Faculty Bibliography

The majority of patients with cancer will experience pain in the course of their disease [Kjaer, M. The therapy of cancer pain and its integration into a comprehensive supportive care strategy. Ann. Oncol. 1997, 8 (3), 15-19; Bruera, E.; Lawlor, P. Cancer pain management. Acta Anaesthesiol. Scand. 1997, 41 (1 of 2), 146-153]. Epidemiological studies [Foley, K.M. The treatment of pain in the patient with cancer. CA Cancer J. Clin. 1986, 36 (4), 194-215; Walley, B.A.; Hagen, N.A. The epidemiology of cancer pain. Pain Dig. 1995, (5) 237-244; Portenoy, R.K. Cancer pain: epidemiology and syndromes. Cancer 1989, 63 (11), 2298-2307] generally categorize the pain as 1) directly caused by the neoplastic process or related phenomena; 2) by treatment; or 3) unrelated to the neoplastic process. In approximately 10% of cancer patients who have pain, the pain is unrelated to the disease or treatment and is most often caused by muscles and connective tissue (Twycross, R. Pain Relief in Advanced Cancer; Churchill Livingstone: New York, 1994; 55-61). An overview of pathophysiological mechanisms of muscle pain is presented, followed by a structured protocol to treat frequently encountered pain of muscular origin. The purpose of this article is to provide to the practicing clinicians easy to apply approaches for the treatment of muscle-related pain

Three patients who were scheduled for surgical procedures for a variety of diagnoses are presented. Each of the patients presented with pain that was interpreted as a result of an operable lesion. None of the patients was assessed for a possible muscular etiology of their pain prior to being evaluated at the author's pain center. In all three patients, muscles were identified that replicated their pain. Each patient received treatment to his or her pain-producing muscles. None of the contemplated surgeries was performed.

Decades of debate have yet to yield a universal solution to the treatment of low back pain, a problem that afflicts 80% of adults in the United States at some point of their lives [1,2]. Exercise, in general, has become widely recognized as playing a large role in the rehabilitation of back pain sufferers. Yet, there is no consensus on which types of exercises to utilize. Most exercise techniques address the muscles with the specific purpose of impacting the skeleton or the spinal cord and nerve roots, rather than the muscles themselves. This reinforces the notion that muscles are not the direct source of pain, but rather only reflect pathology elsewhere. We reintroduce a rational exercise regimen first developed by Hans Kraus, M.D. in 1949. This regimen was shaped over a period of several years, through usage by thousands of back pain sufferers. It directly addresses specific trunk muscle deficiencies and tension, which are postulated by the authors to be the major factors producing low back pain. The exercise protocol has shown to be highly effective and inexpensive to administer on a wide-scale basis. Recent clinical experiences utilizing the Kraus techniques are discussed.