Application of Spinal Segmental Physiology to Evaluating Chronic Pain
by John L. Beck, MD
 We all can agree that chronic pain (CP) occurs in a multitude of
forms that extend to every branch of healthcare and that there are probably as many causes
for these challenging disorders as there are patients seeking relief. Numerous cures have
been proposed at one time or another, indicating that no one specialty has a universal
solution. Truth be told, CP encompasses a wide diversity of causes that demand a
multi-specialty approach. A great deal of time and money is wasted by the chronic pain
patient wandering from office to office in search of a cure. The dilemma confronting the
pain clinician is to determine which specialist is best suited for each patient.
In the interest of trying to resolve this problem, a new diagnostic algorithm for the
evaluation of the chronic pain patient is being presented in this series of articles in
Practical Pain Management.1-3 It is called the P.A.N.E. Process and stands for
‘Practical Applications of Neuropostural Evaluations.’ Although the P.A.N.E.
Process is derived entirely from Western science, it differs in a significant number of
ways from the familiar symptom-directed, anatomic approach of current Western Medicine.
This article presents the second stage of the P.A.N.E. Process: evaluation for spinal
segmental dysfunction as a cause of altered neuroposture and chronic pain. These tests are
called the “R” Tests. The exam process is quite simple, requiring only a few
moments, but can help the clinician identify when spinal segmental dysfunction is the
primary cause of a chronic pain condition—even when the patient does not have spinal
pain. It is the author’s opinion that we have come to rely too much on radiological
and electro-diagnostic technology, and not enough on functional testing. Chronic pain is
usually a functional condition. The novice physician entering practice quickly learns that
back pain encompasses far more problems than answers from the standard methods.
Please refer to the May 2009 issue for the complete text. In the event you need to order a back issue, please click here.
— May 2009
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