Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back - Softcover

Stern M.D. Ph.D., Dr. Jack

Softcover

ISBN 10: 1583335463 ISBN 13: 9781583335468

Publisher: Avery, 2014

Synopsis

A totally new paradigm for treating back pain
 
Virtually every American will suffer from back pain at some point. Dr. Jack Stern, a neurosurgeon and professor at Weill Cornell Medical College, brings relief to these millions of sufferers (including himself) who literally ache for help. Based on the latest scientific data, Dr. Stern developed a five-step solution with a multidisciplinary, holistic perspective that’s been missing from conventional back pain wisdom:

• Step One: Unlock your back’s unique pain code
• Step Two: Prepare to work with health care professionals
• Step Three: Ensure proper diagnosis
• Step Four: Embrace various pathways to healing
• Step Five: Live a life that supports a strong, healthy back

Engagingly written and chock-full of enlightening case studies, Ending Back Pain finally shares the program that’s already helped more than 10,000 grateful patients.

About this title

About the Author:

Jack Stern, M.D., Ph.D., is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York.

Excerpt. © Reprinted by permission. All rights reserved.:

Preface

I COULD CLAIM THAT IT was my wife’s fault. The year was 1990, and over the Labor Day weekend we’d traveled to Martha’s Vineyard to celebrate my birthday. Judy’s gift to me was a “special” massage that she’d thoughtfully scheduled, with the idea that it would help ease my chronic low back pain. But this wasn’t the usual massage rooted in the simple pleasures of Swedish wisdom. This was going to be an experience that had the masseuse gently walking all over my back. As I made myself comfortable on the cushioned table, I pictured a petite lady kneading my back muscles with her dainty feet. Instead, I met a rather robust, Teutonic-looking woman who proceeded to stomp across my back as I moaned and groaned in silence. I really didn’t want to appear wimpy, but I finally had to stop the massage because the pain had taken hold of me and began to sear down my leg. I soon learned that all the narcotics on the island did little to interrupt the connection between my brain and my back pain.

If I had to describe the pain, I’d say that it felt like electrical shocks shooting down my right leg. Though it came on gradually, over several hours, I reached a point where I couldn’t move or even find a comfortable position. I knew I was in trouble when the doctor in the ER offered to call the Steamship Authority and arrange for an emergency spot on the ferry to get me off the island. Luckily, we had taken our station wagon, so I had a reasonably comfortable ride home with the seat in the maximally reclined position. I never before appreciated Percocet and Valium so much!

Judy had called ahead to one of my colleagues, an anesthesiologist, who specialized in pain management so that by the time she dropped me off at the hospital, I had a team waiting to perform an MRI. Going by the images, they were prepared to perform a relatively quick and easy procedure. I had already diagnosed myself as having a disrupted lumbar facet joint, something you’ll read about shortly. This procedure involved what’s called a facet block, and I went home about an hour later, pain-free. I was fortunate to have such amazing access to proper medical care, and the knowledge to quickly figure out my problem. I know that millions of people are not as privileged when something goes so terribly wrong. This is in large part the reason why I wrote this book.

Without a doubt, that experience deepened my understanding of what many of my patients endure, and made me a more empathetic physician. It has allowed me to better understand their plight and have a profound appreciation for the mysterious and sometimes elusive nature of pain. It also has further empowered me to listen to and learn from them, for if I had to say what has influenced me the most throughout my career, it has been my patients. They have been my greatest teachers. Although we experience pain that is unique to each of us, there are patterns of pain—patterns that allow me to better understand the source of pain and enable me to venture a diagnosis and suggest a treatment plan based on how others with the same pattern found relief. In this respect, the diagnosis and treatment of back pain are no different from those for any other disease. They require a thorough history and physical exam; they also usually call for laboratory and/or imaging studies to confirm a diagnosis and identify a course of action that has been shown to be effective.

That said, what makes the treatment of back pain dramatically different from that of most other medical problems is of course the “pain” part. (For purposes of this book, “back pain,” unless otherwise specified, will refer to low back pain. Wherever necessary, I’ll refer to other types of back pain specifically.) My patients have also taught me that pain, especially if it goes undiagnosed or is improperly treated, frequently takes on psychological and social ramifications, all of which can change a person’s life forever. To treat these individuals demands a hefty dose of empathy and honesty—the patience to listen, the compassion to care, and the rectitude to admit failure when things go wrong. To treat these patients also demands the “art” of medicine that comes with time and experience. And on occasion, doctors like me find themselves in that wretched position of having to distinguish (as best we can) between a patient who needs medication and one who seeks it for the wrong reasons. I have to tell the difference between individuals who somehow benefit from the pain—a phenomenon that people usually don’t recognize in their own behavior—from those who don’t. So, in some regards, my job entails a mix of physiology, biology, and psychology. Frankly, that’s all part of what makes my job so intensely complex, challenging, and yet richly satisfying. In order for a physician like me to treat patients in pain, I need to look inward and examine all the moving parts aside from the pain.

A Method to the Madness

The statistics are sobering. Back pain is the second most common neurological ailment in the United States—only headaches are more common. And, after colds and influenza, it’s the second most common reason Americans see their doctors. At some point, almost all of us will have an episode of severe low back pain that will adversely interfere with our quality of life. It’s believed that low back pain costs the economy $50 billion to $100 billion annually. It’s the most common cause of job-related disability, accounts for more than 149 million lost workdays per year in the United States alone, and is the third most common reason for emergency room visits.

That’s a lot of sore backs. You’d think that if the vast majority of the population will experience back pain at some point, then there would be a national outcry for more relief. Despite remarkable advances and new and better ways to diagnose and treat back pain, the problem continues to grow at an alarming rate. Why? Back pain isn’t simple, and the solutions aren’t always straightforward. There is, however, hope. Looking at the problem as a person who both treats and has suffered from back pain, I believe I have an insight that others might not.

As a board-certified neurosurgeon specializing in spine neurosurgery and as cofounder of Spine Options, New York’s first and only center committed to nonsurgical care of back and neck pain, I’ve been on the front lines of the war on back pain for more than three decades and have treated more than 10,000 patients. My professional credentials are as a neurosurgeon, but I am acutely aware that surgery benefits only a select few. As such, my approach from start to finish is substantively different from those of most others in my field, and entails a multidisciplinary, holistic perspective that emphasizes the importance of a correct diagnosis prior to embarking on any treatment. In 1996, when I cofounded one of the nation’s first in-hospital holistic healing centers, I committed to the idea that people can get better without surgery or similarly invasive procedures. I am also a staunch advocate of the philosophy that “less is more.”

My motivation to write this book is simple: I’m alarmed by watching and reading all the misinformation about how to treat back pain. Every month in the United States alone, more than 4 million people Google the term back pain in hopes of finding information on why they hurt and what they can do about it. But what people find online is chaos—scattered information that’s confusing and inconsistent, and an overload of biased, self-serving advertising for various treatments. What’s more, back pain gets short shrift from both doctors and the general medical community, which is probably why chiropractors deliver about half of all back care in the country. And books or programs aimed to help back pain sufferers just don’t do the issue justice. Either they present back pain as an illegitimate, suspect medical issue or they espouse a particular treatment regimen and don’t address the multiple causes and potential remedies for back pain. Many spine-care professionals are familiar with just a limited menu of options and are unable to provide sound advice across the entire field. This has the unfortunate effect of leaving patients confused about which course to take.

In 2013, the topic hit headlines when a new study out of Harvard Medical School revealed that the number of people who have been prescribed powerful painkillers or referred for surgery and other specialty care have increased in recent years—despite guidelines to treat back pain conservatively. “Conservative management” in most cases means using aspirin or acetaminophen (Tylenol) and physical therapy during a wait-and-see approach rather than going directly to advanced imaging procedures, narcotics, and referral to specialists. In the study published in JAMA Internal Medicine, researchers looked at 23,918 outpatient visits for back pain, which was intended to reflect a sample of an estimated 440 million visits made over twelve years in the United States. After factoring out certain variables such as age, gender, and the nature of the pain, they found that during this time, over-the-counter, non-steroidal anti-inflammatory drug use (e.g., Aleve and Tylenol) fell 50 percent, while use of prescription opiates increased by 51 percent and CT or MRI scan tests rose by 57 percent. Meanwhile, referrals to other doctors climbed by 106 percent; the authors of the study pointed out that this likely contributed to the surge in expensive and often unnecessary spine surgeries.

This is alarming, to say the least. Although there is a time and place for painkillers and surgery, as this book will explain, few people are aware that there are safer, much more effective alternatives that can ease or eradicate back pain. Some of the strongest evidence, for instance, actually supports treating pain with exercise for certain types of back pain. And some 95 percent of people will recover from back pain without invasive or risky treatments. I find it telling that a 2012 Japanese study revealed that when adults suffering from chronic back pain visited an amusement park, they reported that their pain decreased significantly. But it came back once the trip was over. So much about back pain can be rooted in one’s psyche and mind, a hotly contested subject matter that will be covered in this book.

Given the fact that most people will develop an aching back at some point, it shouldn’t be viewed as an abnormal condition that necessitates costly medical care. We can probably change the entire back pain industry by just seeing it in a different light. Rather than approaching back pain as if it were an illness or disease, we should acknowledge it as a normal, inevitable aspect to aging that is for the most part ideally managed through patience and a change in lifestyle. Although most of us prefer quick fixes, sometimes the best advice is to wait and see.

Simon Dagenais, D.C., Ph.D., a prolific researcher who conducts studies to support evidence-based management of spinal and orthopedic disorders, articulated it perfectly when he said that choosing a treatment for back pain is akin to “shopping in a foreign supermarket with illegible product labels when one is hungry.” Indeed, there are hundreds if not thousands of possible treatments for back pain, plus dozens of diagnostic approaches. The question is, though, how does the average person navigate all the options and know which is best? And how can a patient learn to be an advocate for his or her health without worrying about being a difficult patient? This book will help you answer these perplexing questions to get the back pain relief you need that is most appropriate for your condition.

A Little History

Lower back pain has afflicted humans for as long as we’ve roamed the planet. It’s an experience nearly as universal as the common cold. In 2003, Drs. Guido R. Zanni and Jeannette Y. Wick wrote a marvelous, well-documented piece for the Journal of the American Pharmacists Association titled “Low Back Pain: Eliminating Myths and Elucidating Realities.” In it, they chronicle the history of back pain from ancient times to the modern era, describing early evidence dating back to an Egyptian papyrus from 1500 BC that may be the first written clinical description, and suggests the treatment of lying down. Biblical references to back pain include the famous one in Genesis in which Jacob is suffering from sciatica after he struggles with an angel. During the Middle Ages, people turned to folk medicine for help with their pain because they believed that supernatural causes created such discomfort.

Formal writings on back pain didn’t really emerge until the 1800s, when physicians finally began to connect back pain with trauma or injury. Up to that point in time, most doctors believed the pain was a form of rheumatism or lumbago, which refers to pain in the muscles and joints. But even then, as today, visible pathology didn’t necessarily translate to predictable symptoms that made sense. One can have clear evidence of damage on an imaging test, for instance, but have absolutely no pain—or vice versa, whereby there’s pain but no obvious source for the pain seen on an X-ray, CT scan, or MRI, or with other imaging technology.

Although doctors didn’t have a handle on back pain throughout much of history, surgery to alleviate the pain has long been among the most common, and most invasive, of medical procedures. One can only imagine the kind of primitive forms of medical treatments that were applied to back pain patients who were desperate to end their misery. In the fifteenth century, the surgeon Şerefeddin Sabuncuoğlu detailed lower back pain in handwritten manuscripts with illustrations. His recommendations for treatment included the use of analgesic medications and, when warranted, a cauterization (burning) procedure.

Dr. Sabuncuoğlu was right to prescribe analgesics to help back pain originating from trauma or injury. Even his surgical interventions may have been helpful for stubborn pain if he managed to hit the exact area from where the problem emanated. After all, how different is this from the common practice of trigger-point injections, a type of pain treatment by which areas of muscular pain are injected with anesthetics and steroids to alleviate the pain? Modern options for treating back pain go back hundreds of years as well. Today’s inversion tables and matted platforms consisting of pulleys, ropes, and weights to relieve back pain are reminiscent of contraptions from the Middle Ages. By some standards, they may look like tools for torture.

Zanni and Wick relate the events of the early twentieth century beautifully: “. . . as societies struggled to develop social systems to address worker disability, physicians and politicians debated the reality of back pain. Some called it a ‘litigation symptom,’ and eminent psychiatrists of the day, including Sigmund Freud and Pierre Janet, went so far as to label back pain as a pathologic manifestation of unconscious conflict. Back pain gained a reputation as an emotional, rather than real, affliction.”

It was during this time period that health statisticians began tracking the incidence of lower back pain. By the 1950s, other areas of medicine, chiefly those th...

About this edition

• Publisher: Avery
• Publication date: 2014
• ISBN 10: 1583335463
• ISBN 13: 9781583335468
• Binding: Paperback
• Number of pages: 320