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CHAPTER 1

A New Approach to Back Pain

Back Pain Bulletin!

If you've been suffering with back pain, we don't need to tell you just how bad it can get. It's an ordeal. You suffer, your family suffers, your friends suffer, your work suffers. Your whole quality of life can take a nosedive. There are millions of other people with the same problem, but that doesn't make it any easier to handle. We know that it's hard to believe, but the book you hold in your hands can help—and help a lot. It's about an exciting new approach to understanding and treating chronic back pain that integrates the very best from both "traditional" and "alternative" medicine so you can resume your normal life as soon as possible. It is based on an explosion of recent scientific research that leads to a whole new way of understanding and treating back pain that has become a chronic problem (lingered more than a couple of months).

Simply put, the book makes three major points:

1. The cause of most chronic back pain is generally misunderstood by both sufferers and the medical community. It is usually thought to be the result of damaged or defective parts in the back. This is a perfectly natural assumption, but, strange as this seems, it simply isn't true. A great deal of scientific research has been done on chronic back pain, and the findings point in a completely different direction. So what does cause chronic back pain? The evidence tells us that while the problem may start with a physical injury or strain, those things usually heal quickly on their own. Tight muscles cause the pain to last, and stress is to blame for tight muscles—stress over pain, worries about the future, disappointments over unsuccessful cures, fears of surgery, anxieties about medical bills, problems at work, unhappiness over strained relationships. The pain is certainly not "all in your head." We know that it is completely real. Muscle tension and spasms can cause intense pain.

2. Most current back pain treatment methods don't work very well because they misunderstand the real cause of the pain. Again the research contradicts typical medical practice. If you are like most people, you've taken your back troubles to one or more doctors. You may have been told to rest, take medicine, or attend "back school." Perhaps you've tried special cushions, braces, physical therapy, a chiropractor, or even surgery. You're probably very careful to avoid reinjuring yourself. Some of these measures may have helped to a degree, but they probably haven't solved your problem entirely or you wouldn't be reading this book. Conventional treatments miss the real cause of most back trouble—they simply don't address the stress and muscle pain problem.

Most treatments also emphasize "taking it easy," "trying not to hurt yourself," or waiting for the pain to go away before resuming activity. Yet all the research and our experience with patients show that a quick return to unrestricted physical movement is the fastest and surest way to recovery.

3. We have great news about your hurting back! Back Sense describes a new way to treat chronic back pain that is more effective and less expensive than conventional methods and allows you to resume full activity. Its goals are to help you understand the true causes of chronic back pain, reduce your stress, and restore your life. The especially exciting part is that you can heal yourself without special treatments and without having to accept disability and the loss of your favorite pastimes. The methods we describe have already helped thousands of back pain sufferers before you. They're safe, too—low risk for almost everyone (we'll tell you how to make sure they're right for you).

We know that all of this is very hard to believe if you've been stuck with back pain for months or years. We were also extremely skeptical when we first heard about it. Please take a chance and read on. The news in this book can be your way out of pain.

Happy Ending: One Patient's True Story

Up until now we have been talking about chronic back pain in general. Here is the story of one man's struggle with the ailment—how he suffered and eventually got better. Your own story will be different, but you may find similarities to what you've experienced.

I'm in my forties now, married, a professional. I was in my early thirties when the ordeal began. I was in decent shape and enjoyed outdoor sports. While on vacation visiting my brother, I decided to try out his cross-country ski machine. The next day, when my back started to ache, I figured that the machine had overstressed my muscles. Like most of us, I had gotten backaches before. But when I returned home from vacation, the pain was worse. I got a bit anxious when the pain moved into my leg, since I thought that this might indicate a nerve problem.

After a couple of weeks of pain I was starting to worry. Not only was the ache still there, but my toes went numb when I was walking. I went to my doctor, who looked worried herself. She sent me to see an orthopedic surgeon connected with a famous medical school. The surgeon ordered a CAT scan of my lower spine and told me to rest in bed until the results were known.

The CAT scan report brought dismal news. I was told that I had a herniated L5-S1 disk that was causing leg pain. The specialist reassured me that "many" patients recovered without surgery—provided they rested enough and avoided reinjuring their backs. I did not find this especially reassuring. I was given anti-inflammatory drugs, muscle relaxants, painkillers, and stern instructions to be careful. I grew dizzy, nauseated, and tired from the medicine.

Out of work, and lying in bed for hours at a time, I was bored and miserable. I had plenty of time to remember all sorts of things that hadn't occurred to me in years. I recalled that my mom had been diagnosed with a "slipped disk" when I was young. I remembered that she had spent months in bed and was forced to use a bedpan. I realized that she had never fully returned to normalcy. I began to imagine life as a disabled person, and the idea filled me with dread.

Each morning, upon awakening, I tried to figure out if the pain was better or worse. There was no clear trend. Sometimes my spirits would lift for a few hours if the pain seemed less, only to crash again when it returned.

One day an idea occurred to me. Maybe a physician specializing in sports medicine might take a more optimistic and active position about my treatment. I called and made an appointment for a consult. This doctor took one look at the disk on the CAT scan and ordered me back to bed, threatening that if I did not heed his warning, I'd be "begging for surgery" in six months.

After weeks of bed rest, the pain and numbness were getting worse. I now imagined myself never being able to ride in the car or go for a simple walk around the block. Desperate, I consulted a chiropractor. Confirming the two doctors' diagnosis, the chiropractor prescribed regular spinal manipulations, ultrasound stimulation, a back brace, and ice packs. I was excited to finally have a more active plan for getting better, and I followed the chiropractor's advice religiously. Despite my hopes, it was not long before it became obvious that the pain and numbness were not really going away.

A couple of months later I began dragging myself to work, ignoring the dire warnings. I installed a bed in my office so that I could lie down most of the time. I couldn't sit for more than ten minutes and couldn't walk for more than a block. I wore a back brace, sat on special cushions, and leaned my car seat back to take the pressure off of my spine. More than once I almost got into an accident because I could hardly see through the windshield.

I now thought of little but my back and leg pain and was terrified of every movement. I became angry, depressed, and bitter. I had always hoped to have children, but I couldn't even take care of myself now. My wife was depressed and exhausted, too, after months of caring for an invalid. One day my wife got fed up with me and suggested that I seemed to complain of more pain when I was emotionally agitated. I dismissed the idea as nonsense and angrily accused her of blaming me for a condition that was beyond my control. She clearly just didn't understand.

A friend at work, hearing of my troubles, suggested that I look into the treatment methods of John Sarno, a famous doctor in New York. Dr. Sarno had supposedly helped a mutual acquaintance. Having read several medical books and seen three doctors, I felt that I already knew enough about back pain treatment to last a lifetime. I ignored the recommendation. The friend again pushed the idea a couple of months later. Fresh out of options, I gave in.

Dr. Sarno's rather strange and improbable idea was that most chronic back pain, and the associated sciatic nerve symptoms, were not due to displaced disks or other structural problems at all. Rather, he insisted, these symptoms were caused by physical reactions to emotional stress. It can't be true, I thought. The pain was too real. The CAT scan was too clear. The doctors and the books all agreed. There was that annoying observation from my wife, though, about my being in more pain when I was upset. Could there possibly be something to this guy's theory? I wondered.

I called the woman who had supposedly benefited from seeing Dr. Sarno.

"How long have you been laid up?" she asked.

"About four months," I replied.

"What are you doing now?" she asked.

"Lying down, of course—that's all I ever do."

"Why don't you go out and buy groceries for the family—your wife will appreciate it."

"Are you crazy?" I inquired.

"No—try it! I spent a year being completely crippled before figuring this out. I've been fine ever since."

I was completely stunned by this conversation. The woman was serious. As far as I knew, she wasn't insane. My situation seemed so dire, yet I wanted to believe that there was a way out.

Summoning all my courage, I decided to try walking around the block. This seemed like a major expedition after all the months of bed rest. As I progressed, filled with the familiar fear, I noticed that my sciatic pain was now moving from one leg to the other. With a sudden shock I realized that this didn't make any sense—the CAT scan clearly showed the disk protruding to one side. Only one leg should be hurting. If the pain was shifting sides, maybe it wasn't being caused by the disk after all!

The following few weeks brought about a remarkable transformation. Gradually, despite my worries, I began moving again. I started to realize that more movement did not always lead to more pain. Sometimes the pain stayed the same, or even diminished, despite the fact that I was doing things that should irritate my damaged spine. Little by little I began acting more normally.

During this time I realized that I had suffered from medical problems in the past that might have been stress-related, including a persistent "pinched nerve" in my neck and chronic heartburn. There seemed to be a pattern here.

Increasingly convinced that my back trouble was probably caused by fear and muscle tension, I started working on regaining my range of motion and rebuilding lost muscle strength. There were ups and downs. When the pain intensified, I would get very discouraged. Still, doing more helped build my confidence, and as it grew, my pain began to diminish. I trained my friends to stop asking about my back and ask instead how I was doing with my fears. My depression and anxiety lifted as prospects of a normal life returned. Over the next several months I gradually returned to the full range of activities I had enjoyed before that fateful day on the cross-country ski machine.

These events took place about ten years ago. This patient is important to us. That is not only because he was, in a sense, our first patient. It is because he is Dr. Ronald Siegel, a clinical psychologist and one of the authors of this book.

Dr. Siegel's story illustrates several crucial points about chronic back pain. Note that even the best doctors may make errors in treating the problem. They are trapped by the same misconceptions about its cause and treatment as patients are. Also, the idea that our spine is damaged seems so powerfully sensible that we tend to believe in it, even when the facts of our own situation don't really fit. We have found that patients' first major breakthrough in treatment often occurs when they notice for themselves that their symptoms aren't entirely consistent with their diagnosis. Dr. Siegel's experience of pain shifting from one leg to the other is just one example of how this happens. His story also shows that motivated, functional people can get caught in the intense downward spiral of the chronic back pain syndrome. In addition, it demonstrates how it is common for back pain patients to have suffered from other stress-related problems in the past. These can include headaches, digestive difficulties, rashes, jaw pain, grinding teeth, neck aches, joint pain, fatigue, and insomnia. Finally, the story illustrates how chronic back pain can rob people of the athletic, social, or other pursuits that they once used to relieve stress. This, of course, only compounds the problem.

You may be thinking that this is a strange and interesting story, and these are curious ideas, but they don't apply to you. Your back really is damaged. Your thoughts and feelings couldn't have anything to do with your back pain. Your pain is too severe to be the result of tight muscles. The plain fact is, muscle tension can produce tremendous pain, under the right circumstances. Unbelievable as it may seem, you too can leave your back pain behind.

Is This Book for You?

The Back Sense program is suitable for almost anyone suffering from pain in the back or neck, as well as related pain that is felt in the legs or arms, that has lasted for more than a couple of months. While we use the term back throughout the book, the treatment principles we outline apply equally well to most neck pain. We say "almost anyone" because there are a very small number of chronic back pain cases that are caused by some kind of underlying medical problem that requires special attention. This is an exception to the rule that affects only about one in two hundred people.