When faced with a patient concerned about his pain in the office, I will propose a menu, but in reality I speak of a ladder.

Why choose a ladder?

Because it is the best way to illustrate how a treatment can be instituted rational for your problem. The staircase has many steps as is the menu options. The first step is the simplest and the last, obviously, the most complex and one expects to not have to go.

Basically: the 1st step is to conduct a complete medical history and complete physical examination, as we were taught by our teachers, who did not have current diagnostic technology and had to make do with the signs that were in the semiotics (translation: review physical).

In this test we must not forget a vital detail that our colleagues from more developed countries routinely include in their investigation of each patient: the patient’s psychological evaluation.

Do not forget that a patient anxious, neurotic, problematized by the vicissitudes of life, which is experiencing labor problems, economic, family, divorce, etc.. threshold has a very down to her pain and probably need psychiatric support and sedative medication.

The 2nd step will coincide with the second query, where the patient will provide us the studies that we requested and which together with the clinical history data of office, rounded causal diagnosis.

The 3rd step is to roll up our sleeves to begin the treatment itself and so we started treatment more accessible to the patient, consisting of: specific analgesic medication, NSAIDs, muscle relaxants, anti-anxiety drugs and corticosteroids.

Can also be included at this stage support the indication of physiotherapy and rest or recommendations so that their activities do not increase your discomfort.

For example, if the patient performs work involving heavy physical activity, you would be advised to change their jobs to a more settled area or find another job.

Health comes first right?.

If you are a professional driver, we recommend changing your seat with one that suits your spine. If, by contrast, develops sedentary office, with the inevitable computer, we recommend improving your posture and review the features of your seat.

There are many more examples.

As for the rest, we are aware that current working conditions often prevent a rest far beyond the days when ideally a month, if the pain is important.

The 4th step means that the previous failed and it is necessary to start with those things that scares people, who are the needles and sanatoriums.

It is actually more scared than anything.

Since not long ago, have been incorporating techniques called “minimally invasive” and consisting of infiltration of inflammatory substances and local anesthetics in strategic locations and they can calm the pain almost instantly.

The idea is that when pain relief is achieved neutralize the vicious cycle of pain-inflammation – contracture, which causes more pain, more swelling and more contracture and so on, which, if it can override one of the links This sadistic chain is as if they managed to break and defeat the acute pain.

With these three steps will get relief to many people, although their basic problem, as you may have intuited the suspicious reader, has not been resolved, so it will be repeated each time the pain returns, this is one to several times per year.

The advantage is that you may know by now what the menu is conducive to their pain, since each patient shows a special sensitivity to each drug or kinesics technique, which is unique for each.