Please be aware that we cannot hope to put all the information from ours and several other books for patients on these disorders.  Please get additional information from one of these sources.  We have listed some in the bibliography.

A new protocol for the quantified diagnosis of neuromuscular pain and more efficient treatment has been developed by Andrew A. Fischer MD, PhD (Great Neck, NY) and Marta Imamura MD, PhD (Sao Paolo, Brazil).  This concept is based on diagnosis and treatment of spinal segmental sensitization.  A brief outline of the protocol is as follows:

Phase I:  Identify the immediate peripheral generator of pain, such as myofascial trigger points, tender spots, muscle spasm or neurogenic inflammation.

Phase II:  Diagnose the spinal segmental sensitization (SSS), specifying the spinal segment corresponding to the peripheral generator.  SSS represents a state of central hyper-reactivity, sensitization, that develops in the spinal cord as response to peripheral nociceptive impulses.  This facilitation spreads from the spinal sensory component to the anterior horn cells and the sympathetic centers in the sensitized spinal segment.  The anterior horn cells induce sensitization of the myotome.  Drs. Fischer and Imamura have developed improved specific diagnostic techniques of palpation, neurological examination and pain diagnostic instruments.  Algometers quantify pressure pain sensitivity and Tissue Compliance Meter objectively document presence of muscle spasm and taut bands.  [My medical team found it extremely useful in our own clinical study to gain objective and reliable measurements in patients with both fibromyalgia and myofascial pain.  DJS]  Phase II diagnoses the dysfunction in the dermatome, myotome, sclerotome and sympathetic hyperactivity.   

Phase III:  Treatment for the SSS, associated PENTAD, that consist of supraspinous ligament sprain and discopathy, radiculopathy, paraspinal spasm and narrowed neural foramina.

The Segmental therapy consist of paraspinous block to desensitize the SSS, a pre-injection block of the hypersensitive area to be infiltrated followed by needling and infiltration of the taut band and TrPs.  Injections are followed by specific physical therapy.

Phase IV:  Diagnosis and control of perpetuating and etiological factors.

CONDITIONS IN WHICH THE NEW APPROACHES HAVE BEEN PROVEN TO BE EFFECTIVE even when conventional therapies have failed:

Painful conditions that could affect various body parts:

• Arthritis with pain in the back, neck, hip or knee.

• Bursitis and tendonitis.

• Injuries – sprains, strains.  Sport injuries such as tennis elbow, golf shoulder, running injuries.

Work injuries. Motor vehicle accidents, whiplash, etc.

• Intervertebral (herniated, slipped) disc problems with degenerative arthritis.

• Sciatica, nerve root compression (pinched nerves).

• Muscle spasm and pain.

• Repetitive stress:  overload syndrome such as typists’ or computer workers’ neck and back pain.

• Pain in Spondylolisthesis or Scoliosis. 

• Painful limitations of movements due to joint dysfunction.

• Pain after operations, particularly in the scar area.

• Reflex Sympathetic Dystrophy (RSD) called also Complex Regional Pain Syndrome (CRPS).

• Amputation and phantom pain have also been treated successfully by this approach.

Pain in upper body:

• Headaches, tension, stress.

• Back and neck pains.

• Shoulder pain:  rotator cuff problems, trigger points, golf or tennis shoulder.

• Frozen shoulder or painful limitation of shoulder movement.

• Chest wall pain and abdominal pain, with gastrointestinal symptoms.

Pain in lower body:

• Lower back pain.

• Hip pain and lower limb pain related to muscle problems.

• Knee pain – arthritis, chondromalacia.

• Ankle pain, sprain.

• Foot pain including heel spurs, pain in sole.

Clinicians who would like to learn more about this method, and broaden the patient data base, can contact Dr. Fischer directly:     

Andrew A. Fischer, MD, PhD
Pain Diagnosis and Rehabilitation Services
233 East Shore Road, Suite 108 
Great Neck, NY 11023
paintreat@aol.com
Phone: 516 829 9332

  Selected references: