A guide to the new science of treating lower back pain.
This is not medical advice of course but one person’s view on a common condition.
Many, if not most, of us have experienced back discomfort at some level and at some time during our lives.
The article discusses one woman (Cathryn Ramin) who fell off a horse at 16 and ended up with back pain for 40 years. Finally she opted, after many other treatments, for a “minimally invasive” surgery. The $8,000 did not fix her back and the pain remained along with new neck aches.
Ramin was a journalist and decided to look deeply into the $100 billion industry and ended up writing a book, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. She will tell you that the medical system is not equipped to help that much. They push towards expensive treatments and interventions and away from things like yoga or psychotherapy which seem to help. This universal ailment almost seems to have no cure for many.
She does a series of exercises call the McGill Big Three (described later) to maintain her back. While yoga, massage, and psychotherapy have been around a long time, there is little high-quality research to understand their effects. She read many articles and research studies and to experts and researchers. Some approaches help a little but with modest effects. No one dies of this kind of pain, but it reduces quality of life, frays relationships, and causes missed days of work. She states that $10 to $20 billions of productivity is lost annually.
Most suffer from “nonspecific low back pain” which means it has no detectable cause, such as a tumor, pinched nerve, or infection. It can be short-term lasting a few days or weeks or be chronic which lasts 12 weeks or more. Many times, the medical community recommends bed rest, surgery, steroids, or pain killers including opioids which can be highly addictive. Studies show that these powerful drugs were no more helpful than anti-inflammatory drugs and acetaminophen. Opioids might even heighten the pain long term. Spinal fusion did not seem to be helpful long term either. Steroids might be helpful in the short term, but the effect dissipate over time. It’s becoming clearer that what’s going on in your brain matters too. Psychological and social factors weigh in also. Stress, depression, anxiety, and catastrophizing make things worse. A new understanding of pain, “central sensitization” suggests that changes in the body and brain heighten sensitivity so that things that don’t hurt are perceived as painful. This may be malfunctioning pain signals.
Fortunately, the medical community is looking at more non-drug therapies such as exercise, massage, acupuncture, tai chi, yoga, psychotherapy, and chiropractic. It’s recognized that none of these are a panacea. They work for some but not all and fortunately are not harmful. Chiropractic may provide relief in the short term but avoid ones that routinely x-ray or do advanced diagnostics or recommend extended programs of care. Regarding the other therapies, if it works for you, then do it. Most have not been subject to rigorous studies and some as acupuncture are controversial.
Doctors are thinking that exercise is better than rest for several reasons. It increases strength, flexibility and range of motion as well as improving blood flow. There is no on winner, but they all contribute to improvement. It may not help in the short-term episodes but after working through that, exercise is something that should be part of your efforts to recover.
Yoga, Pilates, and tai chi seem to help but may not be better than other exercises. (personal note: as a practicing yogi for 15 years, being with others in a class and exercising is socially beneficial as well as helping each other along our journey to good health). The bottom line was, any exercise, is better than no exercise. If it works for you, do it.
The McGill big three includes three exercise you can do at home and no equipment is needed. (see https://www.acefitness.org/resources/pros/expert-articles/7077/low-back-exercises-stuart-mcgill-s-big-three/ or search for the term to find many references and videos). The three are: curl-up; bird dog; and side bridge. The author also recommends finding a clinician who understands how your body works by observing how you walk, sit, stand, and overall posture. You are looking for a “back whisperer” she says. A multi-disciplinary approach can make strides in care as there is an interplay with pain, mood, and coping skills.
The insurance industry is not a lot of help either since most programs make it easier to get opioids or surgery than to obtain a massage or exercise program reimbursement. Some state such as Oregon have broader coverage through the state level Medicaid which covers behavioral factors as well as other modalities.
In wrapping up, Belluz mentions John Sarno, a NYU professor of rehab medicine and back guru. He thought that the brain distracts us from experiencing negative emotions by creating pain. We may not want to accept uncomfortable truths, so we focus on pain. He views chronic back pain as a “biopsychosocial” condition. It’s not just what’s going on in your body and back that matter. Cognitive behavior therapy is being used now for more treatments.
Vox Magazine, Julia Belluz 7/27/18