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

as compared with pre-treatment pain levels. A good result was considered as moderate, marked improvement or total resolution. By these criteria, 66.1% of cases achieved a good result. This series reaffirms the findings of previous studies that rhizolysis has a high degree of success in selected people with chronic back pain.

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.

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.

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.