Do back problems make sense to anyone?

Factual Questions
1

I found this thread oddly prophetic, since virtually simultaneously with its posting, my back likewise went out on me for 24 hours in a totally mysterious fashion Wednesday morning.

Oddly enough, I awoke around two a.m. on Wednesday and, on my semi-conscious trip to the bathroom, actually remarked to myself “Hmmm, you haven’t had any back problems for quite some time now, self, Way To Go!”, peed and promptly went back to sleep. When I woke up three hours later, I was in excruciating back pain.

Actually, I was in pain (similar to the crucifixion, with the agony being localized on my lower back of course) only when I attempted to get out of bed. I writhed around in bed for an hour or so, positioned myself every conceivable whichaway to hoist myself out of bed, and when I finally did so, felt a pain that allowed me only to express lament that God had forsaken me. I finally threw myself back into bed and (long story short) contrived to get myself some Advil, which, with the help of about 150% of the recommended dose plus 24 hous of bed rest, persuaded my back to let up on me a little.

Today, my back is fine. My GQ is: Does anyone understand WTF caused my back to seize up on me in the above-dramatically-told-but-100%-accurate narrative out of freaking nowhere for no conceivable reason? I’ve broken bones in my time, mind you, without realizing at the time that I’d done so (stress fracture in the meta-something bone in my foot), but my doctor explained to me what I’d done, and it made some sense to me. When this happens (maybe half a dozen times in my life) no one can make any sense of it to me whatsoever.

Sometimes I think that lower back agony is a kind of virus–that’s how it feels. I perform no acts involving stress of any kind on my lower back, but nonetheless am transformed into a suffering bag of protoplasm for a period of time, attempt vainly to treat the symptoms for a while, and the agonizing symptoms mysteriously vanish of their own accord after a period of time. This makes no sense to me, but neither does back pain. What action could I possibly have performed in a few hours of peaceful uneventful sleep to take me from congratulating myself that my back had caused me no discomfort at all to feeling like a prisoner under torture clearly outlawed by the Geneva Convention?

When I ask my doctor WTF happened, he explains “Shaddup and take these muscle relaxants.” I read two books by John Sarno, Back Pain Genius, but if I told you what HE thinks my back pain is all about, I’m afraid you’d laugh at me, that’s how counter-logical and downright silly Sarno’s “thinking” is–much loopier than my loopy viral theory of back pain (basically it involves treating one’s back as a sentient being, and asking it all sorts of questions as to why it has decided to cause one such agonizing symptoms.) Does anyone understand whence lower back pain comes, and how it might be treated? If you like, you can try to persuade me that Sarno’s the Man, and explain his ideas to me, but you’d have an easier time persuading me that little leprechauns sneak into my bed and fill my lumbar region with Unlucky But Magical Lower Back Pain Charms, frankly. Otherwise I’m open to explanation, whether they be viral, neuro-muscular, astrological, political, etc in nature.

2

I skimmed to get to the crux of your post. I ain’t a doc, but I’ve been through the back problems enough to know. Broken bones are relatively simple whereas the back is very complex. Your back pain could be muscular and/or skeletal. Add to that how it may be a pinched nerve due to a slipped or herniated disk, or simply an irritated nerve rubbing against the spine.

I have a stenosis - the narrowing of the passage where the nerve exits the spine. When I heard this diagnosis, I thought surgery was my only option. To my surprise, the body is quite resilient. The body responds well to exercise and rehabilitation. So, don’t just jump into surgery…which offers no promises, either.

What DOESN’T make sense is that they claim it’s all because we walk on two legs which places tremendous stress/strian on the lower back. However, I have found that other animals can have back problems. I can only WAG it is less common than how it plagues man? - Jinx

3

I had my first lower-back episode about twelve years ago. Among the doctors I talked to at that time was a neurosurgeon who explained it this way. In the hours or days prior to the intense episode, the back muscles have been subjected to what he called “a series of small insults”. These are usually periods of exertion, heavy or improper lifting, longs periods of standing, etc. The back muscles respond by defensively tensing or contracting, even while the body as a whole is at rest. After this condition has persisted for a while, simply bending over, sneezing, or rolling over in bed may cause the lower back muscles to go into spasms. That’s my memory of the explanation. The solution, in my case, has been to improve the strength of my abdominal muscles by doing situps and crunches, and to treat any episodes of pain using the R.I.C.E method: Rest (lying on my back on the floor), Ice (not heat), Compression (one of those silly-looking trusses or girdles from the pharmacy) and Exercise. I know that in the midst of an episode exercise seems impossible, but it can be done and it helps. You can lie on the floor with your knees up and flatten your lower back against the floor, holding that position for a few seconds, then releasing. It’s a gentle exercise that really does help while you’re having spasms. The situps and crunches can wait until the episode is over. Good luck with your back.

4

I triggered my most intense back pain episodes by doing pretty innocuous things. The first time was when I was a strapping lad of 25 years. I was cleaning my bicycle. I bent over, tipped it forward by the seat with my left hand and turned the pedal with my right. POW! I was in bed for a day and it took days to just stand up straight. That episode was preceded by six months of moving pianos. Another bad one was when I was changing a diaper. I was sitting on the couch and turned to the left to do the diaper thing and a couple days later I was at the doctor hooked up to electrostim and taking muscle relaxers. Crotalus’s neurosurgeon’s explanation sounds right to me. I often see my back as a clockspring that gets wound up, then it snaps, causing all sorts of mayhem. I’ve been able to function fairly normally (exercise, yardwork, playing with the kids, etc.) by constantly monitoring the stress on my back. After almost 20 years I know the signs of when it’s time to quit.

5

I don’t want to seem like a logical nutcase to you folks, but does that explanation really make sense? It may be correct, for all I know, but why would back muscles behave differently from other muscles? For example, if a runner pulls a hamstring muscle in a race, no one would attribute the injury to months of training during which stored-up (??) pressure on the hamstring suddenly manifests itself during that race. Quite logically, the injured hamstring is attributable to forces such as strain being applied DURING THAT RACE. No runner ever, for example, ever injures his hamstring by sneezing or sleeping 24 hours after a race, does he? So what’s so special about back muscles that they, and they alone, manifest symptoms of gross injury at a time far distant from the actual trauma itself? Does this theory of ‘stored up trauma’ really make sense to anyone? Has anyone gotten shot by a bullet that failed to pierce the skin only to find himself with a bullet wound at the spot 24 or 36 hours later? If I showed up in the ER with a fresh hole in my torso and claimed I hadn’t been shot, but I was fooling around with a gun last month, would anyone really take those claims as being anything other than loopy?

6

But it could be attributed to months of training where strains occurred but were not allowed to fully heal, right? The big race comes along, maximum force is applied and an already weakened muscle or tendon is seriously injured.

7

IIRC, John Sarno’s take on back pain was a bit more lucid than you imply, although it may still be a bit hard to swallow. Basically he feels that back pain is instigated by the unconscious mind to divert you from emotional pain. He theorizes that the mechanism for this is mild oxygen deprivation effected by vaso-constriction. He feels that once you are educated about this process (by reading his book), your unconscious mind no longer follows that path (i.e. you don’t have to go to a psychologist to cure it). Obviously reading his book did not do it for you, but its not like he was telling you that your back pain was caused by body thetans.

I don’t have any strong feelings about his theory anymore, but there was a time when I swore by it. One thing that convinced me at the time was that whenever I had some other source of physical pain, my back never bothered me (that may have been coincidental or simply selective observation).

As far as treating back pain, here is my suggestion. First, see a doctor to rule out any gross problems or degenerative diseases of the spine. If a doctor suggests surgery, think long and hard about it and get at least one more opinion. As Sarno points out, xrays & mris will often find malformations of the spine, and those malformations rarely correlate to back pain (the same malformations can be found in people without back pain) After that, go to a physical therapist. They will stretch you in ways you might not be able to do alone and give you some exercises. It ain’t much of a suggestion, but it might help. Good luck.

8

Wow. Another classic misread thread title. I was wondering how you could be so insensitive to the plight of black people. :slight_smile:

9

Hey, I posted in that thread, and I’m the guy that mentioned John Sarno. I actually was treated by him. All I know is that after ten years of back pain, two surgeries, constant medication, and then having a neurosurgeon recommend a third disc removal, he was the last physician I ever saw for back pain, and that was more than two decades ago.

Whenever someone has back pain, they always look back and find where they injured it, sometimes weeks in the past. It was moving that refrigerator yesterday, or waterskiing last weekend, or changing that tire two weeks ago. It’s a case of correlation, not causation. Think about it yourself, any one of you could come up with an explanation for back pain right now, whether you currently feel any or not.

It doesn’t make sense, has anyone ever lifted a couch and found his arm hurting not the next day, but the next week? But people are always claiming this for back pain.

Dr. Sarno claimed that even if you were shown X-rays with “bulged” or herniated discs that didn’t necessarily mean anything. He claimed to be able to find the same structures in people who had never experienced back pain.

His explanation for the cause of back pain and spasm is muscle hypoxia caused by psychogenic vasoconstriction. It’s too complicated for a brief post, but it’s not magic pixies.

Dr. Sarno’s theory is that the vast majority of back pain is psychogenic. If you outright don’t believe in psychogenic disease, no explanation will convince you of this one. If you do believe in psychogenic illness, why do you not believe that back pain could be one?

10

Well, let’s just say I’m appropriately skeptical. “Psychogenic disease” (polysyllabic obscurantism for “it’s all in your mind”) has wrongly explained many uncurable illnesses for which someone finally discovered a physical explanation, at which point the “psychogenic” explanation fell by the wayside. Can you name me two or three other medical condition that are explained by “psychogenic disease”? As medical science develops, we come up with increasingly physical explanations for things formerly attributed to “it’s all in your mind” (ulcers are not caused by anxiety but by a virus, I believe, and even purely mental illnesses have been found to have their roots in chemical imbalances rather than childhood perceptions, as was formerly thought). But back pain, and back pain alone, is somehow attributed to these mysterious and basically inexplicable “psychogenic” explanations.

is there a plausible reason that back pain (and not foot pain, or stomach pain, or upper lip pain) should result from subtle psychological trauma? When your upper lip splits open, does a doctor waste a moment’s time inquiring as to the psychological roots? Does he ever advise you to “talk to your lip and see why it has chosen to bleed. Maybe it’s trying to communicate with you”? That would be arrant horseshit if someone tried that, mainly because you can see a direct correlation between bleeding, say, and getting a punch in the mouth the night before. No big mystery there, nor anywhere in medical science.

Except the back. There it’s all mumbo-jumbo, big words, explanations way too tortuous to be set down on the SDMB. I don’t buy it, though I don’t discount your experience. This has several earmarks of the quack cure-all to me. You say you were cured, and I believe you. But if you were cured, and three of Sarno’s other patients were not, that suggests that maybe your back pain would have gone away by itself anyway (as mine frequently does) and the other three continue to suffer through life.

The thing about medical science is that it’s competitive. Someone who lights on a miracle breakthrough–a Salk or a Sabin–wins immortal fame. Polio is cured, by methods that make sense. It doesn’t work only for a few patients who “believe” in mysterious inexplicable crapola–the vaccine works for everyone, and Salk is justly known for this discovery. Seems to me if Sarno had discovered 20 years ago a technique or a method for curing back pain–which causes the western world to lose umpthy zillion workdays, and for people to collect lifetime disabilities—we wouldn’t have any competing theotries of back pain treatment. He found the answer. Period.

Only he hasn’t, has he? He was seen as a crackpot with a loopy theory, and some devoted patients, twenty years ago, and that’s how he’s seen now. How come? Why have no major universities named their science centers after this revolutionary genius? Why no Nobel? Why is he still operating a lonely clinic in lower Manhattan, same as twenty years ago? Why is there even a single alternative theory to Sarno’s theory about back pain? I could be wrong about this, but it seems to me that someone who finds a cure for back ailments would be far more acclaimed than Sarno is now. His career path has followed that of charlatans far more closely than it has followed the path of a man who has cured a serious and widespread disease.

Again, I don’t mean to belittle you or mock your treatment. I envy you. But when I review Sarno’s treatment methods, something doesn’t add up to me, and it doesn’t help that you claim to be utterly unable to summarize it in scientifically sensible terms here on the SDMB.

11

Absolutely. But the equivalent would be someone racing for months and months with no symptoms whatsoever, who falls asleep, or takes a week off racing to read in a chaise longue, which triggers a torn hamstring. That doesn’t happen, does it? There’s no stored-up psychological tension that causes a hamstring at rest to tear itself, is there? But that’s exactly the explanation that’s offered (and accepted) as the plausible one regarding back muscles, mainly (I argue) because we haven’t yet figured out why it happens, and it makes (slightly) more sense than malevolent leprechauns.

12

Well, you’re the one that asked the question. I can’t help but note that you have offered no alternate explanation yourself, and seemingly have two sets of rules. You have back pain that comes and goes, as you admit, without any cause whatsoever. When someone offers a mechanism, you throw up your hands and say that it makes no sense. If you’d at least offer an alternative, I might take you more seriously. I’m sure that being told you don’t have a bad back, you have a bad brain is distressing.

As far as me not being able to explain it succinctly on a message board, that’s a little unreasonable. As a matter of course I’m unable to explain anything succinctly, and I am not a medical professional, or amateur.

Again, I did not have a bad weekend of back pain. I had 10 years of back pain, was hospitalized on many occasions, had two discs removed, one in 1976 and one in 1981, and was told in 1983 that I needed a third one removed and a spinal fusion. I gotta say those are the guys with the mumbo jumbo, that was over twenty years ago and I seem to be fine. Ask one of them for a brief explanation of why your back hurts, see what you get. Better yet, ask two of them and compare the answers.

Here , and here , and here . and here, and here, and here are some articles about ailments with psychogenic components.

13

I’ll check out your links. Thanks.

As to having no alternative explanation myself, well, yes, that’s why this is “General Questions,” not “General Questions With Plausible Alternative Explanations Supplied.” Your testimony is powerful evidence, but I’ve also explained how charlatans often have people sincerely attesting to their treatment (and plenty of people on whom it doesn’t work, from whom you never hear.) I’m naturally concerned that no one (including Sarno) explains his practice so that it makes even provisional logical sense to me (TALK to your back? Please) and I’m concerned that his discovery hasn’t been embraced by the medical profession. If I were a young orthopedist, looking to set up a successful practice, I might look at Sarno’s methodology, apply some of my recent medical training to it, say “Hey! This makes a modicum of sense, and the world is crying for relief from back pain. I’ll set up a mini-Sarno practice, and I’ll be set for life in a few years, maybe a few weeks. This is a great opportunity.” The fact that there are not Sarno-style Back Pain treatment centers all across the country disturbs me and concerns me. Both this absence and the absence of compelling common sense in the theory itself are, I think you’ll have to agree, fairly compelling reasons to doubt. I mean, you’ve got Christian Scientists telling you (I presume) that prayer is an effective way to deal with back pain, but I don’t notice you running out to become a Christian Scientist. Why Not? Because you’re a sensible guy who says “Prayer cures back pain problems? Hmmm, sounds a little fishy to me,” right?

14

It’s funny that all those people out there who say it isn’t a real cure, and that it’s a placebo effect and my mind has made me well are not willing to concede that it was my mind that was making me sick. As far as the concern that there aren’t Sarno style clinics all over, I’ve got nothing. I’ll tell you this, I saw John Sarno twice, over twenty years ago, and never again. I never even bought a book. He’d have had to charge me a metric buttload of money to be getting rich off that.

I’ll tell you one problem I have with the Sarno method. If we stipulate that stress can cause vasoconstriction, and that knowing that your bad back is caused by this vasoconstriction will prevent the stress from manifesting in this way, where’s the stress gonna go? If it filled some psychological need I have to coccoon up in my house, unable to leave because of back pain, won’t that need then remain unfilled? As far as I remember, he doesn’t address that at all, which might be thought of as irresponsible, like treating someone with a anti-coagulant without telling them to be careful around sharp things.

15

I know you’re being metaphoric, but viruses can cause that sort of pain. I had a virus about five years ago whose entire symptoms were: stuffy nose, voice loss, and severe back pain. A few days later I was fine, but it sucked big time for the duration.

16

Not entirely. A viral explanation at least makes some sense. I presume someone has studied back pain and scientifically shown that it CAN"T possibly be viral, but several similarities plainly exist: unknown causation, severe symptoms, usually symptoms are gone without treatment of any kind in a few days.

17

Um, going out on a limb here, but have you seen a chiropractor? My spine curves backwards, and I have cervical ribs, but seeing a chiropractor helped ease the pain. As far as mysterious back pain after sleeping, you may have tossed, turned, stretched or pulled your back in the wrong way while you were sleeping, and didn’t realize it even happened.

18

I have–one of my best and most trusted former students is now a prominent chiropractor, though between you and me that also seems like mysterioso mumbo-jumbo to me. But I went, and it didn’t seem to do all that much. Felt nice getting stretched out, but I couldn’t see how I was being helped particularly. It was covered by insurance, and my then-girlfriend was going every week and insisted I go too, so I went, but I hardly saw any real results.

Again, have you ever heard of any other chronic injury occurring as a result of traumatic but unnoticed events that occurred while sleeping? Have you ever said, “I must have broken this bone while I was asleep, but didn’t wake up from the trauma”? Or “I must have snapped this tendon while asleep from being curled up in the wrong position”? That’s crazy talk, right? How come that makes sense to you if we’re talking about back pain?

19

Your first link mainly dealt with symptoms that were almost indistinguishable from
faking, and much of the article was about mentally-ill patients pretending to have physcial symptoms to get attention. Is that how you would describe yourself before you went to see Sarno? Did he persuade you that you weren’t actually suffering back pain but simply were seeking attention? That’s not how I remember his treatment.

I’m not denying that Munchausen’s Syndrome and various types of hypochondria exist. But Sarno seems to be saying something very different from these doctors you cite. I don’t think he devotes a iota of his attention to patients faking back injuries for attention (and I’ve never heard of such a thing). Instead ALL of his patients are suffering a real pain in their backs that is caused solely by a psychological blockage. Isn’t that how you’d describe it? The cases you’re citing (I couldn’t find the ‘psychogenic’ reference in your third link, so I gave up there) are a tiny minority of patients complaining of eye pain, or epilepsy or whatever (the vast majority of whom have actual treatable physical causes to their complaint, and of the small minority who don’t, most of them seem to be pretending they’re in pain when they’re not.) But Sarno seems to claim that back pain in general and typically is caused by psychological roots, not physical ones. That’s a very different sort of claim, no? The links you’ve provided concern rare psychological causes for physical complaints. Sarno explains back pain as being caused by psychological roots in general.