2011
Facts and Fallacies about Back Pain, November 2011
Trigger Points as a cause of Back Pain, November 2011
Back Pain Case Studies, December 2011
Back Pain Case Studies 3-7, December 2011
Back Pain Case Studies and Testimonials 8-13, December 2011
Back Pain Case Studies 14-18, January 2012
Back Pain Case Studies 19-22, January 2012
Back Pain Case Studies 23-26, January 2012
Back Pain Follow Up and Results, February 2012
Spreading the Untruths about Back Pain, Feb 2012
Published Papers by Dr Stuckey, February 2012
Monday, February 13, 2012
Published papers by Dr Stuckey
William Penn
Percutaneous *Rhyzolysis: Active Treatment of Chronic Back Pain
Richard H Stuckey, MB
Abstract. When percutaneous rhizolysis was first presented, its efficacy in the treatment of back and neck pain was claimed to be due to denervation of zygapophyseal joints. This claim was quickly refuted, and thus the procedure did not gain general medical acceptance. By focusing attention on posterior vertebral structures as a cause of back pain, it was the forerunner of the more sophisticated zygapophyseal joint blocks and denervation techniques. In the series presented, 73% of a group of 202 patients with hitherto intractable back or neck pain were significantly improved 12 months after percutaneous rhizolysis. As this treatment is targeted at myofascial trigger points, consideration will be given to the link between these peripheral points and underlying osseous pathology. It will be postulated that this treatment interrupts afferent pain transmission from these trigger points, thus effecting longer lasting pain relief than other methods of treating trigger point pain.
Percutaneous rhizolysis was first presented by Rees in 1971. His original paper (1) generated a great deal of world-wide interest both because of the claimed success rate and for focusing attention on the posterior vertebral structures as a cause of back pain.
The explanation given for the pain relief was that this procedure divides the medial branch of the posterior ramus of the segmental nerves, thus denervating the zygapophyseal joints and thereby alleviating any pain coming from these joints. This theory was widely criticized; it was claimed that the blade is not long enough and the incision usually too lateral to reliably access these nerves. Many also stated that even if the joint was denervated, then it would surely degenerate with the passage of time.
Over the years attention has focused on the zygapophyseal joints as a source of back pain. Despite the last criticism mentioned above, more accurate and sophisticated (and expensive) methods of denervating zygapophyseal joints have been developed, including local anaesthetic blocks and destruction of the medial branch of the posterior ramus of the segmental nerves by freezing, radiofrequency diathermy, or sclerosant injection (“facet rhizotomy”). The original procedure seems to have been forgotten.
For more than 2 years I have been using Rees’s modified procedure and will present a series of 202 consecutive cases treated by percutaneous rhizolysis and followed up 12 months later. The results compare favourably with any method of zygapophyseal denervation. An alternative theory will be postulated to explain this pain relief and the advantages of this technique.
The Series:
Patients
The series comprised 254 consecutive patients who pain had been present for more than 6 months, was getting worse at the time of consultation, and had not responded to other forms of treatment. In 202 patients (79.5%) 12-month follow-up was achieved.
The 202 cases comprised 51 cervical, 24 thoracic, and 127 lumbar problems. There were 97 men and 105 women. The average patient age was 59.5 years, and the average pain duration was 13.6 years.
Diagnosis
The diagnoses made prior to presentation were many and varied (Table 1). Osteoarthritis was by far the most common. In a significant percentage of cases no diagnosis had been offered to explain the pain. Where a diagnosis of degeneration or osteoarthritis was made, there was virtually no correlation between the severity of radiological signs and the severity of clinical symptoms.
Prior Treatment
Every patient in this series had, in the past, been unsuccessfully treated with some or all of the following modalities: NSAIDS, physiotherapy, chiropractic treatment, acupuncture, massage, injections, epidural corticosteroid injection, and operation.
The majority had been told that all treatment options had been tried and that there was nothing that could be done.
Physical Examination
In the majority of patients, specific neurological deficits could not be elicited. When limb pain was present, it usually did not correspond to a recognised dermatome. The only consistent physical finding was the presence of well-localised tender spots (“trigger points”, points of Travell (2), distal points of Russel (3) and various other synonyms). These points were usually near the level of maximum pain and often, but not always, they lay over the zygapophyseal joints. If the pain was unilateral, the trigger points were always on the same side as the pain.
The surface anatomy of these points was remarkably constant. While they could be found in any muscle of the body, the vast majority occurred at one of seven sites (Fig 1). Pressure on these points (particularly 3 and 7 in Fig.1) often reproduced the patient’s limb pain.
Table 1: Most common pre-treatment diagnosis
1. Osteoarthritis
2. No diagnosis
3. Disc degeneration
4. Spondylitis
5. Osteoporosis
6. Pinched nerve
Procedure
This was similar to that originally published by Rees (1)
• The appropriate trigger points were identified and marked
• The area was cleansed with topical antiseptic
• 3ml of 0.5% xylocaine plain was injected
• The rhizolysis blade (ENT microblade 52L or M) was introduced 15°cephalad to the vertical, moved caudally 30° and removed. By moving the blade through a much shorter arc, hematoma formation was virtually abolished.
• A pressure dressing was applied (sutures were not used in any patient)
• Subsequent treatments, if required, were usually done at monthly intervals; the average number of treatments was two per patient.
• Patients were deliberately given no post-procedure instructions regarding weight loss, exercises, or lifestyle change; they were instructed to contact me if the pain recurred.
• Follow-up was done 12 months after treatment
Results
At the follow-up examination, patients were asked to allocate their current pain and disability status into one of six groups:
- Worse
- No change
- Mild improvement
- Moderate improvement
- Marked improvement
- Total resolution as compared with pre-treatment pain levels.
A good result was considered as moderate improvement, marked improvement, or total resolution. By this definition 72.8% of cases achieved a good result (Table 2). Almost all who showed improvement commented on a markedly increased mobility of the area treated, and previously tender trigger points were no longer present. None of those who were worse attributed this decline to the rhizolysis procedure. Of the 202 cases, 13 had had previous vertebral surgery – four of these achieved total resolution of their pain and nine were unchanged. Thus, this procedure does not work as well when there has been prior surgery.
This is the first follow-up series of percutaneous rhizolysis to be reported and reaffirms previous publications (non-follow-up) as to the efficacy of this procedure (1,4-7).
Table 2: comparative pain status 12 months after rhizolysis
No of patients
|
%
|
|
Worse
|
7
|
3.5
|
No change
|
37
|
18.3
|
Mild improvement
|
11
|
5.4
|
Moderate improvement
|
33
|
16.3
|
Marked improvement
|
81
|
40.2
|
Total resolution
|
33
|
16.3
|
TOTAL
|
202
|
100
|
Discussion
Uncontrolled trials such as this are, of course, subject to many variables and thus one cannot make dogmatic conclusions. By leaving the follow-up for 12 months, variables such as patient expectations, practitioner’s suggestions, and effect of local anaesthetic would clearly not be operating. It would be reasonable to conclude from the figures that percutaneous rhizolysis provides a variable degree of relief in a high percentage of selected patients with intractable back and neck pain. The main point of discussion must surely be: Why does it work?
The initial assertion by Rees (1) was that this procedure divides the medial branch of the posterior ramus of the intersegmental nerves. This was thought to denervate the zygapophyseal joints and thus relieve any pain arising from these joints. This theory was, for sound reasons, disputed and the procedure was not generally accepted by most of the medical profession. Some of the reasons for this disputation were the following:
• An incision 2-3 cm from the midline would cut the lateral, not medial, branch of the posterior ramus and thus denervation of zygapophyseal joints would not be effect5ed
• In obese people, the blade used is not long enough to reach the intertransverse membrane (8) and thus neither medial nor lateral branches would be cut.
• In many people, points of Travell do not over-lay zygapophyseal joints. While ‘peripheral rhzolysis’ done at these points often produces spectacular results, the improvement obviously has nothing to do with zygapophyseal denervation
• Even if these joints were denervated, what would happen to them in years to come?
Those who levelled this criticism relied (and still rely) mainly on the Mixter-Barr theory (9) as the cause of back pain. This theory suggests that the majority of back pain is due to pressure by either bone, disc material, or ligament hypertrophy on exiting segmental nerves. No significance is attributed to the presence of trigger points. Strict adherence to this theory leaves the majority of back pain sufferers undiagnosed, inadequately and unsympathetically treated, and often unnecessarily operated on.
In the series presented, the only constant factor was the presence of trigger points in the vicinity of the pain. The following theory endeavours to link together underlying osseous pathology, myofascial trigger points, and pain production. It would lead to a more rational explanation as to why percutaneous rhizolysis works:
1. A variety of stimuli (trauma, ‘whiplash’, injury, overuse, arthritis of vertebral body or apophyseal joint, disc degeneration, disc prolapsed) sets up a ‘trigger point’ in adjacent ligamentous or muscular supports.
2. From this trigger point noxious stimuli are transmitted centrally by either the Aᵹ (myelinated) or C (nonmyelinated) slow conducting nerve fibres. These fibres relay in the dorsolateral tracts for central transmission (10). Thus, a sensory (or pain) arc is established and it is not necessarily the initiating cause which propagates the pain (Fig 2)
3. ‘Rhyzolysis’ divides these afferent nerves, thus interrupting the sensory arc and effecting pain relief (Fig 3). The zygapophyseal joints are thus not denervated and continue to function normally.
4. The procedure thus relieves that percentage of the overall pain caused by the trigger points and leaves the patient with the percentage of overall pain which was, in fact, coming from the underlying osseous pathology.
This theory would fit in with most of the objections to the previously published theory on the success of this procedure. It would also explain why most people do not get 100% relief, why some (very few) recur, and why the procedure does not work for clinically obvious and significant vertebral canal stenosis. It should thus be viewed as an adjunct to, and not in competition with, vertebral surgery.
Another observation is that percutaneous rhizolysis effects much longer pain relief than other methods used to treat myofascial pain (injections, freezing, sclerosants, massage, acupuncture, thermal change, etc.).
Thus, whether percutaneous rhizolysis denervates zygapophyseal joints or not, it has a similar success profile to other procedures, is cheaper, simpler and quicker, and obviously is not detrimental to the long-term health of the zygapophyseal joints. It is equally applicable at any level of the vertebral column and can also be used on peripheral trigger points which commonly occur in the trapezius, gluteus, and scapula muscle groups. Percutaneous rhizolysis thus has greater clinical scope than facet denervation by whatever means.
Conclusion
The purpose of this article is twofold: first, to reaffirm, by way of a follow-up series, that percutaneous rhizolysis gives lasting relief to a large percentage of selected patients with intractable back or neck pain; second, to put forward an alternative theory as to why it works. This theory is not viewed as an endpoint, but as a stepping stone to more detailed research and discussion on this, and similar, methods of relieving back pain.
Percutaneous rhizolysis should be viewed as part of the overall treatment protocol in selected patients with intractable back and neck pain before expensive and invasive investigations and operations are embarked upon.
References
1. Rees S. Multiple bilateral sub-cutaneous rhizolysis in the treatment of the slipped disc syndrome. Ann Gen Pract 1971; 16:126-127
2. Travell J, Travell W. Therapy of low back pain by manipulation and of referred pain in the lower extremities by infiltration. Arch Phys Med 1946; 27:537
3. Russel WR. Treatment of intractable pain. Proc Roy Soc Med 1959; 52:983
4. Toakley JG. Subcutaneous lumbar rhyzolysis – an assessment of 200 cases. Med J Aust 1973; 2:490-492
5. Francis JG. Subcutaneous lumbar rhizolysis – an assessment of 200 cases. Med J Aust 1973; Oct 13:102
6. Stuckey RH. Percutaneous rhizolysis: Why does it work? Med J Aust 1990; 152:500
7. Cyriax J. Treatment of intractable back-ache. In: Textbook of orthopaedic medicine, Vol 1 Balliere-Tindall, London, 1982, 348
8. King JS. Randomised computerised trials of the Rees and Shealy methods of the treatment of low back pain. In: Morley TP (ed) Current controversies in neurosurgery. WB Saunders, Toronto, 1976, 89-93
9. Mixter W, Barr, JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934; 211:210-215
10. Travell J, Simons D. Myofascial pain and dysfunction. The trigger point manual. Williams and Wilkins, Baltimore, 1983; 13-17
11. Shealy CN. Facet rhizotomy/denervation. A fifteen year experience. J Neurol Orthop Med Surg 1988; 9:107-109
12. Silvers HR. Lumbar percutaneous facet rhizotomy. Spine 1990; 15:36-40
When Rees first presented this technique in 1971, he claimed that pain relief was achieved by cutting the nerve supply to zygapophyseal joints (1). I have been using the identical technique but believe the procedure produces pain relief by interrupting pain transmission from myofascial trigger points (2, 3).
The following six cases demonstrate the variety of patients suitable for this treatment, and the selectivity of response. A brief comment will follow each case and the commonality of all cases will be considered in the discussion.
Case 1
A 59 year old man developed severe back, neck, and head pains following a motor car accident in 1968. In 1972 the patient had a cervical (C45) fusion which produced mild (but not sustained) improvement; in 1974 he had a laminectomy (L45) which produced no change; and in 1975 a lumbar fusion which he described as ‘moderately successful’.
Over the next 13 years he had crippling neck and head pain (much worse on the left side), in addition to severe lumbar pain and right buttock pain which radiated down to his right knee. Assorted ‘conservative treatments’ along with enormous quantities of analgesics and relaxants produced no pain relief, and he was forced to leave his senior position in his state’s police force.
Physical examination was unremarkable except for obvious restriction of movement and for the prominence of myofascial trigger points in the vicinity of his pain. In the neck, both the symptoms and tenderness were much worse on the left side, and in his low back both the symptoms and tenderness were predominantly right sided.
‘Rhyzolysis’ was performed at three levels at the base of the patient’s neck (C67, C7T1, T1T2) with rapid resolution of all his head and neck pains. Minor recurrence of pain 4 months later necessitated two levels being retreated. A single procedure at the L45 level produced rapid resolution of all his back and leg symptoms. Each procedure took 5 minutes, was performed by the author, with the patient fully ambulant immediately thereafter.
The patient has been virtually pain free for 2 years without any analgesic medication.
Comment
This patient had chronic pain and major underlying vertebral abnormalities in that he had had both cervical and lumbar fusion. His symptoms were attributed to the underlying osseous pathology and no relevance was attached to the presence of trigger points. Rapid pain relief followed appropriate treatment.
Case 2
An exceptionally fit 37 year old man was involved in a serious motor accident in 1986. Back pain began 3 days later and he also rapidly developed head, neck, and leg pain. When he saw the author in 1989 he complained of the following:
1. Constant lumbar pain, worse on the left side
2. Severe burning sensation in his left hip, worse after exercise
3. Constant pain in both legs
4. Constant ache in both groins and testicles
5. Intermittent acute shooting pains in both groins
6. Marked urinary frequency, occasional incontinence, and nocturia, between five and seven times per night
7. Constant neck and right arm pains
8. Frequent occipital headaches radiating to his forehead.
During the previous 2 years the patient had seen a multitude of doctors, orthopaedic surgeons, neurologists, and urologists. Extensive investigations had been performed (including X-rays, CT scans, and renal function studies), all of which were normal. No operative intervention had been suggested and regular physiotherapy had made no difference.
The patient was unable to do any form of work, required one or two walking sticks most of the time, was unable to stand for more than 2 hours, was incontinent and slept poorly due to pain and nocturia.
Physical examination was again unremarkable except for prominent myofascial trigger points. The following levels were treated with the following results.
• L45 – immediate resolution of burning hip pain and reduction in back pain
• L5S1 – leg pain improved, suprapubic pain gone
• L34 – back pain virtually gone, groin pain resolved, nocturia improved dramatically
• C56 – headaches gone, arm pain unchanged
• T12 – less arm pain, scapula pain persists
• T23 – all arm, neck, and head pain gone
• Left thigh and left calf – left leg pain resolved
• Right thigh and right calf – right leg pain resolved
The first six procedures were done over an 8 week period. The last two procedures were performed 5 months later due to the persistence of his leg pains.
The patient is now back in full time work, almost pain free, exercising at least 1 hour per day, training for a triathlon, sleeping well, not having nocturia, and enjoying his life for the first time since the accident.
Comment
No cause could be found for this patient’s severe pain and disability; it was implied that he was malingering. No significance was attached to the presence of trigger points and he obtained relief following percutaneous rhizolysis.
Case 3
Following a motor accident in 1958, a 59 year old man, a former rugby player, developed severe neck pain and headaches, which were exacerbated by a second accident in 1979. Since that time he had had severe, crippling neck pain, and headaches, in addition to bilateral arm weakness and parasthesia. Conservative treatment (physiotherapy and chiropractic) had made no difference. In 1981 he was advised to have a cervical fusion but declined.
I first saw him in 1988. Physical examination revealed a mild restriction in most movements and prominent trigger points on both sides of his cervical spine. X-ray (1988) revealed advanced cervical spondylosis with encroachment on some of the lower intervertebral exit foraminae (Fig. 1A,B).
The first procedure, at C45 level, led to almost immediate relief of the patient’s headaches. Following treatments at C56 and C67 levels his neck pain disappeared. Arm pain and tingling resolved and considerable strength return to both arms. A subsequent heavy fall led to recurrence of some of the pain but this responded to further treatment.
He has now been virtually pain free for 18 months with minimal use of analgesics.
Comments
This patient’s symptoms had, for 20 years, been attributed to cervical degeneration. The tender points in his neck had been noted but not considered significant. Rapid resolution of his pain followed percutaneous rhizolysis treatment, although his advanced cervical spondylosis is possibly worse.
Case 4
A 38 year old woman had experienced constant but fluctuating neck and head pains for 25 years. She described the pains as originating in the base of the neck, radiating to the occiput, and then all over her head; both sides were equally affected. Multiple ‘conservative’ treatments had been tried with no improvement (including medication, physiotherapy, and chiropractic). A diagnosis of arthritis had been put to the patient (despite her age and the fact that no X-ray had been taken). She was never pain free and relied heavily on analgesics.
Physical examination was remarkable except for the presence of trigger points at the C45 level. A single procedure was done at this level. Over the ensuing 14 months she has not had any head or neck pain, used any analgesics, worn a collar, or needed any other therapy.
Comment
In this case a diagnosis of arthritis has been made without an X-ray being taken. Extremely rapid relief of pain, which has been present for more than half her life, followed a single rhizolysis treatment. Again, no significance has been attached to the easily palpable trigger points. Her neck is now nontender.
Case 5
A 70 year old man presented with 20 years of vague, fluctuating back pains which had become markedly worse over the previous 2 years. His pain was mainly right sided and radiated to his right thigh, calf, and foot. The leg and foot pain bothered him more than his back.
Physical examination was unremarkable except for the presence of trigger points in both buttocks and sacrum. Pressure on the buttock trigger points reproduced his leg and foot pain. X-ray showed gross osteoarthritis with a marked spondylolisthesis of L5 on S1 (Fig. 2A, B). His pain had been attributed to the radiologically apparent osteoarthritis.
Following rhizolysis to his two right5 sacral trigger points his foot pain resolved rapidly and his thigh pain improved slowly. The left side was treated likewise 2 months later. For the 12 months following these procedures he has had no back or leg pain.
Comment
In this case gross radiological changes had been presumed to be causing the patient’s symptoms, and the trigger points were ignored as a possible cause of pain. In retrospect, the original diagnosis was incorrect.
Case 6
A 57 year old woman presented with 10 years of increasing lumbar pain. The right side was worse than the left and she also had right calf and foot pain.
Physical examination demonstrated right-sided trigger points but nothing else. Conservative treatments had not helped. X-ray showed ‘advanced degenerative disease’ at both L34 and L45 levels.
Rhyzolysis at the lowest three lumbar levels led to the rapid abolition of all symptoms. Two years later her calf pain recurred. This was associated parasthesia and was more severe than 2 years before. There was no recurrence of her back pain. CAT scan revealed vertebral canal stenosis at the L45 and L5S1 levels and following laminectomy her leg symptoms abated instantly. She has since been free of both back and leg pain.
Comment
As with the other patients, radiological abnormalities had been used to explain her pain for 10 years. Rapid and near total relief followed rhizolysis treatment. Two years later she presented again with typical unilateral pseudo-claudication of vertebral canal stenosis and underwent a very successful laminectomy. The point of debate here is what gave her the initial 2 years of relief.
Discussion
In all these cases, the presence of trigger points had been ignored as a source of pain.
The patients with underlying radiological abnormalities had been told that this was the cause of their pain and that there was nothing that could be done for them. Retrospective assessment has proven this to be wrong in that all have had lasting relief (over 14 months) following percultaneous ‘rhzolysis”.
The patients with normal underlying vertebral columns had been told such things as to ‘pull themselves together’ and ‘forget about the pain’. Both these patients had rapid resolution of their problems and are now leading normal lives.
The last case described demonstrated that this procedure does not work for clinically obvious vertebral canal stenosis (as it does not for acute intervertebral disc protrusion). Both these conditions should be easily recognised clinically and appropriate treatment instituted.
The common thread in each of these patients, and indeed all the patients that I treat, is the presence of trigger points. It is my belief that trigger points are the central issue in most people’s chronic back pain and that this procedure divides afferent, pain-conducting nerve fibres, thus effecting longer pain relief than other methods of treating trigger point pain. Whether ‘rhzolysis’ works by this means or Rees’ theory, or as a myotomy or a fasciotomy, matters little to the patient. In properly selected cases it is highly, and rapidly effective and should be offered to more pain sufferers.
‘Rhyzolysis’ should therefore not be viewed as being ‘in competition’ with surgery or any of the non-invasive methods of treating back pain. Rather it should be viewed as part of the overall treatment protocol of patients with intractable back pain where the passage of time and ‘conservative’ treatments have not helped. Its use should be considered before surgery.
Reference
1. Rees WS. Multiple bilateral sub-cutaneous rhizolysis in the treatment of the slipped-disc syndrome. Ann Gen Practice 1971; 16:126-127
2. Stuckey RH. Percutaneous rhyzolysis: Why does it work? Med J Aust 1990; 152:500
3. Stuckey RH. Percutaneous rhyzolysis: active treatment of chronic back pain. J Neurol Orthop Med Surg 1991; 12:116
Monday, February 6, 2012
Spreading the unwelcome news about back pain
The best thing to do behind a man’s back is to pat it.
Lisa Jane McInnes-Smith
At the beginning of my quest, as I call it, I was a much more conservative doctor than I am now. Perhaps naively, I decided I was going to do things by the book and not unnecessarily step on the toes of my medical peers – if I could help it. I knew I was on to something, and the temptation to go public with my story via the media was a strong one despite the ethical risks over advertising. However, I decided to go through the official channels to begin publicising the procedure. I knew it would not be easy because of the power of the backlash the procedure had generated some twenty years before.
I tested the water by sending an article about my results, taken from my follow-up with patients twelve months after treatment, to the Medical Journal of Australia.
Although the article was rejected, without reason, the editor kindly asked me to write a letter about my work which she undertook to publish in the letters to the editor section. It was duly published in May 1990, but failed to arouse much comment from readers.
Percutaneous rhizolysis: why does it work?
(Copyright ©the Medical Journal of Australia. 1990; 152: 500. Reprinted with permission)
To the editor:
Percutaneous rhizolysis was first described by Rees in 1971 1. Since then many articles have been published demonstrating its efficacy, 2,3,4 and yet it is still offered to relatively few back pain sufferers.
I recently completed a 12 month follow-up of 95 of my first 110 consecutive cases of back pain treated by rhizolysis. In the series the average patient age was 57.6 years (range 17 – 84) and the average pain duration was 13.6 years (range 0.5 – 42 years). The most common diagnosis to explain the pain was osteoarthritis. Every patient had tried (unsuccessfully) some or all of the following treatment modalities; non-steroidal anti-inflammatory drugs, physiotherapy, chiropractic, acupuncture, massage, injection, epidural corticosteroid therapy and operation. In most cases, physical examination yielded unremarkable findings except for the almost universal presence of myofascial trigger points in the vicinity of the pain, regardless of the underlying diagnosis.
At the follow-up examination, patients were asked to allocate their current pain and disability status into one of six groups:
- Worse
- No change
- Mild improvement
- Moderate improvement
- Marked improvement
- Total resolution
The original explanation for this success was that rhizolysis cuts the medial branch of the posterior ramus of the segmental nerve thus denervating the zygapophyseal joint 5. The theory was disputed because: an incision 2 cm from the midline would cut the lateral branch of the posterior ramus; in obese people the blade is not long enough to cut either nerve6, and trigger points often do not lie over zygapophyseal joints.
One explanation for the genesis of myofascial pain is that trigger points can be established by a wide variety of stimuli and that pain perception is transmitted centrally from these points by the Ad nerve fibres and the C slow conducting (group IV) nerve fibres7. Many different methods have been used to deactivate these points, usually with only temporary success.
An alternative theory to explain the success of rhizolysis would be that it divides these afferent or pain conducting nerve fibres thus effecting much longer relief.
For whatever reason rhizolysis works it should be offered to more people with chronic back pain before expensive and invasive instigations and operations are embarked upon.
Richard H Stuckey, MB BS
1. Rees S Multiple bilateral sub-cutaneous rhizolysis in the treatment of the slipped disc syndrome. Ann Gen Pract 1971; 16: 126-127
2. Toakley JG. Subcutaneous lumbar ‘rhizolysis’ – an assessment of 200 cases. Med J Aust 1973; 2: 490-492.
3. Francis J. Subcutaneous lumbar ‘rhizolysis’ – an assessment of 200 cases. Med J Aust 1973; 2: 749-750.
4. Rees WS. Multiple bilateral percutaneous rhizolysis. Med J Aust 1975; 1: 536-537.
5. King JS. Randomised computerised trials of the Rees and Shealy methods for the treatment of low back pain. In: Morely TP ed. Current Controversies in Neurosurgery. Toronto. Saunders Press, 1976: 89-93
6. Cyriax J. Treatment of intractable back-ache. In: Cyriax J ed. Textbook of Orthopaedic Medicine. Vol 1. London: Bailliere Tindall. 1982: 353-355
7. Travell J, Simons D. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins, 1983: 13-17
Encouraged, I wrote to the editor of a leading Australian medical journal in May 1990 asking his advice about writing a paper on the treatment, which I then called percutaneous rhizolysis, with a view to informing other doctors about it. He replied:
Dear Doctor Stuckey,
Thank you for your letter of 28.5.90. Percutaneous rhizolysis has been around for some time now and is a proper subject for discussion. I suggest you write a short article for us – in the order of 2,000 words – which I shall publish under the heading “Point of View”. As you say, no doubt others will wish to criticise what you say, but I see no harm in controversy.
Yours sincerely,
Editor
So far, so good. I wrote the article and sent it off with high hopes. As is usual, the article was given to two specialists to act as referees in judging the suitability of the article for publication.
A few weeks later, the editor wrote back saying that, regretfully, the articles had been declined for publication. He included the unsigned comments of the two referees.
The first was bad enough:
In summary, this paper is wholly without scientific merit. In my opinion it is not of sufficient standard for publication to be considered and its fundamental faults are such that no amount of editing would render it so.
But the second more or less traumatised me.
This is a totally unsuitable article about a largely discredited procedure. There are great dangers in the widespread use of tenotomy or similar knives being plunged into buttocks or para vertebral areas. Many of this age group – 60.4 years – can be expected to respond to any treatment that involves interest and follow-up.
If I had had any doubts about the existence of a backlash against the procedure, I held none after reading those comments. At that point, I concluded there was little point in making further efforts to be published in mainstream Australian medical journals.
A short time later, after receiving a little guidance in the matter from another doctor, I sent the article to the Academy of Neurological and Orthopaedic Surgeons in the United States and asked them to consider it for publication. Imagine my delight a short time later to receive the following reply dated 4 November 1990 which reads in part:
Dear Doctor Stuckey,
Your excellent article has been accepted for publication into our Journal.....
The same organisation then accepted a second article for publication in its journal both of which are included in the latter part of this book.
I was invited to attend and present an address at the convention in Las Vegas in September 1991 of the Academy of Neurological and Orthopaedic Surgeons. I accepted. I was quite nervous about this. Here was I, a general practitioner from Australia, about to address a gathering of leading orthopaedic and neurological surgeons from throughout America; it was intimidating to say the least. I had put together a short video and slide display to present during my address as well as some carefully written notes. By the time it came for me to speak I had become quite relaxed about the whole thing because I felt that I had come better prepared than some of the speakers before me.
I went ahead and addressed about seventy specialists in a conference room at the Bally’s Las Vegas Hotel and at the end of it, I am pleased to report that I was rushed by quite a number of them. The six spare copies of my videotape were gone within a few moments and I found myself busy for quite some time afterwards answering questions about my procedure. It was a gratifying moment in my life as a doctor and one I am proud of. I felt somehow vindicated in the knowledge that at least in the USA there were open minds prepared to listen to what I had to say.
Back in Australia, invigorated and encouraged by my American experience, I entered a hypothesis about Nesfield’s Treatment, entitled “Percutaneous Neurotomy (which I now called it medically because I believed rhizolysis was an inaccurate description); Why Does It Work? For a research grant for general practitioners sponsored by a pharmaceutical company under the auspices of a medical body.
It was rejected on several grounds. First, that the results were not achieved from a controlled* trial, second, that the statistics were questionable and third, that there would be bruising. Neither did they accept my hypothesis as to why it worked, i.e. separating sensory fibres, or trigger points. They did not say why.
I was not overly surprised at the rejection, but it added to my frustration, knowing of the thousands of back pain sufferers still being denied knowledge of a procedure that worked.
*(A controlled trial is one where half of the experiment group receive the active treatment and the other half a sham treatment. No patient knows which they have received. An independent observer (who does not know who has had the active or sham procedure) assesses the results after a specified time interval. A successful result would be where the active treatment produced significantly better results than the sham treatment.)
In 1992, I applied to present on the subject at the world body of musculoskeletal medicine (the International Federation of Manual Medicine) triennial conference in Brussels. My paper was one out of 350 submissions made worldwide and became one of seventy actually accepted and given by me at the conference in September of that year.
Again, I was met with a deeply positive, even enthusiastic, reaction to my address and again, I came away feeling satisfied that outside Australia at least, I was dealing with genuinely open minds.
In November 1991, I lent my assistance to a professional freelance television documentary team who were trying to make a film about Nesfield’s Treatment. I gave them interviews with myself and with a dozen patients. I also allowed them to film the procedure while I performed it. In Sydney, Dr Rees had similarly accommodated them. Although both the British Broadcasting Corporation and Australian Broadcasting Commission in Australia were at first deeply interested in the excellent sample material sent in by the producers, neither was prepared to fund the film. Later, the producers kindly gave me a copy of the material they had put together and allowed me to send it to most of the popular current affairs programs. All rejected the story but did not say why. Three years later (May 1993) one of these programs asked to run the story. I am not sure why they had a change of heart but they produced a segment highlighting opinions for and opinions against Nesfield’s Treatment. The programme drew unprecedented public response with literally thousands of listeners phoning in their opinion or request for further information. I was told it was the biggest response they had had to any story they had ever run.
In 1972, the prestigious ABC program “Four Corners” unit, Mr Gordon Bick, who initially wondered if the show had made a mistake producing such a program, says now that the public reaction to the segment was the greatest in all his ten years working on “Four Corners”; it was astonishing. The ABC phones were still ringing months later with people calling in, eager to find out more about the treatment Dr Rees had demonstrated.
I believe it is reasonable to conclude that there is still powerful resistance to Nesfield’s Treatment here in Australia, despite a deep public interest in it. For obvious reasons, I also believe it is a great tragedy that it has not been commonly available to back pain sufferers for the last twenty years.
Conclusion
This book has discussed a different method of treating back and neck pain. It is particularly aimed at long-term sufferers. I repeat that it is not put forward as an answer to all back pain. Nor is it designed to replace any of the currently accepted treatment methods. It is written primarily to inform people about Nesfield’s Treatment, a misunderstood and under-utilised procedure.
The book has outlined a different method of treating back pain based on a different theory about the causes of pain. Because this method and theory are not discussed or taught in medical schools, chiropractic colleges or physiotherapy schools, very few practitioners know about this procedure and even fewer perform it. Very few patients are ever likely to hear about it. If they do, it will usually be from someone who has successfully undergone the treatment.
Nesfield’s Treatment appears to be totally risk free, is simple and quick to perform, easily learned, cheap to administer, does not require drugs or hospitalisation or expensive equipment and, most importantly of all, on certain patients works better than any other method of back pain treatment.
Old habits die hard and accepted medical dogma is difficult to change. But progress and change can only ever be made when someone is prepared to question established ideas and put forward new ones.
To all back pain sufferers, therefore, when someone next tells you that you have to live with your pain, don’t believe them.
Tuesday, January 31, 2012
Back Pain Follow-Up and Results
'Nothing is terminal. Everything is transitional. What looks like the end of the road will turn out to be a bend."
Robert Schuller
With most methods of back pain treatment it is hard to be certain that the treatment works, and how well it works. How long does it work? Why does it work? What complications develop?
Unless treating practitioners maintain careful long-term follow-up data about all patients, they will have no idea of the answers to the above questions. Virtually no practitioners who treat back pain – surgeons, physicians, physiotherapists, acupuncturists, chiropractors and masseurs included – appear to have any contact with their patients after initial treatment. They tend to presume that if patients do not return then they must be pain free. More likely they have gone elsewhere.
I elected to contact every patient I treated 12 months after the initial treatment. I asked each patient to complete a written questionnaire. I had given no instructions as to exercise, weight loss, tablets, lifestyle changes or indeed any instruction which could be seen to produce or influence as result.
I delayed the follow-up for 12 months to make sure that the benefit was long-lasting and to avoid confusing pain-relief with local anaesthetic effect, ‘placebo response’, or auto-suggestion. If the survey showed the patient had significant pain relief, I could reasonably attribute that to the treatment performed by me twelve months before.
During the survey period six hundred patients were treated. Written follow-ups were achieved from 447 of these. This is considered a very high response rate and increases the validity of the results.
Patients were asked to fill in a simple questionnaire rating their current pain and disability into one of six categories as compared with pre-treatment pain levels twelve months before.
1. Moderate improvement
2. Market improvement
3. Total resolution
Any of these responses was considered a good result.
4. Mild improvement
5. No change
6. Worse
These responses were considered unsatisfactory results.
By these definitions, 310 or 69.4 per cent of patients achieved a good result.
By aggregating the follow-up results into this two-directional outcome (i.e good or bad) it was easier to obtain meaningful statistical analysis.
Almost all those who showed improvement commented on the markedly increased mobility of the area treated and previously tender trigger points were no longer present. None of those who were worse attributed the progression to the Nesfield’s Treatment procedure performed twelve months previously, but rather to the passage of time.
In general, the results of people who had undergone previous spinal surgery were not as good as those who had not. In this group of patients, 31 per cent achieved a satisfactory outcome and 69 per cent an unsatisfactory one.
|
|
No of
patients
|
%
|
|
Worse
|
18
|
4.0
|
|
No change
|
82
|
18.3
|
|
Mild improvement
|
37
|
8.3
|
|
Moderate improvement
|
67
|
15.0
|
|
Marked improvement
|
162
|
36.2
|
|
Total resolution
|
81
|
18.2
|
|
TOTAL
|
447
|
100
|
Medically, of course, my figures prove nothing because my peers consider this an uncontrolled medical trial. But, I am pleased to report, professional analysis of the results proves them to be ‘highly statistically significant’.
The data were given to a qualified statistician, Mr Mark Norrie, now of the University of Queensland, Brisbane, who performed an extensive statistical evaluation of my data. He concluded that: ‘Even though there was not a control group, the results showed a high degree of statistical significance. In simple terms, the chances of these results occurring randomly are approximately 28 million to one’.
Mr Norrie believes, from these statistics, that I have strong proof the procedure works and that it works for 70 per cent of the people upon whom it is performed.
The problem with Nesfield’s Treatment is that it is not currently accepted medical practice, unlike fusion or laminectomy. Main-stream modern medicine refuses to accept that Nesfield’s Treatment works. Until they accept that it does, no research will be done.
Although the situation is frustrating, it is also understandable. The stringent requirements from medical authorities are in the main designed to prevent quackery. (Readers will know there are many quacks working in the field of bad backs). There was a man in Cooma who used a rabbit’s tail to ‘brush’ pain from the patient’s back, down the thighs and finally out through the ankles. After an appearance on national television in 1977, he became so busy that he had a heart attack from the pressure of work and died.
I know of another quack who diagnosed back problems by first briefly but fiercely peering into a patient’s eyes. Then he would move around behind and poke his finger into the top of neck at the base of cranium, hold it there and order the patient to lift his arms up and down a couple of times before pronouncing him ‘much better’. Patients were always given appointments for more treatment before they left. When some of them failed to turn up, he would ring and soundly abuse them – and shame them into coming back. He made a lot of money this way.
There are also many families with what I call ‘Uncle Ernies’ in them. They know how to ‘crack’ bad backs and necks. One day an Uncle Ernie will probably not only crack a back or a neck but he will break it as well – if it hasn’t happened already.
However, I do make the point that where a treatment verifiably and consistently works in more than 50 per cent of cases, it should be more closely looked at. This was one of the great tragedies in the medical fraternity’s dismissal of Dr Rees’s treatment. They simply ignored the central fact that the procedure worked in a great number of cases.
Monday, January 16, 2012
Back Pain Relief Testimonials (Case 23 - 26)
Case 23 – Lower back pain in a male aged 64 years
Mr Robert House
Lockleys, SA
This man had suffered from fluctuating low back pain for about 35 years. The pain had become much worse over the six months prior to seeing me and had begun to radiate to both buttocks and down both legs. He had been told that his pain was due to ‘lumbar spondylitis’ and that nothing would help. He tried an assortment of tablets and physiotherapy, and had been advised not to seek chiropractic.
Within one week of the first treatment, his leg pain had vanished and his back pain had lessened. After three treatments his legs are still 100 per cent and his back pain is much less than previously.
Mr House comments:
All the pain in my hips and legs has gone. I am most grateful for this. The pain is now contained to one small area of my back. I am more than happy with the treatment.
Case 24 – Lumbar pain in a female aged 57 years
Mrs Gladys Lahey
Burleigh Waters, QLD
By the time she saw me, Gladys had suffered agonising low back and leg pain for thirty years. The pain was worse on the right side and radiated down her right buttock, thigh and calf. In the two months prior to our consultation she became rapidly worse. She had tried multiple treatments, taken many different medications, been hospitalised on a number of occasions and seen different specialists. She was told she had osteoporosis and that ‘nothing could be done’. Her pain was so intense that she often needed two sticks to walk with and an air cushion to sit on.
Trigger points were easy to feel in her lumbar and buttock region. Her pain vanished rapidly after the treatment and she has been virtually pain free ever since.
Mrs Lahey comments:
I was in agony before I was treated by Dr Stuckey and completely dependent on others to even move from the floor or bed on which I had to be. After one treatment from Dr Stuckey I could feel a big improvement and after three treatments over a couple of weeks I was leading a normal life including driving the car, shopping and house-work, none of which I would attempt before.
Case 25 – Low back pain in a 48 year old male
Mr Terry Davenport
City Beach, WA
This man developed severe back and leg pain after an accident ten years before seeing me. At the time he was hospitalised and his initial pain slowly subsided. Whilst he continued to improve, he also had stiffness and mild discomfort in his lumbar region. He was forced to sell his fishing business because he was unable to continue with heavy manual work. Three months prior to seeing me, he had another severe episode of back pain.
After performing the treatment twice, he experienced a marked reduction in his back pain over three years.
Mr Davenport comments:
There has been a significant reduction in my back pain and my spine feels more mobile.
Case 26 – Lumbar pain in a female aged 56 years
Mrs Roberta Johnstone
Brisbane, QLD
This lady injured her back twice in separate falls in 1983 and 1990. Her low back pain became excruciating following the second fall. She was forced to leave her job and accept an invalid pension. She was in constant pain night and day, slept poorly, and took an abundance of painkillers, including narcotics. She often needed a stick to walk and had to sit on a rubber cushion. She saw many doctors and specialist and was told that the pain came from a narrow spinal cord and that no operation would help her and that her working days were over.
After treating her, most of her pain has gone. She still has some niggles, however, but sleeps normally, does not need a walking stick or her rubber cushion. She feels she would not have lost her job if she had had this treatment years ago.
Mrs Johnstone comments:
I have a quality of life that I did not think I would ever have again.
At present, I have some seven hundred similar case studies on file, all attesting to varying degrees of success after Nesfield’s Treatment. Conversely, I have some three hundred where the treatment has not helped at all, although it does not seem to have made the pain worse, unlike some treatments.
I am rather surprised by the often muted response of patients who have gained relief from Nesfield’s Treatment. Despite the low-key reaction to their improved pain status, I have found there is a great deal of residual anger in patients when they realise that many years of their lives have been wasted putting up with their pain. If only someone – their doctors or specialists – had told them about the treatment earlier.
More importantly though, the patients listed here have now been liberated from their pain sufficiently to re-enter the process of enjoying pain-free lifestyles – or rejoining the human race. The cost has been minimal, the procedure simple, the recovery rapid and the results have been permanent, without the slightest sign of undue side effects. In my opinion, they are living, irrefutable evidence that Nesfield’s Treatment works.
No wonder they are apprehensive!
Following is a patient’s own version of how Nesfield’s Treatment can benefit.
I suffered an injury on my back at the age of 14 when I slipped and crashed back-first into the protruding corner of a brick wall while running at full speed. Although the injury left me hobbling badly, the pain in my hip and back gradually subsided over a period of months. Two years later, however, my back virtually collapsed while competing at an athletics meeting. The pain was excruciating; I could barely turn my head without pain. I was taken to hospital by ambulance and X-rayed. An intern, after throwing me around on the table like a rag doll, gruffly told me I had probably just pulled a muscle and referred me to a prominent physiotherapist.
For several weeks, I could not sit without great pain, could not walk without pain – there was nothing I could do without pain. My school friends at the boarding school I attended helped me dress and undress and assisted me in the shower. Two months later, experiencing no relief from physiotherapy whatsoever, my mother took me to a well-known chiropractor who relieved me of all pain in one short treatment. I resumed playing football within a week and lived a relatively pain-free, active life for the 24 years, although I was always aware of a nagging ache in my lower back where the injury had taken place. I became a college athletics champion and later a representative Rugby Union player. At times, I used to manipulate my back myself and make it ‘crack back in’ if it ached too much.
At the age of forty, my pain suddenly returned overnight and began changing my life dramatically. Within a few months I could not walk any more than a few yards without sickening pain running down my right leg into my foot and into my big toe. I could not stand in one spot without the same pain, although I could squat, sit and lie flat in comfort. I went to a chiropractor who manipulated my spine several times with no success. He told me my vertebrae were too loose and that the bad disc kept ‘popping out’.
I went to a general practitioner who insisted I have a blood test before he recommended me to a specialist. I still wonder what my blood had to do with my back. I did not have the blood test but went to another doctor for referral to a specialist. In the interim, I went to another chiropractor who, after a couple of unsuccessful manipulations, decided my condition was too bad for him to treat. I then went to a respected orthopaedic surgeon who bluntly told me to exercise and lose weight, although even if I did, I would probably require spinal fusion, or that I would have to just live with my pain. It did not occur to him that I was more or less beyond exercise by then. I gave up for a while and tried to live with the condition.
During this time, however, I did try exercising after taking painkillers, mainly Ecotrin (a heavy dosage of aspirin) and going for short walks and playing squash with my son. I also took painkillers before going out to social events so that I could stand up and talk to people face to face. Usually by the end of the evening, however, when the painkillers had worn off, I found myself squatting at people’s feet trying to talk up to them, like a dwarf.
I was afraid of surgery; I had heard of at least one case where a patient had died during back surgery and another whose lungs had collapsed during it and who had been emphysemic ever since. By then, I was certain the heavy daily doses of aspirin were giving me an irregular heartbeat.
The pain continued to grow worse and I gave up any form of exercise. I quite seriously began to think that the rest of my life would be spent lying in bed, sitting at my desk and squatting on the floor. Luckily, I was self-employed and worked mainly from home using a computer; I knew I could continue my career – as long as I didn’t have to go anywhere.
I then heard about an enzyme injection that apparently dissolved troublesome slipped discs. I found a specialist who gave the injection and travelled from Queensland to Sydney to see him. He took a look at my X-rays and told me my back was so bad that his enzyme treatment would not help it. He also recommended surgery.
At the age of 43, and a solo father to three teenagers, I was a virtual cripple. I could barely walk and my right foot was beginning to flop when I walked.
In desperation, I went to an acupuncturist, who was also a qualified paediatrician. Before giving me acupuncture, he demanded that I breathe into a carbon monoxide levels testing machine. When I did, he rudely abused me for being a smoker. He then reached forward and grabbed the fold of flesh between my eyebrows above my nose and roughly jabbed a very long and painful acupuncture needle into the flesh, and twirled it; it was as though he was punishing me for smoking. I was then ordered to lie down on my stomach whereupon he thrust a multitude of needles into my back, my ears, on my claves and around my ankles; it was extremely painful. I remained in that position for an hour gritting my teeth with pain. When he took the needles out and I was finally allowed to go, I found myself free of back pain – for just an hour. The next day, however, I was barely able to walk, not only because of my back, but also because of the pain in my calves from the needles. It took about ten days before they recovered.
I went to a physiotherapist who, after using ultra-sound on my back, trussed me up like a turkey in a leather harness on an auto-traction machine that ‘surged’, stretching me and then letting me go, stretching me and letting me go. It was uncomfortable to say the least and when I got out of the thing my pain had increased by twenty per cent. I could hardly move. I would not have been surprised to find that I was several inches taller as well.
With some reluctance, or desperation, I then went to a psychic masseuse who had reputedly had a great deal of success with bad backs. She gave me the most lovely ninety minute massage. At the end of it, when I sat up, she told me she had just had a flash of my past lives and would I mind if she told me about them? What could I say? She went on to say that in one distant past life I have been one of Ghengis Khan’s soldiers and in my most recent past life, I had apparently been a Greek woman. I thanked her for the information and hobbled off; my pain was no better.
A short time later, a friend showed me a contraption that he had bought to ease his own back pain. It was a traction machine, like a revolving bed, where you strapped yourself in by the ankles and rotated the bed until you hung upside down by your ankles. I lay on the bed, strapped myself in and lay back. The thing suddenly spun madly and hurled me around, eventually stopping and leaving me hanging upside down by my ankles, trying to recover from the fright it had given me. In the aftermath my pain was at least as bad, if not worse, than before.
I firmly decided against seeking any further treatment for my back pain.
Late in 1990, however, a friend sent me a booklet written by a Dr W Skyrme Rees in Sydney in the late 1970’s about a simple surgical procedure Dr Rees performed for the treatment of back pain, apparently with great results. I read the booklet carefully three times; it seemed too good to be true (by nature I was a sceptical person and even more so in light of my experiences). It was a tatty old photocopied version of the book and, judging by the age of Dr Rees when he wrote it, I doubted he would still be practising, or even be alive by then. There was a phone number on the booklet which I rang out of curiosity. To my surprise, the old man answered the phone himself.
Within a week, I was in his surgery receiving the treatment which he called rhizolysis. The whole procedure – six incisions – took just a few minutes and, apart from the discomfort of receiving local anaesthetics, I didn’t feel any pain during the course of it. Because it was the end of the day and because I had travelled such a long way to see him, Dr Rees offered me a Scotch which I accepted. I then spent another hour with him talking about his work. He was a fascinating man. After a third Scotch, I picked up my suitcase and walked 100 metres to catch a taxi. Significantly I felt no pain, although I assumed initially that was because of the local anaesthetic – or the Scotch.
I awoke the next morning feeling sore from where the incisions had been made but aware that my usual pain seemed to be absent. Later that morning I photocopied 150 pages in triplicate of a document at a client’s office; it took more than an hour standing beside the photocopier. I was amazed to find myself still standing with a minimum of discomfort at the end of it. A day later I flew home to Queensland. Three days later I realised with certainty that the procedure had taken away about 99 per cent of my pain. I was also aware that I still had full sensation in the area where the procedure was performed.
Now 2 ½ years later, I have no pain whatsoever, I walk, run, swim, waterski and travel – everything I used to do before the onset of my pain. I have re-married and, so far, fathered two more children. I am absolutely, delightfully free of my pain and have resumed my life. I have been very lucky.
Naturally, I have told many people about my experience, including pain sufferers and the occasional doctor. Frequently, I have been greeted with tolerant smiles (as though they expect me to fall to bits one day because my nerves have been cut!). One doctor had the hide to tell me that my pain had vanished probably as a result of ‘auto-suggestion’. A number of my back pain suffering acquaintances, however, have consequently undergone the procedure, which I now know as Nesfield’s Treatment, and most have been thrilled at the results.
Apart from the relief and joy I still experience in the recurring realisation that I am free of pain, there is apart of me that is still deeply angry that I suffered four years of agony without knowing about Nesfield’s Treatment; that a friend had to inform me of it, not a doctor. I am totally convinced that some of the specialists I went to knew about Nesfield’s Therapy (or rhizolysis as they would have called it) but none saw fit to tell me.
This story is one of the many that I have listened to in my surgery. While these tales of horror once used to shock me, I have come to realise just how much misunderstanding there still is regarding the treatment of back pain and how many sufferers there are.
Having endured many years of severe pain patients often get depressed and, sometimes, even suicidal. Rather than being told of possible treatment options they are often told to ‘get on with life and to live with their pain’. I often see patients who are considering ‘ending it all’ so they will not have to endure more pain. Those who undergo Nesfield’s Treatment usually experience significant back pain reduction. Unfortunately, most patients are not told of this treatment.
Mr Robert House
Lockleys, SA
This man had suffered from fluctuating low back pain for about 35 years. The pain had become much worse over the six months prior to seeing me and had begun to radiate to both buttocks and down both legs. He had been told that his pain was due to ‘lumbar spondylitis’ and that nothing would help. He tried an assortment of tablets and physiotherapy, and had been advised not to seek chiropractic.
Within one week of the first treatment, his leg pain had vanished and his back pain had lessened. After three treatments his legs are still 100 per cent and his back pain is much less than previously.
Mr House comments:
All the pain in my hips and legs has gone. I am most grateful for this. The pain is now contained to one small area of my back. I am more than happy with the treatment.
Case 24 – Lumbar pain in a female aged 57 years
Mrs Gladys Lahey
Burleigh Waters, QLD
By the time she saw me, Gladys had suffered agonising low back and leg pain for thirty years. The pain was worse on the right side and radiated down her right buttock, thigh and calf. In the two months prior to our consultation she became rapidly worse. She had tried multiple treatments, taken many different medications, been hospitalised on a number of occasions and seen different specialists. She was told she had osteoporosis and that ‘nothing could be done’. Her pain was so intense that she often needed two sticks to walk with and an air cushion to sit on.
Trigger points were easy to feel in her lumbar and buttock region. Her pain vanished rapidly after the treatment and she has been virtually pain free ever since.
Mrs Lahey comments:
I was in agony before I was treated by Dr Stuckey and completely dependent on others to even move from the floor or bed on which I had to be. After one treatment from Dr Stuckey I could feel a big improvement and after three treatments over a couple of weeks I was leading a normal life including driving the car, shopping and house-work, none of which I would attempt before.
Case 25 – Low back pain in a 48 year old male
Mr Terry Davenport
City Beach, WA
This man developed severe back and leg pain after an accident ten years before seeing me. At the time he was hospitalised and his initial pain slowly subsided. Whilst he continued to improve, he also had stiffness and mild discomfort in his lumbar region. He was forced to sell his fishing business because he was unable to continue with heavy manual work. Three months prior to seeing me, he had another severe episode of back pain.
After performing the treatment twice, he experienced a marked reduction in his back pain over three years.
Mr Davenport comments:
There has been a significant reduction in my back pain and my spine feels more mobile.
Case 26 – Lumbar pain in a female aged 56 years
Mrs Roberta Johnstone
Brisbane, QLD
This lady injured her back twice in separate falls in 1983 and 1990. Her low back pain became excruciating following the second fall. She was forced to leave her job and accept an invalid pension. She was in constant pain night and day, slept poorly, and took an abundance of painkillers, including narcotics. She often needed a stick to walk and had to sit on a rubber cushion. She saw many doctors and specialist and was told that the pain came from a narrow spinal cord and that no operation would help her and that her working days were over.
After treating her, most of her pain has gone. She still has some niggles, however, but sleeps normally, does not need a walking stick or her rubber cushion. She feels she would not have lost her job if she had had this treatment years ago.
Mrs Johnstone comments:
I have a quality of life that I did not think I would ever have again.
At present, I have some seven hundred similar case studies on file, all attesting to varying degrees of success after Nesfield’s Treatment. Conversely, I have some three hundred where the treatment has not helped at all, although it does not seem to have made the pain worse, unlike some treatments.
I am rather surprised by the often muted response of patients who have gained relief from Nesfield’s Treatment. Despite the low-key reaction to their improved pain status, I have found there is a great deal of residual anger in patients when they realise that many years of their lives have been wasted putting up with their pain. If only someone – their doctors or specialists – had told them about the treatment earlier.
More importantly though, the patients listed here have now been liberated from their pain sufficiently to re-enter the process of enjoying pain-free lifestyles – or rejoining the human race. The cost has been minimal, the procedure simple, the recovery rapid and the results have been permanent, without the slightest sign of undue side effects. In my opinion, they are living, irrefutable evidence that Nesfield’s Treatment works.
No wonder they are apprehensive!
Following is a patient’s own version of how Nesfield’s Treatment can benefit.
I suffered an injury on my back at the age of 14 when I slipped and crashed back-first into the protruding corner of a brick wall while running at full speed. Although the injury left me hobbling badly, the pain in my hip and back gradually subsided over a period of months. Two years later, however, my back virtually collapsed while competing at an athletics meeting. The pain was excruciating; I could barely turn my head without pain. I was taken to hospital by ambulance and X-rayed. An intern, after throwing me around on the table like a rag doll, gruffly told me I had probably just pulled a muscle and referred me to a prominent physiotherapist.
For several weeks, I could not sit without great pain, could not walk without pain – there was nothing I could do without pain. My school friends at the boarding school I attended helped me dress and undress and assisted me in the shower. Two months later, experiencing no relief from physiotherapy whatsoever, my mother took me to a well-known chiropractor who relieved me of all pain in one short treatment. I resumed playing football within a week and lived a relatively pain-free, active life for the 24 years, although I was always aware of a nagging ache in my lower back where the injury had taken place. I became a college athletics champion and later a representative Rugby Union player. At times, I used to manipulate my back myself and make it ‘crack back in’ if it ached too much.
At the age of forty, my pain suddenly returned overnight and began changing my life dramatically. Within a few months I could not walk any more than a few yards without sickening pain running down my right leg into my foot and into my big toe. I could not stand in one spot without the same pain, although I could squat, sit and lie flat in comfort. I went to a chiropractor who manipulated my spine several times with no success. He told me my vertebrae were too loose and that the bad disc kept ‘popping out’.
I went to a general practitioner who insisted I have a blood test before he recommended me to a specialist. I still wonder what my blood had to do with my back. I did not have the blood test but went to another doctor for referral to a specialist. In the interim, I went to another chiropractor who, after a couple of unsuccessful manipulations, decided my condition was too bad for him to treat. I then went to a respected orthopaedic surgeon who bluntly told me to exercise and lose weight, although even if I did, I would probably require spinal fusion, or that I would have to just live with my pain. It did not occur to him that I was more or less beyond exercise by then. I gave up for a while and tried to live with the condition.
During this time, however, I did try exercising after taking painkillers, mainly Ecotrin (a heavy dosage of aspirin) and going for short walks and playing squash with my son. I also took painkillers before going out to social events so that I could stand up and talk to people face to face. Usually by the end of the evening, however, when the painkillers had worn off, I found myself squatting at people’s feet trying to talk up to them, like a dwarf.
I was afraid of surgery; I had heard of at least one case where a patient had died during back surgery and another whose lungs had collapsed during it and who had been emphysemic ever since. By then, I was certain the heavy daily doses of aspirin were giving me an irregular heartbeat.
The pain continued to grow worse and I gave up any form of exercise. I quite seriously began to think that the rest of my life would be spent lying in bed, sitting at my desk and squatting on the floor. Luckily, I was self-employed and worked mainly from home using a computer; I knew I could continue my career – as long as I didn’t have to go anywhere.
I then heard about an enzyme injection that apparently dissolved troublesome slipped discs. I found a specialist who gave the injection and travelled from Queensland to Sydney to see him. He took a look at my X-rays and told me my back was so bad that his enzyme treatment would not help it. He also recommended surgery.
At the age of 43, and a solo father to three teenagers, I was a virtual cripple. I could barely walk and my right foot was beginning to flop when I walked.
In desperation, I went to an acupuncturist, who was also a qualified paediatrician. Before giving me acupuncture, he demanded that I breathe into a carbon monoxide levels testing machine. When I did, he rudely abused me for being a smoker. He then reached forward and grabbed the fold of flesh between my eyebrows above my nose and roughly jabbed a very long and painful acupuncture needle into the flesh, and twirled it; it was as though he was punishing me for smoking. I was then ordered to lie down on my stomach whereupon he thrust a multitude of needles into my back, my ears, on my claves and around my ankles; it was extremely painful. I remained in that position for an hour gritting my teeth with pain. When he took the needles out and I was finally allowed to go, I found myself free of back pain – for just an hour. The next day, however, I was barely able to walk, not only because of my back, but also because of the pain in my calves from the needles. It took about ten days before they recovered.
I went to a physiotherapist who, after using ultra-sound on my back, trussed me up like a turkey in a leather harness on an auto-traction machine that ‘surged’, stretching me and then letting me go, stretching me and letting me go. It was uncomfortable to say the least and when I got out of the thing my pain had increased by twenty per cent. I could hardly move. I would not have been surprised to find that I was several inches taller as well.
With some reluctance, or desperation, I then went to a psychic masseuse who had reputedly had a great deal of success with bad backs. She gave me the most lovely ninety minute massage. At the end of it, when I sat up, she told me she had just had a flash of my past lives and would I mind if she told me about them? What could I say? She went on to say that in one distant past life I have been one of Ghengis Khan’s soldiers and in my most recent past life, I had apparently been a Greek woman. I thanked her for the information and hobbled off; my pain was no better.
A short time later, a friend showed me a contraption that he had bought to ease his own back pain. It was a traction machine, like a revolving bed, where you strapped yourself in by the ankles and rotated the bed until you hung upside down by your ankles. I lay on the bed, strapped myself in and lay back. The thing suddenly spun madly and hurled me around, eventually stopping and leaving me hanging upside down by my ankles, trying to recover from the fright it had given me. In the aftermath my pain was at least as bad, if not worse, than before.
I firmly decided against seeking any further treatment for my back pain.
Late in 1990, however, a friend sent me a booklet written by a Dr W Skyrme Rees in Sydney in the late 1970’s about a simple surgical procedure Dr Rees performed for the treatment of back pain, apparently with great results. I read the booklet carefully three times; it seemed too good to be true (by nature I was a sceptical person and even more so in light of my experiences). It was a tatty old photocopied version of the book and, judging by the age of Dr Rees when he wrote it, I doubted he would still be practising, or even be alive by then. There was a phone number on the booklet which I rang out of curiosity. To my surprise, the old man answered the phone himself.
Within a week, I was in his surgery receiving the treatment which he called rhizolysis. The whole procedure – six incisions – took just a few minutes and, apart from the discomfort of receiving local anaesthetics, I didn’t feel any pain during the course of it. Because it was the end of the day and because I had travelled such a long way to see him, Dr Rees offered me a Scotch which I accepted. I then spent another hour with him talking about his work. He was a fascinating man. After a third Scotch, I picked up my suitcase and walked 100 metres to catch a taxi. Significantly I felt no pain, although I assumed initially that was because of the local anaesthetic – or the Scotch.
I awoke the next morning feeling sore from where the incisions had been made but aware that my usual pain seemed to be absent. Later that morning I photocopied 150 pages in triplicate of a document at a client’s office; it took more than an hour standing beside the photocopier. I was amazed to find myself still standing with a minimum of discomfort at the end of it. A day later I flew home to Queensland. Three days later I realised with certainty that the procedure had taken away about 99 per cent of my pain. I was also aware that I still had full sensation in the area where the procedure was performed.
Now 2 ½ years later, I have no pain whatsoever, I walk, run, swim, waterski and travel – everything I used to do before the onset of my pain. I have re-married and, so far, fathered two more children. I am absolutely, delightfully free of my pain and have resumed my life. I have been very lucky.
Naturally, I have told many people about my experience, including pain sufferers and the occasional doctor. Frequently, I have been greeted with tolerant smiles (as though they expect me to fall to bits one day because my nerves have been cut!). One doctor had the hide to tell me that my pain had vanished probably as a result of ‘auto-suggestion’. A number of my back pain suffering acquaintances, however, have consequently undergone the procedure, which I now know as Nesfield’s Treatment, and most have been thrilled at the results.
Apart from the relief and joy I still experience in the recurring realisation that I am free of pain, there is apart of me that is still deeply angry that I suffered four years of agony without knowing about Nesfield’s Treatment; that a friend had to inform me of it, not a doctor. I am totally convinced that some of the specialists I went to knew about Nesfield’s Therapy (or rhizolysis as they would have called it) but none saw fit to tell me.
This story is one of the many that I have listened to in my surgery. While these tales of horror once used to shock me, I have come to realise just how much misunderstanding there still is regarding the treatment of back pain and how many sufferers there are.
Having endured many years of severe pain patients often get depressed and, sometimes, even suicidal. Rather than being told of possible treatment options they are often told to ‘get on with life and to live with their pain’. I often see patients who are considering ‘ending it all’ so they will not have to endure more pain. Those who undergo Nesfield’s Treatment usually experience significant back pain reduction. Unfortunately, most patients are not told of this treatment.
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