Back pain fuels a multi-billion dollar industry.
US journalist Cathryn Ramin suffered for years and spent a small fortune looking for relief before she decided to put her investigative reporting background to use and delve into it.
The picture Ramin paints isn’t pretty – she says the US industry is rife with false promises and procedures that can make pain worse, not better.
She chronicles her discoveries in Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.
“A great deal of what was on offer was not really effective, there was no evidence base for it the medical literature made that very evident and contradicted itself frequently.
“That’s how I got set on the path for this book because I’m an investigative reporter, I have been for four decades. If I can’t sort this out I’m reasonably sure most other people can’t!”
She soon found out it was a big problem, with people driven by the hope of escaping their own pain to choose treatments not based on any clinical evidence.
In Ramin's case, an MRI scan revealed she had what is called degenerative disc disease, which usually means a trip to the surgeon.
“There’s no such thing as degenerative disc disease. In the US it is very definitely a marketing term. It’s like saying you need surgery for your grey hair. It was an extremely common diagnosis and people would decide to have surgery based on that.”
MRI scans reveal a plethora of ‘problems’ that many people without pain could also have, she says.
“We’ve known since the 1980s that MRIs in terms of low back pain they’re not diagnostic because people with no back pain, you see the same things on their MRIs – the herniated discs, flat discs, bulging discs, and facet impairment and other structural problems.”
After the scan, a note comes back with a diagnosis of degenerative disc disease, but it fails to mention that this a condition common to everyone as they age, she says.
Although less popular in other countries, chiropractic treatment is very common in the US. Ramin is dubious about its benefits.
“I’ve met people who have been going to the chiropractor for years and years and years and they feel – and they will tell you this – the chiropractor is helping them and the treatment they are receiving is very satisfactory.
“At this point, I always scratch my head because I think how can it be working if you have to go every week for the rest of your life? That is not 'working'. What definition of working is that?”
She is doubtful adjustments performed by some chiropractors have any benefit.
“You’re having your x-rays and you’re having your back cracked and maybe you’re having your neck cracked.
“How many chiropractic strokes are emerging from neck adjustments? As far as I’m concerned, one chiropractic stroke from a neck adjustment is one too many.”
She also casts doubt on epidural steroid injections.
“They are given in large numbers in this country and there is no evidence for their effectiveness.”
“If you have a sudden case of sciatica driven by a herniated disc that occurred last week and your leg is on fire and you can’t walk then a perfectly targeted epidural steroid injection that delivers payload to exactly the right place on the inflamed nerve can be helpful ... but getting it there – wow, very complicated.”
On the whole, these injections are given for all sorts of non-legitimate reasons, she says.
So what does work?
Ramin found herself a “back whisperer”, which is not as New Agey as you might think - it's something like a coach with orthopaedic knowledge who devises a series of effective exercises and helps keeps you motivated to do them.
Sometimes, she says, the brain can simply be dumb.
“In the majority of cases hurt does not mean harm, that’s one of the hardest things for people to grasp. Everything we know about hurt says stop.”
A muscle in spasm is the brain panicking, she says.
“The brain thinks ‘Spine in danger! Spine in danger!’ And it slams on the brakes. The brain’s idea of how to slam on the brakes is to spasm all of those muscles.”
Best to ignore the brain and keep moving, she says. Staying in bed and not exercising will make your recovery much more difficult.
And if you’re considering surgery, consider the group of 100 back surgeons who were recently asked if they'd undergo spinal fusion.
One of them said they would.