By Dr. Scott Saunders, M.D.
Lindsey was sent to me by her surgeon for a routine pre-operative physical prior to having surgery on her spine. After a few minutes, it was clear that she wasn’t a candidate for surgery. She had three previous back surgeries and was still in pain. Here was our conversation:
Question: “What did you have the three previous surgeries for?” – Answer: “Pain.”
Question: “Why didn’t it work the first three times?” – Answer: “I don’t know.”
Question: “What is going to be done differently this time?” – Answer: “I don’t know.”
I knew that she would have a less than 10% chance of being pain-free after the surgery, so I asked her about other options she had tried.
“Acupuncture?” - “No.”
“Chiropractor?” - “No.”
“Massage?” - “No.”
She had been to a physical therapist only after her previous back surgeries, but the pain never fully resolved and later even got worse. I had her see a chiropractor before she went to surgery and she called me after the first treatment, “I cancelled the surgery! I feel much better after only one treatment!”
On the other hand, Dillon came to see me after suffering with back pain for five years. He was going to his chiropractor every week for that time, which gave him temporary relief, but he was still in pain. We did some tests and found he had a lesion on his spine that required surgery, which he had, and the pain resolved.
Back pain is a very complex issue. The large majority of cases do not need the services of a medical doctor for drugs, a surgeon for surgery, or even manipulation. Most of the time, back pain is a problem that can be treated at home.
When CT scanners became available, doctors started looking at the anatomy of the spine and found “slipped disks” in many people with back pain. This means that the soft disk that is between the vertebral bones in the spinal column would rupture and spill out, sometimes pressing against a nerve. It made sense that if you remove this bulge the pain should go away. However, it doesn’t always work. Later, studies were done on normal people indicating that there are about the same number of “slipped disks” in people who have never had back pain. (1)
When to See a Doctor for Back Pain
There are some good reasons to see a doctor, but the pain itself isn’t one of them. There are other indicators of potential nerve damage that may require back surgery or some form of treatment that you wouldn’t be able to do at home. If you have any of these three listed below, you should see a competent doctor, chiropractor, or surgeon to get an evaluation and find the cause of the symptoms. Sometimes all that is needed is adjustment. However, there are serious causes such as fractures, cancers or multiple myeloma.
- Numbness – Numbness indicates there is a sensory nerve that is being “impinged” or pinched. If the pinched nerve in the back that is causing pain also produces numbness in any part of the body, then it indicates there is damage to a nerve. The longer it impinges on that nerve, the harder it is to heal and come back to normal after it is repaired.
- Weakness – When the muscles become weaker because of a lack of nerve stimulation, it means a motor nerve is damaged. If this is a physical damage from being pinched, then it should be repaired so the problem doesn’t get worse and lead to disability.
- Loss of function – This is the way of saying that if anything isn’t working correctly, then it needs evaluation by a competent physician. For example, the nerves in the lower back can affect the function of the bladder and bowel; incontinence may be due to a nerve impingement. I think that any dysfunction deserves a consultation to determine the cause.
- Worsening pain that does not resolve with other modalities. If it is getting worse, or not going away, then this indicates treatment failure and either another treatment is needed, or there is something more serious.
Treat Back Pain at Home
In the 1970s, a physiatrist (a medical doctor who specializes in physical therapy and rehabilitation) noticed that he had patients with severe back pain who were going to surgery and coming back in the same condition. Since then, multiple studies have confirmed that even with “bulging disks” you only have a 7% chance of being pain-free after a surgical intervention for back pain. This particular doctor, John Sarno, MD, began doing research and found that the back pain would go away when people resolved their emotional issues.
It seems that the back musculature is especially sensitive to a lack of blood flow. When these muscles don’t get enough circulation, they build up an oxygen debt and lactic acid, which causes spasms and pain. The worst pain human beings experience is spasm, such as labor pains during the delivery of an infant.
However, though this pain is severe, it doesn’t do damage. This is where all the diagnosis and treatment by surgeons and medical doctors in the past have been less-than-accurate. The assumption has always been that if there is pain, then there must be damage of some kind. But in the case of back pain, this is rare.
The brain is in control of the blood flow of the entire body through its ability to open and close blood vessels. When people have painful emotional problems that they either aren’t able or don’t want to deal with, the brain is able to create a physical pain to allow its expression.
Dr. Sarno believes it is a diversion that allows the person to avoid the emotional pain. It is automatic, part of the autonomic nervous system, and is therefore not under the direct control of the individual.
Dr. Sarno found that often, just acknowledging an emotional issue would allow the pain to go away, even in those with years of severe debilitating back pain. He has since written several books that I recommend to my patients with back pain. You can see a list of these books HERE.
In these cases, treatment may temporarily resolve the pain, but it just comes back. Massage, heat, ice, pain medications, muscle relaxants, manipulation, and other treatments that improve the blood flow will work for a time, but when the pain returns it is a good sign that this may be an autonomic nervous system dysfunction such as we discussed.
I have known people on serious pain medications for many years to completely resolve their pain to become pain-free by working on their emotional problems and get off of the medications. I have tried so many treatments that work well, but are only temporary. When this happens, I recommend one of the books by Dr. Sarno, Mind Over Back Pain. It is important to read the book because a brief explanation doesn’t apply to individuals – each case is different.