I danced around the house yesterday just like my dogs do when we bring them a new toy. Beatrice and I went to dinner and I was enamored of showing off all my new (old) moves (again). I had renewed life in oldish bones.
Did something structurally change? Did my L4-5 disc herniation go from 5mm to 4mm, and I felt an equational mathematical relief? Was I “healing,” finally, after 10 months? If so, in what precise mathematical/chemical/physical way? ‘Just the numbers, ma’am.’
…2 things happened since I posted yesterday: Hacking and Tweaking at Back Pain Day By Day. It’s in important order, this time.
- Doing the post itself, then reading and engaging in comments made my pain recede even more. That’s pretty amazing, wouldn’t you say—when an act that involves writing, verbalizing, thinking, etc., reduces pain—and even if you’re sitting on your ass on an iPad (see the post, sitting is a big factor)?
- Exuberant by #1, I had a renewed interest in how my own brain is fucking with me. I’ve already read Sarno and I hate to watch movies or read books a second time. So I looked, and found something new: The Great Pain Deception: Faulty Medical Advice Is Making Us Worse. The guy is a TOTAL unpolished geek and I love it. I’m well into chapter 2, now.
I got up this morning, Teetered, and soon got a comment on yesterday’s post from a retired surgeon.
Sorry to hear that you are still having that much trouble with your back. For what it’s worth: you have fiddled with it long enough. Get it fixed, L4-5 takes a while for the nerve root to recover. Over age 50, your chances of a repeat decrease. I wish you the very best of lucks. Been there, done that, and had that. (Retired orthopedic surgeon).
TJ has been in comments a while, and I see where he’s coming from. I respond like this.
Well, I do have the anecdotes of my dad and 2 brothers who swear by their surgeries for the exact same thing (dad and 1 bro by the same surgeon). OTOH, I have my own experience in getting over a cervical herniation (also confirmed by MRI), with months of ache in my right arm. Years later, nothing at all, and no surgery. I lafed it away, literally.
I’m reading a new book I started last night:The Great Pain Deception: Faulty Medical Advice Is Making Us Worse
by Steven Ray Ozanich
He’s not a doc or professional practitioner, but a sufferer himself for 3 decades who’s helped a lot of others. And he seems to be on 1st name basis with Sarno and a lot of other TMS focussed docs and naturo’s.
Thing is, I find that when I laf at or apply heat to one pain area, it often goes away and comes back in another place. How does structural deficit medicine address that?
I understand fully the pain is real (oxygen depravation to an area), but I question whether it’s ALL and ONLY about some structural problem (like a herniation). If I break my femur in two, it’ll be pain free in a few weeks, healed in about six. How can a petty little disc herniation (which almost everyone over 50 has, and most with zero pain) CAUSE pain for decades? Pinched nerve? OK, then how come if I physically pinch a nerve, it goes numb, not cause excruciating, aching pain for hours upon hours?
This happened when I read Sarno and eventually got over my arm pain. I could feel the pain dancing from place to place as I read the book and simply realized there is nothing physically wrong with me, that for whatever reason, my brain is fiddling with the oxygen supply knobs to various places. Eventually, it all quieted down. Came back twice months later (did I “reinjure?” No). First time it came back I was able to mentally set it aside in 2 weeks and the 2nd time, in one week and have seen neither hide nor hair since.
In this case, I finally began to see this as exactly the same thing and not some structural problem, and I’m 70% better on average, almost perfect standing, walking, and laying. My working hypothesis is that all the standing is simply forcing increased blood flow, hence more oxygen, hence undercutting the oxygen knob futzing my brian is doing, and so I’m getting a ton of pain dancing, now, which is the sign it’s running to find new hosts.
But, interested in your take.
And I am interested.
So, I decided to do a bit of original digging. Right off the bat, via PubMed:
There have only been a few randomized controlled trials of surgical treatment of chronic low back pain caused by degenerative disc disease. Fusion surgery has been compared primarily with nonoperative treatment, whereas disc arthroplasty has been compared with fusion surgery. The results for either of the two surgical procedures are modest in terms of pain relief and improved function.
[The Introduction and Analysis section is a good read to assist your future endeavors in not just automatically fooling yourself. Nice statement of limitations and challenges. Nice.]
Implications for clinical practice
Surgeons and others believe that surgery is effective for back pain. They base this belief either on their own experience or on observational studies. This belief is, by and large, not vindicated by the outcomes in well-reported clinical trials. Those trials indicate that only a small proportion of patients do well from surgery. If surgeons achieve better outcomes than those reported in the controlled trial literature, the community would benefit from the publication of those outcomes. In the absence of contradicting evidence, the benefits of surgery must be regarded as small. Because improvements from surgery are small and because not all patients benefit, it becomes critically important to carefully select patients in whom fusion surgery is performed for chronic back pain. Furthermore, it is important that patients have a clear understanding of the procedure and its potential results and complications so that they can participate in the decision.
Differences in results from one study to another may be explained by the selection of patients, but the surgical procedure itself and its performance are likely to influence outcomes as well. In an editorial, Fritzell  posed the question: ‘is surgical treatment consistent with evidence-based medicine?’, and answered it with: ‘yes, in selected patients’. But surgeons have not yet articulated the definition of the correctly selected patient, and tested it prospectively. The reputation of surgery rests on the observation, after treatment, that some patients sometimes do well, with some procedures. That is little solace to the majority of patients who do not do well, who suffer complications, or who are rendered worse by surgery.
Yes, I understand fully that this specific literature review deals with fusion and not the ‘dectomy thingy. Feel free to make Grand Distinctions if you like.
I wish to go a WTF step further, and integrate a political/social aspect. It completely does not go unnoticed with me that reported chronic pain appears to be a disease of modern societies with their advanced geopolitical maneuvering everyone believes they’re a very important (not impotent) part of (among too many other differences to mention, of course). They wear stickers on their lapels signifying their importance in the grand scheme of things they have zero control over.
So, is modern social antagonism more likely to breed stress, or catharsis? It’s a simple question.
I read a really strangely different book in 1990: The Neo-Tech Discovery. I took many things from it, but the one most important thing, the one thing that has guided my life generally ever since—a lot of times very imperfectly, but I know where home base is—is:
The human mind is a reality integrating organ, not a reality creating organ.
Don’t gloss over that; because, when you begin to unpack, you’ll find that very, very much in the realm of human social interaction from relationships to families to states turn very much on a whole lot of mind-created “realities,” and these “realities” are in conflict with one-another, and antagonism is the result. On a geopolitical scale, war, murder and genocide is the result, and there will always be millions cheering on their mind-created “reality” if they’re on the winning side—making excuses if on the other.
Let me leave you in the lurch on that, for now. Best to see how much mind created reality comes my way in comments….