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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Scheduled Test Information
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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
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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. 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. 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. 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. 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. 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. 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. 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. 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 - -
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