Why Peripheral Nerve Surgery is Not Accepted by the Medical Community

Dr. Tollestrup removes Jackson's piriformis muscle and decompresses superior cluneal nerves

Three Reasons Why Peripheral Nerve Surgery is Not Widely Embraced by the Medical Establishment

Reason Number 1 – Opium Option Overutilized

There are many reasons why Peripheral Nerve Surgery  has not been accepted into the mainstream medical community. Here we will articulate three of the main factors limiting the growth of Peripheral Nerve Surgery.

First, the traditional approach to chronic pain has been to treat it medically. Despite many advances in modern medicine, patients with chronic pain are relegated to treatment options akin to the ancient Egyptians more than 5 millennia ago – opium based pain medication.

In the case of acute pain, for example if someone twists their ankle and it swells up and turns black and blue, we don’t say – “Gee, looks like you’re in pain there. Here is some Percocet and good luck with that.” That would be considered malpractice in the 21st century. Instead, we investigate the SOURCE of the pain so that we can treat it appropriately.

However, once the patient crosses the threshold from “acute” pain to “chronic” pain, the medical community switches it’s thinking from identifying the source to managing the chronic pain. Typically, the patient is told they must adapt to a life of living with the pain.

Instead of the status quo, the approach should be to identify which part of the patient’s body is hurting and what nerve or nerves go to that area. Those nerves should be evaluated to see if they show signs of nerve damage. If they do show nerve damage, the appropriate surgical steps should be taken to correct the problem. This would provide a solution to much of the chronic pain that exists in the world today. Instead, chronic pain patients, with few exceptions, end up being treated with technology that’s essentially 5,000 years old.

Reason Number Two – Lack of Knowledge

The second reason is intertwined with the first and has to do with the profound lack of knowledge that exists among virtually all physicians and other medical professionals regarding the complex anatomy of the peripheral nervous system. The peripheral nervous system is made up of all the nerves in the body with the exception of the brain and spinal cord. Peripheral Nerve Anatomy is incredibly complex and can vary significantly from one person to the next.

This is compounded by the fact that very little peripheral nerve anatomy is taught at any stage of a doctor’s medical or surgical training.

As a result, peripheral nerve-related chronic pain problems are like listening to a foreign language being spoken. Eventually the physician or surgeon treating the patient gets frustrated or bored and passed them along to languish in the pain management setting in perpetuity.

It is an intimate understanding of peripheral nerve anatomy that functions as the “Rosetta Stone” which unlocks the mystery of chronic pain. Without this knowledge, which no doctors learn, it is virtually impossible to understand and identify the source of most chronic pain. That’s why it’s called “Pain Management” rather than “Pain Elimination,” or “Pain Eradication.”

Reason Number Three – Lack of Knowledge

Third, it is very difficult to create and disseminate new knowledge in medicine. There are many obstacles in the way. Most physicians have a default position of being very skeptical of new concepts or treatments, which is not necessarily a bad thing.

Beyond that, however, this knowledge threatens some fields of medicine who view it as a direct threat to either their income or to their ego or both. Physicians or surgeons who have spent years in training are usually resistant to the idea that there is a whole field of anatomy, pathology and treatment related to chronic pain of which they know little-to-nothing about.

Another reason is the amount of new information that is constantly being generated in medicine. Most doctors do well to read just one journal in the own field of expertise regularly, much less absorb new information outside their chosen area of practice.

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