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Novel mind-body program outperforms other treatments for chronic back pain (bidmc.org)
325 points by yasp 62 days ago | hide | past | favorite | 212 comments

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.

My dad has been fighting cancer for the past 13-ish years. He recently told me that he's expected to live another six months or so because he has ran out of treatment options. Though we've known for most of these past years that his cancer is terminal, I feel like him telling me the news set something off inside of me.

Starting shortly after the time of hearing this news, I started to feel subtle, hard-to-pinpoint discomfort near my tailbone & perineum (sorry, TMI). I went to the doctor multiple times, had all types of exams and scans, but everything was coming back as "normal". My symptoms got worse as weeks went on, and I became incredibly anxious, though I was not able to recognize it as "anxiety".

At the peak of all this I found myself having what I would assume was an anxiety or panic attack. I could not control my breathing, started sweating, feeling like I was about to pass out. My wife was able to calm me down by helping me breath. I would break down crying on the phone trying to schedule doctors appointments (I'm 30 years old). I was unable to sleep at all for several days in a row even though I felt completely exhausted. Had to take time off (Incredibly thankful for coworkers/managers who were understanding) Chest pain, digestive issues, etc.

It's been a weird few months, but I finally think (hopefully) I am starting to get back to my "normal" self. The experience has taught me at least a couple things:

- Mental / emotional heath is something that is taken for granted. Now I have a new perspective on the importance of trying to maintain it and want to be understanding toward others.

- I think some (all?) of my symptoms were definitely related to what was going on in my life, and how things played out as I tried to fix them. This is hard for me to wrap my head around, but really I have found no other logical explanation.

From my own (anecdotal) experience, stress most definitely plays out in physical ways in your body. Throughout the day or night, you can be tightening muscles without knowing it. They can eventually fatigue and set off a chain of other muscles compensating for it, etc. They can even cramp up in ways that they push on nerves, resulting in nerve-pain symptoms. It's all fairly logical, but for some reason there's this preconception that there is absolutely no linkage between our bodies and minds, which makes people look everywhere else first. The worst cases tend to be cyclical, where your worsening symptoms add to your stress, which leads to more symptoms, etc.

The caveat is that sometimes, it's not just stress. You shouldn't neglect your symptoms, if they persist.

The canonical book on this that people recommend is "The Body Keeps The Score". I should probably get round to reading it.

I read the book after a recommendation on this site in fact. It was eye opening to say the least how conditions like ADHD, PTSD, childhood trauma, anxiety and depression have both psychological and physiological effects. Some of which are surmountable (trauma in adult hood) whereas early childhood trauma can leave long term physical changes to the brain and body making it something that has to be managed.

The first 2/3 of the book is very illuminating the last 1/3 a little polemic on healthcare policy and funding.

Enlightening book all in all.

That is unfortunately the case with me and it took me several years to start realizing that prolonged stress can result in this cascading effect where muscles tightening can distort your body slightly. This in turn can put strain on muscles initially unaffected which can themselves become locked because you cannot release the initial strain. By the time I started realizing it I couldn't answer anymore the question what it feels like for my body to be relaxed.

Are you doing better now?

So sorry to hear what you were going through. My partner had something similar due to the stress from the pandemic. What helped her the most was actually a regular psychiatrist appointment.

Did you do something specific when you took your time off and saw your symptoms disappear? Curious what helped you the most.

When I took time off it was simply because I could not function in any meaningful way.

- Anxiety medication (I feel hesitant taking this and question if it helps or not. Hard to know.)

- Talked to a therapist weekly (now doing monthly)

- Yoga weekly

- Forced myself back into a regular exercise routine. I love exercising, but I had fallen out of my routine.

- Modified my diet and eating habits. I track everything I eat now. Still experimenting with this.

- Focused, deep breathing for 5 to 10 minutes three times a day.

- I think time in general helped me heal.

So sorry to hear about your dad and your symptoms, that sounds very tough. I'm very glad to hear you're feeling closer to your "normal" self, I hope that continues.

Anxiety/stress/panic attacks are no joke. I think a lot of us in technical fields discount the "mind" - "it's a brain, it's just a meat computer" - and while I don't ascribe any supernatural aspect to it, the brain/mind can have really powerful impacts on the body.

Just to chime in, it's not only people who work in technical fields. I had similar symptoms (chest/back pain, lethargy) from stress from the pandemic + overwork a year ago. And I studied psychology and knew that these things could happen, but when it first happened to me I thought I had heart problems (not likely since no familial history + obvious lifestyle risks). It went away as soon as I quit and went for some therapy, not because I didn't like the job, but there was no way for me to mentally get away from it.

That’s a powerful story. I’d encourage you to try yoga. Do the Beachbody 3 week yoga retreat. Then continue doing one of the final “flow” routines every day. It’s 30 mins and is very accessible. It cured my chronic back pain and has eliminated anxiety about a range of things. After 4 years of doing this its also left me with an insanely strong core and great flexibility.

The Black Lotus app [0] is an incredible help to deal with mental issues related to stress, anxiety and lack of focus/mindfulness.

Personally, I have used it twice successfully to come out of sudden mental anxiety I found brewing in myself.

Thoughts are also a form of energy – if they don't get channelized or remain unspent in your subconscious/unconscious, they can create mental problems. Meditation and related activities, prescribed as part of the RARE framework of this app, help in cleaning these otherwise overlooked corners of our mind.

0: https://www.blacklotus.app/

I was one of them. I thought panic attacks were some stupid made up thing for weak people, same with anxiety and the rest of them. Then it happened to me. And it affected so many things you wouldn't believe, from chest pains to fatigue to brain zaps to esophogal tremors to stool color even.

I will gladly eat crow, I'm only admitting as much because I understand how easy it is to dismiss psychosomatic ailments. When you don't have any to worry about, it's nearly impossible to begin to comprehend. I liken it to ghosts...some folks swear they've seen or experienced them, but I don't see how it's possible. I half expect to be proven wrong on that, also.

I believe ghost sightings are real - but caused by visual system trying to map inconclusive/limited information to something it already has a pattern for, and once a pattern (no matter how absurd) is found, it latches onto it.

AFAIK what we "percieve" of the world is anyway a hallucination produces by our brain based on sensory input. And particular conditions can mess this up briefly.

I've seen things twice that weren't there and realized what was going on only when got closer. First was when in the middle of the night I saw through a half open door my son (1 y at the time) walking in a room - I entered the room, and realized it was not plausible he could have been where I saw him a second a go. I backtracked what I saw and realized there was play carpet with road patterning on the floor, plus miscellanious kids stuff on the background. It was nearly pitch black. From my pov the scene mapped to my son in my visual system, and then it maintained this pattern just long enough for me to "see him walking".

Second was when I during a normal day observed what only could be two crows fighting or mating on a small tree. I got close. Really close. Then it suddenly 'stopped' being two crows and I realized it was just a black plastic bag fluttering in the wind.

I have no idea how to teach people of the fragility of our cognition in a way that would not involve a pathology as you had - realizing fragility of psyche is real similarly as death is real - but I feel realizing this would make people more emphatic towards all sorts of problems our fellow humans have.


Pareidolia (/ˌpærɪˈdoʊliə, ˌpɛər-/;[1] also US: /ˌpɛəraɪ-/)[2] is the tendency for perception to impose a meaningful interpretation on a nebulous stimulus, usually visual, so that one sees an object, pattern, or meaning where there is none.


You can train yourself to see things in the dark.

People have a lot of difficulty understanding things they haven’t experienced.

This leads to a number of people treating other people’s behavior as if they were doing it. If the only reason they would not be successful is laziness, then everyone who doesn’t succeed is lazy.

To them, it isn’t fair that other people get stuff “for free” when they had to work for it.

> People are incredibly reluctant to believe that ailments might actually be partly or mainly psychological.

There are two simple reasons why people don't want their ailments to be psychological.

First, there are no real tests for determining if something is psychological or physical. Doctors just test for some stuff, and if the tests come back negative or inconclusive, they just explain it away as "psychological." You can never be sure whether you have a physical problem or whether your doctor is just lazy.

Second, the medical system just gives up on you if the issue is psychosomatic. There are no treatment protocols that work, so agreeing that something is psychological is just having your case tossed on the trash heap to be ignored.

Modern medicine does have a light side and a dark side. On the light side are known ailments with known tests and treatments. On the dark side is everything fuzzy and uncertain. Doctors HATE being faced with ambiguity, and patients know that if their case falls into the dark side that treatment and recovery are hopeless.

> Second, the medical system just gives up on you if the issue is psychosomatic. There are no treatment protocols that work, so agreeing that something is psychological is just having your case tossed on the trash heap to be ignored.

Maybe it's because we need to change our approach to psychotherapies in general. The reason psychology as a whole is not considered hard science is because replication is hard and in some cases impossible (good luck finding subjects who haven't heard about the Stanford prison experiment today). Why don't we accept this is just the way it works. That some therapies will work for some people and won't work at all for others (or might even make their symptoms worse). That therapy needs much more time than a pill to work - instead of hours, we're talking weeks and months, possibly years. That the evaluation of the results always has an element of subjectivity: sure, you can measure some physiological aspects, but there is always the internal component of well-being.

> there are no real tests for determining if something is psychological or physical

This is not true. Also, even if it was true, it's not a reason not to treat a patient.

> the medical system just gives up on you if the issue is psychosomatic

Both pain killers and psychiatric drugs are often overprescribed in some countries, especially US, as the health system is focused on profit.

> There are two simple reasons why people don't want their ailments to be psychological.

Another reason is that most people find it scary if someone starts tinkering with their psyche. I honestly think that every therapy should start with strategies to overcome this fear.

You couldn't have picked a worse example than CFS to include in that list - a syndrome that for decades was dismissed as psychosomatic, and that many people (read: most notably medical professionals) today still dismiss as such, despite the evidence that no, actually there's some kind of physical dysregulation going on (probably triggered in many cases by a viral infection.)

Interestingly...well to me, at least, I went to the doctor for being constantly tired when I was younger. The doctor asked how many friends I had, I said oh a few, then diagnosed me with depression and recommended an antidepressant. I left and never went back.

Two or so years later I got a long term girlfriend, who told me I quit breathing in my sleep and gasped for air. Obviously, this is something you don't even think of yourself.

I didn't go on CPAP, but did see an ENT who did a couple sinus surgeries and put me on steroids for chronic sinus inflammation. That treatment changed my whole life. The fatigue disappeared immediately.

That was almost my exact experience with a former girlfriend, except my advising her about sleep apnea.

I was amazed no one had mentioned it to her before, as she had quite lengthy pauses and then gasps after them, all night! Scared the hell out of me, until I finally said something, and she went for a sleep study.

It's so wild. The first time I woke up to her hitting and shaking me, she was visibly disturbed by it as I'm sure you were. And here we are our whole lives not even knowing we are doing it!

Similar experience for me except the root cause was low testosterone (probably ultimately caused by a traumatic brain injury).

I kept telling them the only damned thing I was depressed about was how tired I was.

That was exactly my sentiment! Crazy how many doctors look for the easy way out. Glad you also found your cure.

Hey can you please PM me a bit more info on how you were treated and some facts about your case if you are comfortable to?

I have been using CPAP for years but my case is weird: I was diagnosed in my early 20s, I was not and am not overweight, I only drink socially (so less than once per week), I don't and have never smoked, etc.

CPAP has massively improved my life, I'm feeling much better, but honestly my sleep specialist was kind of shit when it came to answering questions. When I asked about surgeries and the like he just said "No, we can't do that" and I couldn't get him to elaborate on why.

I never pushed it because I used to be too poor and I was too exhausted to bother with screwing with my treatment but I'm reconsidering that. Don't worry I won't take anything you say as medical advice or anything, I just... I dunno I guess I'm curious to hear about the experiences of someone who had a different treatment avenue in some depth. It might make me feel for comfortable/proactive about seeking a second opinion and pushing for specific answers


So to avoid confusion here, my surgery wasn't some alternative to CPAP per se, but fixed my breathing issue. In short, my nose got so restricted I could barely breathe from it at all.

My journey began by seeing a doctor for it, who tapped on my forehead and said I don't have a sinus infection, take an allergy pill and go away. Nothing but pseudofed ever helped at all, and that got expensive and restricted.

Then I saw an allergy doctor, who said that's a stupid test and did an MRI and found that I have something like a constant sinus infection, and inflammation everywhere. He sent me to an ENT, which honestly is probably where I should have started. As a side note, I did try allergy shots for about a year with no luck.

The ENT has these cool but odd feeling cameras they shove deep into your nose to see around. It's a horrible feeling tbh, sometimes you feel it in your eye or even tooth(nerves, I guess). He determined I had polyps really bad and a deviated septum, so in one marathon surgery did both.

Afterwards, it was great, and slowly got worse. ENT said polyps were coming back, so put me on a daily sinus rinse with budesonide(sp?). So each night I rinse my nose with that, and have for going on 8 years now I guess. It's kinda gross, you wouldn't believe all the snot that comes out after the steroids open everything up, which usually takes about 20 mins.

Feel free to ask any questions.

Ah thanks. I've had the scope shoved in my nose it is terrible (I had a chuckle after getting tested for COVID because boy is that camera worse).

I definitely don't have a constant sinus infection, so it sounds like your situation isn't at all like mine. At least probably not. Nonetheless I really appreciate your time writing all of that out, thank you

I managed to recover from ME/CFS 20 years ago (with no symptoms since). It was entirely through psychological/behavioural changes that I was able to recover.

>actually there's some kind of physical dysregulation going on

The only replicated findings are with the HPA axis (the stress system). There are some studies pointing towards impaired mitochondrial respiration due to reduction in the link step between pyruvate and the TCA cycle. However, if you take a quick look on google scholar, you'll see that that link step is downregulated by the glucocorticoid receptor (the stress system again), so that would seem to be the likely cause.

There are also some studies showing reduced work capacity after repeat CPET. But again, the HPA axis influences CPET performance, so that is a possibility there as well.

The point is: just because there is "physical dysregulation" doesn't mean it can't be caused by stress or psychology. That is literally how the brain works (if it didn't, we wouldn't be alive and conscious). Psychology is intrinsically linked to the immune system, HPA axis, autonomic nervous system. Psychological stress has been repeatedly shown to cause neuroinflammation, cyyokine release, impairment of the parasympaethetic nervous system, to name a few.

Further, here is landmark position paper from Mayo from mid 2021 [1] on ME/CF. It’s an absolutely brutal disease: absolutely no cure, no treatments, give or take 5% chance of ever beating it, and almost 50% of people are house or bed bound for the rest of their life and even more can’t work.

Graduated exercise (run 1 mile today, 1+X tomorrow) and talk therapy (CBT, etc) have been contra indicated for a few years now and the former can actually make the condition worse.

For something first diagnosed in 1958 (but observed since 1889/1880/1917, and also medieval times) to have absolutely no progress or even a unifying theory of how it works while it’s believed to impact up to a million Americans is absolutely baffling.

ME/CF is a total beast and monster of a disease. That’s why the suicide rates are so high.

[1] https://www.mayoclinicproceedings.org/article/S0025-6196(21)...

Only some forms of graduated exercise are contra-indicated. It's important to note that exercise is still a feature of effective treatment for ME/CFS.


>5% chance of ever beating it

If you actually read the paper where that 5% figure comes from (Cairns,2005) you'll see that it is for untreated, naturalistic recovery. Looking at recovery after treatment (e.g. MRT) the figures are more like 30-35%. Heck, even the Rituximab trial resulted in 38% remission at 4 year follow-up just due to the placebo effect!

If you read the more recent work, there's figures of 80/90/95%+ mentioned from the ME/CF national association as well as several of the hospital associated treatment centers.

I mean I hope you're right, and it's 35%+, and anecdotally and on a branch here, some of the eerily similar but inconclusive SARS, avian flu, and Covid linked cases seem to be recovering faster from self reported individual data points. But I can't prove this.

What's interesting, and seems to either support or intermingle with an earlier point you made is a recent paper that showed if you had childhood trauma you were (this might be the wrong word) either more susceptible or more likely to be in the MECF group. Which suggests, to your point, maybe the cohort has "weaker" psychological baselines. What's not clear, is once you get it, if that baseline is at all relevant to the actual disease (just like it doesn't matter if you initially got it from the Epstein Barr virus or another viral infection). But it sort of aligns with what you're saying.

However the counterfactual is hard to work against. We know CBT/ACT/DBT/etc are highly effective for other issues.....all these people that are essentially disabled (can't work, require care, often can't even be materially ambulatory). Why wouldn't the self select into CBT/ETC? And if you're right, why wouldn't you see a tsunami of self reported or clinically measured recoveries? And therefore the consensus articles would say "do therapy". But they don't. Theres an old medical school anecdote: listen to the patient sometimes they're telling you the diagnosis. In economics you could draw the comparison to the concept of revealed preferences; we don't have to go through all this hand wringing of mechanisms and (im arguing slandering and blaming the victim) others. If you're right, shouldn't you see these landmarks papers saying "hey xyz protocol of ABC therapy plus DEF manual therapy produces an XX% recovery". Where is that paper? Because you'd think the MDs that work in this space would know about it and center their care around it. Id argue it doesn't exist, it's just internet warriors making stuff up.

>And therefore the consensus articles would say "do therapy". But they don't.

The problem is twofold. [1] There is a widespread prejudice against psychosomatic illness. and [2] There have been some mis-steps, e.g. PACE trial which put deconditioning and fear of activity front and centre. This caused a huge and predictable backlash, as clearly some fear of activity is rational with this illness.

>why wouldn't you see a tsunami of self reported or clinically measured recoveries?

We do. See for example:




But due to the prejudice, most people just get on with their lives once they recover. When you put your story out there (as I have done) you get hit with a huge ton of personal attacks and abuse. People deny you had the illness in the first place and they say incredibly nasty things about you. I see this on a daily basis.

>Because you'd think the MDs that work in this space would know about it and center their care around it. Id argue it doesn't exist, it's just internet warriors making stuff up.

You do see some. Fred Friedberg. B Van Houdenhove. Wyller. etc. But most patients hate these people, or at least actively ignore them, because they simply don't believe it.

Good info!

+ Bruce Lipton's "Cell membranes are brains" theory. https://youtu.be/3tZ513NeSIc?list=PL2S-_LNXy9Vx24_o9zSTF6MAD...

Also noteworthy: one of the top co-morbidities for COVID-19 is anxiety. https://youtu.be/iY98nuD3Bco?list=PL2S-_LNXy9Vx24_o9zSTF6MAD...

> We considered 2 exposures of interest: 1) specific underlying medical conditions and 2) the number of conditions. We captured data on both exposures by using ICD-10-CM diagnosis codes from inpatient or outpatient hospital records in PHD-SR from January 2019 up to and including a patient’s first inpatient encounter for COVID-19. We used 1 encounter with an ICD-10-CM code to establish the presence of an underlying condition because few patients had multiple encounters in this hospital database. We excluded 3 ICD-10-CM codes (ie, oxygen support, dependence on a ventilator, and tracheostomy) listed during the patient’s COVID-19 encounter because they could be part of COVID-19 treatment.


> To further differentiate underlying conditions from acute complications of COVID-19, a panel of physicians (K.K.W., W.M.K., H.G.R., B.B., N.T.A., J.M.N.) classified the 314 CCSR categories into “likely underlying” (274 categories; eg, asthma); “indeterminate,” which could include underlying or acute complications or both (29 categories; eg, cardiac dysrhythmias); or “likely acute” (11 categories; eg, acute pulmonary embolism).

Am I reading this correctly that they are determining "likely underlying fear and anxiety disorder" from a single ICD-10 code that was likely generated at the time of admission for severe COVID-19? If that's correct, it seems rather flawed at determining if these people had an actual underlying anxiety condition or if the anxiety was due to severe COVID-19 symptoms(moderate to severe difficulty breathing, lack of sleep, lack of food/fluids and pain).


I would say that "dismissing" something as psychosomatic is the type of "oh it's all in your head" bullshit that, yes, has happened far too much in the history of ailments like CFS (and still happens today, I'm sure). And I'm completely against that.

But at the same time, I know people with CFS who refuse treatment like CBT, antidepressants, counselling, getting more regular exercise, on the grounds that it must be a viral/bacterial infection, or genetic, or autoimmune. Those things are all possible and should be researched - but so should the idea that it's partly or largely a mental illness. And there may well be physical dysregulation - that can be caused by the brain in many ways.

Regular exercise makes it worse because of PEM [1], and graduated exercise therapy is contra indicated [4] because their ATP energy system doesn’t fully work [2]. You could cripple them by forcing progressive exercise dogmatically. Talk therapy is no longer recommended [2] and many antidepressants are not effective [3].

If you read the book Why Zebras Get Ulcers by Sapolski there’s this story about the African farmer who has his cow die, and can no longer farm or support his family after. Sapolski says in America you’d give antidepressants, in Africa you’d just chip in and buy a new cow.

No offense, and as respectfully as possible while getting the point across, but you’re being a dick to your friend. These people bounce between doctors for years [5] because there’s no FDA approved diagnostic test, with a hyper complex disease that’s literally debilitating to them do you really think you can drive by diagnose and they just missed completely obvious and first pass treatment options? Your comment is the “I could build it in a weekend” response to ShowHN.

Edit: note, I believe in somatic experiencing of symptoms, as described in the link to this threads article. For example there’s quite a few stories in the biography of Chairman Mao [6]of high status officials suffering “neurotic crises” and requiring bed bound recuperation, arguably because of the repressive environment they lived in. But ME/CF is completely different.

1. https://www.cdc.gov/me-cfs/healthcare-providers/clinical-car...

2. https://www.mayoclinicproceedings.org/article/S0025-6196(21)...

3. See dots in bottom left quadrant for Paxil/Zoloft/etc etc. https://www.researchgate.net/figure/CureTogethers-page-on-ch...

4. https://me-pedia.org/wiki/Graded_exercise_therapy quote: “ Graded exercise therapy (GET) is a form of physical therapy for the treatment of chronic fatigue syndrome (CFS) where physical activity is gradually increased over time. It is a treatment that was offered to ME/CFS patients in the UK by the National Health Service (NHS) as specified in the NICE guidelines from 2007-2021, but the recommendation was removed by the 2021 NICE guidelines because of high rates of harm.”

5. https://www.omf.ngo/what-is-mecfs/ quote “ People with ME/CFS often go years before diagnosis, and 90% of sufferers have never been properly diagnosed.”

6. https://www.amazon.de/Mao-Biographie-Alexander-V-Pantsov/dp/...

I think you're reading more into my comment then is there. I didn't say anything about forcing progressive exercise or GET, CBT may not be widely effective but there are other forms of talk therapy not mentioned in your links, and your CureTogether link is self-reports, which also shows meditation as one of the most successful. And I'm a bit offended, you know nothing about my relationship to those in my life with CFS, I obviously don't tell them "it's all in your head, get some exercise", I just wish they'd be more open to different possibilities.

I think CFS is likely a complex ailment, probably really several different things grouped together because of similar symptoms. Some of the people with what we call "CFS" may have some kind of post-viral syndrome, some may have a genetic disease, some may have depression/anxiety/stress, some may have a combination. I think the real error is stated pretty well in one link I found (somewhere in one of your links): "We now have evidence confirming what millions of people with this disease already know, that ME/CFS isn’t psychological," - to say outright that a disease that isn't yet well understood is absolutely not psychological is dangerous. CFS isn't measles or diabetes, we simply do not know the full cause(s) yet, period.

How do they measure success of the talking therapies? Because I know people who just buy cannabis on the black market and won't tell doctors about it - they improve but not down to the therapy. They attend talk therapies out of fear of being discharged. It's a huge waste of resources. Nobody I know got helped by these.

Ok fair on tone. Apologies.

First you’re opining on what the disease is? It’s actually the converse to your preposition: it’s a giant symptom cluster (50+) and no one generally believes it’s multiple diseases lumped together. Read the Mayo paper.

The rest of your comment has a logical fallacy which renders it moot: do they have a diagnoses, yes/no? If yes, then your “try other things” and “maybe it’s psychological” comments make no sense and are refuted clinically. It’s like saying “is your computer turned on? No? Ok, it’s probably a software bug. Let’s just be open to possibilities and not be close minded here.”

Also a) you’re assuming they didn’t try therapy. And b) “they’d be open to more possibilities”…like what specifically? The self reports is 20k data points and they got bought by 23andMe; but we could pull PubMed and get to the same result. Nothing seems to work and more importantly other than a believed onset from a post-viral infection, there’s no known even rudementary understanding of how it works. Clinically there’s no known above zero effectiveness non-“say no to everything” modality. What do you suggest these people that have spent 2 to 3 years probably trying everything imaginable attempt?

Like it’s so straight forward. Try talk therapy for a year and then try anti depressants. Oh it didn’t work across a gigantic cohort? And the scientific community generally agrees psychological isn’t a recommended approach? Very Donald Trumpian to say “who knows who knows, let’s keep an open mind here” with no backing on data to stand on other than an intrinsic belief regarding a clinical topic.

You’re suggesting a high rate of false positives. The links show an expected 91% of false negatives (I’m assuming due to the sheer difficulty of diagnosis) and literally no comment of false positives. Not clear how you can defend that assertion.

The Mayo paper seems to be quite slanted against psychological aspects.

There is quite a lot of research, and it shows that both stressful life events and viral infections tend to be triggers. (We know that viral infections are physiologically stressful, in that they activate the HPA axis).

There is also an abundance of evidence that psychological therapy and multidisciplinary rehabilitation helps patients. So this definitely isn't just laziness in saying "maybe it's psychological".

Yeah I mean 23 MDs went to retreat to try to summarize current best understanding of this disease versus your individual opinion.

Which evidence? And why did Mayo/British NIH/CDC/WHO happen to miss this "abundance of evidence"? Without pointing to wonky stuff, how could all those cumulative people employed at those organizations be wrong, and you random internet stranger with no citations happen to have nailed it? I'm assuming you're not claiming Mayo is somehow dishonest. So are you claiming they're incompetent? If neither on what ground do you assert its incorrect?

This is like arguing with an anti-vaxxer who argues "we just don't know, I heard the jab makes you infertile". Almost seems like a waste to even bother replying.

You have no idea who i am. Try looking on google scholar, or even wikipedia. Im done with you.

>ATP energy system doesn’t fully work

No, that hasn't been proven. If you look at the Fluge and Mella study that you're referncing for this, you'll see that the scatter graphs overlap, so the evidence isn't terribly convincing. Also, the downregulation of the pyruvate link step that they found is consistent with increase glucocorticoid receptor activity (the stress system).

>Talk therapy is no longer recommended

That's a pretty skewed review you posted. All the evidence points to CBT being effective for CFS. Certainly it can hurt patients when applied improperly, such as forcing patients to ignore exacerbation of symptoms. But that doesn't mean it is all bad.

The former point is super interesting. Can you link to the overlapping scatter graphs?

If that underlying assumption is wrong it's even more mysterious how these patients are so tired. You then have to pivot to the cytokime storm position.

Its just in the full text of the fluge and mella study into mitochondria. Im done with you after your attack on me in another comment.

Few things are worse than a doctor denying care because of such denialism.

Something I only discovered recently is how much of an impact sustained mental stress/anxiety can have on your body. It puts your body into a state of fight or flight, which eventually wears you down. It's a very valid root cause to look for in diagnosis.

Sample size of 35 and mindfulness is not novel or new. It probably does help some people. However, a huge grain of salt should be taken with any diagnosis illness/disease being due to stress or psychosomatic. Some doctors immediately jump to this after doing very little due diligence and diagnostics. It should be a diagnosis of absolute last resort.

Stanford does have a CFS clinic investigating pathogen-related causes[1].

1. https://med.stanford.edu/chronicfatiguesyndrome.html

This is not mindfulness. They actually compared against a mindfulness-based treatment (MBSR) and found their method performed significantly better.

They literally have you go through "Worry Less, Live More: The Mindful Way Through Anxiety Workbook", so it's at least building off of it in some way. Mindfulness with a pain-oriented focus is not new.

Looking at their patient groups on Table 1, it seems MBSR and Usual Care had participants with more spinal injections and surgical interventions. MBSR and Usual Care have higher "Pain bothersomeness" scores and "Roland Disability Questionnaire Scores" at the start.

It's a very small-scale pilot study. I am very skeptical it's not a ploy to try to sell his books.

MBSR teacher (well, learning!) here. I would also be skeptical based purely on the sample size, but MBSR as a treatment is pretty well researched and documented. It's been around for 40+ years and there is fairly extensive supporting research [1].

So - I wouldn't be in any way surprised if there are other related treatments which have high levels of efficacy...

[1] https://en.wikipedia.org/wiki/Mindfulness-based_stress_reduc...

Agreed, sample arms were n=11 or 12.

>It should be a diagnosis of absolute last resort.

No, it should be equal.

>Stanford does have a CFS clinic investigating pathogen-related causes[1].

They haven't come up with anything, and their scientists are problematic: Montoya getting fired for sexual harassment, and Davis saying that anyone who doesn't think CFS has a molecular basis is a fool.

>No, it should be equal.

Okay, what is the consistent testing/diagnostic methodology that accurately measures stress and psychosomatic impact across patients?

Typically it is going to be a diagnosis of exclusion. If you think you're diagnosing someone with stress/psychosomatic causes before comprehensive testing, imaging and/or specialists visit have been done, then you're jumping the gun, and potentially adding further stress to the patient as they try to follow a regimen that has little effect at helping their condition.

I was not aware of the Stanford CFS clinic drama.

Yes, the doctor should explore all possible causes with the patient. Tests can be done, and the doctor can also discuss stress. That is generally how it is done. Quite often in these cases there will be no final diagnosis.

That sounds a lot like a diagnosis of last resort. Especially if the best tool available for measuring stress is a yes/no question to the patient and a 5-question anxiety questionnaire. Hardly definitive evidence of stress/psychosomatic causes, especially if it comes back "negative".

There is no “stress” diagnosis test. It can never be a definitive diagnosis. The patient just needs to consider it.

Yeah, part of the problem is in the wording too. It's incorrect to say "it's all in your head" because this makes it sound like the person experiencing the pain is just imagining it or that it's entirely a construct of their mind. What Sarno points out is that there might be some underlying physical issue at play, but it's the extent of the pain that has a psychological component to it. As an example, two people can have the same exact x-ray of their back showing some alignment or other issue. One person will experience extraordinary pain and the other barely any at all. The fact that this is left unexplained by chiropractors (who are mostly kooks IMO), for example, should be a big red flag. How can it be that people who are supposedly experts in this field cannot explain for a basic a discrepancy like this?

I think the right way to open people up to this is to acknowledge and validate their pain, that it's real (not "in your head"), but have them consider that the mind-body connection could explain more than perhaps they had previously realized. If you start out the gate with "it's all in your head", not only in this not correct, but it turns the person off because it sounds dismissive and pseudo-scientific.

>One person will experience extraordinary pain and the other barely any at all. The fact that this is left unexplained by chiropractors (who are mostly kooks IMO), for example, should be a big red flag. How can it be that people who are supposedly experts in this field cannot explain for a basic a discrepancy like this?

Not sure what chiropractors have to do with this, you can see an MD for your back pain too but they'll be equally hard pressed to find the reason for the difference. And that's simply because there are countless variables-- x-rays don't show you cell level differences between the patients, central sensitization in the brain plays a part, different pain tolerance(ie something as simple as being a redhead is associated with increased pain), the level to which a certain amount of pain causes psychological distress can also change, coping mechanisms used, etc

Except that it is all in our heads, ultimately. Pain is a sensation in our brains, based on inputs from everything else. That "everything else" is often our physical nerves, but can also be everything else going on in our heads. If someone needs to meld the idea of psych-driven pain with physical pain, trying to deny that they come together in our heads can backfire. It is more important to focus on what we even mean by pain being "real", and that it being in our heads does not invalidate it in the slightest. It is real, and there are more paths to recovery to explore.

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.

What was your eventual diagnosis?

Autonomic neuropathy.

So how was that diagnosed, and what is the treatment that saved your life?

Saw a neurologist who ran a QSART, which I failed spectacularly.

Treatment is supportive (vasodilators, beta-blockers, anticholinergic).

I was at extremely high risk of stroke or dangerous fall until appropriately treated.

> are all things that sincere people truly are suffering from...that may be mainly psychological/psychosomatic

The back pain being cause by physical issues is not exception. The doctors and physiotherapists that wrote articles I read, had talks I has seen and the ones people I know visited never mentioned that. Instead, they recommended to fix the posture a set of "exercise" routines for rehabilitation. They also explained back damage as a mechanism.

And those actually worked. Back pain can be very often helped, if you fix posture and do rehabilitation. It is not exception for it to be purely physical.

The moment you claim it is psychological, the people who have fixable mechanical issue, won't get any help. And that help, quite apparently, actually makes difference. And not just with back pain.

There are different kinds of back pains, and for a few years I had them on and off, and it very likely was posture related. The first time I tried a good lumbar support my pain almost disappeared while using it. It was such a relief that even now, a decade later, I have that lumbar support for all the chairs I sit in - home or work - even when I'm pain free.

However, my pain was unusual (did not fit the usual symptoms people normally have). There are other types of back pains. Sarno was always insistent that a physiological cause always be investigated, and if one is found, to treat it accordingly. Absent that, he would recommend a psychological approach. One thing he highlighted that I've anecdotally found to be true when discussing with others[1]: The pain often disappears near/after retirement. And almost all physiological problems get worse with age - not better.

Me personally: Sarno's approach didn't work with other pains (ones he claims are within the scope of this type of pain). I don't know what the cause is - doctors never found anything and physical therapists have told me they've never dealt with my types of pains. Maybe it is psychological, but I must emphasize: Sarno's approach didn't work for me.

[1] A former boss is an example. He said he had severe back pain on and off for so many years - had to take time off from work, etc. Nothing really worked. But eventually, in his mid 50's it went away and he doesn't know why. He's near retirement (senior guy with money), kids all grown up and graduated from college (or near graduating). Once a lot of his life worries got resolved, so did his pain.

His story is fairly common.

> Sarno was always insistent that a physiological cause always be investigated, and if one is found, to treat it accordingly. Absent that, he would recommend a psychological approach

That is much different the what post I responded to claims tho. Or what title claims too. The comment I responded to frames these issues being primary about psychological being and then maybe some few exceptional people having physical cause. And even that is supposed to have strong psychological component as well.

This is quote:

> 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

What you say in your cment is "when all attempts to find and fix physical issues failed, remaining patients have more luck trying psychological treatment then physical one again".

Which is much weaker claim. It does not imply that psychological is strong component nor that only some back pain is cause by physical. It implies some of it, when you exclude all known physical causes, might be psychological.

[1] This here is pure speculation. The changes you described affect also lifestyle and behavior, not just stress. That story does not prove original issue was psychological, it just shows we can't always tell what the cause was.

Fair enough, but do you have any actual evidence that actual physiological causes are the majority? 2 people I know have bad back pain due to car accidents. For everyone else, no clear source of the back pain has been found. Occasionally they point to issues with herniated discs or pinched nerves, which makes sense, but from what I've read, most people who have such conditions do not suffer chronic back pain, which makes it a dubious cause.

My PCP doesn't bother treating back pain that isn't due to an obvious injury. He said that in his decades of looking into it, he's observed:

1. None of the treatments out there show good evidence of actually working vs a placebo.

2. While it often recurs, each episode almost always resolves on its own.

He does not believe it has a psychological cause - he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatever the patient asks for (pain killers, physical therapy, etc).

The only time he pays attention is when the pain extends to the legs, which is the minority of the times.

> 2 people I know have bad back pain due to car accidents. For everyone else, no clear source of the back pain has been found.

That is anecdotal and clear source of back pain in your story requires one big event. Mine experience is anecdotal too. For people I know, it was bad posture causing damage over time (when sitting mostly) and the physiotherapy with rehabilitation exercises helped.

> Fair enough, but do you have any actual evidence that actual physiological causes are the majority?

Do I need to do hunt for that since the original claim was "majority is psychological" was not just without proof, but with blatantly bad logic in it? "We excluded people where physical treatment helped" does not lead to results you can use about overall efficacy of any treatment.

> he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatev

This honestly sounds like a bad doctor. He does not even makes attempt at diagnosing known physical causes of back pain. The physiotherapy/rehabilitation exercises that were recommended to me and people I know were simple and did helped. It required maybe 10 minutes a day.

I understand that there might be different causes and unknowns, but doctor who is not even trying being unable to improve any patients is not exactly an argument.

I agree with all of this but just to add, the pain can indeed be a real physical issue directly caused by mental health.

For example, anxiety often causes muscle tension and bad posture which can lead to real mechanical pain causing issues. I suffer from panic attacks and they are a very physical experience. My temperature stops regulating itself properly and I get GI problems. This is likely an indirect consequence of the adrenaline surge, but there are other known and theorised ways that your mental state can influence your body.

Also, being psychosomatic does NOT mean they are ficticious, which is a widespread opinion.

The brain is involved in all pain. The fact that the brain can help fix it doesn't mean it's psychosomatic. It just means you can interrupt the process at some place other than where the damage is.

Chronic pain is aggravatingly hard to trace to the source. Maybe it's psychosomatic, maybe it's not. Calling it psychosomatic causes stigma -- it implies that it's fake and their choice. But they do want to get better.

It's more than just thinking yourself healthy. It requires some counterintuitive ways to create new pathways. It's great that there is more research showing an improved way.

All pain is psychological.

I imagine for most people with back pain there is a physical component, they didn’t have back pain as children, but if we had full control of the brain we could turn off the pain sensation if it’s not useful.

Many doctors believe what you say and dismiss patients as psychosomatic if they can't find anything obvious. Sometimes they refer them to psychiatrists or insinuate they are drug seeking. It's a disgrace. This treatment from health "professionals" almost drove me to suicide. Actually my own research got me into a path of finding out I have a rare disease and I had to pay private consultants to help with diagnosis. Only then and a threat of lawsuit got the doctors treat me seriously and I actually got help.

What is the disease?

There can also be physical issues that can be masked psychologically. You can train your brain to ignore and mask many pains and aches and dull them down. IMHO, managing pain can definitely be done psychologically, at least to some extent.

Being too aware of the pains, obsessing over them, and being anxious and stressed definitely aggravate the conditions in my experience. Having an otherwise healthy balanced life in terms of work, relationships etc. with healthy amount of stress, makes some of the ailments very manageable or a non-issue.

I knew a guy who had an extremely stressful job and a bad skin condition, it cleared up as soon as he left. The brain and body are extremely connected.

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.

You are unwittingly just promoting yet another form of back pain snake oil and there is already plenty. If I had fallen into the idea that my back pain was “just in my head” I would have gotten no where. I encourage anyone suffering to get an MRI as early as possible so at least you know what is wrong. Doctors and chiropractors will regularly misdiagnose you. There are lots of ways a back can go bad and everyone has their pet advice which probably doesn’t apply to you.

> I encourage anyone suffering to get an MRI as early as possible

Tons of people will have worse outcomes after getting an MRI, as it will reveal a physical abnormality that would have been symptomless otherwise.

Get an MRI and consider that psychological stress can have physiological or physiological-seeming consequences.

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.

The back pain-industrial complex is an incredible web of interlocking interests where no part has an incentive to really cure anything long term. The canonical expose of this system is the recent book "Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery"[0], where a seasoned investigative reporter surveys the entire industry in detail. She gave a nice summary on this podcast[1]. And she has a detailed section on the breakthrough ideas of Dr. Sarno, and how he was ignored for decades.

The book is in three sections. The first section is a very depressing history of back surgeries and devices attached to the back, that almost uniformly fail after a few years, leaving the patients worse than they started. The second section covers various exercise and bootcamp approaches, including the MedX lumbar extention machine invented by Arthur Jones, who also invented Nautilus machines with adjustable strength curves via cams. The MedX lumbar machine was the only device that could isolate and recruit the inter-vertebral muscles, which have been shown to be weak in patients with lower back pain. The machines came in a medical version[2] and an exercise version[3]. The back pain industry saw that the medical machine was working much too well and cutting into their income, so they had insurance companies stop paying for "exercise" modalities, and that approach died. The third section of the book is on the wide range of body manipulation techniques, like pilates, etc.

[0] https://www.amazon.com/Crooked-Outwitting-Industry-Getting-R...

[1] https://informfitness.com/podcast/50-outwitting-back-pain-ca...

[2] https://youtu.be/Ao1CkBbe2nw

[3] https://youtu.be/1Z-FyeG7pqY

i have kyphosis (moderate) and scoliosis (mild). i had debilitating pain at times and thought I’d need surgery. I was lucky and ran into doctors that wouldn’t give me pain meds and insisted I not pursue surgery. Finally in my early 30s read Crooked and took up weight lifting, very slow progression, empty bar for each olympic lift. my back feels _amazing_ now. I never get pain anymore and have a new obsession.

I believe that's the standard currently. My father had back issues and when I consulted my brother who's an MD he said surgery is used as a last resort as it almost inevitably has its own heavy side effects. Pain medication, when used, is symptomatic treatment and not meant to be a solution-- when used it's just to allow a relatively normal life so that you don't lose you job and neglect your kids until you can get your treatment sorted out. Referrals to physical therapists or chiros is the standard, as the best thing one can do is apply simple therapies(hot & cold packs, electric stimulation, local steroid injections to reduce swelling, etc) and teach exercises to strengthen support muscles.

Some doctors can be malicious, but most are just trying to navigate a very difficult issue with little few silver bullets

It appears I am younger than you (late 20's), but this is my experience. I spent 11 months with extremely challenging back pain and sciatica that started the day after snowboarding with lower back tightness. Luckily I had a doctor that encouraged me to wait a year (a year!) on surgery and the injury resolved 3 weeks before the surgery date.

Had I been less patient, I would have been on my 8th doctor/experiment/magic cure and that would have received all the credit.

Golf & Baseball - very challenging.

Running - Not a problem, which surprised me. I ran the NYC marathon 3 weeks ago and felt better than ever. BUT I can feel a definitive reduction in lower back strength, so I've started spending more time on core exercise.

Familiar athletic movements - Totally fine. Basketball, throwing a football, etc all seem to be fine as long as I keep my body under control.

Awkward athletic movements - Wrestling, new sports... basically anything awkward that requires twisting is bad. Seems obvious when written like this, but many sports can surprisingly fit the bill (Soccer, Volley ball serves, bowling, archery, etc)

Sitting and Sleeping - Every once in a while my SO and I sit down at a restaurant and I have to bail out. There are some chairs that just do not work with my back and trigger sciatica in 10-15 minutes. Very confusing, but luckily she's quite forgiving.

Thanks for the very detailed breakdown of activities and experiences with them. I could relate to some of those.

As a counter point, my back problem was chronic for 2months and didn't magically go away by itself.

I was skeptic about physiotherapy only would help, but after a week I had real improvement.

I guess I'm in the box "if I did physio, I'd believe that helped me". However, as long as I was waiting until it goes away itself, nothing happened, or it degraded even worse.

Everybody is different, my advice is, instead of reading random internet healing pro-tips, go to an expert.

Yes, there seem to be many different causes and just as many random internet tips. I'm glad you figured out how to help your back.

My daughter injured her back, she's a competitive power lifter; I was worried because of my own experiences. The causes and successful remedies of her pain were completely different than mine, and her back is now healed.

Go to an expert indeed!

I have some back pain that increases when I drink too much coffee (for a few days). Stress intensifies it, but not nearly as much as coffee.

Interestingly, walking and running improves it too, this one looks like unanimous here.

Unusual exercises increase the pain a lot, but unless there is some extreme level of twisting, the pain decreases as the exercise gets familiar.

Also, for chairs, I found that the most relevant feature is a correct sized seating depth. That's actually a large problem, because the size is standardized in labor conventions so every chair seems to have the same.

Look up “foundation training” , by Dr. Goodman, it’s a different way of moving and looking at back injuries. Helped me a lot!

Is that the same as the book: "True to Form: How to Use Foundation Training for Sustained Pain Relief and Everyday Fitness" by Eric Goodman?

Same person indeed. For me it did a lot of good.

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.

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.

One point to make is to not use the word psychological or "head". That still triggers people to think we're saying they're just imagining it. The best explanation I've seen wasnin Reddit where the person said its circuits in your brain that cause the pain but not your muscles. This is amazing since it clearly communicates that yes it's in your head but no it's not your fault.

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.

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.

Same experience here. I recall hearing about him on HN a long time ago and read his book, which I attribute to helping alleviate chronic back pain.

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.

same here. Heard it on HN, saved my career, and since then try to spread the word in real life or online disussions.

"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.

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.

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.

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.

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.

There are hundreds if not thousands of quack cures for every ailment under the sun. How else, other than scientific process, is one to separate the wheat from the chaff?

You say "crystal healing doesn't work and people shouldn't try it." Why not? Aren't you being closed-minded? How is crystal healing any worse than any other scientifically unsupported remedy?

There's a spectrum between crackpottery and solidly evidence-backed consensus treatments. The middle of that spectrum:

- The existing evidence, although positive, may be low quality, or preliminary.

- The treatment is advanced by some otherwise legitimate practitioners, even if it isn't consensus mainstream.

- The treatment has been used safely in traditional medicine for a long time, and simply hasn't been studied yet in a scientific framework.

- The promoters aren't transparent crackpots, and don't use empty buzzwords like "quantum".

- Any proposed mechanisms at least make some basic sense and don't break the basic principles of physics and biology, and aren't clear woo.

What I am saying is that if a treatment ticks some of the above boxes and is safe, then give it a go. They're less likely to work, but the expected value is high because the costs are low.

Crystal healing ticks none of these boxes and therefore can be discarded with more confidence, since the expected value is low, even though it's true we can't be absolutely certain that it doesn't work.

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.

> 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!

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.

When I had carpal tunnel syndrome 10 years ago someone on HN recommended the Harvard RSI program that follows Sarno’s technique.


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.

> Keep wrists above the pad, and tilt the kbd downward.

TIL! This is the opposite of what I’ve been doing to date.

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!

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.

what's the secret without having to read a whole book?

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.

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.

Yeah a common phrase is to "rule out the life threatening, then rule in mind-body disorder."

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.

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.

Wish I could say the same. It did nothing for me

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.

"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"


"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 …

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.

> 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.

Bloodletting was still a thing a hundred years ago. Medical science went far since then, but not too far.

You should check out this article: 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.

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?

No, there have been sham controlled trials of surgical interventions before, they're just rare. One example is kyphoplasty.

Sham surgery for some procedures. Saline for injections.

I had back surgery and it only helped for 1 year. I can't explain that one either...

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.


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.

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.

In my experience Mg helps me relax and sleep better and Ca relieves the pain. I feel 10 years younger.

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.

> Almost complete sacralization of L5-S1 and bulging disc pressing on nerves.

I have no idea what this is, but the one thing I would have you ask yourself (or the doctors) is: How many people who have this physical condition you have are in back pain.

From what I've read, for example, that most people with compressed nerves/slipped discs do not have chronic pain. If you give a doctor an X-ray of a typical slipped disc, they will not be able to predict which ones had back pain and which didn't.

Yeah, good question. I really don’t know but my guess would be no based on how little most specialists actually know about this stuff

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.

Thanks for the response. I’ve been doing yoga, swimming is not something I’ve tried. Agreed on how crude tools can be effective, I’ve already made lots of changes (I only use a standing desk).

I’m very skeptical of saying being effective, but am open to being wrong. I’ll check out that book, alleviate the rec!

I highly recommend Barbell Medicine's content. Their youtube channel has tons of videos with science backed information for training and dealing with pain, specifically back pain.

Austin Baraki is an advocate for the biopsychosocial model of pain that the parent post is effectively evidence of. I would love if more people read his "Aches and Pains" article: https://startingstrength.com/article/aches-and-pains It contains a lot of surprising information regarding the efficacy of common treatments for pain - and r great argument for why pain is more complicated than a or b being out of alignment.

My advice would be to learn as much about pain, self efficacy, catastrophizing, the nocebo effect, etc. from the Barbell Medicine crew - and if you have the money do a pain and rehab consultation with them. I sincerely think their team is THE best in the world.

Thanks for the suggestion, I’m open to reading another book so I’ll give it a shot.

Been there. Unfortunately once a disc is damaged and starts bulging, it never really can get better. It's odd they discouraged a fusion or disc replacement, obviously I don't know the specifics of your situation, but it was a immediate off-switch to all the pain for me. Did the full gamut of other things including several specious medication recommendations that had me switch doctors several times they were so awful. Steroid injections were a minor relief but not much.

Sadly my US insurance at the time was a right bunch of horrible cunts and refused to cover a disc replacement, only a fusion, but after years of suffering I felt 10 years younger once I was back on my feet hobbling around for rehab.

Well none of the doctors have even discussed disc replacement, only fusion.

I hear you on the insurance front. I’ve had “good” insurance this whole time but I’m still several tens of thousands of dollars more broke now

Going on well over 10 years now with my pain... spinal stenosis and degenerative disc disease. I had an L4-S1 laminectomy and it only helped for 1 year. I've tried all the other stuff you mention as well like cortisone shots, branch blocks, physical therapy, chiropractic, acupuncture etc. and practically nothing helps, even tried basically all of the currently available CBD and THC variants... only thing that always works is really hard narcotics like oxy that I don't want to take for obvious reasons. I can walk on my own for maybe 10 minutes max before I just can't take the pain anymore.

Have you tried this - https://www.youtube.com/watch?v=4BOTvaRaDjI. I found it on reddit and it's been absolutely amazing for my back.

I have not but I’ll give it a go. Thanks for sharing!

I will second fasting as something to try. There is also a comment about taking calcium and magnesium. You might try that as well, plus possibly B vitamins and getting the right dietary fats.

Thanks for the reply! I’ve very consciously changed my diet to one where I pay attention to nutritional content, but yeah I’m sure nutrition has an impact.

I mentioned in another response that I’m very skeptical of fasting doing anything. I’m open to being wrong but I don’t see how fasting could possibly undo real damage to my spine and make the bulging disc stop pressing on nerves.

Did you heard of this book, Pain Free at Your PC? For me it's hard put into practice because of the time demand, but exercises and reasoning is quite good.

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.

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/

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.

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.

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.

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 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.

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:


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.

I'm currently lining up a surgeon to do a nerve decompression surgery, which took me 1.5 years to find a surgeon who even does the surgery, for what took me 15 years to learn on my own is something called piriform is syndrome - for which no other doctor or specialist even looked into relating to "sciatica" pain for which it can mimick; it's no wonder many people suffer without resolution, most doctors don't seem even look at known possibilities.

The mind can also be strong, so it seems you may be able to teach some people who's mind isn't too disabled or interrupted by their pain level to engage more strongly to overcome and mask pain signal(s) coming from their body and therefore "heal" it simply with mindfulness.

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):


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!

Oh, I was agreeing with your remark regarding the issue almost always being in the tissue!

I see now! Sorry, it was way too early in the morning. I shouldn't comment before coffee... :)

Had you changed your diet at all during your journey to problem solve the pain?

Not GP but personally I have found limiting caffeine consumption to help a lot with back pain. More than one cup of coffee (12g of beans) seems to result in exacerbation of any minor back pain I may have on that day. I also now take a day or two off from drinking any coffee after a few days of consumption. With this change, more sleep and some light stretching on some days I no longer have back pain. Oh, I also moved to a firm mattress.

I drastically reduced the amount fat I eat, but I did that to accommodate my partner's new diet, not entirely voluntarily. :)

Did you have any MRIs that showed actual damage? That’s the boat I’m in. I’ve tried a lot of things and nothing has worked so far. I’m happy to give another book a shot, but everything else I’ve read so far has not been applicable.

Yes, I have multiple scans of a semi-herniated (not fully herniated, but thinned and a bit bulging) disc in the lower end of my spine, but it's far from being in the state of needing surgery. My solution was (with the help of the book) to identify and treat my trigger points. Regular swimming and bodyweight exercises also helped/helps me a lot, but they help more with reducing the number of painful episodes, not making the pain go away when I have it. I can do that only with massage.

Gotcha. I’ve been slowly adding weight training to my treatment plan, I really should find a pool… thanks for the response!

I am happy to help! I wish you good health! :)

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.

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"?

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

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-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/ You can find many examples of people in similar situations receiving professional advice from their staff free of charge.

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.

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.

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.


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/)

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.

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

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.

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

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!


> 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.

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.

You're of course welcome to share your experience here, but please don't call names ("woo"). It's against the site guidelines because it significantly degrades discussion. We can all make our substantive points without such swipes.


Completely disagree. If the "woo" you describe is so ineffective, placebos wouldn't be a thing. Sure, there are problems that may require some kind of invasive treatment, but there are also a lot that we seem to include in that group that can be treated with much less invasive procedures.

David Epstein touches on this here [0]: "A unique study at five orthopedic clinics in Finland compared APM with “sham surgery.” That is, surgeons took patients with knee pain to operating rooms, made incisions, faked surgeries, and then sewed them back up. Neither the patients nor the doctors evaluating them knew who had received real surgeries and who was sporting a souvenir scar. A year later, there was nothing to tell them apart. The sham surgery performed just as well as real surgery. Except that, in the long run, the real surgery may increase the risk of knee osteoarthritis. Also, it’s expensive, and, while APM is exceedingly safe, surgery plus physical therapy has a greater risk of side effects than just physical therapy."

[0] https://www.propublica.org/article/when-evidence-says-no-but...

Placebos don't fix issues, if they would, we would sell half placebo pills to save money. They sometimes have some temporary effect.

If placebos worked, we could not use then to gage treatment effectiveness in trials. And treatment passes trial only if it does better then placebo.

>>If placebos worked, we could not use then to gage treatment effectiveness in trials.

What? The reason placebos are used in trials is because they work.

The treatment is considered working when it produces better results then placebo. When the treatment is undistinguishable from placebo, then the conclusion of trial is that "improvements are result of chance rather then treatment".

Placebo is used so that patients, doctors and anyone else is not affected by their expectations/wishes of whether treatment should or should not work.

The whole point is to measure actual physical improvements. You can't replace real treatment by placebos and expect them to have the same results - clinical trials are done so that this is guaranteed to not work with drugs that passed them.

The conclusion is most definitely not "improvements are result of chance rather than treatment". You've also used quotes here but there doesn't appear to be any reference so I can only assume you're quoting yourself :)

I assume you didn't read (or perhaps chose to disregard) the article I referenced in my original comment as that provides evidence to the contrary of what you are claiming. Another much shorter article that you may like to read states "Experts have concluded that reacting to a placebo is not proof that a certain treatment doesn't work, but rather that another, non-pharmacological mechanism may be present." [0]

[0] https://www.health.harvard.edu/mental-health/the-power-of-th...

I used to think about things exactly in the same terms as you do, rejecting anything that didn't have "strong" scientific backing in peer reviewed journals. I considered things like meditation complete bullshit quackery and because of this cynical view I ignored things that could have given me significant help at the time I needed them.

Of course when you eventually hit rock bottom you try everything available and then I realized that ignoring all "non-scientific" evidence is not the correct way to evaluate things.

I had similar experience a couple of times. It is about the mind or you are lazy or exaggerating until eventually actual physical cause is found by random. And it makes massive difference.

And then you find out the fix was available all along. But, they would have to take your issues seriously instead of just dismissing it and blame your brain.

So how do you interpret the results of this study? Patients who went through what you call "woo" did report less pain.

He does not. He was misdiagnosed therefore "woo" is bullshit. Sound logic If I've ever seen one.

Please don't be snarky or take HN threads further into flamewar. We're trying for the opposite here.


Why are you assuming that there is no such thing as psychosomatic pain just because yous isn't? Such an unjustified leap.

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.

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...

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.

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

The corresponding author on this is a very serious scientist, most of whose work is in metabolic resuscitation and cardiac arrest. It's cool to see him applying his skills to this leading cause of disability and suffering. I guarantee you it isn't just "woo".

Not all pain is associated with an existent physical injury. For example I had tears in my achilles last years which have since healed but I still feel pain when I walk. Look into fibromyalgia and nociplastic pain if you want more info. The tldr is that our bodies can react to danger/injuries by increasing our pain sensitivity, which means that minor activities which pre injury caused no pain can later cause debilitating pain even when physically healed. This is why pain is now being explored through a biopsychosocial lens.

It's woo to call anything that doesn't fit into your personal model of reality as woo.

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