“The closer one is able to get to the root cause and resolve it, the more likely it is to find a cure or significant long-term pain relief,” says Dr. Ko. Like Dietrich Klinghardt, MD, originator of this Four-Component theory in treating chronic disease, he asks the patient, “What was happening at the very beginning of the pain problem?”
This often gives clues about the area to focus on. For example, structural causes of low back pain include car accidents, falls, collision sports and traumatic childbirth. These often lead to strained sacroiliac joint ligaments, which Dr. Ko treats with Platelet-Rich Plasma (PRP) injections.
Biochemical causes include Celiac disease (gluten sensitivity—only 50% of patients have bowel complaints), hidden infections such as Lyme disease, and exposure to toxins such as pesticides on a farm or golf course, heavy metals and solvents.
Psychological problems include post-traumatic stress disorder (a screening question is to ask about nightmares). Neurological causes include neuropathic pain that can follow surgery or trauma, often characterized by burning pain that is worse at night. Other symptoms may include electric shocks, pins and needles, numbness and even itching.
A doctor needs to also ask another key question, says Dr. Ko: “What worries you the most about your symptoms?”
If the patient responds, ‘I lost my prescription and need more narcotics,’ then they should be directed to a pain-addiction specialist who can monitor safe and appropriate drug use. If they say, ‘I fell in a parking lot and my lawyer wants a report,’ then they should be seen instead by a medico-legal specialist. If they are anxious about having symptoms similar to their relative with Multiple Sclerosis or Rheumatoid arthritis, then the doctor needs to investigate and resolve this concern. When the key concern is that of resolving pain to get back to full activity or sport, then this is likely a motivated patient that can be treated effectively.