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770 Stabbed in the Back

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Bonus Interview:
Dr. Hadler describes research on regional back pain interventions.

click here if you cannot view audio player: Nortin Hadler Bonus Interview.mp3

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click here if you cannot view audio player: PP-770.mp3

Back pain is extremely common, but there is not great consensus about how it should be treated. Billions are spent on surgery without much evidence that it makes a significant difference. Our guest, Dr. Nortin Hadler, has examined the evidence and finds it lacking when it comes to regional back pain.

Our other guest, Dr. John Sarno, agrees that surgery, drugs or manipulation are not generally helpful. He has a unique approach to back pain. What do his patients think?

Guests: Nortin Hadler, MD, MACP, FACR, FACOEM, is author of Stabbed in the Back: Confronting Back Pain in an Overtreated Society. He is professor of medicine, microbiology and immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. His previous books include Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person: How to Stay Well Despite the Health Care System. The photo is of Dr. Hadler.

John Sarno, MD, is attending physician at the Howard A. Rusk Institute of rehabilitation medicine at New York University Medical Center and professor of clinical rehabilitation medicine at NYU School of Medicine. His books include: Mind Over Back Pain, Healing Back Pain: the Mind-Body Connection, The Mindbody Prescription: Healing the Body, Healing the Pain and The Divided Mind: The Epidemic of Mindbody Disorders.

Madeline Guven heads Guven Design, a graphic design firm that produces Memopause notepads. She has experience as a patient of Dr. Sarno.

The podcast of this program will be available the Monday after the broadcast date. Podcasts can be downloaded for free for six weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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What worked and works for me: swimming.

I agree 1000 percent with the doctor. Western medicine forget that human being are not only a fantastic machine but a brain and soul all untangled and interfere together all the time. Orientals have understood for centuries that and doctors check your stress or your emotional state before taking decision for the treatment for physical pain like back pain.

While you did mention on more than one occasion that this "science" applies only to individuals without acute structural trauma or defect, Dr. Hadler strongly stated that his conclusions and experience applies to all cases. He also does his profession no credit when he suggests that all his colleagues are too ready to intervene surgically.
Deteriorating disc disease is very real and for him to suggest that in every case the person needs to come to terms with "what is really bothering him" insults many legitimate victims of stenosis, arthritis, herniation, etc. that will not respond to two or three two hour lectures.

While I agree that stress does cause dehydration and contraction of the tendons and muscles which can reorient the nerves causing pain, many of the tolerances between nerves, tendons, muscles and bone have created a legitimate invasive pain which will respond to surgical intervention.

The true challenge for the medical profession is to be able to triage the categories and apply the treatments which are successful for that particular set of symptoms overlaid on that physical finding.

While I agree that there are those patients and physicians too prone to surgical intervention, it is just as irresponsible to highly suggest that in every case this intervention is unwarranted.

While Dr. Hadler was being interviewed, all I could think about was how Dr. John Sarno's book Mind over Back Pain literally saved the "life" of my back. Not knowing that he was also to be interviewed, I wanted to interrupt the show to mention the work of Dr. Sarno. When the Graedon's began interviewing Dr. Sarno, I was thrilled. Here's my experience with his approach to back pain.

In 1985, I woke up with so much lower back pain, I couldn't even stand up straight. For nearly a year, I had chronic pain that waxed and waned, but for the most part remained with me and interfered with my usually active, physical life. I saw chiropractors who all told me that I had "compression" and other structural "issues."

In the late summer of 1986, I was on an exercise cycle, despite constant, nagging pain, and I was reading that same New York magazine mentioned on the show by Ms. Guven. The article was about Dr. Sarno, with a few important highlights about his approach. What caught my attention was his idea that we unconsciously hold our stresses, that without realizing it, we keep the muscles in the location of our pain tight, which causes, or at least contributes to the experienced pain.

He claimed that we "posture" without knowing it, maintaining the pain out-of-awareness, thinking that the pain is permanent and only physically-based. Part of me scoffed at his ideas, but when I arrived home, it dawned on me that I had nothing to lose by trying the experiment mentioned in the article. While standing by a couch, I decided to "flop" onto the couch, collapsing like a puppet with no muscles or skeleton to hold me up. Right before I did so, I had a thought that the pain would be excruciating, but that the effort was worth a try.

I remember that at the exact moment I flopped, I had a split second of hope or acceptance that this just might have some truth to it. Guess what? After collapsing onto the couch, I realized no pain whatsoever. Zero. I was amazed. But, even more important, as I got myself up from the couch, I observed myself holding my body a certain way, "posturing" if you will, and the pain immediately returned. How could this be? If I had so-called structural damage, how could the flop to the couch result in no pain, no sensation at all? And, why did it return as I raised myself from the couch?

It all rang true to me in a moment of awareness. In fact, as I stood there, my left buttocks (no joke) literally released tension. I actually felt the physical release of the muscles. I then watched myself as I walked, got in and out of my car, and so on. I "saw" myself posturing and holding many times. Paying attention to this, I would think of Sarno and my initial experience and relax as best I could. It seemed to work!

I then read Dr. Sarno's book, and through living a normal life, and relaxing my back each time I felt a twinge of pain or discomfort, I've returned to a life with no chronic back pain. None. Oh, and what was going on in my life around the time I woke up on that day in 1985? I'm not sure what it was that might be the emotional cause of my stress-based pain, but at the time I was unhappy in my job and in a relationship that was not going well.

Frankly, I don't spend time trying to determine if those life circumstances were the actual cause. What I do care about is knowing that my pain was indeed a mind-body connection that through awareness and self-observation, I was able to overcome completely. I now do Vipassana meditation, which (obviously) helps me with this process. Thanks, Dr. Sarno!


This is about prevention.
All the males in my family have suffered from back pains with or without connection to tension from early age on.

I was once told during my childhood that if I wish to avoid this I should keep my back strait - always. Particularly while sitting. I always did this and suffered no back pains - ever.

I suffer from bouts of lower back pain as my job requires me to spend a good part of my workday driving a small pickup. I know that on stressful days the pain becomes intense. I had hoped this week's program would provide tips to help alleviate my condition. As the hour drew to a close I wondered whether I had slept through the best part, or was this actually an "Infomercial" on the station I support. The good doctor encouraged your listeners to buy his four books and attend his seminars. One caller indicated she found relief by attending his seminar.

I am disappointed that neither of the hosts requested any specific detail or included more than a single caller's endorsement of his program. My wife was listening in another room and felt the same way. She discovered she had bought and read one of his books, and yes, she still suffers from back pain.

The People's Pharmacy marks the start of every weekend for me. Most of the programs are informative and interesting, and yes, there are times that the bonus happens. That's when I feel better because I took a suggestion to heart, tried it, and felt better. Thank you for the shows you air that encourage caller input and those that provide information along with statistical data to back up your guests claims.

In massage therapy we are aware of the mind body connection. I have attended classes in "awakening mind body work" and EFT (emotional freedom technique). Most clients just want body work but occasionally someone has enough stress factors in their life to want to try something more, and they are often amazed at how much better they feel.

EFT uses tapping on points on meridian lines in combination with talk/repetition to reduce the intensity of the emotions causing the pain/problems.

This may seem like a strange comparison but after listening to Dr. Sarno's theories on back pain being related to the emotional things occurring in our lives and that bulging discs and spondylolysis, etc actually don't cause back pain I have to wonder how that can be true. I have a 13 year old Golden Retriever who suffers from very real back pain.

He has been diagnosed with spondyloslysis. One would have to infer that if spondylolyis, bulging discs, etc are actually not painful to a human then it also is not painful to an animal. Are we then supposed to attribute this dogs back pain to his emotions? How would he explain the vast improvement in mobility and relief he gets when treated with an anti-inflammatory? (which he does not know is an anti-inflammatory so can not be attributed to some sort of psychological response to it).

I realize dogs and humans are not the same but we aren't so different that you could say that spondylosis hurts in a dog but not in a human.

Dr. Hadler sounds like a disturbed person. His pedantic ramblings did not make for interesting radio nor give much creedance to the Graedon's espousal of alternative choices. In short, he's a crock, boring as hell and must bore all who avail themselves of his "opinions".

I have been a regular listener - but consider your program much less credible following this program. I am a 64 yr old female who has had lower back pain- episodic leg pain and numbness etc for 12 yrs. I have had a laminectomy following a chunk of herniated material resting on a nerve. I am absolutely flabbergasted to think that you would host a guest who suggests that these type of medical issues are a result of emotional status or stress in their environment.

Public Radio generally can be depended on to give information that has a factual basis and this program certainly falls below their standards. At the very least - we should hear the other side of the story. Paulette L

That was the oddest and most disappointing show ever. I was excited that the subject of back pain was going to be discussed. I kept waiting for any kind of solution that he might have to offer but all I got was basically, "you've got emotional problems if your back hurts." He never said what might help. Psychotherapy? Deep breathing? Not until the end when a patient lauded the doctor did I hear anything vaguely specific.

I clicked on one star (left side) but somehow it rated him a 4 star. ugh.

Dr. Sarno is my hero. His books gave me the key to overcoming almost constant pain and various other health challenges (acid reflux, skin conditions, etc). My emotions have been holding me hostage for a long time. I am finally gaining control over my body through understanding how my mind works. It is astonishing! Thanks for airing this segment.

I have been suffering from chronic back pain for 30 years. It began with an injury and never really got better, only worse over the years.

I have had many different treatments from medical doctors and alternative therapists with both good results and no results.

I also suffer with Fibromyalgia and all the accompanying symptoms.

I believe the doctor is correct in his thinking that stress and emotions are the root cause of all of these problems. Looking back, I can see where increased stress and emotions increased my pain and continued in an ever-widening spiral.

I believe the medical community has to be made aware of the effects emotional stress has on the body so patients can be treated with the treatment that will help them manage their lives better to reduce the stress.

Our society has it all backward. People feel that stress is a good thing, that they're being lazy if they aren't stressed out over something. I have done a number of alternative therapies and psychotherapy which have helped me to realize the importance of relaxation and stress reduction.

I am a recovering perfectionist and people-pleaser. Too late so smart.

The best remedy for my back pain was a memory foam mattress. which i purchased for about $200.00 at Walmart. It is 4 inches thick and is placed upon my older mattress.

It was wrapped in plastic and required about two weeks of airing out on my porch before I could use it. But after a week of sleeping on it, I could say goodbye to pain pills.

Another great program. I was advised by my sister many years ago to read Dr. Sarno's "Healing Back Pain." Previously, I had such severe back spasms I was admitted to the hospital for seven days with uncontrollable pain (except by intravenous pain killer.)

Months of "taking it easy" eventually eased the pain but not without recurrences of a lesser degree. I was skeptical but after reading it and realizing how my brain was taking stress or subconscious thoughts and channeling them to my lower back, I was healed.

It is true that simply understanding what the brain does will heal you. After reading that book, I now at 53 do more activities without worry of my back "going out" than I did when I was 30-45.

I just caught the last of Dr. Sarno's broadcast on today's show, and found myself thinking - "yes, but", then -after listening to one his patients who successfully recovered from a her pain after taking his course of "treatment" (I swear she said that consisted of three LECTURES), I found myself feeling less skeptical and willing to look into it further.

I have chronic sciatica, manageable by megadoses of ibuprofen, but I don't feel comfortable taking it (and fret it may not always work), so I'm ready to try "the lectures"! Yes, I do believe in the mind/body connection - attributing much of my health issues to stress. Dr. Sarno has given me some indication that it's never too late!

I enjoyed the show about back pain, since I have chronic back pain. While I agree that emotions can frequently cause pain or other physical ailments, I'm not sure I agree with Dr. Sarno that the ultimate cause of most back pain is emotional. I have degenerative disc disease, which sometimes causes sciatica, especially if I'm doing something physical.

I'm also undergoing injections on both sides of my sacroiliac, which is diseased. I've had one session, and I feel an improvement. Hopefully, the other two sessions will make me feel even better. I almost always have back pain after I've done yard work or a lot of housework where I've done a lot of bending over. It's the physical movement that caused the pain, not my emotions.

Maybe some people have pain as a result of what is going on emotionally in their lives, but I can pinpoint what I physically do that caused my pain. I don't think a deprivation of oxygen to the nerves has anything to do with my pain. I also have pain when I'm sleeping, so how can my emotions affect my pain when I'm in a deep sleep and having pleasant dreams?

As a psychiatrist for over 25 years I was very interested in Dr. Sarno's comments. I believe there is SOME truth in what he says and I have seen many people for whom the psychological aspects of back pain are primary. The truth is usually much more complicated than how he presented it. The cause is multifactorial... why must we oversimplify? To sell a book?

Here are just some of the factors that contribute to the epidemic of back pain. I realize that most of these are interconnected:

1) Being overweight
2) Weak abdominal muscles contributing to a body out of alignment.*********
3) Sedentary lifestyle both at work and during leisure time. (Computer usage, TV's, office work)
4) Imbalanced lives i.e.: work vs play, rest vs movement...... this sets up an imbalanced body AND mind.
5) Injuries from irregular activities ( as opposed to a daily routine of exercise)
6) Stress that leads to muscle spasms and secondary injury.
The way stress causes pain is through biochemical / neurotransmitter changes that effect the whole body. So Dr. Sarno is correct that stress can cause pain. I just object to his oversimplification.

This could have potentially been a good episode. I was looking forward to it. I agree with some of the other commenters that it does not live up to the normal People's Pharmacy show standards. It was very light on specifics and felt more like a pre-interview than something that should have made it to air. Maybe you could have both doctors back on, and have a doctor who can counterpoint from a traditional back/pain management perspective in order to get all 3 of them talking about how to actually do what they suggest as therapy (mind-body, medication, biofeedback or otherwise).

Thanks for trying! This one just fell short.

I thought this was fascinating. I've long believed our minds and emotions influence our health. When I'm super stressed is when I feel pain or become ill in some way.

I hurt my back riding a horse, it's a real pain and hard to believe I can control it with my mind. Over some months the pain has decreased but it feels like a couple of my lower vertebrae have fused.

I don't consider going to an allopathic doctor as they will only prescribe pain pills, or suggest physical therapy that may produce results, but after listening to this show, I really think I'm going to work on reducing stress and changing my attitude towards these aches and pains. I'm 58 years old, and know there's also the aging process to consider.

I'm sorry several of these responses tossed out completely the possibility that Dr. Sarno's approach may actually reduce pain. I'm all for medication-free living and am determined to stay so until I die. OK, an occasional ibuprofen will be taken, but that is the extent of it. Well, an antibiotic is useful at times, also. Providing I don't fall and break a bone, I do my best to stay out of any doctor's office.

I have never met Nortin Hadler, but I find nearly all of his writings (and all of his books) to be clear, fascinating, and helpful. His comments on back pain (regional) are spot on target, and I know I am very fortunate to have had (and have now) physicians who understand back pain (and other kinds of orthopaedic pain) to be almost exactly as he describes. Notice that he speaks often about "an educated patient."

Perhaps it is more difficult to understand these concepts if you are a patient who presents and says, "fix me." Recovery from back pain (and many other orthopaedic pains) requires commitment from the patient and the willingness to exert a lot of effort to overcome it (or to suppress it). I am always so pleased to listen to Dr. Hadler on your program, and I can count on learning a lot from him.

I normally enjoy PP, but in my opinion this episode borders on giving voice to outright quackery, or at least the hack medicine that this show is famous for debunking.

I will state the following fully recognizing that the plural of "anecdote" is not "evidence".

Case in point: In 1992, WITHOUT A PRECIPITATING INCIDENT, I suffered an episode of severe lower back pain, which eventually resulted in a lower left leg numb by pinprick below the knee 360-degrees, and a foot that was numb, top, bottom, all toes. I was rapidly losing the ability to walk normally, and my left hamstring was contracting so I could no longer fully extend my leg. The associated pain was extreme. I eventually needed to take three months off from work; 100 years earlier I would have wound up begging for coins in the street.

After an unproductive referral to an orthopedist and a counterproductive round of traction, muscle relaxants, etc., I consulted the then head of the Department of Neurosurgery at the University of North Carolina, Chapel Hill. After a thorough neuro workup and other tests, I underwent a 365-minute microdiskectomy on L5-S1, after which my surgeon told me mine was the worst disk rupture he had encountered in a career of perhaps a thousand cases.

As he described it, 60% of the nucleus pulposus was outside the disk, instead of where it was supposed to be.

Ultimately, the operation has completely eliminated my symptoms for 18 years, except for some remaining sensory deficit on the sole of my left foot.

The point is, THERE WAS NO PRECIPITATING INCIDENT TO MY CONDITION. I have had the usual backaches and neck aches that come and go through the years, both before this incident and since, for which I have done nothing. Fine -- the episode I am describing was in an altogether different category.

I am appalled that there are licensed physicians, including one with the same university affiliation as my surgeon, that would argue that my condition was, to cut out the prevarication, psychosomatic, and that interventional therapies would be ineffective, solely because there was no obvious cause for my condition.

I would note in passing that your UNC-CH guest is not affiliated with neurology, neurosurgery, orthopedics, or orthopedic surgery. And the guest from NYU was beyond the pale, far too doctrinaire to be credible. I am overjoyed I wasn't referred to either of your guests!

MD's are entitled to their opinion, but that's all they're entitled to. Does that also make them entitled to a national media audience? Shame on you, Graedons.

In my opinion, any suggestion by an MD that back pain without a precipitating incident is ipso facto psychosomatic, and that interventional therapies would be worthless, is borderline malparactice.

I was hit head-on in a car accident (my forehead broke the windshield and chest hit the steering wheel) and noticed lower back pain a year later. Went to a chiropractor and then an osteopath who treated the pain with manipulation. He reported that the injury to my back was at midback where my chest hit the steering wheel, but I continued to experience it in my lower back.

Later that year I began dragon-boat racing that required a long-stretching paddle stroke with a deep bend at the waist. This created muscle development in shoulder, stomach, back, buttocks, legs, etc. It also lengthened muscles in the arms, shoulders and lower back. Since then, the pain did not recur. I think the lengthening and strengthening of muscles, particularly in the lower back, as well as the fun of participating on the dragon boat racing team saved me from a life of back pain. I was 40-45 at the time and am 59 now.

I was interested in Dr. Sarno's mind-body connection and his way of connecting oxygen flow to the painful area as well as the way he involves the patient in finding a solution to generalized back pain. Thank you fr an interesting show.

This "expert's" view is less revolutionary than you, your listeners and Sarno himself may think and as with most medically based information is in error. To say that that no clinical findings or symptom groups point to a correct diagnosis of back pain is a misfortune to anyone who listened to it and denies the beautiful organization of the human system and the corrected model of same which alternative systems like chiropractic and acupuncture recognize.

Witness what the 5 element acupuncture model describes: anger is associated with liver/gallbladder/ viscera while fear relates to kidney bladder and therefor a spinal focus. What was really expressed in Dr. Sarno's show was the poverty of the western medical model and it's dependence on imaging procedures. Chiropractors, for instance, have other "non technical" visioning systems which even a cursory review of the appropriate literature will reveal.

Yes, emotions are connected to all disease entities but the emotions are correspondents of the specific disordered organ system - neither cause nor effect per se of a certain disease (ref: 5 element medicine and homeopathic models). And yes, in some cases the specific emotion is clinically addressable. But to say that the pro-inflammatory cytokines released from inflamed nerve tissue, an inflamed disc annulus (recurrent nerve of von Lutchka), spinal stenosis, irritated apophyseal joint capsule is not a cause of the pain cycle is just inter -professional ignorance and very misleading to the consumer - an more dangerous even than snake oil.

Get with it and off the medical bandwagon. Be the leaders you think you are. Sarno needs to broaden his education.

After having an MRI and x-ray of my back and being diagnosed with spondylothythisis (facet disease), bilateral hip bursitis and a bulging disk in the 12th thoracic vertebra I have been very disappointed to find that chiropractry, physical therapy and now 6 mos of exercising with the Egoscue Method have not eliminated my pain.

A neurologist has discouraged me from having back surgery saying that it is 50% effective at best. I don't know whether Dr Hadler or Dr. Sarno's books can help me, but at this point I'm willing to try anything. Thanks for giving me another option to try.

I, like several of those reviewing the show, felt that it did not live up to the normal quality of People's Pharmacy. Way too much simplification. My back is good now but about 10 years ago when it was bad, I might get out of the car and twist my body in a certain way that shot pain throughout my lower back. Was that really caused by stress in my life? I don't think so.

My back got better when I stopped running after 41 years of running.

Since 80% of back pains go away no matter what is done, any snake oil salesman can make a good living "curing" back pain. Dr. Sarno's rejection of most physical causes of back problems, causes me to put him with at least one foot in the snake oil salesman category. I agree though that our mind can make pain worse due to it causing muscles to tense up.

Injuries can cause back pain, I sat on a milk crate bolting together a small folding trailer and injured my left hamstring where it attaches to the hip. I tried muscle relaxers, Chiropractor, and finally went to orthopedic doctor who found the cause. He hit one spot on my left buttock and I almost went off the table. I had damaged the tendon where it attached to the hip. Those attachments like to be straight, but the healing process crosses the fibers. He prescribed physical therapy where they treated the injury and taught me stretching and after 10 sessions I have not been back. I was very sensitive to what surfaces I could tolerate and carried my own cushion for a long time. I still drive with an Obusforme cushion. I can tell when I slack off on the stretching exercises. I now do 30 minutes of yoga 3-5 times per week and have the heating pad by my recliner. Lipitor now contributes to my aches, but I have not been to a doctor with back problems in 25 years.

In 2008 I spent 5 days in UNC hospitals for a catheter ablation and the bed time there on those blinkety blanking airbeds really aggravated that hip and it took a couple months to recover. On a later 3 day visit I requested a memory foam mattress topper and that worked much better though I was more mobile on that visit as well

Dr Hadler/Sarno state that they always rule out what you claim they don't. I was a massage therapist for 15 years and helped people the surgeons - after many surgeries - could no longer help, many also avoided it. At least these two Drs are trying to help people with common sense modalities!!!

Your guest Nortin Hadler, MD, MACP, FACR, FACOEM spoke very eloquently and knowledgeably regarding the complicated interplay of the psychological, emotional, and societal aspects that are intertwined with the experience of low back pain. He also is obviously very familiar with a large body of scientific literature as it pertains to low back pain and not only do I commend him for this, I think society would be lucky to have more physicians who are aware of these things.

However, his appearance on your show was remarkably lacking in some very important points that your listeners should be familiar with. First off, there are plenty of situations in which acute or regional low back pain should be imaged with tests including x-rays, MRIs, and CT scans to name a few. The problem with diagnostic imaging is that providers such as physicians, physician assistants, nurse practitioners, and chiropractors are not sufficiently trained to be able to differentiate between those people who need imaging studies and those who do not. The net result of this is that a very large proportion of people who undergo diagnostic imaging don’t need the tests and a smaller number who need them sometimes can’t get them prescribed because their providers believe the tests are of no use. Perhaps this is both because of messages like the ones Dr. Hadler puts out and the overall lack of training healthcare professionals receive.

This brings me to my second point. Evidence shows that in medical school physicians-in-training undergo only 2.1 weeks of musculoskeletal training. What’s more, it has also been shown that only 42% of allopathic (M.D.) medical schools require a module or course in musculoskeletal education and only 21% require a musculoskeletal clinical experience. This is an embarrassing fact that hardly qualifies your average M.D. to treat a sprained ankle, let alone a diagnosis so complex as low back pain. Making matters worse, there has been a series of studies performed that show that the average physician fails a test on orthopedic knowledge. In fact, one study from 2005 showed that only 20% of those tested (including medical students, resident physicians, and staff physicians) can pass a knowledge-based examination on orthopedic problems. Their average score was only 57. The only group that performed acceptably was orthopedic physicians and unfortunately they do not treat the majority of musculoskeletal complaints.

Interestingly, in a later study physical therapists were shown to perform better than the physicians on the same examination with the notable exception of the orthopedic physicians. Part of why this is interesting is that physicians are generally responsible for not only referring patients to therapists but also for overseeing that care. The point of all of this is that physicians are very poorly placed to evaluate and treat low back pain ad for this reason it is no surprise that they do very poorly at it. This makes the generalizations that Dr. Hadler made troubling to me. On the other hand, I have repeated experiences with fixing low back pain yet nothing in his interview even hinted that such a thing can occur.

Moving on to my third point, it is regrettable that the diagnosis of low back pain is so complicated and can be best described as a large collection of very different problems. Low back pain, for example, could arise from a variety of structures within the thoracic or lumbar spine, pelvis, hip joints, lumbopelvic musculature or other soft tissue, and abdominal organs just to name the big ones. There can also be complicated intermingling of multiple body regions in what otherwise appears to be one simple problem. This extremely large pool of pathologies means that I typically take at least an hour to thoroughly evaluate any complaint associated with low back pain. And, yes, this often includes actual “injuries” which is a phenomenon that Dr. Hadler denied exists. There are plenty of people who literally injure tissues in their low back with such activities as bending or lifting and this in many ways is no different than an ankle injury.

That having been said, in my professional opinion Dr. Hadler’s headache analogy is a very good one that often proves to be true: a backache can be like a headache in that there is no discernible cause. This, however, is far from being a concrete rule. I say this as a healthcare professional that has not only treated low back pain for years but also as someone who has worked full time in a worker’s compensation environment that has seen a fair number of acute injuries.

This brings us to my fourth point. Dr. Hadler mentioned that there is scarcely a good modality for treating low back pain. I follow this up with a couple questions of my own. How can it be that a physician with an average of 2.1 weeks of professional education in musculoskeletal healthcare can accurately choose which modality to prescribe and have it be effective? And, since physicians rule our healthcare system how can society expect good musculoskeletal care from practitioners with minuscule knowledge on how to treat common musculoskeletal problems such as low back pain?

Furthermore, scientific literature has such a hard time investigating something so complex as low back pain that I assure you much of the data that Dr. Hadler cited is in many ways misguided at best. Bearing that in mind you nor your listeners should be surprised when I say that much of what I do when treating low back pain is as much of an art as it is a science. I would say that to successfully treat low back pain in as many cases as possible one should be both up to date on the research and very capable with hands-on evaluation and treatment techniques. It just so happens that physicians are not set up to be able to do either of these.

That having been said I would argue that your average physical therapists is also grossly lacking in these skills despite a better likelihood of having the time to use them. Personally I have been back to school twice since graduating with an entry-level degree and currently I am enrolled in a third post-professional musculoskeletal educational program. After all of this education I am sad to say that I am hard pressed to find a healthcare professional who is competent enough to treat low back pain despite how common a problem it is.

I am compelled to comment on your guest last Saturday, John Sarno MD of NYU. I have heard many people on willradio, but none has been more pompous and arrogant than the good doctor. He claims that conventional treatment of back pain including herniated discs is basically psychosomatic and can be traced to some psychological event like one of his patients who you had as a g guest which she attributes to her little dog being attacked by a larger one.

What makes Dr. Sarno so arrogant, is that he does not say some, many or most of conventional treatments are ineffective but ALL. My wife recently had a herniated disc which rendered her immobile. She had a few epidurals without success. She was operated on by at the University of Maryland. Before the operation, Dr. Ludwig lifted her right leg whereupon she let out a scream that I am sure every person in the Baltimore Harbor heard. After the short MICROSURGERY, he raised her effective leg and she was pain free.

She proclaimed in ecstasy that she was ready to apply to the Rockettes. He said that she could leave in a few hours. Sharon did work at home for a week and was back at her desk after that and did not need physical therapy that she was told she would have to undergo by surgeons using the conventional operating procedures. It was obvious to me that Mr. Sarno must have given you the name of his successful patient.

I assume your budget does not allow you to have found a patient who underwent his treatment without success. My wife's experience with Dr. Ludwig, certainly disproves Dr. Sarno's pompous statement that ALL conventional back treatment including herniated discs is ineffective.

Yes, Dr. Sarno has a great point in many cases. I am a Licensed Mental Health Counselor and before I ever became licensed, I applied that same knowledge. A client in a group I ran had severe pain for quite a while caused by lifting his child, or so he thought. He told the story of his narcotic addicted nurse brother who committed suicide. My client appeared to be carrying the burden of that loss to the extent that I saw his pain as his emotional shrine to his brother.

Once I suggested that to him, he returned without pain the next week and I ran into him 2 years later and still he had no pain. he thanked me for helping him to free himself through recognition. Note: He had many interventions and physical therapy prior to our group meetings.

We do carry our pain for many reasons physically after the emotional pain becomes strong enough yet we fail to see the connection. I think certain diseases come on because we harbor unspoken emotions and thoughts connected to the loss of a loved one. It is as though if we go where they are, we have now done more than we did for them prior to their death.

While the two doctors interviewed contributed a helpful counterbalance to the surgical approach to back pain, I found the show as a whole simplistic. There are many many possible physiological, muscular and dietary influences on back pain other than Sarno's blanket "It's all from negative emotions" nostrum. For a few: sugars in the diet cause muscle tension; weak abdominal muscles, whether from surgery or whatever reason, stress the low back; constant sedentary work at a computer causes muscular imbalance which hurts the back indirectly; et cetera et cetera.

There's a big middle spectrum between spinal surgery, on the one hand, and "it's all psychosomatic," on the other, that needs investigation.

You might have mentioned massage, breath work, physical therapy and strengthening regimens like Pilates as benign forms of therapy that loosen imbalanced ligaments, tighten the abs., teach you to walk properly and breathe properly

I have read two of Dr. Sarno's books, and he makes very clear that back pain may be caused by physical pathologies which must be ruled out before beginning his program. He also states that, once he started screening out potential patients who seemed unreceptive to the notion that their pain might be psychological in origin, his success rate went to 90+% (if I recall correctly).

Nobody who reads his books with any care can come away with the belief that he claims that all back pain can be made to disappear with one office visit, two lectures, and no physical therapy. Just the great majority of it. If he's even half right, it sounds to me as though his approach would be worth a shot for most people (noting the caveats about ruling out serious underlying pathologies).

Someone experiencing back pain, who rejects the possibility that psychological factors could be at cause, citing only a feeling of "I don't think so," is perfectly free to do so, and may even be proved correct, but is not practicing science.

I can tell you right now that Dr Sarnos books work! I know many many people who have spent thousands of dollars on drugs and surgery and if there is not pathological reason for the pain its TMS. For those of you who don't want to accept the diagnosis good for you because when a well respected neurologist told me it was stress and I didn't want to believe him it cost me 7 years of paralysis.

When I heard it from Sarno I accepted it but back then I knew nothing about the good doctor. Sarno is not arrogant he has stumbled upon something that has helped millions and he is not a quack he doesn't need the money if he did he would promote the hilt out of his books. Most of them are from word of mouth.

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