Sample diagnostic paradigm and treamtent algorithm

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Researchers from Johns Hopkins Hospital have reported that 40%-80% of chronic pain patients are misdiagnosed. To combat this problem, researchers from Johns Hopkins Hospital developed an "expert system" questionnaire with 72 questions and 2008 possible answers, which is computer scored. This is a copy of a sample output which a client would receive, after they have taken the Diagnostic Paradigm and Treatment Algorithm at www.MarylandClinicalDiagnostics.com. The diagnoses generated by answers to the questionnaire have a 96% correlation with diagnoses of Johns Hopkins Hospital staff members. The Treatment Algorithm lists the proper test to use to confirm each diagnosis. The testing recommended are tests typically used by physicians at Johns Hopkins Hospital, and are not commonly used by most physicians. The efficacy of this system is documented by published outcome studies, showing markedly increased return to work rates, a 90% reduction in the use of narcotic medication, and 45% reduction in doctor visits, with a cost savings of $20,000 to $175,000 for long term cases.

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Sample diagnostic paradigm and treamtent algorithm

  1. 1.  My Hom e Page  Logo ut  Scheduled Test Information To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method. Today's Date : Apr 20, 2010 Prefix: Mrs. First Name: Priscilla Middle Initial : R Last Name: XXXXX Suffix : Street Address (2) : XXXXXXX Street Address : City : XXXXXXXX Country : United States State or Province : Maryland Postal Code : XXXXXX Phone Number: ( 999 ) 999 - 999 Client Company : Free Test User Claim / Account Number: 732 Authorization Number : 100002895 Test Language : English Test To Take : Diagnostic Paradigm and Treatment Algorith Test (tm) Test Scheduled to be taken between : 04/07/2010 -04/08/2010 Test Completed : 04/07/2010 Test Status : Completed Test Score : 0.000000 To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method. Test Messages : The following is a report of those conditions and information that the patient indicated on the Pain Test: The patient was born on 04/10/1940.
  2. 2. Patient reports that the pain is not the result of an accident. Patient reports having the following conditions: "Lupus", "Arthritis", "Heart disease, or high blood pressure, or stroke". The patient did not report having any of the following conditions: "Diabetes", "Thyroid disease", "Multiple Sclerosis or M.S.", "Cancer", "Infection", "Muscular Dystrophy". The injury that gave rise to the claim occurred on 02/24/1989. Patient reports not having had accidents or injuries before this date. Patient reports not having had accidents or injuries since this date. Patient reports having a low back problem. Patient reports having had no surgery to the low back. Patient reports that low back pain: "comes and goes". Patient reports that the low back problem feels like: "dull ache". Patient reports that the low back problem gets worse when: "I ride in a car", "I lift things", "I stand too long". Patient reports that the low back pain gets better when: "I lay down", "I rest". Patient reports having no problems in the left leg. Patient reports having had no surgery or injury to the left leg. Patient reports having no problems with the right leg. Patient reports having had no surgery or injury to the right leg. Patient reports having no neck problems. Patient reports having had no surgery or injury to the neck. Patient reports having no problems with the left arm. Patient reports having had no surgery or injury to the left arm. Patient reports having no problems with the right arm. Patient reports having had no surgery or injury to the right arm. Patient reports having no problem just in front of the ear (where the jaw hinges the skull). Patient reports having no problem with the chest or ribs. Patient reported having had no injury to the chest. Patient reported having had no surgery to the chest. On the left side of the body, the patient reported the following: Left side of low back: "pain that comes and goes". On the right side of the body, the paitient reported the following: In right middle finger: "weakness", "swelling". In right middle finger: "pain that comes and goes".
  3. 3. Right side of the low back: "pain that comes and goes". The patient also reported the following: Along left ribs, in the back: "pain that comes and goes". The Patient reported no problems in the mid back. Patient reported having an injury to the mid back. Patient reported having no surgeries on the mid back. Patient reported not having a medical problem other than injury or surgery in the mid back. Patient reported the mid back problem, "comes and goes". Patient reported that the mid back problem feels like a: "dull ache". Patient reported that the mid back problem gets worse if: "I ride in a car", "I lift things". Patient reported that the mid back problem gets better if: "I lie down", "I rest". Below is a list of possible diagnoses, organized into groups for viewing purposes: Group 2 - Lumbar Herniated Disc L2-S1  L5-S1 Herniated or Disupted Disc - Score=0.916667  L4-L5 Herniated or Disrupted Disc - Score=0.666667  Unstable Spinal Segment at L3-L4 - Score=0.500000  Unstable Spinal Segment at L4-L5 - Score=0.500000  Spondylolysis/Spondylolythesis/Anterio-Lysthesis/Unstable Lumbar Spinal Segment - Score=0.500000  Unstable Spinal Segment at L5-S1 - Score=0.500000  L3-L4 Herniated or Disrupted Disc - Score=0.416667  Lumbar Facet Syndrome L3-S1 - Score=0.250000 Lumbar Herniated Disc L2-S1 Treatme nt Number Treatment/T est If Positive, next Treatme nt Number If Positiv e then: If Negative, next Treatme nt Number If Negativ e then: Treatment/T est Time 2.1 Bed rest as needed, NSAID, muscle relaxants, and narcotics STOP - 2.2 - 3 weeks 2.2 Trial with corset STOP STOP. Remov e 2.3 - 3 weeks
  4. 4. corset. If pain returns , go to #2.3 2.3 Flexion- Extension X- Rays with obliques of lumbar spine 2.5 - 2.4 - 1 day 2.4 M.R.I. of L2- S1 2.5 - 2.6 - 1 day 2.5 EMG/Nerve conduction studies of legs, and neurometer studies 2.7 - 2.6 - 1 day 2.6 3D-CT of L2- S1 2.10 - 2.7 - 1 day 2.7 Body jacket with thigh spika to leg with less pain 2.11 - 2.8 - 1 day 2.8 Root blocks, L2-L3, L3- L4, L4-L5, L5-S1 2.10 - 2.9 - 2 days 2.9 Provocative discogram L2-S1 2.11 - 14.1 If Negativ e, go to protocol for Lumbar Facet Syndro me 1 day 2.10 Orthopedic surgery consult 2.12 - 2.11 - 1 day 2.11 Neurosurgical consultation 2.12 - 2.13 - 1 day
  5. 5. 2.12 Discectomy and fusion and/or foraminotomy 2.13 Wait 1 year, then go to #2.13 2.14 - 1 year 2.13 Functional capacity evaluation, then vocational rehabilitation - then STOP STOP - STOP - 2 days to 3 weeks 2.14 M.R.I. with gadolinium, to rule out scarring 2.13 - 2.15 - 1 day 2.15 3D-CT to rule out broken fusion 2.11 - 2.16 - 1 day 2.16 Bone scan - rule out infection 2.11 - 2.17 - 1 day 2.17 Indium 111 scan 2.11 - 2.18 - 1 day 2.18 Gallium scan 2.11 - 2.3 Rule out disc above or below fusion site is disrupte d. 1 day Group 14 - Lumbar Facet Syndrome  Lumbar Facet Syndrome L3-S1 - Score=0.250000 Lumbar Facet Syndrome Treatm ent Number Treatment/ Test If Positive , next Treatm ent If Positive then: If Negativ e, next Treatm ent If Negative then: Treatment/ Test Time
  6. 6. Number Number 14.1 Muscle relaxants, NSAID, bed rest as needed STOP - 14.2 - 3 weeks 14.2 Corset STOP - 14.3 - 3 weeks 14.3 Flexion- Extension X-rays with obliques 14.4 If positive for facet sclerosis, go to #14.4 14.4 - 1 day 14.4 Facet blocks L3-S1 14.5 - 14.6 - 1 day 14.5 Facet denervation at appropriate level STOP There is a 40% chance the patient will have 2 years of relief - STOP 14.6 Immediat ely, or if the facet denervatio ns lose their effectiven ess, new diagnoses are to be considere d - a) Facet break, b) neural foraminal stenosis, or c) unstable back. Go to 14.6 1 day 14.6 3D-CT STOP The diagnosis will be either: (A) Facet break (B) Neural foraminal stenosis. Go to appropriate 14.9 Consider unstable spine, then go to 14.7 1 day
  7. 7. surgery: (A) Intrabody fusion or factectomy (B) Foraminot omy 14.7 Facet break STOP Go to appropriate surgery STOP - 12 weeks 14.8 Neural foraminal stenosis STOP Go to appropriate surgery STOP - 3 weeks 14.9 Body jacket with thigh spika to leg without pain or leg with less pain 14.11 - 14.11 - 6 weeks 14.10 Fusion at appropriate level STOP - 14.13 - 1 year 14.11 Provocative discogram 14.12 - 14.13 - 1 day 14.12 Discectomy, and fusion STOP - STOP - 1 year 14.13 Bone scan, indium 111 scan, gallium scan, blood studies CBC with diff, sed rate, C3. C4. Total compliment, alk phos for infection 14.14 - 14.14 1 day 14.14 Institute medical therapy STOP - 14.15 and 14.16 - weeks to months 14.15 Group STOP - STOP - 1 year
  8. 8. therapy for chronic pain patients 14.16 Functional capacity evaluation and return to work, after vocational rehabilitatio n - STOP STOP - STOP - 2 days to 3 weeks Group 15 - Herniated or Disrupted Thoracic Disc T1-T12  T1-T4 Herniated or Disrupted Disc - Score=1.000000  T1-T4 Facet Syndrome - Score=0.750000  T5-T8 Herniated or Disrupted Disc - Score=0.687500  T5-8 Facet Syndrome - Score=0.625000  T9-T12 Herniated or Disrupted Disc - Score=0.416667 Herniated or Disrupted Thoracic Disc T1-T12 Treatme nt Number Treatment/T est If Positive, next Treatme nt Number If Positiv e then: If Negative, next Treatme nt Number If Negativ e then: Treatment/T est Time 15.1 Do MRI of T spine, Provocative discogram of T spine and 3D-CT of T spine. 15.2 - 15.2 - - 15.2 Does MRI and/or 3D-CT show compression fracture? 15.6 - 15.3 - - 15.3 Does MRI or 3D-CT show neural foraminal stenosis or 15.7 - 15.4 - -
  9. 9. spinal stenosis? 15.4 Does MRI or 3D-CT show facet disease? 15.8 - 15.5 - - 15.5 Is Provocative Discogram positive? 15.10 - 15.11 - - 15.6 Do vertebroplasty STOP - 15.12 - - 15.7 Do decompressio n STOP - 15.11 - - 15.8 Do facet blocks above, at the site, and below the site 15.9 - 15.11 - - 15.9 Do facet denervation STOP - 15.11 - - 15.10 Do disectomy and fusion STOP - 15.12 - - 15.11 Body jacket with thigh spika 15.10 - 15.12 - - 15.12 Epidural Morphine Pump STOP - 15.13 - - 15.13 Use pain medication STOP - STOP - - To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method. Save Changes Printable Version Cancel View or Print the Authorization Letter

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