Is there a place for ‘off-piste’ medicine?
NICE (or the National Institute of Health and Clinical Excellence) is the organisation which regulates the NHS.
In my view, they’re very good with huge data sets such as ‘Big Pharma’ drug trials. In areas like these, they’re a bit like pisteurs, preparing the slopes for clinicians to go down safely.
However, I believe they’re not so good for conditions outside global protocols. Patients with conditions like this may remain untreated, so a more tailored approach is usually more appropriate. This is particularly the case in more niche treatments.
A typical case which required “off-piste”care was a 35 year-old man with severe “tophaceous” Gout. Gout’s often perceived as funny, but this condition is no joke. My patient had been treated conventionally, over a period of 8 years, but had worsened until his severe joint pain near-disabled him.
I combined two agents – neither of which are in current guidance – and managed to get him well and gout free within 6 months. He remains gout free today. And there are many other conditions which can benefit from more non-conventional approaches.
My special interest is for the treatment of back pain in those who have failed conventional therapy with physio, exercise, and pain-killers.
It can be hard to diagnose spinal pain correctly. It can be done, however, but first you need a narrative that matches the patient’s story. In younger patients (18-55) for example, most problems stem from tearing of the interior of the intervertebral disc. This leads to back pain and ‘one’s back going out’. Ultimately, these symptoms last longer, occur more frequently, and then finally become continuous.
By going one step beyond typical assessments and using interventional diagnostic techniques, it’s usually possible to accurately determine which structures are causing the back pain. It’s therefore much easier to treat – and this is what I do.
I have successfully treated around 150 cases of disc-related back pain and numerous cases of sciatica using using non-standardmethods and have also recently published a series of successful cases using the newly described Modic antibiotic therapy (MAST).