The American Back Society is a non-profit corporation founded in 1982 by an orthopedic surgeon, Dr. Aubrey Swartz, to create a forum for health care professionals and scientists interested in relieving pain and diminishing impairment of spinal patients through proper diagnosis and treatment. The success of the first decade is due to its commitment to being both open and comprehensive. The society is composed of:
ABS symposium attendees predictably concentrate in rapt attention when Dr. Becker speaks, in part because he has a gripping, amusing style, but above all because the clinical information he provides can be taken directly back to the clinic or office the very next Monday and applied to the day's patients. Dr. W. H. Kirkaldy-Willis, a British-Canadian orthopedic surgeon and distinguished immediate past president of ABS is himself a Dr. Becker fan. Dr. Kirkaldy-Willis, as the editor/author of Managing Low Back Pain (NY: Churchill Livingstone Publishers), recently invited Dr. Becker to describe his red flags in the forthcoming third edition of his widely used, interprofessionally authored, textbook. For a more complete discussion of Dr. Becker's red flags, you will want to put the book on order. Meanwhile what follows may be useful.
Dr. Becker's red flags suggest the likelihood that the patient's pain includes a psychological component. Their absence, Dr. Becker stated in a recent symposium, suggests that a functional overlay such as somatization probably is not complicating the diagnostic and treatment situation. In the context of a thorough history and a careful physical examination, red flags may alert the clinician to important but easily missed psychological dimensions of the illness.
Dr. Becker's Red Flags as Symptom Distortion in the History
-- Discrepancy between observed vs. tested motion
-- Discrepancy between sitting vs. recumbent straight leg raise
-- Low back pain on gentle cervical compression
-- Tenderness on gentle palpation (jumping jack syndrome)
-- Patient grab or pushes examiner's hands away
-- Symptoms worsen or proliferate despite treatment
-- Gloved or stocking hyperesthesia or pain
-- Give-way weakness or variable grip in the absence of atrophy
Dr. Becker's Red Flags in Personal Style
-- Emergency room visits by ambulance for pain medication
-- Narcotic overuse or dependence
-- Blames current life problems on physical condition
-- Insists illness is purely somatic and unrelated to stress
-- Claims, "Pain has changed entire life."
-- "I just want to get rid of the pain and get on with my life."
-- "I keep my feelings inside," or, "I don't show my feelings."
-- Histrionic presentation, often as a strange limp
-- Patient doleful, tearful or weeps
-- Tattoos, especially macho tattoos
Dr. Becker's Red Flags in Interpersonal Relations
-- Blames mood (irritable, depressed) on physical condition
-- Has family member phone for medications (passive dependency)
-- Patient angry at employer and is generally irritable
-- Denial of psychosocial problems or blames them on pain
-- Critical of previous doctors
-- History of doctor shopping
-- Patient angers or frustrates doctor
Dr. Becker's Red Flags Relating to Work
-- States, "I've worked all my life" in asserting former independence
-- Describes inappropriate activity curtailment
-- Has "learned to accept" invalid status as a victim
-- Setback as return to work date approaches
-- Multiple return to work date extensions
-- "Fears" will be unable ever to work again
You've heard them all in your own office. They are Dr. Becker's red flags, and they alert you to the need to consider the appropriate and necessary psychosocial steps you must take.
The Spring Symposium on Back Pain will convene in New Orleans at the New Orleans Marriott, May 13-17, 1992. Drs. Becker and Kiraldy-Willis will be there, along with many other outstanding experts on spinal disorders.
If you would like more information about the American Back Society or want a copy of the program for the spring Symposium on Back pain, phone (510) 536-9929, or write me:
Dr. Robert Anderson
American Back Society
2647 East 14th Street
Suite 401
Oakland, California 94601
Robert Anderson, M.D., Ph.D., D.C.
Oakland, California
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