internet based expert system to control workers compensation costs documented by outcome studies

This article reviews the current approaches to evaluating chronic pain patients involved in litigation, which have proven to be neither cost effective, nor accurate. It addresses the need to utilize physiological testing, such as root blocks, facet blocks, and peripheral nerve blocks, rather than the standard anatomical tests, which lead to a misdiagnosis rate of 40%-67%. The author offers alternative methods to evaluate these patients, using an Internet based expert system, with documented cost savings, based on published outcome studies from a leading medical school

Comparison of clinical diagnoses versus computerized test diagnoses for chronic pain

Past research from Mensana Clinic found that 40 - 71% of chronic pain patients had overlooked diagnoses, underscoring the need for more accurate diagnostic methodology. In this study, 937 diagnoses were made by the senior author during the initial evaluation of 87 chronic pain patients. Of these diagnoses, 903 diagnoses made by the senior author were also made by the computer scored and interpreted Mensana Clinic Diagnostics [MCD] "Diagnostic Paradigm." The MCD Diagnostic Paradigm matched the senior author's evaluation 96.37% of the time, and the Diagnostic Paradigm missed 34 diagnoses made by the senior author, for a 3.63% "missed diagnosis" rate, based on the initial clinic evaluation. Overall, there were 2764 "false positives", i.e. diagnoses made by the Diagnostic Paradigm, but not made by the senior author. However, when analyzed by diagnostic groups, 2639 of the 2764 or 95.5% of the "false positive" diagnoses were in the same diagnostic group as the diagnoses made by the senior author. Therefore, these patients would receive the same diagnostic studies, thereby helping differentiate the correct diagnoses from the "false positive" diagnosis

Differential diagnosis of complex regional pain syndrome, type I [RSD]

Of 38 patients referred to Mensana Clinic with the diagnosis of complex regional pain syndrome, Type I [CRPS Type I, formerly called RSD], 27/38 [71%] of the patients were found not to have clinical and diagnostic studies to support this diagnosis. Before referral to Mensana Clinic, 16/38 patients never received a sympathetic block [42%], which is considered one of the essential diagnostic tests needed to confirm the presence of CRPS I. After diagnostic evaluation at Mensana Clinic, only 1/38 [3%] of the patients actually had CRPS I exclusively, while 10/38 [26%] had a mixture of both CRPS Type I and nerve entrapment syndromes, thoracic outlet syndrome, disrupted disc, and/or radiculopathies. The largest category of missed diagnoses was nerve entrapment syndromes, which were verified at Mensana Clinic in 37/38 [96%] of the patients, followed by thoracic outlet syndrome found in 16/38 [42%]. A simple diagnostic framework is reported, to assist in the differential diagnosis of CRPS I and nerve entrapment syndromes. Note: Throughout this article, for the sake of consistency, earlier references, that used the terms of reflex sympathetic dystrophy, or RSD will be referenced or quoted as CRPS, Type I, despite the original nomenclature. This same approach will be used for references using the term causalgia, which will be changed, for the sake of continuity, to CRPS, Type II