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By the time people come to me with back pain, they have been to many other doctors and have been suffering for many years. Their pain has become the three-ton elephant in the room. Persistent back pain, the second most common human affliction after the common cold, affects 31 million Americans at any given time. Chronic, moderate-to-severe low back pain affects over two-thirds of patients enrolled in chronic-pain centers. Unfortunately, many Americans live in physical and often emotional agony from poorly controlled back pain. Because it can be hard to find the source of the pain, some doctors blame it on the patient's emotional problems. Unfortunately, the patients and their families believe this.
Diagnosis is an art as well as a science, and diagnosing back problems is challenging because the cause of the pain is often hidden and may not show up on X-rays or other scans. Pain travels along the complicated nervous system pathways, so the source of pain is often far from where it is perceived. Because chronic pain affects our emotions and everybody has a different pain threshold, this adds to the difficulty and frustration in finding treatment that works. When we cannot verify the presence of pain or measure its severity, the result is insufficient understanding and treatment by society, the medical profession, insurance companies, and the family and friends of the person in pain. There is almost always a physical cause of back pain. A conscientious doctor, willing to face the challenge with a cooperative patient, will almost always identify it.
Treatment for spinal pain should begin with the simplest, most conservative therapy before invasive therapy is even considered. For example, most herniated disks eventually shrink, and the pain and weakness or numbness they caused resolves. Yet far too many people are rushed into surgery. This often results in being married forever to the medical system and more spinal surgery. As you will see in this book, very few conditions warrant surgery.
The cause of back pain is often multifaceted and in many cases back pain can be relieved, lessened, or even prevented by changes in lifestyle. Weight loss, proper exercises, and posture, as well as good pain medication, should be used intelligently and creatively to maximize your pain relief before you consider any more invasive procedures. I know this is easier said than done, but it is not impossible. There is no reason for your aching spine to destroy you or your quality of life.
I am neither a proponent nor opponent of any medication, physical therapy, surgery, implantable devices, or anything else. There are many therapies to help you deal with chronic spinal pain, depending on the diagnosis and your personal situation. Diagnosis, not just pain management, is the key to successful treatment. Getting the correct diagnosis and subsequent high-quality treatment may well cost you money out of pocket, a very good reason not to allow yourself to go down the financial tube before getting yourself turned around with proper treatment. I want to liberate you from the pain clinic and medical system as much as possible so you can go on about whatever life you may have on this planet. We have all recently been reminded just how tenuous life can be. Live it to the fullest.
Throughout the book you will find stories of people who thought they would never get rid of their back pain — yet did. Because your spine is a living — and aging — part of your superstructure, it may cause pain again over the years. In my own case, as I sit for long hours at my desk writing this book under the stress of a deadline, I have been doing everything I tell you not to do. This stress and my minimally arthritic back have worked together to create back pain. However, despite minor arthritic changes in my spine, I don't always have back pain. My stress level fluctuates, as does strain on my back, while sitting for hours on end writing a manuscript or standing still slightly bent over a patient for long periods of time during a difficult procedure.
I hope this book will take some of the mystery out of why your back hurts and what you can do about it. By learning exactly how your spine, muscles, and nerves work, you will gain insight into how they can be damaged or cause pain.
The first part of the book is meant to enlighten you about your spinal anatomy, how to get your pain properly diagnosed, and how to find the right doctor and treatment.
The second part examines the most common sources of back pain and how they should — and should not — be treated.
And, finally, there is a chapter on prevention, so you can avoid future back pain at home or at work or away. There are key points at the end of each chapter to help you digest what you've learned.
Copyright © 2004 by Emile Hiesiger, M.D., and Marian Betancourt