Dr. Hal Blatman and a New Theory of Pain Management
By Stuart Diamond, Editor-in-Chief of Empowered Doctor
Outside of regular check-ups, pain, of some sort or another, is probably the primary reason why patients visit a doctor in the first place. Pain, in all its forms and intensities, is easily the most debilitating aspect of not being well. And the failure to ameliorate pain – both chronic and acute – is the most identifiable reason why patients are dissatisfied with their medical treatments.
Pain management is also one of the largest fields in medicine. Yet treating pain, effectively and consistently, remains in many ways elusive. In today’s Western-allopathic model of medicine, pain is managed using pharmacological and/or interventional procedures — that translates into drugs, or some form of surgery, or a combination of both. Today, most of these drug and surgical interventions have become relatively simple and minimally invasive. For example, protocols for treating chronic back pain might include epidural steroid injections, facet joint injections, neurolytic blocks, spinal cord stimulators, drug delivery system implants, laser treatments, etc. However, how individuals respond to treatment can vary dramatically from patient to patient, often making finding an effective prescription and dosage difficult. Each of these interventions also has a range of unintended side effects and potential complications – some of which may include addiction and over-dosage, which sometimes can lead to organ damage and even death.
Yet, what if the entire concept of pain, what it is, and where it comes from, and how it can be treated was wrong? What if modern medicine has virtually ignored an entire system of the body, a system that helps to structure the human anatomy, helps the organism communicate internally, and is the place where most pain originates and is perceived? What if modern medicine had undervalued a complex anatomical structure, dismissing it as simple soft tissue with limited biological function? Yet, what if this system was key to how pain manifests and functions? And had untold impact on the wellness of an individual?
An interesting premise, and one I discussed at length with Dr. Hal Blatman, who works both in New York City and Cincinnati, Ohio, offering non-pharmaceutical, non-invasive treatments for a range of chronic pain issues, including back, knee and shoulder pain, scoliosis, headache, migarine, arthritis, carpal tunnel, and a host of other issues normally treated by a traditional orthopedist.
During his training in orthopedics, Dr. Blatman also spent time observing both the successes and, more importantly, the limitations, of conventional treatments for patients who presented with both acute and chronic pain. In the moral and ethical pursuit of finding what was best for his patients, Dr. Blatman began to examine new possibilities – exploring new paradigms that challenged what was taught in medical school. And even though some of these treatments worked, his inherent curiosity demanded answers, looking for the science and evidence behind the clinical practice and successes.
The Fascial System
His search brought him to the exploration of fascia – the web of soft connective tissues that some scientists now consider a body system unto itself. It is a honeycombed matrix made from collagen and elastin that covers, penetrates and is interwoven into every muscle and bone in the body. It also covers and supports every organ, including the heart, lungs, brain, and spinal cord. The fascia also provide a protective sheath that surrounds every artery, vein and nerve, allowing the structures to bend and flex without being damaged. If you have ever confronted a raw steak, where the fat and gristle had to be cut away, you were probably removing the fascia as well – the thin membrane sticking to the meat and bone.
The fascial system is not just a separate collection of tissues associated with different parts of the body. Rather, it is one continuous structure that extends from head to toe without interruption. It is a continuous networked system that connects every part of the body, interweaving every site of the body to every other site. Perhaps, the web-like structure of the Internet is an apt metaphor. Fascia also secrets a lubricant that lets organs, muscles, nerves, bones and cardiovascular structures bend and move freely against each other.
Until recently, classical anatomy presumed that fascia had limited biological function – relegated to structuring the overall anatomy of the body. Often in anatomy classes the fascia is simply removed so one can study the organs, bones and muscles underneath. More recently, researchers have begun to focus on the fascia itself, finding that there is far more to it than previously thought. Could it be a system of communication in its own right – an alternate signaling network — a cobweb of intercellular communication than goes beyond the functions of the nervous system? Synaptic signaling – nerve to nerve signaling – is one way how the body interacts with different parts of itself. However, researchers have established that electrons flow along the membrane of the fascia, flowing from positive to negative poles. Is there critical information being passed along these conduits? Also, is it possible that the sheath that protects nerves and cardiovascular vessels is a conduit for the transport of nutrition, hormones, peptides, other signaling molecules, as well? Additional research demonstrates that the fascial connective tissue also contains muscle fibers — and that the fascia itself can actually contract in small amounts, almost like an ancillary muscle.
A New Theory of Pain
However, in pursuit of a new paradigm for the nature on pain, we must mention one more interesting fact: Next to the skin, fascia has the highest density of afferent or sensory nerve cells – far more than muscles or bones. The implications are important: It implies that what we perceive as pain – soreness, cramps, aches, bruises, etc. — is actually generated in the fascia – not in the muscles or bones. In fact, our entire perception of our physical body – our kinesthesia — is the perception of the fascia.
So if we are injured – through an accident, disease, even emotional stress — the actual pain felt is primarily from the fascia, not from the skin, muscles or organs. Yes, a muscle or organ can be damaged, inflamed and swollen: yet it is more likely the pressure against or the inflammation of the fascia that one feels, not the muscle or organ itself.
There is still another dimension of pain to mention — referred pain, also called reflective pain. Referred pain is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction (heart attack), where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury. Though the theoretical basis for referred pain is still being debated, pain specialists have become very knowledgeable as where to look for the source, based on where the pain is perceived.
For example, let’s discuss a pain that most of us have experienced at one time or another – the pain associated with sciatica. Sciatic pain can be felt from the lower back and hip down the entire leg into the foot and toes. The degrees of pain can range from a mild tingling to a dull ache to a pain that is excruciating and disabling. However, the source of the pain – the place of trauma – could begin with a herniated disc in the spine or perhaps a torn, swollen or inflamed piriformis, a muscle in the buttocks. In either case the disc or swollen muscle might be pressing on the sciatic nerve that runs down the leg. The result is an irritated sciatic nerve that is inflamed and swollen.
Normally, classic anatomy presumes that the pain we feel is from the sciatic nerve. But that is a misleading explanation. What we experience as pain is not from the sciatic nerve directly – which is a motor nerve – but from the sensory nerves located in the fascial sheath that surrounds the sciatic nerve. Yes, the sciatic nerve may be swollen and irritated, but it is pressing against the fascial wall. It is the nerve fibers in the fascia that are firing and sending signals to the brain that is experienced as pain.
But now let us return to the world of clinical practice, and Dr. Hal Blatman. His understanding of the multiple roles fascia plays in our perception of injury and pain is the beginning of a profound and new way of healing the body and mitigating pain. His methodology not only addresses the underlying source of the injury (e.g. muscle tears and bruises, herniated discs, etc.), but directly seeks to alleviate the source of the pain – which is in the fascia – both locally and referred). For Dr. Blatman, it is crucial that both issues be treated addressed simultaneously. Unless the pain, both local and referred, is treated, the pain itself can create an environment that limits the ability for the injured tissue to heal quickly and fully. Pain in itself creates a cascade of stress inducing scenarios – reduced blood flow, release of cortisol and other inflammatory factors, as well inhibited immune function. Without a bilateral approach that treats both the problem and the symptoms effectively, the body may not fully heal – and the problem can persist or return.
The other key element to Dr. Blatman’s approach is that all his treatment options are holistic, meaning that even though he is a fully licensed and certified physician, his use of pharmaceuticals or any surgical approaches is limited. He primarily relies on natural methods that provide long-lasting solutions without no or minimal risks or side effects. His treatment protocols include an array of techniques, each with their own efficacy, but when combined, provide gentle, yet effective long-lasting therapeutic relief and healing. These are healing strategies that works with your body and does not damage other part of the body in pursuit of a medical solution.
His range of treatment options include: Acupuncture, Body Cleansing, Herbal Medicine, Diet and Nutrition, Prolotherapy, Prolozone, Thermography, and multiple massage and body work techniques and therapies.
Platelet Rich Plasma Therapy for the Treatment of Pain
However, it is Dr. Blatman’s insight and innovative use of Platelet Rich Plasma (PRP) directly into the fascia that is revolutionizing the field of pain management.
Platelet Rich Plasma (PRP) is produced from a person’s own blood. It is a concentration of platelets, a type of cell found in the blood that is essential for blood clotting. Platelets and the liquid plasma portion of the blood contain many additional healing factors that can stimulate cell multiplication, cell specialization and attract other factors that can help regenerate healthy tissue, such as stem cells.
After a blood sample is obtained from a patient, the blood is put into a centrifuge, which separates the blood into its many components. The collected platelet rich plasma is then delivered to an injured area. In traditional orthopedics the PRP is usually injected into soft tissue, such as a tendon, ligament or joint.
Numerous scientific studies have demonstrated that PRP has proven to be successful in regenerating tissue and mitigating both chronic and acute pain. Dr. Blatman’s insight was to deliver and inject small doses of PRP directly into the fascia – both at the site of the actual injury and the site of the referred pain. By delivering a healing agent directly to the points of pain in the fascia, Dr. Blatman’s patients have had transformational results – overcoming pain that has sometimes afflicted their lives for decades.
Since he is using a patient’s own blood, there is minimal risk for side effects or from any immunological reaction. Given what we know about how PRP interacts with other injured soft tissue, it assumed that the PRP is aiding in the actual healing of the fascia — which is the source of pain. With both the site of the injury and the site of the referred pain being treated, the body can heal quickly and effectively.
Though his work at this point is limited to his own patients, other researchers and clinicians are now looking to set up trials to expand the study of Dr. Blatman’s work, and prepare his findings for publication.
Dr. Blatman is a former President of The American Holistic Medical Society. He practices both in New York and in Cincinnati, Ohio.