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

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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.

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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...