13 ms·

To treat back pain, look to the brain not the spine

212 points by kawera 9y ago

madengr 9y ago
Don't know why the author states physical therapy is expensive. It is cheap compared to anything else. Having sciatica on and off for several years, 8 sessions of physical therapy definitely helped, specifically the excercises they teach you.
- neom 9y ago
  and "cheap" is relative, my friend.
melling 9y ago
The Mind Body Approach: Cures back pain, rsi... https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connection/dp/0446557684 https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connectio... http://www.rsi.deas.harvard.edu/mb_what_is.html http://www.rsi.deas.harvard.edu/mb_what_is.html
- ta8457348 9y ago
  FWIW, this worked for me. I had absolutely debilitating pain in a hip joint as if I had a handful of needles loose in there. I had it for several months, I had an MRI, a bone scan, tried physio, acupuncture and what have you with zero effect. At some point got a "procedure" scheduled for some sort of steroid injection directly into the spine column and was prescribed some nasty anti-inflammatory pills to "prep" for the thing (but in the end decided against the whole thing). The only thing that helped _a bit_ were the 600 mg Ibuprofen pills. In any case, saw this book recommended here on HN, picked it up, read a quarter and realized that it applied. I was under an enormous stress at the time, both on work and personal fronts. On the work side I was running a one-man project with several thousand active daily users. On the personal end we just had a kid and the massive lifestyle change that came with it. A couple of days after realizing that the stress might've been the cause of the pain, the pain disappeared. Just - poof, gone. This was over 10 years ago and it never came back. The end.
  - maxxxxx 9y ago
    I read the Sarno book and I didn't get anything out of it. From reading your comment it seems that it may apply to psychosomatic pain but not to pain where there is a physical cause. Is this correct? It kind of makes sense. When I am stressed I am much more susceptible to pain and disease than when I am happy.
    - jaggederest 9y ago
      The whole point is that there's no difference between psychosomatic pain and pain where there's a physical cause. The brain activity that people think of as being "just psychosomatic" is actual, physical changes that causes both direct perception of pain within the brain itself and also changes in the rest of the body that result in peripheral pain. Stress doesn't just make you imagine you have joint pain, it actually causes it directly in measurable ways. Catecholamines are extremely powerful and if you start cranking them out because you're stressed, everything works worse, which often results in pain, which is of course an additional stressor.
      - maxxxxx 9y ago
        I accept that your thoughts can create pain but I think there is also pain that's being caused first by a physical event. Example: someone drilling your tooth.
        tudorw 9y ago
        You're right, that's known as nociceptive pain, the other is known as neuropathic pain, here's a nice piece, it's moving on the knowledge that these types of pain, emotional and physical if you like, cause a similar area of the brain to 'light up' (http://www.pnas.org/content/108/15/6270.abstract http://www.pnas.org/content/108/15/6270.abstract), and how advances are allowing more fine grain observation of these reactions http://healthland.time.com/2013/05/06/a-pain-detector-for-the-brain/ http://healthland.time.com/2013/05/06/a-pain-detector-for-th... Although to be a pedant, tooth drilling is apparently not quite nociceptive as it's the nerve being vibrated that causes an intense sensation that's easy to interpret as 'pain', I try and think about fireworks instead...
- theparanoid 9y ago
  FWIW, it worked for my RSI with semi-crippling pain when typing.
  - melling 9y ago
    What did that involve? How did you reduce your stress?
- tudorw 9y ago
  Me too, years of issues with 'Carpal Tunnel', 'RSI', my own research into psychoneuroendocrinology and encountering the Sarno approach changed the way I looked at my situation, sensations from my nerves means I am alive, they are not to be relied on as reliable indicators of 'pain', 'pain' should be reserved for things we can do something about. Unwrapping the psychological foundations as to why I chose to start interpreting these signals as 'pain' is a complex and interesting task that is not 'over', but the progress is meaningful and long lasting. I believe advances in continuous arrays and high resolution fMRI together with a raft of new devices that are looking at change over time will bring a scientific lense to Sarno's work and start to close the loop on the mind body experience we call life :)
katastic 9y ago
I've been living this horror for six years. If I could just magically stop using medicine and not being treated like a drug addict for merely taking prescribed medicine by all walks of society (from cops, to nurses, to neighbors), don't you think I'd have already fucking taken that choice? The majority of people don't want to be on pills. They want to get better. If I'm in too much pain to physically get out of bed, how am I supposed to exercise? It sounds like this is just an advertisement for CBT, and 90% of it is summed up as "get an anti-depressant" and "go to therapy." Well everyone is already doing that. I mean, are we really going to suggest everyone in the medical industry related to pain management is just a scam? That doctors don't try a mirade of tools to help their patients and instead just throw addictive pills at them? Surely some do. But who says "I want to go to medical school to sell pills" instead of "helping people"? I don't know. I find it hard to analytically process this article since I'm so close to the source. But I literally spend >60% of my days in complete writhing agony. I had to FIGHT to get the medicine I needed and I had to FIGHT to get the back surgeries that took me from almost dying to "surviving." So if the world is really handing out pills and surgeries, it sure as hell wasn't doing it in my area.
- ianai 9y ago
  As a migraine sufferer I feel the same way. I tell people who don't take my pain seriously to watch me take a round of Botox for them. It's something like 8 syringes in my scalp. I absolutely would not go through that if a single migraine didn't inflict much more pain upon me. I'll never forget having a migraine come back on as I was leaving the ER one night. They had already dosed me up well. All the drugs did though was make me not care that it felt like an ice pick was boring into my head. Still felt the pain. I've lost way too many things to this pain over the years. It's awful.
  - manmal 9y ago
    I'm sure you have had your share of well meaning advice. But have you checked out PEMF devices? There is evidence that therapeutic pulsed EM helps reduce migraine pain [1], among a lot of other positive effects. The selfhacked.com guy heavily endorses a device called ICES which costs "only" around $400 (but is of course weaker than the heavy duty devices since it runs on a 9V battery). 1: https://www.ncbi.nlm.nih.gov/m/pubmed/11279973/ https://www.ncbi.nlm.nih.gov/m/pubmed/11279973/
amriksohata 9y ago
Try yograj guggulu with yoga, the Indian Hindu sages knew their stuff
bambax 9y ago
Not one mention of The Mindbody Prescription (if only to dismiss it)? If you're suffering from back pain, or carpal tunnel syndrome, or such ailments, read this book, it might change your life! (and if it doesn't it can't harm) https://www.amazon.com/dp/0446675156/ https://www.amazon.com/dp/0446675156/
- chrismealy 9y ago
  I read about three chapters of this and it cured my wrist pain. Never would have believed it possible if it hadn't happened to me.
  - KGIII 9y ago
    I am skeptical. What about those three chapters resolved your physiological ailment?
    - chrismealy 9y ago
      It sounds impossible but it actually happened - just acknowledging the stress I was under made the pain go away (it's not like you have to solve anything). I think it only took about four days. The crazy thing is it was actually visible. The throbbing swollen veins in my forearms receded. I was receptive to the idea because the pain was the worst the summer my dad was dying in a hospice and I wasn't working at all. The bummer is there's no way to know if it's stress or not, but it doesn't hurt to give it a try.
      - phlillip 9y ago
        This; when my Father was diagnosed with cancer I was under a lot of stress but acting like everything was fine. Pretty soon I got alopecia, in my beard not my head. The body communicates with you in very different ways and it can be overlooked. Finding the root cause of pain in your life is the key. Not always, but often.
        kxs 9y ago
taxicabjesus 9y ago
I've watched some older family members degenerate over the years... Sometimes doctors do good work, sometimes the medical-industrial complex makes work for itself. I knocked myself out at the lake when I was 17 years old. I mostly recovered over the following six months, but rapidly developed an inflammatory condition when I went off to college a year later. Retrospectively, my apathy towards my degree program was an important factor. After the fourth doctor I said to myself, "screw you guys, I'm going to figure myself out." I wrote about this previously: https://news.ycombinator.com/item?id=13123659 https://news.ycombinator.com/item?id=13123659 When I was suffering through college I decided it would be helpful to be able to "relax" (mind awake, body asleep), and to visualize. What a long, strange road it's been...
azag0 9y ago
Wouldn't it be more conclusive to look at what neuronal signals travel from the lower back to the brain, and how (if) they differ between chronic-pain patients and healthy people? Or do we miss technology to do that?
gforge 9y ago
Lovely article, as an orthopaedic surgeon I can tell you that most of us know this. Treating chronic pain with surgery is generally a bad idea, I spend a large share of my time explaining this. Some patients are grateful for this, but I think that many go and try to find "a real doctor". An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. More are accepting that just as the pancreas may stop delivering insulin, the brain may fail to uphold the proper seretonin levels. Unfortunately it is not as simple as that, fixing seretonin or any other substance is like pouring oil over an engine and hope that it reaches the target. Still, I'm sure that we will see a huge change as true targeted treatments are no longer just sci-fi. Getting people to the right specialist is until then a good start.
- tcj_phx 9y ago
  > An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. Psychiatry is the only medical specialty that has a resistance movement and survivors groups. I think psychiatrists do okay with diagnosis, but commonly-used treatments frequently make the patients' condition worse. Ref: Whitaker's Anatomy of an Epidemic > More are accepting that just as the pancreas may stop delivering insulin, the brain may fail to uphold the proper seretonin levels. The MAOIs were reasonably effective as anti-depressants, but fell out of favor as newer & less-effective patent medicines were approved. The SSRIs are slightly better than a placebo, for some patients. I think the Paxil hawkers recently lost a lawsuit over a lawyer who rapidly became suicidal after starting that drug. He threw himself in front of a train: https://www.madinamerica.com/2017/05/change-in-chicago-playing-go/ https://www.madinamerica.com/2017/05/change-in-chicago-playi...
  - gforge 9y ago
    I agree, there are serious issues with many of the drug treatments and psychiatry has some dark history - but so does orthopaedics (e.g. the pseudotumors associated with hip resurfacing). Even if anti-depressants are no more effective than placebo, I still think a knife may be an even worse alternative and I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. My hope is that if we are able to correctly identify the cause we can start getting somewhere with the treatment. This said, there are indications that there is a subset of cases where the pain actually is triggered by the spine. The SweSpine register has some interesting numbers that show the results after surgery over time (http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf page 37, DDD). There is also the very fascinating study by Arlbert et al (https://www.ncbi.nlm.nih.gov/pubmed/23404353 https://www.ncbi.nlm.nih.gov/pubmed/23404353) that show that antibiotics may help. As always LBP is most likely a mix of diagnoses where we need to identify the correct subgroups before we even start to test treatments.
ZeroGravitas 9y ago
I've had some minor back issues in my life. One of the most thorough, scientific approaches I found was Dr Stuart McGill' s books. A proper academic with a deep understanding of what's going on but also able to translate that into pragmatic advice for people in pain. Highly recommended. You can find various YouTube videos with him in then, which gave me the confidence that he was a knowledgeable geek and not some huckster. Often the videos are related to his work with high performance athletes, but his books apply to ordinary Joes or old people just as much. If I can sum it up poorly, it's about understanding which muscles and bones work together in various movements and avoiding putting them under inappropriate strain, by slightly altering habits and building up muscles to provide support. He is also skeptical of the benefit of surgery in most cases. He does also touch on some brain related stuff but it wasn't related to my particular pain so I don't know much about that part of his approach.
- ZeroGravitas 9y ago
  I noticed the author of the piece has a top level link dedicated to Dr McGill's work on her website for the book: https://www.cathrynjakobsonramin.com/resources/2016/12/22/dr-stuart-mcgill-backfitpro?rq=Stuart%20McGill https://www.cathrynjakobsonramin.com/resources/2016/12/22/dr...
ApolloRising 9y ago
Had back pain for 15 years, took up weight lifting with a pro bodybuilder as a trainer. Fixed all my back pain in less than 3 months, I don't even think about it anymore.
kuwze 9y ago
For anyone interested, the back pain industry is considered worth more than $100 billion[0]. [0] https://qz.com/1010259/the-100-billion-per-year-back-pain-industry-is-mostly-a-hoax/ https://qz.com/1010259/the-100-billion-per-year-back-pain-in...
eric_b 9y ago
This article doesn't have one mention of TMS or the work that John Sarno did? That is borderline irresponsible. Read "Healing Back Pain: The Mind Body Connection" by Jon Sarno.[1] I lived with chronic knee pain for over 8 years, and would routinely have "carpal tunnel like symptoms" with my wrists. Literally within a week of reading that book my knee pain was gone, and my wrists have not had any issues since. My personality type is exactly that described in the book, so it might not work for everyone. But boy howdy it worked for me. [1] https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connection/dp/0446557684 https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connectio... Edit: As it relates to the article - Dr. Sarno attributes most of the pain to your brain and unconscious emotional rage. It sounds kind of quackish, but he lays out excellent explanations of how your brain works against you to cause this chronic pain. I was a skeptical as well (I won't give away spoilers but the treatment plan is HILARIOUSLY simple) but it has really worked for me.
- deleted 9y ago
  [deleted]
- e40 9y ago
  I won't give away spoilers but the treatment plan is HILARIOUSLY simple Seriously? This isn't a novel or TV show. That statement of yours just makes me think it is a scam.
  - cJ0th 9y ago
    The idea of Dr Sarno is not really in accordance with the scientific literature but it is indeed a very simple method and has worked like a charm for me, too. So I wouldn't say it's a scam. At worst, his method might turns out to be a placebo. You may want to read up about "tension myositis syndrome" on Wikipedia: https://en.wikipedia.org/wiki/John_E._Sarno#Tension_myositis_syndrome https://en.wikipedia.org/wiki/John_E._Sarno#Tension_myositis...
  - skimming88 9y ago
    May or may not work for you, but once understood and accepted, it will help you. If you're a sufferer and skeptical, go to a library and read it in an afternoon, then buy it if it suits you.
zacurry 9y ago
Sharing my experience with back pain in the hope that it might benefit some one. I am a programmer and I used to work 11 hour days frequently. After some years I started experiencing excruciating lower back pain. The pain would flare up if sit for more than 30 minutes. I went for physiotherapy and the pain lessened. The therapist told me I had no core strength and I started taking yoga lessons. Yoga felt good and I continued for 3 months, when things got worse. I consulted a specialist and he advised against yoga and all sorts of exercise. I haven't done any exercise in the past 6 months . And I have no pain in my back if I sit for 8 hours. Sit longer, and mild pain appears. The point I want to stress is when doing exercise and yoga, I felt good and pain lessened, but the mild pain was there at all times when I was sitting. Now with no exercise , I can sit pain free for 8 hours easily.Consequently ,I am much more productive at work , but the lack of exercise makes me sometimes feel dull and unhealthy :( .
twobyfour 9y ago
There are a lot of different types of back pain. I'm always stunned at how they get lumped together. Lower back muscle ache caused by stress and poor posture is a very different beast from a pinched nerve or a herniated disc or even muscle spasms caused by a glute injury. It makes sense for a psychological component to treatment to be effective for stress-related back pain. And yes, stress can aggravate pain from a physical injury. But there are also plenty of physical injuries that aren't psychosomatic.
regecks 9y ago
A very interesting read. I developed chronic pain after a fairly minor injury (at least, now I can see it was minor) and then proceeded to waste 4 years on diagnosis and physical therapy and exercise that wasn't helping at all. My latest doctor did mention 'central sensitisation', but it wasn't suffuciently contextualised for me to do anything with that information. I gave notice at my job of 4.5 years for unrelated reasons and had a complete reversal of pain within a couple of weeks. While it is great to be out of that hell, it is completely terrifying that I wasn't able to recognize what was keeping me in pain.
scandox 9y ago
This is my story without advice or conclusions: 10 years of lower back pain. Average of 5 serious strikes a year would take me out for 3 or 4 days completely. A feeling of weakness or mild pain occurring regularly in between those. Nothing on MRI. Lots of different Physio etc at different times. Special chairs, special cushions, Difene (diclofenac) ... too much. Late 2016 got sciatic pain for the first time. Took me out for 5 days. Got over it. Started Pilates. Early 2017 got hit with sciatic pain again - decided to just go through it. After 6 weeks I gave in and took some very heavy anti-inflammatories. Woke up with massive stomach pains and assumed I was reacting to the drugs. Went to the hospital and was diagnosed with Appendicitis. They took it out. Spent a couple of days taking lovely drugs. Got out. Back still rough but different somehow. Took a valium just once, slept 16 hours. Have not had any back pain for 9 months. No drugs. No special exercise. No idea what happened. My back just feels different.
seekstrength 9y ago
I had severe back pain in the last two years of high school. I eventually figured out how to sleep differently and move differently to avoid triggering the pain. Standing for longer than 20 minutes usually made my back ache like crazy. I found some stretches and positions that got my back muscles out of spasm. Unfortunately I had already gotten other weird muscle compensations by that point that resulted in more problems. I had a lot of other aches and pains (wrist, knees, hips, feet, etc.) by my mid-20s that were hitting me hard pretty much all day every day. It took A LOT of learning, stretching, strengthening, massaging, etc. but I'm in my mid-30s now and can do more than I have ever been able to do before. I've made it a career helping people in chronic pain as a trainer with a different perspective. A couple resources that may help someone in severe back pain: Back in Control by David Hanscom, MD. The author is a spine surgeon who, after years of performing spine surgeries and seeing the real effects and real research results, realized that surgery was NOT a good answer for back pain. This is an excellent read with some very practical advice. Also an excellent read is this article that appeared in Vox recently: vox.com/science-and-health/2017/8/4/15929484/chronic-back-pain-treatment-mainstream-vs-alternative I would also echo the sentiments of others here. It is VERY possible to beat back pain without surgery and pills, but the level of complexity varies from individual to individual. From the last 10 years of professional experience, I've seen some people solve back pain in two weeks, and I've seen some people take more than a year. I have a client that I still train who had unremitting back pain for nearly 13 years. She had radiating leg pain and eventually had microdiscectomy that helped a little. Even after that and after more PT and all kinds of alternative medicine, she still had debilitating back pain daily. For her, working on her hips has been the big key that now keeps her feeling really good. She's now able to go dance classes, do long road trips, sit on a plane for vacation, etc. The process was difficult and required patience, but together we figured out what helps her. Exercises that restore muscle balance is HUGE. And shockingly this is not an approach you'll see in medical or physical therapy textbooks. For a little more perspective, Framework is another good book by an orthopedic surgeon who generally advises against surgery. He notes that the vast majority of doctors receive a maximum of 2 weeks of musculoskeletal education. Most receive far less. Doctors who know muscular anatomy in-depth are a very small minority. It's just not something covered in standard medical education. However bad things may seem, DO NOT GIVE UP. Focus on taking control.
twblalock 9y ago
The worst part about having back pain is that everyone you tell about it recommends some kind of remedy. That is evident in most of the replies in these threads.
sunstone 9y ago
Every back is different, your mileage may vary. I hurt my back to the point I couldn't take a running step for 3 years. Serious lower back spasms for a year at least. If you've messed with the cartilage/disks of your vertibrae you're looking at at least a year of gentle recovery. Now I can sit all day (and run) but I need a chair with a seat plate that can tilt forward (basically pelvic tilt while sitting). If you're new to back injury the most important thing that they don't tell you is: the damage you do today to your back won't be evident until tomorrow. The feed back loop is way too slow. In my experience, the best treatment for lower back pain is (once the cartilage is repaired) to walk, no matter how bent over you are, walk and walk some more. I think the stretching etc can be helpful too but I haven't tried that. I'm just very careful about how I use my back when I'm bending over.
Mikhail_Edoshin 9y ago
Does anyone have experience with the Alexander technique? I've recently got interested in it, not because of back pain, but they say it helps with back pain as well. Basically it's a way to change your movement habits and get a better posture as a result. It probably not a cure for every case, but what I've heard so far was very interesting.
bar-b-q 9y ago
If someone also has some serious advice for shoulder pain related to sitting/working a lot in front of a computer, I would much appreciate this. I constantly have pain in my left shoulder for years now and cant find a way how to ease the pain. I have this pain the whole day, but sitting in front of a computer increases it. Already tested a lot of therapist and tried different sitting positions. Standing does not make it better.
- jpm_sd 9y ago
  Get checked for a cartilage tear. You may need a contrast MRI, and you may need statical repair.
jtanner 9y ago
After reading this article I followed up with the author book "CROOKED Outwitting the Back Pain Industry and Getting On the Road to Recovery". As a computer programmer who has just gone through 1 year of bullshit therapies and recommendations, this book is a godsend. If you have back or neck problems and want some non-bullshit explanations, read this book immediately. https://www.cathrynjakobsonramin.com/books/crooked/overview/ https://www.cathrynjakobsonramin.com/books/crooked/overview/
z3t4 9y ago
When I lift heavy weights regularly it's like the pain threshold goes down several levels.

212 points by kawera 9y ago

Don't know why the author states physical therapy is expensive. It is cheap compared to anything else. Having sciatica on and off for several years, 8 sessions of physical therapy definitely helped, specifically the excercises they teach you.

neom 9y ago
and "cheap" is relative, my friend.

melling 9y ago

The Mind Body Approach: Cures back pain, rsi... https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connection/dp/0446557684 https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connectio... http://www.rsi.deas.harvard.edu/mb_what_is.html http://www.rsi.deas.harvard.edu/mb_what_is.html

ta8457348 9y ago
FWIW, this worked for me. I had absolutely debilitating pain in a hip joint as if I had a handful of needles loose in there. I had it for several months, I had an MRI, a bone scan, tried physio, acupuncture and what have you with zero effect. At some point got a "procedure" scheduled for some sort of steroid injection directly into the spine column and was prescribed some nasty anti-inflammatory pills to "prep" for the thing (but in the end decided against the whole thing). The only thing that helped _a bit_ were the 600 mg Ibuprofen pills. In any case, saw this book recommended here on HN, picked it up, read a quarter and realized that it applied. I was under an enormous stress at the time, both on work and personal fronts. On the work side I was running a one-man project with several thousand active daily users. On the personal end we just had a kid and the massive lifestyle change that came with it. A couple of days after realizing that the stress might've been the cause of the pain, the pain disappeared. Just - poof, gone. This was over 10 years ago and it never came back. The end.
- maxxxxx 9y ago
  I read the Sarno book and I didn't get anything out of it. From reading your comment it seems that it may apply to psychosomatic pain but not to pain where there is a physical cause. Is this correct? It kind of makes sense. When I am stressed I am much more susceptible to pain and disease than when I am happy.
  - jaggederest 9y ago
    The whole point is that there's no difference between psychosomatic pain and pain where there's a physical cause. The brain activity that people think of as being "just psychosomatic" is actual, physical changes that causes both direct perception of pain within the brain itself and also changes in the rest of the body that result in peripheral pain. Stress doesn't just make you imagine you have joint pain, it actually causes it directly in measurable ways. Catecholamines are extremely powerful and if you start cranking them out because you're stressed, everything works worse, which often results in pain, which is of course an additional stressor.
    - maxxxxx 9y ago
      I accept that your thoughts can create pain but I think there is also pain that's being caused first by a physical event. Example: someone drilling your tooth.
      - tudorw 9y ago
        You're right, that's known as nociceptive pain, the other is known as neuropathic pain, here's a nice piece, it's moving on the knowledge that these types of pain, emotional and physical if you like, cause a similar area of the brain to 'light up' (http://www.pnas.org/content/108/15/6270.abstract http://www.pnas.org/content/108/15/6270.abstract), and how advances are allowing more fine grain observation of these reactions http://healthland.time.com/2013/05/06/a-pain-detector-for-the-brain/ http://healthland.time.com/2013/05/06/a-pain-detector-for-th... Although to be a pedant, tooth drilling is apparently not quite nociceptive as it's the nerve being vibrated that causes an intense sensation that's easy to interpret as 'pain', I try and think about fireworks instead...
theparanoid 9y ago
FWIW, it worked for my RSI with semi-crippling pain when typing.
- melling 9y ago
  What did that involve? How did you reduce your stress?
tudorw 9y ago
Me too, years of issues with 'Carpal Tunnel', 'RSI', my own research into psychoneuroendocrinology and encountering the Sarno approach changed the way I looked at my situation, sensations from my nerves means I am alive, they are not to be relied on as reliable indicators of 'pain', 'pain' should be reserved for things we can do something about. Unwrapping the psychological foundations as to why I chose to start interpreting these signals as 'pain' is a complex and interesting task that is not 'over', but the progress is meaningful and long lasting. I believe advances in continuous arrays and high resolution fMRI together with a raft of new devices that are looking at change over time will bring a scientific lense to Sarno's work and start to close the loop on the mind body experience we call life :)

katastic 9y ago

I've been living this horror for six years. If I could just magically stop using medicine and not being treated like a drug addict for merely taking prescribed medicine by all walks of society (from cops, to nurses, to neighbors), don't you think I'd have already fucking taken that choice? The majority of people don't want to be on pills. They want to get better. If I'm in too much pain to physically get out of bed, how am I supposed to exercise? It sounds like this is just an advertisement for CBT, and 90% of it is summed up as "get an anti-depressant" and "go to therapy." Well everyone is already doing that. I mean, are we really going to suggest everyone in the medical industry related to pain management is just a scam? That doctors don't try a mirade of tools to help their patients and instead just throw addictive pills at them? Surely some do. But who says "I want to go to medical school to sell pills" instead of "helping people"? I don't know. I find it hard to analytically process this article since I'm so close to the source. But I literally spend >60% of my days in complete writhing agony. I had to FIGHT to get the medicine I needed and I had to FIGHT to get the back surgeries that took me from almost dying to "surviving." So if the world is really handing out pills and surgeries, it sure as hell wasn't doing it in my area.

ianai 9y ago
As a migraine sufferer I feel the same way. I tell people who don't take my pain seriously to watch me take a round of Botox for them. It's something like 8 syringes in my scalp. I absolutely would not go through that if a single migraine didn't inflict much more pain upon me. I'll never forget having a migraine come back on as I was leaving the ER one night. They had already dosed me up well. All the drugs did though was make me not care that it felt like an ice pick was boring into my head. Still felt the pain. I've lost way too many things to this pain over the years. It's awful.
- manmal 9y ago
  I'm sure you have had your share of well meaning advice. But have you checked out PEMF devices? There is evidence that therapeutic pulsed EM helps reduce migraine pain [1], among a lot of other positive effects. The selfhacked.com guy heavily endorses a device called ICES which costs "only" around $400 (but is of course weaker than the heavy duty devices since it runs on a 9V battery). 1: https://www.ncbi.nlm.nih.gov/m/pubmed/11279973/ https://www.ncbi.nlm.nih.gov/m/pubmed/11279973/

amriksohata 9y ago

Try yograj guggulu with yoga, the Indian Hindu sages knew their stuff

bambax 9y ago

Not one mention of The Mindbody Prescription (if only to dismiss it)? If you're suffering from back pain, or carpal tunnel syndrome, or such ailments, read this book, it might change your life! (and if it doesn't it can't harm) https://www.amazon.com/dp/0446675156/ https://www.amazon.com/dp/0446675156/

chrismealy 9y ago
I read about three chapters of this and it cured my wrist pain. Never would have believed it possible if it hadn't happened to me.
- KGIII 9y ago
  I am skeptical. What about those three chapters resolved your physiological ailment?
  - chrismealy 9y ago
    It sounds impossible but it actually happened - just acknowledging the stress I was under made the pain go away (it's not like you have to solve anything). I think it only took about four days. The crazy thing is it was actually visible. The throbbing swollen veins in my forearms receded. I was receptive to the idea because the pain was the worst the summer my dad was dying in a hospice and I wasn't working at all. The bummer is there's no way to know if it's stress or not, but it doesn't hurt to give it a try.
    - phlillip 9y ago
      This; when my Father was diagnosed with cancer I was under a lot of stress but acting like everything was fine. Pretty soon I got alopecia, in my beard not my head. The body communicates with you in very different ways and it can be overlooked. Finding the root cause of pain in your life is the key. Not always, but often.
      - kxs 9y ago

taxicabjesus 9y ago

I've watched some older family members degenerate over the years... Sometimes doctors do good work, sometimes the medical-industrial complex makes work for itself. I knocked myself out at the lake when I was 17 years old. I mostly recovered over the following six months, but rapidly developed an inflammatory condition when I went off to college a year later. Retrospectively, my apathy towards my degree program was an important factor. After the fourth doctor I said to myself, "screw you guys, I'm going to figure myself out." I wrote about this previously: https://news.ycombinator.com/item?id=13123659 https://news.ycombinator.com/item?id=13123659 When I was suffering through college I decided it would be helpful to be able to "relax" (mind awake, body asleep), and to visualize. What a long, strange road it's been...

azag0 9y ago

Wouldn't it be more conclusive to look at what neuronal signals travel from the lower back to the brain, and how (if) they differ between chronic-pain patients and healthy people? Or do we miss technology to do that?

gforge 9y ago

Lovely article, as an orthopaedic surgeon I can tell you that most of us know this. Treating chronic pain with surgery is generally a bad idea, I spend a large share of my time explaining this. Some patients are grateful for this, but I think that many go and try to find "a real doctor". An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. More are accepting that just as the pancreas may stop delivering insulin, the brain may fail to uphold the proper seretonin levels. Unfortunately it is not as simple as that, fixing seretonin or any other substance is like pouring oil over an engine and hope that it reaches the target. Still, I'm sure that we will see a huge change as true targeted treatments are no longer just sci-fi. Getting people to the right specialist is until then a good start.

tcj_phx 9y ago
> An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. Psychiatry is the only medical specialty that has a resistance movement and survivors groups. I think psychiatrists do okay with diagnosis, but commonly-used treatments frequently make the patients' condition worse. Ref: Whitaker's Anatomy of an Epidemic > More are accepting that just as the pancreas may stop delivering insulin, the brain may fail to uphold the proper seretonin levels. The MAOIs were reasonably effective as anti-depressants, but fell out of favor as newer & less-effective patent medicines were approved. The SSRIs are slightly better than a placebo, for some patients. I think the Paxil hawkers recently lost a lawsuit over a lawyer who rapidly became suicidal after starting that drug. He threw himself in front of a train: https://www.madinamerica.com/2017/05/change-in-chicago-playing-go/ https://www.madinamerica.com/2017/05/change-in-chicago-playi...
- gforge 9y ago
  I agree, there are serious issues with many of the drug treatments and psychiatry has some dark history - but so does orthopaedics (e.g. the pseudotumors associated with hip resurfacing). Even if anti-depressants are no more effective than placebo, I still think a knife may be an even worse alternative and I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. My hope is that if we are able to correctly identify the cause we can start getting somewhere with the treatment. This said, there are indications that there is a subset of cases where the pain actually is triggered by the spine. The SweSpine register has some interesting numbers that show the results after surgery over time (http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf page 37, DDD). There is also the very fascinating study by Arlbert et al (https://www.ncbi.nlm.nih.gov/pubmed/23404353 https://www.ncbi.nlm.nih.gov/pubmed/23404353) that show that antibiotics may help. As always LBP is most likely a mix of diagnoses where we need to identify the correct subgroups before we even start to test treatments.

ZeroGravitas 9y ago

I've had some minor back issues in my life. One of the most thorough, scientific approaches I found was Dr Stuart McGill' s books. A proper academic with a deep understanding of what's going on but also able to translate that into pragmatic advice for people in pain. Highly recommended. You can find various YouTube videos with him in then, which gave me the confidence that he was a knowledgeable geek and not some huckster. Often the videos are related to his work with high performance athletes, but his books apply to ordinary Joes or old people just as much. If I can sum it up poorly, it's about understanding which muscles and bones work together in various movements and avoiding putting them under inappropriate strain, by slightly altering habits and building up muscles to provide support. He is also skeptical of the benefit of surgery in most cases. He does also touch on some brain related stuff but it wasn't related to my particular pain so I don't know much about that part of his approach.

ZeroGravitas 9y ago
I noticed the author of the piece has a top level link dedicated to Dr McGill's work on her website for the book: https://www.cathrynjakobsonramin.com/resources/2016/12/22/dr-stuart-mcgill-backfitpro?rq=Stuart%20McGill https://www.cathrynjakobsonramin.com/resources/2016/12/22/dr...

ApolloRising 9y ago

Had back pain for 15 years, took up weight lifting with a pro bodybuilder as a trainer. Fixed all my back pain in less than 3 months, I don't even think about it anymore.

kuwze 9y ago

For anyone interested, the back pain industry is considered worth more than $100 billion[0]. [0] https://qz.com/1010259/the-100-billion-per-year-back-pain-industry-is-mostly-a-hoax/ https://qz.com/1010259/the-100-billion-per-year-back-pain-in...

eric_b 9y ago

This article doesn't have one mention of TMS or the work that John Sarno did? That is borderline irresponsible. Read "Healing Back Pain: The Mind Body Connection" by Jon Sarno.[1] I lived with chronic knee pain for over 8 years, and would routinely have "carpal tunnel like symptoms" with my wrists. Literally within a week of reading that book my knee pain was gone, and my wrists have not had any issues since. My personality type is exactly that described in the book, so it might not work for everyone. But boy howdy it worked for me. [1] https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connection/dp/0446557684 https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connectio... Edit: As it relates to the article - Dr. Sarno attributes most of the pain to your brain and unconscious emotional rage. It sounds kind of quackish, but he lays out excellent explanations of how your brain works against you to cause this chronic pain. I was a skeptical as well (I won't give away spoilers but the treatment plan is HILARIOUSLY simple) but it has really worked for me.

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e40 9y ago
I won't give away spoilers but the treatment plan is HILARIOUSLY simple Seriously? This isn't a novel or TV show. That statement of yours just makes me think it is a scam.
- cJ0th 9y ago
  The idea of Dr Sarno is not really in accordance with the scientific literature but it is indeed a very simple method and has worked like a charm for me, too. So I wouldn't say it's a scam. At worst, his method might turns out to be a placebo. You may want to read up about "tension myositis syndrome" on Wikipedia: https://en.wikipedia.org/wiki/John_E._Sarno#Tension_myositis_syndrome https://en.wikipedia.org/wiki/John_E._Sarno#Tension_myositis...
- skimming88 9y ago
  May or may not work for you, but once understood and accepted, it will help you. If you're a sufferer and skeptical, go to a library and read it in an afternoon, then buy it if it suits you.

zacurry 9y ago

Sharing my experience with back pain in the hope that it might benefit some one. I am a programmer and I used to work 11 hour days frequently. After some years I started experiencing excruciating lower back pain. The pain would flare up if sit for more than 30 minutes. I went for physiotherapy and the pain lessened. The therapist told me I had no core strength and I started taking yoga lessons. Yoga felt good and I continued for 3 months, when things got worse. I consulted a specialist and he advised against yoga and all sorts of exercise. I haven't done any exercise in the past 6 months . And I have no pain in my back if I sit for 8 hours. Sit longer, and mild pain appears. The point I want to stress is when doing exercise and yoga, I felt good and pain lessened, but the mild pain was there at all times when I was sitting. Now with no exercise , I can sit pain free for 8 hours easily.Consequently ,I am much more productive at work , but the lack of exercise makes me sometimes feel dull and unhealthy :( .

twobyfour 9y ago

There are a lot of different types of back pain. I'm always stunned at how they get lumped together. Lower back muscle ache caused by stress and poor posture is a very different beast from a pinched nerve or a herniated disc or even muscle spasms caused by a glute injury. It makes sense for a psychological component to treatment to be effective for stress-related back pain. And yes, stress can aggravate pain from a physical injury. But there are also plenty of physical injuries that aren't psychosomatic.

regecks 9y ago

A very interesting read. I developed chronic pain after a fairly minor injury (at least, now I can see it was minor) and then proceeded to waste 4 years on diagnosis and physical therapy and exercise that wasn't helping at all. My latest doctor did mention 'central sensitisation', but it wasn't suffuciently contextualised for me to do anything with that information. I gave notice at my job of 4.5 years for unrelated reasons and had a complete reversal of pain within a couple of weeks. While it is great to be out of that hell, it is completely terrifying that I wasn't able to recognize what was keeping me in pain.

scandox 9y ago

This is my story without advice or conclusions: 10 years of lower back pain. Average of 5 serious strikes a year would take me out for 3 or 4 days completely. A feeling of weakness or mild pain occurring regularly in between those. Nothing on MRI. Lots of different Physio etc at different times. Special chairs, special cushions, Difene (diclofenac) ... too much. Late 2016 got sciatic pain for the first time. Took me out for 5 days. Got over it. Started Pilates. Early 2017 got hit with sciatic pain again - decided to just go through it. After 6 weeks I gave in and took some very heavy anti-inflammatories. Woke up with massive stomach pains and assumed I was reacting to the drugs. Went to the hospital and was diagnosed with Appendicitis. They took it out. Spent a couple of days taking lovely drugs. Got out. Back still rough but different somehow. Took a valium just once, slept 16 hours. Have not had any back pain for 9 months. No drugs. No special exercise. No idea what happened. My back just feels different.

seekstrength 9y ago

I had severe back pain in the last two years of high school. I eventually figured out how to sleep differently and move differently to avoid triggering the pain. Standing for longer than 20 minutes usually made my back ache like crazy. I found some stretches and positions that got my back muscles out of spasm. Unfortunately I had already gotten other weird muscle compensations by that point that resulted in more problems. I had a lot of other aches and pains (wrist, knees, hips, feet, etc.) by my mid-20s that were hitting me hard pretty much all day every day. It took A LOT of learning, stretching, strengthening, massaging, etc. but I'm in my mid-30s now and can do more than I have ever been able to do before. I've made it a career helping people in chronic pain as a trainer with a different perspective. A couple resources that may help someone in severe back pain: Back in Control by David Hanscom, MD. The author is a spine surgeon who, after years of performing spine surgeries and seeing the real effects and real research results, realized that surgery was NOT a good answer for back pain. This is an excellent read with some very practical advice. Also an excellent read is this article that appeared in Vox recently: vox.com/science-and-health/2017/8/4/15929484/chronic-back-pain-treatment-mainstream-vs-alternative I would also echo the sentiments of others here. It is VERY possible to beat back pain without surgery and pills, but the level of complexity varies from individual to individual. From the last 10 years of professional experience, I've seen some people solve back pain in two weeks, and I've seen some people take more than a year. I have a client that I still train who had unremitting back pain for nearly 13 years. She had radiating leg pain and eventually had microdiscectomy that helped a little. Even after that and after more PT and all kinds of alternative medicine, she still had debilitating back pain daily. For her, working on her hips has been the big key that now keeps her feeling really good. She's now able to go dance classes, do long road trips, sit on a plane for vacation, etc. The process was difficult and required patience, but together we figured out what helps her. Exercises that restore muscle balance is HUGE. And shockingly this is not an approach you'll see in medical or physical therapy textbooks. For a little more perspective, Framework is another good book by an orthopedic surgeon who generally advises against surgery. He notes that the vast majority of doctors receive a maximum of 2 weeks of musculoskeletal education. Most receive far less. Doctors who know muscular anatomy in-depth are a very small minority. It's just not something covered in standard medical education. However bad things may seem, DO NOT GIVE UP. Focus on taking control.

twblalock 9y ago

The worst part about having back pain is that everyone you tell about it recommends some kind of remedy. That is evident in most of the replies in these threads.

sunstone 9y ago

Every back is different, your mileage may vary. I hurt my back to the point I couldn't take a running step for 3 years. Serious lower back spasms for a year at least. If you've messed with the cartilage/disks of your vertibrae you're looking at at least a year of gentle recovery. Now I can sit all day (and run) but I need a chair with a seat plate that can tilt forward (basically pelvic tilt while sitting). If you're new to back injury the most important thing that they don't tell you is: the damage you do today to your back won't be evident until tomorrow. The feed back loop is way too slow. In my experience, the best treatment for lower back pain is (once the cartilage is repaired) to walk, no matter how bent over you are, walk and walk some more. I think the stretching etc can be helpful too but I haven't tried that. I'm just very careful about how I use my back when I'm bending over.

Mikhail_Edoshin 9y ago

Does anyone have experience with the Alexander technique? I've recently got interested in it, not because of back pain, but they say it helps with back pain as well. Basically it's a way to change your movement habits and get a better posture as a result. It probably not a cure for every case, but what I've heard so far was very interesting.

bar-b-q 9y ago

If someone also has some serious advice for shoulder pain related to sitting/working a lot in front of a computer, I would much appreciate this. I constantly have pain in my left shoulder for years now and cant find a way how to ease the pain. I have this pain the whole day, but sitting in front of a computer increases it. Already tested a lot of therapist and tried different sitting positions. Standing does not make it better.

jpm_sd 9y ago
Get checked for a cartilage tear. You may need a contrast MRI, and you may need statical repair.

jtanner 9y ago

After reading this article I followed up with the author book "CROOKED Outwitting the Back Pain Industry and Getting On the Road to Recovery". As a computer programmer who has just gone through 1 year of bullshit therapies and recommendations, this book is a godsend. If you have back or neck problems and want some non-bullshit explanations, read this book immediately. https://www.cathrynjakobsonramin.com/books/crooked/overview/ https://www.cathrynjakobsonramin.com/books/crooked/overview/

z3t4 9y ago

When I lift heavy weights regularly it's like the pain threshold goes down several levels.