15 ms·

Novel mind-body program outperforms other treatments for chronic back pain

325 points by yasp 5y ago

ethbr0 5y ago
I'm assuming this is the research in question: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476063/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476063/
hirundo 5y ago
"The novel intervention ... is based on an idea pioneered by the late John Sarno, MD" John Sarno's book "Healing Back Pain" saved me from truly agonizing torture and made me functional again in just a few hours, though I went to it with extreme skepticism. It's great to see formal research being done on this approach.
- someelephant 5y ago
  Same. And yet so many people are unwilling to take the leap of faith. It's sad because the same thinking patterns that cause them to avoid Sarno likely lead to a lot of grief in other areas of their lives.
  - csee 5y ago
    It's the scientism mindset which is common among technical types. Anti-woo errs into a more dogmatic dismissal and closed mindedness towards anything not backed by multiple large RCTs and consensus among experts. I think a balance is in order. It's good to explore things that don't have conclusive evidence with an open mind while maintaining a degree of healthy scepticism. If it improves subjective well-being then it works for all practical purposes. Whether that's all placebo doesn't even matter at that point. Rigorous epistemology != a good approach to self-help.
    - Barrin92 5y ago
      I'm about as far away from the scientism mindset as one can get but I don't think that's really the reason. To assume that someone can solve a debilitating problem that affects millions in hours by selling you a book is probably in 99% of cases a scam. And the subjective well being point isn't so simple as well. If there really is a physical problem the placebo isn't a treatment but masks symptoms, which is counter-productive long term. Plenty of people pour substantial money into alternative medicine that doesn't address their illnesses because they feel subjectively better for a while.
      - csee 5y ago
        This is where the healthy skepticism part comes in. Going all out woo or quack isn't what I'm suggesting, and I'd agree that that's even worse than being too closed minded. Crystal healing doesn't work and people shouldn't try it. But if something sounds sort-of plausible, has some tentative but low quality evidence, and it's low cost and low risk, and it's not going to distract you from more proven treatments, then just try it out and see if it works. A small handful of people won't even go that far because of dogmatically orthodox thinking, and those are the people I'm addressing. > To assume that someone can solve a debilitating problem that affects millions in hours by selling you a book is probably in 99% of cases a scam. If it's psychosomatic pain, there's legitimate scope for a self-help book to actually improve things for them. Also why wouldn't we expect practitioners who have been hands on with clients for 20 years to not have picked up some useful tricks that didn't make it into peer reviewed studies? I feel like your statement here is too heavy on the skepticism, even though you're right that there are loads of books that are quackery. There can be learned wisdom built up through practice that isn't peer reviewed.
        tomByrer 5y ago
        I haven't read the book, but am familiar with the story. The pain origins don't need to be "psychosomatic" for the mind to override it; the pain may be real. The back surgeon interviewed patients long after back surgery. They reported some help, but some pain / discomfort remained. He looked at Xrays of painful vs pain-free, & found Xrays looked very similar. That's when he started teaching 'pain management'. IMHO teaching 'pain management' would be helpful for all. Could prevent some surgeries, but even if they got corrective surgery, the self-help management could still prove useful.
    - BeetleB 5y ago
      > It's the scientism mindset which is common among technical types. Interestingly, Carl Sagan, in his book The Demon Haunted World, discusses physical ailments arising purely from the brain and in passing points out that there are reasons to believe back pain is one of them. The book is a fantastic read, because for some reason many people in the pro-skeptic movement recommend the book, despite the fact that quite a bit of the book is critical of skeptics!
- 300bps 5y ago
  When I had carpal tunnel syndrome 10 years ago someone on HN recommended the Harvard RSI program that follows Sarno’s technique. http://www.rsi.deas.harvard.edu http://www.rsi.deas.harvard.edu It took work but it literally cured me. Went on to use the same techniques for back pain and haven’t had that in many years.
  - pitched 5y ago
    > Keep wrists above the pad, and tilt the kbd downward. TIL! This is the opposite of what I’ve been doing to date.
    - raindropm 5y ago
      That image made me think about all those fancy 'thicc' mechanical keyboard on Youtube. My wrist hurt just seeing the video. Low profile keyboard FTW!
    - BeetleB 5y ago
      If you had that particular type of pain, it will become "obvious". You'll feel the pain of maintaining the wrist flat, and the pain will be less in that posture. Same with my back pain and lumbar support. Once the lumbar support gave me relief, I could easily tell which chairs/couches were terrible for the back as the bad ones would give instant pain.
- ranger_danger 5y ago
  what's the secret without having to read a whole book?
  - papandada 5y ago
    Dr Sarno 12 Daily Reminders The pain is due to TMS, not to a structural abnormality The direct reason for the pain is mild oxygen deprivation TMS is a harmless condition caused by my repressed emotions The principal emotion is my repressed ANGER TMS exists only to distract my attentions from the emotions Since my back (replace with whatever pain you’ve got) is basically normal there is nothing to fear Therefore, physical activity is not dangerous And I MUST resume all normal physical activity I will not be concerned or intimidated by the pain I will shift my attention from pain to the emotional issues I intend to be in control-NOT my subconscious mind I must think Psychological at all times, NOT physical.
    - kranner 5y ago
      Sarno started with first ruling out physical causes with checkups and investigations. Only after that did he attribute pains to TMS, only if conventional treatment had not cured the pain.
      - 1121redblackgo 5y ago
        Yeah a common phrase is to "rule out the life threatening, then rule in mind-body disorder."
    - mebiles 5y ago
      ok thank you this. To all the people that has doubted their own pseudo science skepticism every time this book comes up here at HN- you may be relieved as it doesnt work if you have a structural cause for the pain.
  - curioussavage 5y ago
    The idea is basically that your brain/subconscious creates pain and other health problems as a coping mechanism. If I remember correctly the solution was basically to learn about that and acknowledge it and do exercises like tell your mind/body thank you for looking out for me. It I don’t need that. Go to psychotherapy and other stuff. I’m definitely a partial believer in the ideas. Read about it decided to stop going to chiropractors after doing so for over a decade due to often severe neck and back pain and now 2 years later I am virtually neck and back pain free. While doing nothing, in fact while eating worse, not exercising , being stressed out, bad posture etc. I just decided that it was psychosomatic and it eventually went away.
- weird-eye-issue 5y ago
  Wish I could say the same. It did nothing for me
- 1121redblackgo 5y ago
  Same. Some folks who I love and owe unending appreciation to, that are doing public outreach and education for this in 2021, are Nicole Sachs and Dan Buglio. Their youtube channels, podcasts, and websites, and the guidance and experience therein, saved my life.
crehn 5y ago
TL;DR: > Psychophysiologic Symptom Relief Therapy (PSRT) is designed to address underlying stressors and psychological contributors to persistent pain as well as conditioned pain responses and fear avoidant behaviors. Good to see research into this. I've definitely had enduring pain relief by a deeper change in mindset.
cupcake-unicorn 5y ago
While this is exciting work, I'm really terrified that the efficacy of this treatment will cause doctors to jump on this modality for a number of disorders it's not really suited for, as what is happening with CBT. There are a number of treatments that are great if done with the right intent, but when they go into a mass treatment setting it loses connection with the humanistic portion. I could see doctors jumping to over prescribe this for pain or other conditions without listening to the patient or worse blaming the patient when the treatment didn't work for them, which is basically what's happening when say someone with physiological issues gets suckered into doing CBT for insomnia. I do think it's important we take these holistic approaches to pain relief but the medical institution and worse yet insurance will bungle this in the US and I'm scared for that :( But glad to learn of it since I can get a copy of John Samo's book. Another treatment that has shown anecdotal success for chronic pain is Internal Family Systems therapy. I feel like that one would be a lot harder to mess up.
pdoege 5y ago
Yeah, I suffered through this. "We all have aches and pains", "Don't catastrophize", etc. Turns out I had a chunk of spinal disc the size of my little finger impinging on my spinal column. I think that this "mind-body" stuff is woo. Drugs work. Physical therapy works. Woo doesn't. However, woo is really cheap. And it offloads the blame onto the victim.
- discordance 5y ago
  50 years ago I’m sure regular doctors would laugh at the idea of treating anxiety disorders with meditation instead of meds, electroshock or whatever. Is there not enough space for both the Woo and our usual western methods? The patient journey could be: diagnosis, imaging, woo (if appropriate), physio, chiro and if need be, surgery.
  - weird-eye-issue 5y ago
    Well, in my experience meditation alone was not effective at all for my anxiety. Actual doctors (in the US and in SE Asia) put me on medication for it and that was effective. I don't think many "regular doctors" are telling people to just meditate for their anxiety...
    - s1artibartfast 5y ago
      Surely you can respect that not all solutions are based in pharma or surgical intervention. Take depression for example. Some people might have a chemical imbalance. Some might be in terrible marriage or struggling with other trauma. The idea here is pretty simple and not particularly crazy: Some people have problems that can be solved best with treatment other than drugs or surgery.
      - weird-eye-issue 5y ago
        It's usually a combination of things. For me, my anxiety was causing me to not do things that could have ultimately helped me have less anxiety. Meditating didn't cure that. I had to go on meds to get over that initial anxiety and now I don't need the meds as much Sure meditation can help some people but I don't think it's as effective as a lot of people seem to think
glasscannon 5y ago
As someone with fibro/nociplastic pain, it's great to see more emphasis being placed on the non-biological drivers of pain. I'm currently building a platform to address pain more holistically. If you're interested in chatting feel free to reach out.
seibelj 5y ago
My back pain began at the tender age of 16. I have a few impinging discs in my lower back that “the cure (surgery) would be worse than the disease”. The only thing that has consistently made me feel better is high intensity workouts and core strength. I’m in extremely good shape but still in a lot of pain, but luckily that hasn’t stopped me.
- stillblue 5y ago
  Can you elaborate? I'm in a similar boat and I've tried everything. I can't workout too much cos the back pain gets really worse after that. What do you mean when you say "high intensity workouts"?
  - seibelj 5y ago
    Core strength training like planks and squats, also biceps and legs, bench press, essentially lifting in all forms - except anything that is related to bending over. I don’t do any exercises that involve bending or leaning forwards if it doesn’t involve using the bench for support. Also a lot of cardio. In terms of work I’m a software guy and WFH, I rotate between standing, sitting, and laying throughout the day. Sometimes I work on the floor. Basically I work until I start to feel sore then I switch positions.
  - generalenvelope 5y ago
    If you are interested in training, and especially if you experience pain while doing it, I cannot recommend Barbell Medicine enough. Specifically: "4 Steps For Managing Pain in the Gym" https://www.youtube.com/watch?v=mdwj5ORPmX0 https://www.youtube.com/watch?v=mdwj5ORPmX0 Austin is a professional doctor/coach/lifter and an expert on the topic. The lesson I linked corresponds to this article: https://www.barbellmedicine.com/blog/pain-in-training-what-do/ https://www.barbellmedicine.com/blog/pain-in-training-what-d... Aside from paying for a pain and rehab consultation with the Barbell Medicine team - I'd recommend posting on their forum: https://forum.barbellmedicine.com/ https://forum.barbellmedicine.com/ You can find many examples of people in similar situations receiving professional advice from their staff free of charge.
Ozzie_osman 5y ago
> However, common therapies such as surgery and steroid injections intended to address physical origins of back pain have not been clearly proven to work in randomized clinical trials. This is a terrifying statement.
- jjtheblunt 5y ago
  Is it just that "randomized clinical trials" can not exist for definitive actions like surgery or steroids, as there's nothing that can play the role of placebo?
  - pseudalopex 5y ago
    Sham surgery for some procedures. Saline for injections.
  - mrestko 5y ago
    No, there have been sham controlled trials of surgical interventions before, they're just rare. One example is kyphoplasty.
    - cpncrunch 5y ago
      There have been a few: https://en.wikipedia.org/wiki/Sham_surgery#Examples https://en.wikipedia.org/wiki/Sham_surgery#Examples
- helge9210 5y ago
  Bloodletting was still a thing a hundred years ago. Medical science went far since then, but not too far.
- generalenvelope 5y ago
  You should check out this article: https://startingstrength.com/article/aches-and-pains https://startingstrength.com/article/aches-and-pains many conventional methods of treatment don't have the efficacy you might expect. As an aside - strength training when combined with knowledge of the biopsychosocial model, self efficacy, not-catastrophizing (the things Dr's Baraki and Feigenbaum preach) has changed my life.
brandonmenc 5y ago
Plug for the book that helped me. Evidence-based self-treatment from an expert spine researcher. If you've ever heard of the "McGill Big 3" exercises, this is the guy. https://www.backfitpro.com/books/back-mechanic-the-mcgill-method-to-fix-back-pain/ https://www.backfitpro.com/books/back-mechanic-the-mcgill-me...
patmcc 5y ago
People are incredibly reluctant to believe that ailments might actually be partly or mainly psychological. Chronic fatigue, fibromyalgia, chronic lyme disease, back pain, are all things that sincere people truly are suffering from...that may be mainly psychological/psychosomatic but lots of people refuse to consider it. Probably due to the general dismissal of mental illnesses and being told for years "it's all in your head". I think partly, people with these conditions are sometimes accused (or think they're being accused) of malingering; I don't think that's the case very often, I think they legitimately feel the symptoms they report, but the root cause may be in the mind/brain rather than the rest of the body. Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well. I suspect we'll (some day) get better treatments for all the things I mention, if mental illness stigma ends and they can be honestly considered from all possible causes. Edit: to be clear, I'm not saying that all cases of back pain or CFS or whatever are psychosomatic - just that it shouldn't be dismissed, especially when the treatments are relatively low-risk.
- pfortuny 5y ago
  Also, being psychosomatic does NOT mean they are ficticious, which is a widespread opinion.
- playpause 5y ago
  It’s odd that “all in your head” means “not a serious problem” or “you can fix it by yourself”. It seems to me that a problem being located in the head/brain/mind is, almost by definition, particularly difficult to fix, let alone to fix without external guidance.
- casion 5y ago
  However, quite dangerously, those ailments are also often misdiagnosis's. Fibro was a misdiagnosis for me, and I nearly died because I accepted it and worked on a psychological and rehab program rather than continue to pursue symptoms.
  - cpncrunch 5y ago
peterbozso 5y ago
For my fellow chronic lower back painers out there: over the course of many years I tried many things (always staying in the confines of modern medicine). There's certainly no magic bullet, but finally this book (which I have no financial incentives to promote) brought me a long lasting solution: https://www.painscience.com/tutorials/low-back-pain.php https://www.painscience.com/tutorials/low-back-pain.php The whole thing certainly worths a read, since the goal of the book is to make you understand your condition and give you relief partly through that. But for me, the single most important thought of the book is "the issue is (almost) always with the tissue". If you have chronic (lower) back pain and you feel like you have tried everything, I recommend learning and applying self-massage regularly. Combined with other important, conservative treatments (physiotherapy, yoga, swimming, workout, etc.), it did wonders for me and I hope it will for others with similar problems.
- kranner 5y ago
  The program referred to above, PSRT, is based on John Sarno's work. In his book Sarno stresses that physical causes to chronic back pain must be ruled out first. He only treated patients with his mind-body awareness methodology after investigations had ruled out physical causes. By the way, I can highly recommend this documentary on Sarno (paywalled): https://vimeo.com/ondemand/alltherage https://vimeo.com/ondemand/alltherage
  - peterbozso 5y ago
    Understood! As I noted in my comment, the book I recommend also stresses the importance of the fact that most chronic back pain is "all inside yor head" and tries to give some relief by making you understand and ruling out most of the possible non-psychological sources for such pains. I highlighted the self-massage thing only because next to understandting my condition, that was the single most important tool the book gave me to deal with the non-psychological components of my pain. But this might not have been totally clear from my comment above, I am sorry for that!
    - loceng 5y ago
deleted 5y ago
[deleted]
deleted 5y ago
[deleted]
rgrmrts 5y ago
I’m following along this thread in a desperate attempt to find a solution. I’ve been struggling with chronic lower back pain for almost 2 years now. Unfortunately, 2 years of many different physical therapists and doctors (nerve blocks + cortisone shots) later there’s little to no improvement for me (except being able to just deal with the pain/ignore it a bit better). I wish I could attempt these mind-body treatments but I do have a physical cause. Almost complete sacralization of L5-S1 and bulging disc pressing on nerves. The worst part is I thought a physiological cause would make back pain easier to treat, alas it does not. Surgeons discourage spinal fusion surgery - a well regarded spinal surgeon told me odds of surgery improving my pain were worse than a coin flip. I’ve also read a bunch of commonly recommended books like back mechanic and 8 steps to a pain free back and they both did nothing for me. I continue to do core exercises and everything else 2 years of therapists suggested to no avail.
- seer 5y ago
  First off - fasting, like 10 days water fast kinda thing. Generates new stem cells that can fix neurological problems, massively reduces inflammation. Lifespan book by Dr. Sinclair does a deep dive on that. Next swimming/yoga/qigong - make your muscles be able to better support your spine. Standing desks also help a lot in that regard if you can handle them. It’s surprising how much crude tools like that can help inflammation/pain problems. It’s usually not just the movements themselves, it is the whole culture of mindfulness around it. You get to spend more time being at peace with yourself, as well as meeting a lot of people who do it too and encourage you. And that helps a ton as well. I’ve seen several people embark on those paths with “untreatable” problems with good results, but it might be important that this is not treated as panacea - we don’t want to end up like Steve Jobs. I personally think fasting is incredibly powerful medical short and longterm tool. And the rest is more psychological one, still very powerful too. I went to wing chun mostly because of the martial arts training, but did qigong too because it was expected in the peer group. I’ve found that even if the explanations of “why” it worked were clearly bogus (blocked energy pathways - earth/fire/air kinda things) the motions themselves and the culture around them was incredibly soothing. Now I myself didn’t suffer from illnesses but I did meet several people there who mentioned turning to it as a last resort, with positive results. Maybe it’s survivorship bias but I’d recon its still effective.
jamesknelson 5y ago
This treatment is based on the work of Dr John Sarno - who I first heard of here on HN almost 10 years ago. And of all the wonderful things I’ve discovered on HN, Dr Sarno’s work is probably the one that’s had the biggest positive impact on my life. When I first heard about his approach to chronic pain, I was pretty skeptical. But I’d tried everything else to solve my debilitating RSI, and nothing else had worked despite only being in my early 20s, so I was willing to give it a try. 6 months later, I was back working pain-free after being out of action for 2 years. As patmcc mentions, people can be incredibly reluctant to believe that physical pain can have psychological causes. And in many cases, there are underlying physical issues, so this should certainly not be your first approach to treatment. But if you’ve tried everything and nothing works, I encourage you to take a look at Sarno’s work. It made a world of difference for me and for many others.
- Mizza 5y ago
  I'll also throw my hat in here, I got the book after a recommendation from HN. I'm glad it's moving in from the fringes.
- 2OEH8eoCRo0 5y ago
  Same. I tell everybody to read Sarno's book, back pain or no. It's a short read and even if it doesn't help with one pain it will probably help with something else. With that said, other than my girlfriend, nobody that I have recommended it to has actually read the book. They get defensive.
- xwowsersx 5y ago
  Same, though I did not hear about Dr Sarno from HN. Healing Back Pain is an incredible book. It is sad to see so many people who are close to me suffering from back pain spinning their wheels to find relief -- surgery after surgery, chiropractor after chiropractor. The connection between the experience of pain and the psychological dynamics that Dr Sarno elucidates is so critically important. I recommend his book to everyone who experiences persistent back pain.
- geewee 5y ago
  Approximately the same story here. I'd had debilitating upper back pain for 4..5 years, gotten MRI's and a plethora of scans and nothing seemed off. Every time I got physical therapy it'd last for a few hours and then the pain would be back. I tried accepting that it was more of a mental than a physical ailment, and although it was difficult and took multiple tries, I'm now finally pretty much pain-free for a few years after having tried everything for years on end.
throwawaymanbot 5y ago
[dead]
01100011 5y ago
I think a clear distinction needs to be made between something which is 'all in your head' and something which is driven by your internal psychological state(which, surely, can be influenced by other physical sources, but I digress). In my experience with back pain(which varies a bit, due to several types of back pain), I believe most of my issues stemmed from my psychological state and were not "in my head". First off the back is poorly evolved for modern, upright, bipedal life, so it's not surprising that it would be a common source of issues for modern man. That said, there are still patterns and behaviors one can learn, and which do not necessarily develop automatically during childhood, which can allow the back to function without so many issues(See Stuart McGill and others. i.e. hinge at the ball joints, limit loaded spinal flexing, etc). Further, there are psychological states, stress, sadness, depression, which can affect posture, specifically thoracic posture, which contribute dramatically to back pain. Since learning better movement patterns and becoming aware of my psychological connection to my posture, I have, at 46 and after years of pain, been able to vastly reduce my chronic back pain. Another big piece of this was improving my proprioceptive senses as well. When I did manage to improve my posture, it felt quite wrong, both because of the proprioceptive sensations as well as how it felt out of alignment with my moods(i.e. it's odd to puff out your chest when you're depressed). "Modern posture", with excessive thoracic curvature, rounded shoulders, and overall "turtle"/"protective"/"insecure" (all my terms for myself) posture is a major component of spinal pain, even into the lumbar region. Obviously back pain is complex and many folks have other issues than I have experienced, but I think it's worth mentioning that sometimes the mind is the issue but that the issue is not in the mind.
1121redblackgo 5y ago
https://www.youtube.com/channel/UC_o_MGVac1_ijjIeig37zVQ https://www.youtube.com/channel/UC_o_MGVac1_ijjIeig37zVQ
visarga 5y ago
I tried mindfulness for back pain and it worked, for a short while, while I kept on meditating daily. But it was a struggle. In the meantime I discovered that taking Ca + Mg supplement does away with my pains. No doctor was able to give me this hint, I discovered it by mistake when I took an effervescent pill.
- deleted 5y ago
  [deleted]
- 0134340 5y ago
  Calcium worked for you? It's not been my experience nor some others. I've heard it explained that since calcium is needed for nerve transmissions, pain can be worse if you take excess Ca. It's all anecdotal but I feel like my back pain is worse when taking Ca supplements.
  - visarga 5y ago
    In my experience Mg helps me relax and sleep better and Ca relieves the pain. I feel 10 years younger.
charles_f 5y ago
I can so relate to the bi-directional relationship between low morale (anxiety, depression) and pain. Feeling down makes me feel pain in my teeth, and vice versa. On a side note, I had a lot of back problems till I lost 30 pounds and didn't have any anymore. I gained another 10 since then and it's coming back
marmoto 5y ago
"However, common therapies such as surgery and steroid injections intended to address physical origins of back pain have not been clearly proven to work in randomized clinical trials" vs. "To assess whether PSRT can reduce symptoms and pain-related anxiety in patients with non-specific chronic back pain, Donnino and colleagues enrolled 35 participants" 35 participants …
- PaulKeeble 5y ago
  Like most psychology findings there will also be issues reproducing the results as well. It is a bit of a common occurrence to get these big calls around how people don't need pain drugs anymore while all the recipients of these new treatments are crying out in pain on support forums across the globe. It never seems to actually work.
nickhodge 5y ago
More "pray the pain away" bullshit.
Tomte 5y ago
My summary regarding the book was: "Listen to your doctor! It's not a good idea to chase miracle cures. But trying this book on top of what your doctor tells you? I can't see anything wrong with that. You're not harming anything. You're not refusing conventional medicine. If it works for you, great. If not, you have lost ten bucks and two hours of your time." (https://backpain.2uo.de/ https://backpain.2uo.de/)
janimo 5y ago
Sarno's book, mentioned in other comments was also on YC's reading list a while ago: https://blog.ycombinator.com/ycs-2017-summer-reading-list/ https://blog.ycombinator.com/ycs-2017-summer-reading-list/
andy_ppp 5y ago
A lot of anxiety in these comments! I had the opposite issue to a lot of people here; it wasn’t a psychological health issue causing it, it was caffeine that I’d tolerated well most of my life before. I stupidly drank some caffeinated tea before watching Dune which made the whole experience terrifying!
m0zg 5y ago
If you don't have bulging discs or other severe pathology, the easiest way to fix your back is to train the posterior chain via low bar barbell squats. Start light, work slowly up to your body weight, you don't have to go much further, but you can if you want to. Most men should be able to handle at least 1.5x their lean body mass after a couple of years of very mild training, added by balanced nutrition. Train 3x a week. Your back problems will resolve in a month. Most people's back problems are caused by atrophy of back stabilizer muscles, which, in turn, is caused by not using them and sitting hunched over at their desk all day. Doctors will _never_ advise this, but it works. I couldn't even bend over without any weight, and had to lie down on the floor in the office sometimes it was so bad. I also had RSI in my wrists to the point I couldn't sleep some nights. After I started training with a barbell it all went away never to return. I know 4 people who followed my advice and did the same thing, and their back problems resolved as well. Best of all, you don't have to do it all the time, once you develop quality musculature there, the effect lasts for years with little upkeep. Although you should keep it in shape, of course - it's better for you, and increased muscle mass is good for weight loss, too (a lot of people think they have back problems, but they really have a huge chunk of fat hanging on the front of their body and it's pulling on their back and destroying their knees, too).
austincheney 5y ago
Whenever I have severe back pain my go to solution is a bunch of magnesium citrate. This won’t work for most people as it’s an extreme laxative, but it doesn’t work that way for me. Magnesium is a mineral nutrient tasked with the transfer of oxygen from blood to cell tissue. Insufficient magnesium is the primary reason for muscle tissue distress. Upping magnesium intake will allow muscle relaxation and healing in the case of stress. Magnesium citrate appears to be an extremely soluble form of magnesium in the body. It also relieves constipation from which lower back pain is a symptom.
todd8 5y ago
Sometime in 1990 I injured my back. I still remember the details. The injury was caused by a strong sneeze while I was bent over picking up a briefcase. In a single second, I couldn't stand, I couldn't get up off of my knees. It was really quite bad. I went to a few doctors and got advice, but it was more along the lines of it looks like degenerative disk disease. In a few weeks the pain went away and my back felt completely normal. I am posting this in the hope that some HN reader will find it useful. Since that original "injury" other seemly small stresses on my back, especially when leaning over or twisted to one side can trigger this sharp sudden onset persistent back pain. Even sleeping in the wrong bed while traveling can cause me problems. The strange thing is, it goes away on its own after a few weeks and then I feel fine. If I was a yoga practitioner I would believe that yoga was curing it, if I went to a chiropractor then I would believe that chiropractic was curing my back, and if I was a meditator then I would believe that meditation was curing my back. Back issues like mine get better on their own after a few weeks, this explains why there is such a wide range of "cures" for back problems in general despite the wide variety of causes, some of which won't "get better" on their own. Of course I've been to doctors, and the radiological diagnosis is degenerative disk disease, but I think this is common for any person with back pain and no obvious physical cause. Everyone thinks they know what is wrong. And I think that some of them are right and some of them are wrong. I don't believe that it has anything to do with my psychological state. I've been through many stressful events in my life and had to work and live under high levels of mental pressure, I've been happy, sad, frustrated on and off over the years--most people have. These states are not correlated in the least with the onset of my back pain. On the other hand, recovery could be affected by one's psychological state, being able to relax the back muscles so that back can heal requires some ability to deal with the mind-body issues and the anxiety causes by pain. I had a trainer that was always stressing functional fitness. This definitely didn't seem to be useful and was sometime injurious. Throwing medicine balls again a wall and doing every exercise one handed while balancing on one leg weren't helpful. The issue for me was the twisting that was encouraged by this training philosophy. Simply keeping fit and keeping my weight down were much more helpful. The best advice I got was from a consultation with a neurosurgeon. This physician was trained to do back surgery but uniquely also treated patients with alternative therapies when surgery wasn't clearly indicated. She encouraged me to take vitamin D, omega-3 supplements, and curcumin to reduce inflammation. This has been helpful to me, reducing the frequency, severity, and duration of my back problems. Consulting with her also reduced my anxiety over pain and this might be mitigating the severity of the episodes. Golf -- the was very bad for me, an hour at the driving range could produce debilitating pain that made walking even with a cane almost impossible. I was just learning--maybe I was doing it wrong. Running and jogging -- these didn't seem to bother my back at the time I was doing it. I was able to train for and run marathons and even a wild cross country obstacle course race. I'm not a great runner, but I was able to place well in my age group. What I found was that marathon training is time consuming and leads to some muscle imbalances. My lower back (and upper body too) got weaker because my exercise was just running. The tightness in my lower back from hours of running also gave me concern and occasional, brief, but significant discomfort in my lower back. Overall though, I didn't feel that my back bothered me any more than the typical running overuse injuries, like planter fasciitis, knee pain, or IT band pain afflicting my fellow runners. I was able to finish all of the marathons I started training for (training takes around 7 months if you already do a bit of jogging). I hope this encourages people to remain active if their back pain is like mine (I understand that there are many types). I do wonder if so much running could be hard on the disks, does anyone know? Brazilian Jujitsu -- I had to give it up. I never got hurt, but I felt it was the sort of thing that a senior citizen with back problems should not be doing. Sitting and sleeping -- surprising to me was that thick memory foam mattresses that was supposed to be good for backs (Tempur-Pedic back in the 90s) bothered my back while a very firm mattress on top of a solid platform didn't. For the sake of my spouse, I found that one of the Casper mattresses works for both of us. Some chairs are great, and some end up causing me back issues. The Zero Gravity Recliner is great, but now they seem very pricey. I got my unmotorized one years ago. When I have a bad episode of pain, sitting in it is one of the only ways I can get relief. I use an adjustable height standing/sitting desk with a Motion Stool by UPLIFT. The adjustable desk helps me be things just right, and I've discovered that chairs like the Motion Stool, while requiring some getting use to, allow me to work for hours at my desk without discomfort. It's really terrible to be in bad back pain, but for me, I've found some adjustments to my lifestyle have allowed me to be very happy and to hold off on employing more drastic measures for thirty year so far.
generalenvelope 5y ago
I've injured (ie: resulted in reduced physical performance) my back numerous times lifting weights. The first couple times it scared the life out of me, and I suffered in moderate to severe pain for a week or two, unable to put my shoes on. Even went to the ER and the doc basically said "I dunno" and offered muscle relaxants. I later stumbled upon some content from Austin Baraki and Jordan Feigenbaum (their company is Barbell Medicine) when rehabilitating a back tweak, and it changed my life. I learned about pain science and developed so much self efficacy that if I experience pain I don't even think of seeing a doctor at first (assuming certain red flag symptoms aren't present). Recently I tweaked my back and was incredibly effective about recovery thanks to these guys. In about a week I could squat 100kg+ discomfort free (!). I highly recommend Austin's article regarding the "bio-psycho-social model" for pain: https://startingstrength.com/article/aches-and-pains https://startingstrength.com/article/aches-and-pains And the barbell medicine youtube channel for content on pain, nutrition, and training, regardless of if you personally do resistance training - though I highly recommend that as well. It's invigorating to see yourself briefly injured squatting, and through reassurance & load/exercise management recovering almost entirely in a matter of days.
zuj 5y ago
Talking of mind-body, recently tried floating(sensory deprivation tank). While I haven't really experienced anything amazing in my first session, I can see the potential. There is something in there and I can feel it will provide help in alleviate some of my physical and mental problems.
david422 5y ago
I had some chronic back pain for a while. I went to see a specialist and they basically told me - hard to diagnose, the discs in the back do degrade over time, the primary solution is to strengthen other muscles, especially core muscles, to support it. I went to PT for a while and basically exacerbated whatever the issue is - badly. However, I took prednisone. This solved the issue temporarily, but allowed a reprive so that I could do muscle strengthening exercises. This solved my issue for about 5 years until recently with COVID and kids and I stopped working out. Now the issue seems to be resurfacing. I do think the primary solution is to work out more and strengthen my body.
- godDLL 5y ago
  I've gotten through something like that. The solution should be to rebuild your body, using strengthened core to support yourself after. The rebuild starts with autophagy, which is achieved by fasting. To get into 3 days every three weeks (which is what you'll need to clean up old tissue, to have place for new tissue) you'll want intermittent fasting. IF will normalize your perception of hunger. After a couple of months of eating only after 14:00 and before 16:00 you'll be ready to go into a three-four day water fast. You stretch when you fast, and you exercise every other day in the week coming off of a fast. In four months from your first three day water fast you'll know you want to keep it up. I did. Don't go beyond four days of fasting, no matter how good you feel after day two. The idea is to give your body direction, not to force it into a condition. Don't overdo it. Cheers!
deleted 5y ago
[deleted]
sjg007 5y ago
Improving your core abdominal strength is the main treatment for back pain. There are some PT exercises like bird dog, crunches, and superman that will help as well as some stretches. You also want to sleep in a neutral position and walk about as much as you can. Most are caused by muscle strain when lifting or doing something with your back in a weird position. I think you get continual muscle spasms as well. So the nerves are irritated, the muscles contract and it gets painful so you have to basically get the muscles to relax. Sometimes the muscles along the hips can be involved as well and figuring out a way to stretch them will help. Chiropractors like to realign them. Keeping up your core strength is apparently the best option though.
- ectopod 5y ago
  Yes. I had thirty years of back pain. Then I reached an age where ones muscles naturally atrophy and I was really in trouble. But after four years of back exercises, weight lifting and core exercises the pain is almost entirely gone. My back feels better than it ever has. One weird thing was that it sometimes took me a couple of years to realise I was doing an exercise wrong. But I don't think I was initially capable of doing the exercise correctly. I literally didn't have the muscles, and it took a couple of years of wonky exercises to start developing them. If, like me, you're an older geek with little sympathy for your body, it takes a long time to develop it. But it's worth the effort.

325 points by yasp 5y ago

I'm assuming this is the research in question: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476063/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476063/

hirundo 5y ago

"The novel intervention ... is based on an idea pioneered by the late John Sarno, MD" John Sarno's book "Healing Back Pain" saved me from truly agonizing torture and made me functional again in just a few hours, though I went to it with extreme skepticism. It's great to see formal research being done on this approach.

someelephant 5y ago
Same. And yet so many people are unwilling to take the leap of faith. It's sad because the same thinking patterns that cause them to avoid Sarno likely lead to a lot of grief in other areas of their lives.
- csee 5y ago
  It's the scientism mindset which is common among technical types. Anti-woo errs into a more dogmatic dismissal and closed mindedness towards anything not backed by multiple large RCTs and consensus among experts. I think a balance is in order. It's good to explore things that don't have conclusive evidence with an open mind while maintaining a degree of healthy scepticism. If it improves subjective well-being then it works for all practical purposes. Whether that's all placebo doesn't even matter at that point. Rigorous epistemology != a good approach to self-help.
  - Barrin92 5y ago
    I'm about as far away from the scientism mindset as one can get but I don't think that's really the reason. To assume that someone can solve a debilitating problem that affects millions in hours by selling you a book is probably in 99% of cases a scam. And the subjective well being point isn't so simple as well. If there really is a physical problem the placebo isn't a treatment but masks symptoms, which is counter-productive long term. Plenty of people pour substantial money into alternative medicine that doesn't address their illnesses because they feel subjectively better for a while.
    - csee 5y ago
      This is where the healthy skepticism part comes in. Going all out woo or quack isn't what I'm suggesting, and I'd agree that that's even worse than being too closed minded. Crystal healing doesn't work and people shouldn't try it. But if something sounds sort-of plausible, has some tentative but low quality evidence, and it's low cost and low risk, and it's not going to distract you from more proven treatments, then just try it out and see if it works. A small handful of people won't even go that far because of dogmatically orthodox thinking, and those are the people I'm addressing. > To assume that someone can solve a debilitating problem that affects millions in hours by selling you a book is probably in 99% of cases a scam. If it's psychosomatic pain, there's legitimate scope for a self-help book to actually improve things for them. Also why wouldn't we expect practitioners who have been hands on with clients for 20 years to not have picked up some useful tricks that didn't make it into peer reviewed studies? I feel like your statement here is too heavy on the skepticism, even though you're right that there are loads of books that are quackery. There can be learned wisdom built up through practice that isn't peer reviewed.
      - tomByrer 5y ago
        I haven't read the book, but am familiar with the story. The pain origins don't need to be "psychosomatic" for the mind to override it; the pain may be real. The back surgeon interviewed patients long after back surgery. They reported some help, but some pain / discomfort remained. He looked at Xrays of painful vs pain-free, & found Xrays looked very similar. That's when he started teaching 'pain management'. IMHO teaching 'pain management' would be helpful for all. Could prevent some surgeries, but even if they got corrective surgery, the self-help management could still prove useful.
  - BeetleB 5y ago
    > It's the scientism mindset which is common among technical types. Interestingly, Carl Sagan, in his book The Demon Haunted World, discusses physical ailments arising purely from the brain and in passing points out that there are reasons to believe back pain is one of them. The book is a fantastic read, because for some reason many people in the pro-skeptic movement recommend the book, despite the fact that quite a bit of the book is critical of skeptics!
300bps 5y ago
When I had carpal tunnel syndrome 10 years ago someone on HN recommended the Harvard RSI program that follows Sarno’s technique. http://www.rsi.deas.harvard.edu http://www.rsi.deas.harvard.edu It took work but it literally cured me. Went on to use the same techniques for back pain and haven’t had that in many years.
- pitched 5y ago
  > Keep wrists above the pad, and tilt the kbd downward. TIL! This is the opposite of what I’ve been doing to date.
  - raindropm 5y ago
    That image made me think about all those fancy 'thicc' mechanical keyboard on Youtube. My wrist hurt just seeing the video. Low profile keyboard FTW!
  - BeetleB 5y ago
    If you had that particular type of pain, it will become "obvious". You'll feel the pain of maintaining the wrist flat, and the pain will be less in that posture. Same with my back pain and lumbar support. Once the lumbar support gave me relief, I could easily tell which chairs/couches were terrible for the back as the bad ones would give instant pain.
ranger_danger 5y ago
what's the secret without having to read a whole book?
- papandada 5y ago
  Dr Sarno 12 Daily Reminders The pain is due to TMS, not to a structural abnormality The direct reason for the pain is mild oxygen deprivation TMS is a harmless condition caused by my repressed emotions The principal emotion is my repressed ANGER TMS exists only to distract my attentions from the emotions Since my back (replace with whatever pain you’ve got) is basically normal there is nothing to fear Therefore, physical activity is not dangerous And I MUST resume all normal physical activity I will not be concerned or intimidated by the pain I will shift my attention from pain to the emotional issues I intend to be in control-NOT my subconscious mind I must think Psychological at all times, NOT physical.
  - kranner 5y ago
    Sarno started with first ruling out physical causes with checkups and investigations. Only after that did he attribute pains to TMS, only if conventional treatment had not cured the pain.
    - 1121redblackgo 5y ago
      Yeah a common phrase is to "rule out the life threatening, then rule in mind-body disorder."
  - mebiles 5y ago
    ok thank you this. To all the people that has doubted their own pseudo science skepticism every time this book comes up here at HN- you may be relieved as it doesnt work if you have a structural cause for the pain.
- curioussavage 5y ago
  The idea is basically that your brain/subconscious creates pain and other health problems as a coping mechanism. If I remember correctly the solution was basically to learn about that and acknowledge it and do exercises like tell your mind/body thank you for looking out for me. It I don’t need that. Go to psychotherapy and other stuff. I’m definitely a partial believer in the ideas. Read about it decided to stop going to chiropractors after doing so for over a decade due to often severe neck and back pain and now 2 years later I am virtually neck and back pain free. While doing nothing, in fact while eating worse, not exercising , being stressed out, bad posture etc. I just decided that it was psychosomatic and it eventually went away.
weird-eye-issue 5y ago
Wish I could say the same. It did nothing for me
1121redblackgo 5y ago
Same. Some folks who I love and owe unending appreciation to, that are doing public outreach and education for this in 2021, are Nicole Sachs and Dan Buglio. Their youtube channels, podcasts, and websites, and the guidance and experience therein, saved my life.

crehn 5y ago

TL;DR: > Psychophysiologic Symptom Relief Therapy (PSRT) is designed to address underlying stressors and psychological contributors to persistent pain as well as conditioned pain responses and fear avoidant behaviors. Good to see research into this. I've definitely had enduring pain relief by a deeper change in mindset.

cupcake-unicorn 5y ago

While this is exciting work, I'm really terrified that the efficacy of this treatment will cause doctors to jump on this modality for a number of disorders it's not really suited for, as what is happening with CBT. There are a number of treatments that are great if done with the right intent, but when they go into a mass treatment setting it loses connection with the humanistic portion. I could see doctors jumping to over prescribe this for pain or other conditions without listening to the patient or worse blaming the patient when the treatment didn't work for them, which is basically what's happening when say someone with physiological issues gets suckered into doing CBT for insomnia. I do think it's important we take these holistic approaches to pain relief but the medical institution and worse yet insurance will bungle this in the US and I'm scared for that :( But glad to learn of it since I can get a copy of John Samo's book. Another treatment that has shown anecdotal success for chronic pain is Internal Family Systems therapy. I feel like that one would be a lot harder to mess up.

pdoege 5y ago

Yeah, I suffered through this. "We all have aches and pains", "Don't catastrophize", etc. Turns out I had a chunk of spinal disc the size of my little finger impinging on my spinal column. I think that this "mind-body" stuff is woo. Drugs work. Physical therapy works. Woo doesn't. However, woo is really cheap. And it offloads the blame onto the victim.

discordance 5y ago
50 years ago I’m sure regular doctors would laugh at the idea of treating anxiety disorders with meditation instead of meds, electroshock or whatever. Is there not enough space for both the Woo and our usual western methods? The patient journey could be: diagnosis, imaging, woo (if appropriate), physio, chiro and if need be, surgery.
- weird-eye-issue 5y ago
  Well, in my experience meditation alone was not effective at all for my anxiety. Actual doctors (in the US and in SE Asia) put me on medication for it and that was effective. I don't think many "regular doctors" are telling people to just meditate for their anxiety...
  - s1artibartfast 5y ago
    Surely you can respect that not all solutions are based in pharma or surgical intervention. Take depression for example. Some people might have a chemical imbalance. Some might be in terrible marriage or struggling with other trauma. The idea here is pretty simple and not particularly crazy: Some people have problems that can be solved best with treatment other than drugs or surgery.
    - weird-eye-issue 5y ago
      It's usually a combination of things. For me, my anxiety was causing me to not do things that could have ultimately helped me have less anxiety. Meditating didn't cure that. I had to go on meds to get over that initial anxiety and now I don't need the meds as much Sure meditation can help some people but I don't think it's as effective as a lot of people seem to think

glasscannon 5y ago

As someone with fibro/nociplastic pain, it's great to see more emphasis being placed on the non-biological drivers of pain. I'm currently building a platform to address pain more holistically. If you're interested in chatting feel free to reach out.

seibelj 5y ago

My back pain began at the tender age of 16. I have a few impinging discs in my lower back that “the cure (surgery) would be worse than the disease”. The only thing that has consistently made me feel better is high intensity workouts and core strength. I’m in extremely good shape but still in a lot of pain, but luckily that hasn’t stopped me.

stillblue 5y ago
Can you elaborate? I'm in a similar boat and I've tried everything. I can't workout too much cos the back pain gets really worse after that. What do you mean when you say "high intensity workouts"?
- seibelj 5y ago
  Core strength training like planks and squats, also biceps and legs, bench press, essentially lifting in all forms - except anything that is related to bending over. I don’t do any exercises that involve bending or leaning forwards if it doesn’t involve using the bench for support. Also a lot of cardio. In terms of work I’m a software guy and WFH, I rotate between standing, sitting, and laying throughout the day. Sometimes I work on the floor. Basically I work until I start to feel sore then I switch positions.
- generalenvelope 5y ago
  If you are interested in training, and especially if you experience pain while doing it, I cannot recommend Barbell Medicine enough. Specifically: "4 Steps For Managing Pain in the Gym" https://www.youtube.com/watch?v=mdwj5ORPmX0 https://www.youtube.com/watch?v=mdwj5ORPmX0 Austin is a professional doctor/coach/lifter and an expert on the topic. The lesson I linked corresponds to this article: https://www.barbellmedicine.com/blog/pain-in-training-what-do/ https://www.barbellmedicine.com/blog/pain-in-training-what-d... Aside from paying for a pain and rehab consultation with the Barbell Medicine team - I'd recommend posting on their forum: https://forum.barbellmedicine.com/ https://forum.barbellmedicine.com/ You can find many examples of people in similar situations receiving professional advice from their staff free of charge.

Ozzie_osman 5y ago

> However, common therapies such as surgery and steroid injections intended to address physical origins of back pain have not been clearly proven to work in randomized clinical trials. This is a terrifying statement.

jjtheblunt 5y ago
Is it just that "randomized clinical trials" can not exist for definitive actions like surgery or steroids, as there's nothing that can play the role of placebo?
- pseudalopex 5y ago
  Sham surgery for some procedures. Saline for injections.
- mrestko 5y ago
  No, there have been sham controlled trials of surgical interventions before, they're just rare. One example is kyphoplasty.
  - cpncrunch 5y ago
    There have been a few: https://en.wikipedia.org/wiki/Sham_surgery#Examples https://en.wikipedia.org/wiki/Sham_surgery#Examples
helge9210 5y ago
Bloodletting was still a thing a hundred years ago. Medical science went far since then, but not too far.
generalenvelope 5y ago
You should check out this article: https://startingstrength.com/article/aches-and-pains https://startingstrength.com/article/aches-and-pains many conventional methods of treatment don't have the efficacy you might expect. As an aside - strength training when combined with knowledge of the biopsychosocial model, self efficacy, not-catastrophizing (the things Dr's Baraki and Feigenbaum preach) has changed my life.

brandonmenc 5y ago

Plug for the book that helped me. Evidence-based self-treatment from an expert spine researcher. If you've ever heard of the "McGill Big 3" exercises, this is the guy. https://www.backfitpro.com/books/back-mechanic-the-mcgill-method-to-fix-back-pain/ https://www.backfitpro.com/books/back-mechanic-the-mcgill-me...

patmcc 5y ago

People are incredibly reluctant to believe that ailments might actually be partly or mainly psychological. Chronic fatigue, fibromyalgia, chronic lyme disease, back pain, are all things that sincere people truly are suffering from...that may be mainly psychological/psychosomatic but lots of people refuse to consider it. Probably due to the general dismissal of mental illnesses and being told for years "it's all in your head". I think partly, people with these conditions are sometimes accused (or think they're being accused) of malingering; I don't think that's the case very often, I think they legitimately feel the symptoms they report, but the root cause may be in the mind/brain rather than the rest of the body. Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well. I suspect we'll (some day) get better treatments for all the things I mention, if mental illness stigma ends and they can be honestly considered from all possible causes. Edit: to be clear, I'm not saying that all cases of back pain or CFS or whatever are psychosomatic - just that it shouldn't be dismissed, especially when the treatments are relatively low-risk.

pfortuny 5y ago
Also, being psychosomatic does NOT mean they are ficticious, which is a widespread opinion.
playpause 5y ago
It’s odd that “all in your head” means “not a serious problem” or “you can fix it by yourself”. It seems to me that a problem being located in the head/brain/mind is, almost by definition, particularly difficult to fix, let alone to fix without external guidance.
casion 5y ago
However, quite dangerously, those ailments are also often misdiagnosis's. Fibro was a misdiagnosis for me, and I nearly died because I accepted it and worked on a psychological and rehab program rather than continue to pursue symptoms.
- cpncrunch 5y ago

peterbozso 5y ago

For my fellow chronic lower back painers out there: over the course of many years I tried many things (always staying in the confines of modern medicine). There's certainly no magic bullet, but finally this book (which I have no financial incentives to promote) brought me a long lasting solution: https://www.painscience.com/tutorials/low-back-pain.php https://www.painscience.com/tutorials/low-back-pain.php The whole thing certainly worths a read, since the goal of the book is to make you understand your condition and give you relief partly through that. But for me, the single most important thought of the book is "the issue is (almost) always with the tissue". If you have chronic (lower) back pain and you feel like you have tried everything, I recommend learning and applying self-massage regularly. Combined with other important, conservative treatments (physiotherapy, yoga, swimming, workout, etc.), it did wonders for me and I hope it will for others with similar problems.

kranner 5y ago
The program referred to above, PSRT, is based on John Sarno's work. In his book Sarno stresses that physical causes to chronic back pain must be ruled out first. He only treated patients with his mind-body awareness methodology after investigations had ruled out physical causes. By the way, I can highly recommend this documentary on Sarno (paywalled): https://vimeo.com/ondemand/alltherage https://vimeo.com/ondemand/alltherage
- peterbozso 5y ago
  Understood! As I noted in my comment, the book I recommend also stresses the importance of the fact that most chronic back pain is "all inside yor head" and tries to give some relief by making you understand and ruling out most of the possible non-psychological sources for such pains. I highlighted the self-massage thing only because next to understandting my condition, that was the single most important tool the book gave me to deal with the non-psychological components of my pain. But this might not have been totally clear from my comment above, I am sorry for that!
  - loceng 5y ago

deleted 5y ago

[deleted]

deleted 5y ago

[deleted]

rgrmrts 5y ago

I’m following along this thread in a desperate attempt to find a solution. I’ve been struggling with chronic lower back pain for almost 2 years now. Unfortunately, 2 years of many different physical therapists and doctors (nerve blocks + cortisone shots) later there’s little to no improvement for me (except being able to just deal with the pain/ignore it a bit better). I wish I could attempt these mind-body treatments but I do have a physical cause. Almost complete sacralization of L5-S1 and bulging disc pressing on nerves. The worst part is I thought a physiological cause would make back pain easier to treat, alas it does not. Surgeons discourage spinal fusion surgery - a well regarded spinal surgeon told me odds of surgery improving my pain were worse than a coin flip. I’ve also read a bunch of commonly recommended books like back mechanic and 8 steps to a pain free back and they both did nothing for me. I continue to do core exercises and everything else 2 years of therapists suggested to no avail.

seer 5y ago
First off - fasting, like 10 days water fast kinda thing. Generates new stem cells that can fix neurological problems, massively reduces inflammation. Lifespan book by Dr. Sinclair does a deep dive on that. Next swimming/yoga/qigong - make your muscles be able to better support your spine. Standing desks also help a lot in that regard if you can handle them. It’s surprising how much crude tools like that can help inflammation/pain problems. It’s usually not just the movements themselves, it is the whole culture of mindfulness around it. You get to spend more time being at peace with yourself, as well as meeting a lot of people who do it too and encourage you. And that helps a ton as well. I’ve seen several people embark on those paths with “untreatable” problems with good results, but it might be important that this is not treated as panacea - we don’t want to end up like Steve Jobs. I personally think fasting is incredibly powerful medical short and longterm tool. And the rest is more psychological one, still very powerful too. I went to wing chun mostly because of the martial arts training, but did qigong too because it was expected in the peer group. I’ve found that even if the explanations of “why” it worked were clearly bogus (blocked energy pathways - earth/fire/air kinda things) the motions themselves and the culture around them was incredibly soothing. Now I myself didn’t suffer from illnesses but I did meet several people there who mentioned turning to it as a last resort, with positive results. Maybe it’s survivorship bias but I’d recon its still effective.

jamesknelson 5y ago

This treatment is based on the work of Dr John Sarno - who I first heard of here on HN almost 10 years ago. And of all the wonderful things I’ve discovered on HN, Dr Sarno’s work is probably the one that’s had the biggest positive impact on my life. When I first heard about his approach to chronic pain, I was pretty skeptical. But I’d tried everything else to solve my debilitating RSI, and nothing else had worked despite only being in my early 20s, so I was willing to give it a try. 6 months later, I was back working pain-free after being out of action for 2 years. As patmcc mentions, people can be incredibly reluctant to believe that physical pain can have psychological causes. And in many cases, there are underlying physical issues, so this should certainly not be your first approach to treatment. But if you’ve tried everything and nothing works, I encourage you to take a look at Sarno’s work. It made a world of difference for me and for many others.

Mizza 5y ago
I'll also throw my hat in here, I got the book after a recommendation from HN. I'm glad it's moving in from the fringes.
2OEH8eoCRo0 5y ago
Same. I tell everybody to read Sarno's book, back pain or no. It's a short read and even if it doesn't help with one pain it will probably help with something else. With that said, other than my girlfriend, nobody that I have recommended it to has actually read the book. They get defensive.
xwowsersx 5y ago
Same, though I did not hear about Dr Sarno from HN. Healing Back Pain is an incredible book. It is sad to see so many people who are close to me suffering from back pain spinning their wheels to find relief -- surgery after surgery, chiropractor after chiropractor. The connection between the experience of pain and the psychological dynamics that Dr Sarno elucidates is so critically important. I recommend his book to everyone who experiences persistent back pain.
geewee 5y ago
Approximately the same story here. I'd had debilitating upper back pain for 4..5 years, gotten MRI's and a plethora of scans and nothing seemed off. Every time I got physical therapy it'd last for a few hours and then the pain would be back. I tried accepting that it was more of a mental than a physical ailment, and although it was difficult and took multiple tries, I'm now finally pretty much pain-free for a few years after having tried everything for years on end.

throwawaymanbot 5y ago

[dead]

01100011 5y ago

I think a clear distinction needs to be made between something which is 'all in your head' and something which is driven by your internal psychological state(which, surely, can be influenced by other physical sources, but I digress). In my experience with back pain(which varies a bit, due to several types of back pain), I believe most of my issues stemmed from my psychological state and were not "in my head". First off the back is poorly evolved for modern, upright, bipedal life, so it's not surprising that it would be a common source of issues for modern man. That said, there are still patterns and behaviors one can learn, and which do not necessarily develop automatically during childhood, which can allow the back to function without so many issues(See Stuart McGill and others. i.e. hinge at the ball joints, limit loaded spinal flexing, etc). Further, there are psychological states, stress, sadness, depression, which can affect posture, specifically thoracic posture, which contribute dramatically to back pain. Since learning better movement patterns and becoming aware of my psychological connection to my posture, I have, at 46 and after years of pain, been able to vastly reduce my chronic back pain. Another big piece of this was improving my proprioceptive senses as well. When I did manage to improve my posture, it felt quite wrong, both because of the proprioceptive sensations as well as how it felt out of alignment with my moods(i.e. it's odd to puff out your chest when you're depressed). "Modern posture", with excessive thoracic curvature, rounded shoulders, and overall "turtle"/"protective"/"insecure" (all my terms for myself) posture is a major component of spinal pain, even into the lumbar region. Obviously back pain is complex and many folks have other issues than I have experienced, but I think it's worth mentioning that sometimes the mind is the issue but that the issue is not in the mind.

1121redblackgo 5y ago

https://www.youtube.com/channel/UC_o_MGVac1_ijjIeig37zVQ https://www.youtube.com/channel/UC_o_MGVac1_ijjIeig37zVQ

visarga 5y ago

I tried mindfulness for back pain and it worked, for a short while, while I kept on meditating daily. But it was a struggle. In the meantime I discovered that taking Ca + Mg supplement does away with my pains. No doctor was able to give me this hint, I discovered it by mistake when I took an effervescent pill.

deleted 5y ago
[deleted]
0134340 5y ago
Calcium worked for you? It's not been my experience nor some others. I've heard it explained that since calcium is needed for nerve transmissions, pain can be worse if you take excess Ca. It's all anecdotal but I feel like my back pain is worse when taking Ca supplements.
- visarga 5y ago
  In my experience Mg helps me relax and sleep better and Ca relieves the pain. I feel 10 years younger.

charles_f 5y ago

I can so relate to the bi-directional relationship between low morale (anxiety, depression) and pain. Feeling down makes me feel pain in my teeth, and vice versa. On a side note, I had a lot of back problems till I lost 30 pounds and didn't have any anymore. I gained another 10 since then and it's coming back

marmoto 5y ago

"However, common therapies such as surgery and steroid injections intended to address physical origins of back pain have not been clearly proven to work in randomized clinical trials" vs. "To assess whether PSRT can reduce symptoms and pain-related anxiety in patients with non-specific chronic back pain, Donnino and colleagues enrolled 35 participants" 35 participants …

PaulKeeble 5y ago
Like most psychology findings there will also be issues reproducing the results as well. It is a bit of a common occurrence to get these big calls around how people don't need pain drugs anymore while all the recipients of these new treatments are crying out in pain on support forums across the globe. It never seems to actually work.

nickhodge 5y ago

More "pray the pain away" bullshit.

Tomte 5y ago

My summary regarding the book was: "Listen to your doctor! It's not a good idea to chase miracle cures. But trying this book on top of what your doctor tells you? I can't see anything wrong with that. You're not harming anything. You're not refusing conventional medicine. If it works for you, great. If not, you have lost ten bucks and two hours of your time." (https://backpain.2uo.de/ https://backpain.2uo.de/)

janimo 5y ago

Sarno's book, mentioned in other comments was also on YC's reading list a while ago: https://blog.ycombinator.com/ycs-2017-summer-reading-list/ https://blog.ycombinator.com/ycs-2017-summer-reading-list/

andy_ppp 5y ago

A lot of anxiety in these comments! I had the opposite issue to a lot of people here; it wasn’t a psychological health issue causing it, it was caffeine that I’d tolerated well most of my life before. I stupidly drank some caffeinated tea before watching Dune which made the whole experience terrifying!

m0zg 5y ago

If you don't have bulging discs or other severe pathology, the easiest way to fix your back is to train the posterior chain via low bar barbell squats. Start light, work slowly up to your body weight, you don't have to go much further, but you can if you want to. Most men should be able to handle at least 1.5x their lean body mass after a couple of years of very mild training, added by balanced nutrition. Train 3x a week. Your back problems will resolve in a month. Most people's back problems are caused by atrophy of back stabilizer muscles, which, in turn, is caused by not using them and sitting hunched over at their desk all day. Doctors will _never_ advise this, but it works. I couldn't even bend over without any weight, and had to lie down on the floor in the office sometimes it was so bad. I also had RSI in my wrists to the point I couldn't sleep some nights. After I started training with a barbell it all went away never to return. I know 4 people who followed my advice and did the same thing, and their back problems resolved as well. Best of all, you don't have to do it all the time, once you develop quality musculature there, the effect lasts for years with little upkeep. Although you should keep it in shape, of course - it's better for you, and increased muscle mass is good for weight loss, too (a lot of people think they have back problems, but they really have a huge chunk of fat hanging on the front of their body and it's pulling on their back and destroying their knees, too).

austincheney 5y ago

Whenever I have severe back pain my go to solution is a bunch of magnesium citrate. This won’t work for most people as it’s an extreme laxative, but it doesn’t work that way for me. Magnesium is a mineral nutrient tasked with the transfer of oxygen from blood to cell tissue. Insufficient magnesium is the primary reason for muscle tissue distress. Upping magnesium intake will allow muscle relaxation and healing in the case of stress. Magnesium citrate appears to be an extremely soluble form of magnesium in the body. It also relieves constipation from which lower back pain is a symptom.

todd8 5y ago

Sometime in 1990 I injured my back. I still remember the details. The injury was caused by a strong sneeze while I was bent over picking up a briefcase. In a single second, I couldn't stand, I couldn't get up off of my knees. It was really quite bad. I went to a few doctors and got advice, but it was more along the lines of it looks like degenerative disk disease. In a few weeks the pain went away and my back felt completely normal. I am posting this in the hope that some HN reader will find it useful. Since that original "injury" other seemly small stresses on my back, especially when leaning over or twisted to one side can trigger this sharp sudden onset persistent back pain. Even sleeping in the wrong bed while traveling can cause me problems. The strange thing is, it goes away on its own after a few weeks and then I feel fine. If I was a yoga practitioner I would believe that yoga was curing it, if I went to a chiropractor then I would believe that chiropractic was curing my back, and if I was a meditator then I would believe that meditation was curing my back. Back issues like mine get better on their own after a few weeks, this explains why there is such a wide range of "cures" for back problems in general despite the wide variety of causes, some of which won't "get better" on their own. Of course I've been to doctors, and the radiological diagnosis is degenerative disk disease, but I think this is common for any person with back pain and no obvious physical cause. Everyone thinks they know what is wrong. And I think that some of them are right and some of them are wrong. I don't believe that it has anything to do with my psychological state. I've been through many stressful events in my life and had to work and live under high levels of mental pressure, I've been happy, sad, frustrated on and off over the years--most people have. These states are not correlated in the least with the onset of my back pain. On the other hand, recovery could be affected by one's psychological state, being able to relax the back muscles so that back can heal requires some ability to deal with the mind-body issues and the anxiety causes by pain. I had a trainer that was always stressing functional fitness. This definitely didn't seem to be useful and was sometime injurious. Throwing medicine balls again a wall and doing every exercise one handed while balancing on one leg weren't helpful. The issue for me was the twisting that was encouraged by this training philosophy. Simply keeping fit and keeping my weight down were much more helpful. The best advice I got was from a consultation with a neurosurgeon. This physician was trained to do back surgery but uniquely also treated patients with alternative therapies when surgery wasn't clearly indicated. She encouraged me to take vitamin D, omega-3 supplements, and curcumin to reduce inflammation. This has been helpful to me, reducing the frequency, severity, and duration of my back problems. Consulting with her also reduced my anxiety over pain and this might be mitigating the severity of the episodes. Golf -- the was very bad for me, an hour at the driving range could produce debilitating pain that made walking even with a cane almost impossible. I was just learning--maybe I was doing it wrong. Running and jogging -- these didn't seem to bother my back at the time I was doing it. I was able to train for and run marathons and even a wild cross country obstacle course race. I'm not a great runner, but I was able to place well in my age group. What I found was that marathon training is time consuming and leads to some muscle imbalances. My lower back (and upper body too) got weaker because my exercise was just running. The tightness in my lower back from hours of running also gave me concern and occasional, brief, but significant discomfort in my lower back. Overall though, I didn't feel that my back bothered me any more than the typical running overuse injuries, like planter fasciitis, knee pain, or IT band pain afflicting my fellow runners. I was able to finish all of the marathons I started training for (training takes around 7 months if you already do a bit of jogging). I hope this encourages people to remain active if their back pain is like mine (I understand that there are many types). I do wonder if so much running could be hard on the disks, does anyone know? Brazilian Jujitsu -- I had to give it up. I never got hurt, but I felt it was the sort of thing that a senior citizen with back problems should not be doing. Sitting and sleeping -- surprising to me was that thick memory foam mattresses that was supposed to be good for backs (Tempur-Pedic back in the 90s) bothered my back while a very firm mattress on top of a solid platform didn't. For the sake of my spouse, I found that one of the Casper mattresses works for both of us. Some chairs are great, and some end up causing me back issues. The Zero Gravity Recliner is great, but now they seem very pricey. I got my unmotorized one years ago. When I have a bad episode of pain, sitting in it is one of the only ways I can get relief. I use an adjustable height standing/sitting desk with a Motion Stool by UPLIFT. The adjustable desk helps me be things just right, and I've discovered that chairs like the Motion Stool, while requiring some getting use to, allow me to work for hours at my desk without discomfort. It's really terrible to be in bad back pain, but for me, I've found some adjustments to my lifestyle have allowed me to be very happy and to hold off on employing more drastic measures for thirty year so far.

generalenvelope 5y ago

I've injured (ie: resulted in reduced physical performance) my back numerous times lifting weights. The first couple times it scared the life out of me, and I suffered in moderate to severe pain for a week or two, unable to put my shoes on. Even went to the ER and the doc basically said "I dunno" and offered muscle relaxants. I later stumbled upon some content from Austin Baraki and Jordan Feigenbaum (their company is Barbell Medicine) when rehabilitating a back tweak, and it changed my life. I learned about pain science and developed so much self efficacy that if I experience pain I don't even think of seeing a doctor at first (assuming certain red flag symptoms aren't present). Recently I tweaked my back and was incredibly effective about recovery thanks to these guys. In about a week I could squat 100kg+ discomfort free (!). I highly recommend Austin's article regarding the "bio-psycho-social model" for pain: https://startingstrength.com/article/aches-and-pains https://startingstrength.com/article/aches-and-pains And the barbell medicine youtube channel for content on pain, nutrition, and training, regardless of if you personally do resistance training - though I highly recommend that as well. It's invigorating to see yourself briefly injured squatting, and through reassurance & load/exercise management recovering almost entirely in a matter of days.

zuj 5y ago

Talking of mind-body, recently tried floating(sensory deprivation tank). While I haven't really experienced anything amazing in my first session, I can see the potential. There is something in there and I can feel it will provide help in alleviate some of my physical and mental problems.

david422 5y ago

I had some chronic back pain for a while. I went to see a specialist and they basically told me - hard to diagnose, the discs in the back do degrade over time, the primary solution is to strengthen other muscles, especially core muscles, to support it. I went to PT for a while and basically exacerbated whatever the issue is - badly. However, I took prednisone. This solved the issue temporarily, but allowed a reprive so that I could do muscle strengthening exercises. This solved my issue for about 5 years until recently with COVID and kids and I stopped working out. Now the issue seems to be resurfacing. I do think the primary solution is to work out more and strengthen my body.

godDLL 5y ago
I've gotten through something like that. The solution should be to rebuild your body, using strengthened core to support yourself after. The rebuild starts with autophagy, which is achieved by fasting. To get into 3 days every three weeks (which is what you'll need to clean up old tissue, to have place for new tissue) you'll want intermittent fasting. IF will normalize your perception of hunger. After a couple of months of eating only after 14:00 and before 16:00 you'll be ready to go into a three-four day water fast. You stretch when you fast, and you exercise every other day in the week coming off of a fast. In four months from your first three day water fast you'll know you want to keep it up. I did. Don't go beyond four days of fasting, no matter how good you feel after day two. The idea is to give your body direction, not to force it into a condition. Don't overdo it. Cheers!

deleted 5y ago

[deleted]

sjg007 5y ago

Improving your core abdominal strength is the main treatment for back pain. There are some PT exercises like bird dog, crunches, and superman that will help as well as some stretches. You also want to sleep in a neutral position and walk about as much as you can. Most are caused by muscle strain when lifting or doing something with your back in a weird position. I think you get continual muscle spasms as well. So the nerves are irritated, the muscles contract and it gets painful so you have to basically get the muscles to relax. Sometimes the muscles along the hips can be involved as well and figuring out a way to stretch them will help. Chiropractors like to realign them. Keeping up your core strength is apparently the best option though.

ectopod 5y ago
Yes. I had thirty years of back pain. Then I reached an age where ones muscles naturally atrophy and I was really in trouble. But after four years of back exercises, weight lifting and core exercises the pain is almost entirely gone. My back feels better than it ever has. One weird thing was that it sometimes took me a couple of years to realise I was doing an exercise wrong. But I don't think I was initially capable of doing the exercise correctly. I literally didn't have the muscles, and it took a couple of years of wonky exercises to start developing them. If, like me, you're an older geek with little sympathy for your body, it takes a long time to develop it. But it's worth the effort.