
To treat back pain, look to the brain not the spine - kawera
https://aeon.co/essays/to-treat-back-pain-look-to-the-brain-not-the-spine
======
katastic
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.

~~~
ransom1538
Hey man after 3 years I just _finally_ beat back pain - it is possible. In my
case it was physical therapy until i understood the routine to strengthen the
core and stretching. I also changed how I work: no sitting, ever. Laying or
standing. I lost weight (i am 6'1 got down to 165). I took stretching serious,
you should be able to touch your toes. You need to drink milk. For depression
find a position to work while you lay down, so you can get lost in work (most
don't get backpain while laying down). The data on back surgeries is _not_
good, plain physical therapy does better. If you _need_ something for
depression I would look into edibles with lots of cbd - do your best to stay
away from opioids.

ALSO: Research the anti-inflammatory nabumetone. I don't know why doctors
don't bring it up. (not additive, no high)

~~~
sg47
+1 to this. I suffered from back pain for a long time. Long distance running
made it worse. Running made my core weaker and my back pain became worse.
Physical therapy did not help. MRI scan revealed a 5 degree scoliosis and a
slightly bulging disc (L5/S1). What has helped since then is massaging my
glutes thoroughly with a lacrosse ball regularly. Foam rolling my back,
glutes, ITB and quads. Strength training for the back, core and upper body in
general. Before starting strength training, focus on relieving tightness for a
couple of weeks.

~~~
ghthor
Running and walking are the ultimate efficent exercises homo sapiens. In a
perfect world all humans, within the standard deviation, are taught first and
foremost how to care for there personal physical health from the time they can
walk till they die. Walking and running would be the most efficient exercise
for all humans. IMHO

The issues that come from running are related to where you start from lacking
knowledge and lacking physical health. Knowledge guides interpretation of
pain(what different types of pain mean, when to stop when to push through).
Understanding pain is a communication skill that very few people will teach
you, but in my opinion is more valuable then literacy. Knowledge also enables
positive feedback loops concerning form and efficiency of movement.

Physical health is the structal integrity of the core and stabilizer muscles.
Each of these items are on a sliding scale, and somewhere in that scale is a
tipping point where if you pass under it you are hurting yourself instead of
healing yourself. I hypothesize that 80% of our population falls on the injury
side, but that this could be solved with education and PT.

I'm glad you didn't give up, or had the nerve to push past anyone saying
"that's just the way you are, you can't fix that" because I feel that
statement couldn't be further from the truth.

~~~
snovv_crash
I'm sorry, but no amount of "ultimate efficient exercise" rhetoric makes
running by itself a sufficient workout regime.

You also need to do some kind of strength training. A push, a pull, a spinal
compression and a spinal tension. Eg pushups, rows, squats, pullups.

Otherwise your core will be weak and you will be missing key stabilizing
muscles that prevent injury when you are in an unusual position, like picking
up a suitcase or changing a tire. Which is exactly what causes back pain.

~~~
ghthor
This is exactly the issue with what people think about running/walking and how
people execute their motion. You can make any exercise a core strength
exercise. I run and walk from my çore, I perform all motion from my core. This
is a feeling and skill you learn from taijiquan and it is applicable to any
type of exercise.

------
gforge
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
> 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-
playi...](https://www.madinamerica.com/2017/05/change-in-chicago-playing-go/)

~~~
gforge
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.

~~~
tcj_phx
Thanks for responding, and for the links.

> I've seen patients spiraling down into an abyss of pain after repeated
> failed surgeries.

I think surgery is commonly seen as better than doing nothing. Someone I know
has some deterioration from cortisone medications. He just heard that his neck
implant didn't fail, now the next joint down is gone. He'd rather not have
surgery again, but is rather miserable currently, and some doctors make their
money by doing surgery...

Do you have any comments on Inertia in Medicine? Doctors try to stay up to
date, but... well, cardiologists seem to resist acknowledging that statins
don't actually help many patients, and psychiatrists are very resistant to
admitting that antipsychotics prevent their patients from recovering from
their psychotic episodes...

What does medicine do well, and how can use of practices and procedures with
limited benefit be curtailed?

~~~
gforge
There is an inertia but I would say that it is often of benefit to the
patients. The problem is that I as a surgeon love to operate (note that we
don't even have a monetary incentive) and I truly want to help my patients.
This makes me biased and the inertia has saved me quite a few times for
starting performing new cool procedures.

The biggest problem is that we often have a big problem with discontinuing
treatment s, see my post on clavicle fractures
[http://gforge.se/2017/08/clavicle-gate/](http://gforge.se/2017/08/clavicle-
gate/) I am not a cardiologist so I don't know the full details on the
statins, but I would be careful not to skip them. Cardiovascular mortality has
decreased hugely the last decades and this one of the major treatments - they
must be doing something right.

Also be careful of flat-earth arguments, there are plenty of people who want
to disprove medicine - some of us are researchers but others are just writing
blog posts after finding a single article contradicting a treatment. It is
incredibly hard to do medical research, it takes years to recruit patients and
collect data. You always think that there is a ton of patients with this
condition and then you find that the inclusion and exclusion criteria that you
believed to be so brilliant (others had forgotten about them in their studies)
actually get in your way of being able to finish the study. If this wasn't
enough, once you are done with disproving the treatment, you will find that
the person that a few years ago popularized it is no longer doing it... They
would never do that, now they're doing treatment B, a completely different
thing. It's a game of whack-a-mole.

~~~
tcj_phx
Hi, thanks again for your comments. I am trying to better understand the
mindset behind the medical status quo, and you've given some good insights.

> I am not a cardiologist so I don't know the full details on the statins, but
> I would be careful not to skip them. Cardiovascular mortality has decreased
> hugely the last decades and this one of the major treatments - they must be
> doing something right.

Statins cause massive numbers of side effects:
[http://www.skepticalob.com/2009/06/doctor-listen-to-your-
pat...](http://www.skepticalob.com/2009/06/doctor-listen-to-your-patient.html)
\- this doctor figured out that an elderly patient's "progressive muscle
weakness" was caused by the statin that he'd been on for years.

> Also be careful of flat-earth arguments, there are plenty of people who want
> to disprove medicine - some of us are researchers but others are just
> writing blog posts after finding a single article contradicting a treatment.

My girlfriend was grievously harmed with the injection of Depot-Provera ~10
years before she met me. This drug is known to be defective - usually it just
makes women fat, but sometimes it makes them suicidal - but doctors inject it
anyways. One theory is that depot provera was approved by the U.S. FDA because
that agency's job is to approve drugs, and was long ago captured by the
industry it supposedly regulates.

Medical apologists could say that Provera is very effective at preventing
babies, so "they must be doing something right". But you have to ignore the
carnage:
[https://www.youtube.com/results?search_query=depot+provera](https://www.youtube.com/results?search_query=depot+provera)
\- "Depo Provera has destroyed me" has a compelling title.

Assuming there is good basis for common medical practices is a great
impediment to medical progress.

~~~
gforge
A common problem that we have is that there is no such thing as the perfect
drug. Any drug that is stronger than placebo will inevitably have side-effects
(note that even placebo has side effects). It is always a cost-benefit and
this is a tricky thing to fully convey to patients - what does 10% risk of
side-effect mean? For the patient that gets the side-effect they usually have
it a 100%.

I wish that we doctors were immune to the industry's influence but
unfortunately we also sometimes fall prey to the cunning tricks. I think the
OxyContin scandal says it all [http://theweek.com/articles/541564/how-
american-opiate-epide...](http://theweek.com/articles/541564/how-american-
opiate-epidemic-started-by-pharmaceutical-company) Mind-blowing that doctors
actually believed that there is a free lunch - a morphine product without
addiction...

There is hope though, here in Sweden doctors during the 90:s were frequently
taken to nice dinners and other events in the name of drug companies
representative costs. In early 00 this basically disappeared and today we get
a sandwich during lunch break in order to hear about the new thing that they
want to sell us. I think the awareness of the "no free lunch" concept (see
[http://www.nofreelunch.org/](http://www.nofreelunch.org/)) is much higher
today than 20 years ago when I started med-school.

One cost that you have to be prepared for is that the system becomes
"communistic": if we prescribe any drug that is outside the recommended set of
drugs our clinic has to cover the costs. The adoption of new drugs is
generally slower (although not for important drugs e.g. cancer treatments) and
we are no longer allowed to make local deals with suppliers, everything has to
go through centralized deals (even if we can get a better deal). In my mind
it's a small price to pay if it keeps our patients safe and we get to spend
the money on our health-care where it matters, but I think this system would
never pass the American legislative system...

------
eric_b
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-
Connectio...](https://www.amazon.com/Healing-Back-Pain-Mind-Body-
Connection/dp/0446557684)

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.

~~~
e40
_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
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...](https://en.wikipedia.org/wiki/John_E._Sarno#Tension_myositis_syndrome)

------
bambax
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
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
I am skeptical. What about those three chapters resolved your physiological
ailment?

~~~
chrismealy
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
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
Did it resolve your Alopecia?

------
ZeroGravitas
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
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...](https://www.cathrynjakobsonramin.com/resources/2016/12/22/dr-
stuart-mcgill-backfitpro?rq=Stuart%20McGill)

------
melling
The Mind Body Approach: Cures back pain, rsi...

[https://www.amazon.com/Healing-Back-Pain-Mind-Body-
Connectio...](https://www.amazon.com/Healing-Back-Pain-Mind-Body-
Connection/dp/0446557684)

[http://www.rsi.deas.harvard.edu/mb_what_is.html](http://www.rsi.deas.harvard.edu/mb_what_is.html)

~~~
ta8457348
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
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
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
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
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-
th...](http://healthland.time.com/2013/05/06/a-pain-detector-for-the-brain/)

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...

------
twobyfour
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.

------
twblalock
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
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.

------
scandox
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.

------
zacurry
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 :( .

------
taxicabjesus
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...

------
regecks
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.

------
jtanner
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/)

------
bar-b-q
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
Get checked for a cartilage tear. You may need a contrast MRI, and you may
need statical repair.

------
Mikhail_Edoshin
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.

------
kuwze
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-
in...](https://qz.com/1010259/the-100-billion-per-year-back-pain-industry-is-
mostly-a-hoax/)

------
azag0
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?

------
ApolloRising
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.

------
z3t4
When I lift heavy weights regularly it's like the pain threshold goes down
several levels.

------
seekstrength
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.

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

------
madengr
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
and "cheap" is relative, my friend.

