The Price of Pain

Shame on Newsweek. I am a Neurologic Surgeon, the specialty that preforms most spinal operations, and as our association has stated time and again herniated discs RARELY cause low back pain. The fact is that only one in three lumbar herniated discs ever come to clinical concern and then only with radicular or limb symptoms. In those situations 3 different studies performed first by Canada-the Quebec study- then the United States-Agency for Health Care Research-and finally by the European Union have found that the treatment of choice for radicular pain lasting longer than six weeks is surgically. Chiropractic management, PT and injections either have no place or should be used in the first 30 days. Surgical management is CHEAPER and is more enduring. The success rate for a simple discectomy for disc herniation approachs 98%- there is up to a 20% recurrence rate that is not influenced by the fact that the patient had surgery or not-this is the natural history of the disease. These are the facts.
Instead of telling this story the authors of the article focus on the grey area of low back pain. Very, very few patients with LBP are surgical- the majority of back surgery is done for radicular or overt structural problems, not for pure low back pain. LBP is primarily a functional problem-weight, tobacco use, deconditioning, etc.. Every reputable practice guidline including those published by the American Association of Neurologic Surgeons requires that all remediable factors are managed BEFORE any sort of intervention- be it PT, chiropractic, pain management, or finally surgery. If your back hurts, chances are VERY high that you are overweight, deconditioned, smoking or all of the above.
Lastly remember that physicians don't confer health on people- ultimately it is the patient's responsibility to become informed-internet, second or third opinions, talk to people who have had similar problems, etc, etc.. We live in an information age, and if people passively accept what they have been told, or refuse to become participants in their own care they bear more than a small amount of responsibility for their failed back.

Perhaps when the allopathic (drug and surgery) physicians are prevented from initial contact with patients until examined by a chiropractic physician, I might come out of retirement. Until then, the $2 billion spent on drug ads every month keep it a 'drug 1st' society. And lose some weight, America-it's more embarrassing than our foreign policy. There, I feel better now...

AMAZING. It's amazing that in a three-page article (not sure how many pages it is in print), chiropractic wasn't mentioned ONCE. Instead the answer is eat well, lose weight, take a pain pill, and let it work itself out. How about trying a chiropractor? Chiropractic is over 95% successful in treating back and neck pain. Where does it say that in the article? I'd be curious to see the print edition and see how many drug ads are flanking the pages. When will they learn? On the other hand, the article did point out that the surgeries that cost thousands of dollars are essentially ineffective. That's a step in the right direction, I suppose.

I wish they would come up with something that would be a cure for chronic back pain. I was in a freak boating accident 2 years ago. I fractured a lumbar disc and had a "Vertebroplasty" (sorry about the spelling). Basically they injected a medical "cement" around the disc to stabilize it. However, I have had back pain ever since.
I now only get 4-5 hours of sleep a night. Sometimes I get 8 but usually because of sheer exhaustion. After 8 hours I wake up in terrible pain and sit at the side of the bed trembling and trying to control severe nausea because I hurt so bad. X-rays and MRI's haven't revealed anything wrong. They say everything is spaced correctly and no degeneration.
I have tried muscle relaxers and pain pills. I still take a pain pill every now and then but never more than one a day for fear of addiction. I have seen a chiropractor and massage therapist that have provided modest short term relief. I try not to let it stop me. We have a two week Central America trip coming up and plans for a ton of hiking and scuba diving. I'm 36 and do worry what old age has in store with me though.

Most poeople -- especially medical doctors - don't understand the mind/body connection when dealing with back pain. I didn't either, until i suffered from intense shoulder and neck pain and no doctors could diagnose the problem accurately. I went to the emeergency room, saw specialists, had injections, strong pain meds, and physical therapy. It was all a joke. Then i picked up the book Healing Back Pain, by Dr. John Sarno, and the realization that my pain was stress-induced and could also be cured by my mind was invigorating. Immediately my body healed on its own because of that realization, and now I can control my symptoms whenever i start to feel the twinges in my shoulder muscles.

I've had low back pain for over 25-yrs, I'm currently 45 yo. I have multiple herniated discs and irregular spinal curve which is basically flat no curve. When I was in my early 20's a kaiser Doc suggested lower back surgery, during the preOp consultation i elected not to have the surgery, and do not regret doing so. Since I've tried martial arts which made my back worse, and basic exercise and stretching had some improvement. it wasn't until I started physical therapy to strengthen my core improve flexability that I experiences consistant pain relief and better mobility. But the best I've found is Hot Yoga coupled with ongoing core exercise routine. The yoga is by far the best medicine and a must for pain relief, overall stregthening, and flexability. Yoga works the whole body and the secondary muscles groups. Medicine and surgery seem to cause more problems than they alleviate.

I've had low back pain for over 25-yrs, I'm currently 45 yo. I have multiple herniated discs and irregular spinal curve which is basically flat no curve. When I was in my early 20's a kaiser Doc suggested lower back surgery, during the preOp consultation i elected not to have the surgery, and do not regret doing so. Since I've tried martial arts which made my back worse, and basic exercise and stretching had some improvement. it wasn't until I started physical therapy to strengthen my core improve flexability that I experiences consistant pain relief and better mobility. But the best I've found is Hot Yoga coupled with ongoing core exercise routine. The yoga is by far the best medicine and a must for pain relief, overall stregthening, and flexability. Yoga works the whole body and the secondary muscles groups. Medicine and surgery seem to cause more problems than they alleviate.

I have used chiropractic for over 20 years for neck and then low back pain. The pain got worse 3 years ago and my primary care MD referred me to a pain management clinic. I spent 2 years doing acupuncture, trigger point injections, physical therapy (along w/chiropractic), and finally disk injections. After 2 years of trying everything else, I was referred to a surgeon. He referred me to a pain psychologist to determine my need and readiness for surgery. After 6 months I did have a lumbar fusion w/implants due to degenerative disc disease and spinal stenosis. This was done by my surgeon who felt that I had exhausted my options and was starting to fall. I also had a fusion in my neck. I don't regret it. It did help and yes I still had to do exercise, stabilize my core, and watch my diet. I felt my medical team worked well together and that I wasn't lining anyone's pockets. I can't imagine what my life would be like if I had not had the surgery. I think we need to remember that we shouldn't stereotype individuals by categorizing them. Each patient is different and should be treated as such. Articles such as these are confusing to those looking for real answers. I think you have done your readers a real disservice by publishing such an off the cuff opinion. Could be my meds, but I don't recall there being any numbers of patients in pain in the studies mentioned. That leads one to question the statistical significance of the "research" presented, nor were there mentions of other modalities of treatment being used to justify the conclusion. Food for thought.

I used to have terrible back pains. Through a combination of acupuncture and Yoga practice, I'm now pain free. Surgery is rarely the answer for back ppains. I highly recommend that people check out alternative treatment such as acupuncture, as well as Yoga and relaxation techniques.

All the commentary by chiropractors is very intertesting, particularly when one realizes the preponderance of evidence from well designed clinical trials indicating value in the limited use of spinal manipulation has been done by physical therapists. This must, however, be taken in the context that manipulation is not appropriate for every presenting patient.
The reality is that back pain is, indeed, a multifactorial, complex problem. There is no magic bullet. The article and research has numerous flaws which are eloquently stated by Dr. Fessler. As is typically the case, the popular press fails to adequately assess research and makes dramatic, sweeping statements.

Most back pain is caused by the psoas muscle. Unfortunately the medical ignores this possibility.

The psoas (pronounced "so - az") primarily flexes the hip and the spinal column. At about 16 inches long on the average, it is one of the largest and thickest muscles of the body (in animals it's known as the tenderloin). This powerful muscle runs down the lower mid spine beginning at the 12th thoracic vertebrae connecting to all the vertebral bodies, discs and transverse processes of all the lumbar vertebrae down across the pelvis to attach on the inside of the top of the leg at the lesser trochanter.

It is the pressure of tight psoas muscles that squeezes the vertebrae and disks. When the muscle becomes contracted due to injuries, poor posture, prolonged sitting, or stress, it can alter the biomechanics of the pelvis and the lumbar, thoracic and even cervical vertebrae.

The psoas can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side. The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis, lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.

It can also pull the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging or tearing, especially with twisting and bending movements.

What about patient responsibilty and follow through with conservative care to prevent surgery and following through with aftercare to increase positive benefits of surgery. It is important to take care of your own body, everybody wants a quick fix but its your responsibility to lose weight if you are overweight, get in shape, learn and use proper body mechanics - I realize this won't cure all back pain it would signigicantly reduce the occurences and increase the success of conservation treaments and post op success

What about the responsibility of the patient pre and post surgery and in the prevention of surgery - lose weight, get fit, strengthen your core, take care of your own body. Everybody wants the quick fix but if you spend the time learning proper body mechanics, strengthening weak muscles and lengthening tight muscles a majority of back pain will resolve.

Sadly, this article is terribly symbolic of the type of dismissive attitude the medical profession harbors for chiropractic. With years of patient testimony and ever increasing scientific data, the belligerant exclusion of chiropractic care as the most consistent and effective course of care is so blatently obvious that it makes this article and Dr. Deyo laffable. Maybe if these sort of MD's weren't so focused on power and prestige but the desire to help their patients, they would research the benefits of chiropractic and make the appropriate referral or suggestion.

2 and a half years ago, I suffered a major hernia in the L5 vertebrae of my lumbar spine. The pain was beyond belief, far worse than child birth. At the emergency room they did an MRI and the surgeon wanted to operate. He told me that if I didn't get the operation I risked permanent paralysis. Despite the pain, I refused the operation and went to my Chiropractor. Thank God I did. I was very quickly well again and have not had any problems since. But I have learned that there were very serious risks attached to the surgery that could have actually left me in a wheelchair.

Don't go to a barber unless you don't want a haircut.

Shouldn't we all cast a jaundiced eye on the opinions of a "spine surgeon" in such matters? I'm sorry, NWdoc1, but my experience has been that I never (and I mean never) met a surgeon who did NOT recommend surgery when it was an option for treatment. After a while, one can't help but see self-interest shape professional opinions of doctors. Doesn't that make those opinions "at best, uninterpretable and at worst, misleading?"

This is in response to Dr. Fessler. I have all the respect in the world for the medical profession and all the miracles that happen each and everyday with the practice of medicine. However, I take exception to the HOGWASH that you have written here. It's just like the medical profession to put some kind of spin on the fact that pharmacological and surgical management for most spinal related problems simply is NOT EFFECTIVE. It would be nice, one of these days, for people like you, a well respected Neurosurgeon I'm sure, to wake up and start researching how and why CHIROPRACTIC CARE IS SO EFFECTIVE WITH THESE TYPES OF PROBLEMS. You can comment on how the Newsweek study was performed and what kind of parameters surround it, but the bottom line is that your profession and the surrounding medical community has to acknowledge the efficacy and validity of Spinal Manipulation performed by a Chiropractor (AND A CHIROPRACTOR ONLY, NOT OSTEOPATHS OR PHYSCIAL THERAPISTS WHO THINK THEY CAN PERFORM JOINT MANIPULATION) who has virtually perfected the art of a short lever spinal adjustment. There are alternatives and I can't tell you how many spinal surgery patients have come into my office and seen relief in only a few treatments and forever regret not giving CONSERVATIVE CHIROPRACTIC CARE A SHOT. Please wake up and tell the rest of your profession to start referring to the DOCTORS who truly know what to do with musculoskeletal disorders. What do you possibly have to lose?!?!
Respectfully
Backdoc-