The $100B per year back pain industry is mostly a hoax • Hacker News Board

Re: The $100B per year back pain industry is mostly a hoax

#181

Post by DanBC » Wed, Jul 05, 2017, 7:16 AM UTC

seanwilson wrote: post #80

grardb wrote: post #70

Earlier quoted context omitted.

Seriously. I always roll my eyes when somebody claims that acupuncture "doesn't work," because it's worked for me on multiple occasions. Typically, it comes from people who have never tried it. A little over four years ago, I had a ton of shoulder pain. I went to two doctors, had an MRI scan, and was prescribed physical therapy. After all of that, I was still in pain, and neither of the doctors could figure out why,…

Why after decades then has acupuncture not been shown to work in any rigorous high quality studies? It's not like it hasn't been studied and proper studies are significantly more reliable than acendotes.

That's incorrect. There are a couple of recent studies showing acupuncture is better than treatment as usual for some musculoskeletal problems.

https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...

(On mobile, apologies for the weird URL).

For lower back pain I think the advice is, after seeing a doctor, to start exercising.

Re: The $100B per year back pain industry is mostly a hoax

#182

Post by mirimir » Wed, Jul 05, 2017, 7:18 AM UTC

Many years ago, after going down hard while skiing, I learned the importance of exercise. Both for protecting against accidents, and in recovery from them. Because muscles can take stress off joints, and help prevent exceeding safe ranges of motion.

That lesson has generalized very well. For other injuries, and for age-related arthritis. Basically, if I notice pain somewhere, it tells me that I'm not exercising that area properly.

Re: The $100B per year back pain industry is mostly a hoax

#183

Post by DanBC » Wed, Jul 05, 2017, 7:19 AM UTC

Hasknewbie wrote: post #146

grardb wrote: post #70

Earlier quoted context omitted.

Seriously. I always roll my eyes when somebody claims that acupuncture "doesn't work," because it's worked for me on multiple occasions. Typically, it comes from people who have never tried it. A little over four years ago, I had a ton of shoulder pain. I went to two doctors, had an MRI scan, and was prescribed physical therapy. After all of that, I was still in pain, and neither of the doctors could figure out why,…

Seriously. I always roll my eyes when somebody claims that acupuncture " does work," because the placebo effect worked for them on multiple occasions. Typically, it comes from people who don't want to admit they were cured by a placebo, otherwise it would work all the time, for everyone . There, fixed it for you.

Here's a link showing that placebo is better than placebo for some types of long term pain.

https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...

Re: The $100B per year back pain industry is mostly a hoax

#184

Post by DanBC » Wed, Jul 05, 2017, 7:23 AM UTC

seanwilson wrote: post #76

pavel_lishin wrote: post #62

Earlier quoted context omitted.

First, you're taking a god-of-the-gaps approach to acupuncture. "It hasn't been proven to be ineffective for condition X, so keep your mind open!" Second, they have run good trials on many of the conditions acupuncture claims to cure. You picked the one paragraph that might be interpreted to support your claim: > It's a shame that Western science seems so intent on dismissing non-western treatments and techniques, ra…

> And bitch all you want about "western medicine", but if you have a heart attack, or need a kidney transplant, or break a bone - you're probably going to choose the western system. I always find it weird that people can't see alternative medicine is only used by advocates on problems than tend to come and go by themselves or are susceptible to placebo effect but any time something serious comes up like the problems…

You're pretty sniffy about the effects of long term pain which can be debilitating, even life threatening. Some people who die by suicide were in long term pain.

And here's a large, we'll run, study showing acupuncture is more effective than sham accupuncture

https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...

Re: The $100B per year back pain industry is mostly a hoax

#185

Post by CogitoCogito » Wed, Jul 05, 2017, 7:25 AM UTC

femto wrote: post #16

I can personally vouch for the effectiveness of a morning routine of 15 minutes of exercise at home, targeting the pelvic muscles. The only equipment required is a floor mat, if the floor is hard. I started gently and naturally progressed to a higher level, taking the attitude that there is no hurry, because I'm going to be doing this for the rest of my life, so there is plenty of time to progress. My initial routine…

> I don't mean to be smug, as back pain really is an individual thing. There's an element of searching for what works, and I was lucky in that I was pointed directly towards an effective treatment.

I think this is extremely important for everyone to remember. People tend to (correctly) scoff at anecdotal experience, but often that's all you can work with. When studying health problems, most studies will tend to find the "best" thing overall for a varied group of people, but basically forces the solution to be the lowest common denominator. You see this all the time with different diet studies, were people "prove" that some diets are better than others. Of course the true answer is that there is no solution that's best for everyone.

Really you need to experiment and just learn a lot about your body. For example, I've been able to rid myself of my back problems by running. If I stop running for a few weeks all my really painful back problems start to come back. Since I mentioned the diet example earlier, I should point out that for myself the most effective way to lose weight is basically just starvation. I exercise a lot and track calories and only consume between 1500 and 2000 a day (I probably need at least 2500 a day and maybe closer to 3000). It's always been much easier for me to just be constantly hungry for a couple months than to play different diet games and figure out which foods are most filling.

You need to learn to listen to your body.

> My doctor's rule was "pain free exercise". Go as far as you can, but stop if hurts.

1000 times this! If I'm running in form, I'll probably run 6 days a week, but I've learned to just quit if I feel acute pain or if my muscles are very tight and I can't get them to loosen. You gotta know when to fight your battles. An injury today means no exercise for a while and that's way worse than whatever gains you'll get by continuing.

Re: The $100B per year back pain industry is mostly a hoax

#186

Post by m00x » Wed, Jul 05, 2017, 7:26 AM UTC

pif wrote: post #171

taneq wrote: post #144

Earlier quoted context omitted.

Weight loss isn't "known intractable". Physically it's very simple, if an overweight person is physically prevented from eating too much, they'll lose weight, just like physically it's very simple to quit addictive drugs. And the drug analogy is a good one, because just like quitting drugs, you can't quit overeating (barring the aforementioned option of someone physically preventing you from doing so - which is liter…

> Weight loss isn't "known intractable". Indeed, weight loss is "simple", as you said. The problem arises when you have managed to get to your target and you realize that, short of amphetamines or similarly dangerous drugs, there is no known way to keep your weight stable with an acceptable life quality . Obese people are not stupid when they choose to keep eating; they've just learnt by experience that, unless you s…

Do you mean no known way for obese people?

If you're already fit, it's incredibly easy to stay fit.

Also, most of the time, obese people don't only eat to satisfy hunger, but much past that.

Re: The $100B per year back pain industry is mostly a hoax

#187

Post by DanBC » Wed, Jul 05, 2017, 7:27 AM UTC

lr4444lr wrote: post #25

Anyone who has endured back pain knows it is an erratic dictator. It takes hold of your psyche, demanding your attention and devotion before all else—before you can plan a hike, return to a work routine, pick up your child for a hug. So when someone offers to make that dictator disappear, it’s hard to resist—no matter what the price. Although there are many people who do manual labor for whom the inability to move pr…

You can see how an acute episode is different to chronic pain right? You can understand that a pain that comes, lasts a few days, and then goes is different to pain that you live with every single day of your life?

Re: The $100B per year back pain industry is mostly a hoax

#188

Post by tmbsundar » Wed, Jul 05, 2017, 7:30 AM UTC

_delirium wrote: post #17

transreal wrote: post #15

Anyone suffering from back pain who really wants to recover should read Dr. John Sarno's work. Here's a link to his book: https://www.amazon.com/Healing-Back-Pain-Mind-Body-Connectio... I was skeptical at first, but just reading his book and thinking through what he presented healed my lower back pain.

Wait, the process of thinking through the book's contents itself healed the pain?

You need to read the book and his work to understand that bit.

It's not just reading the book. "Reading the book" makes you understand the way the brain works and can induce and "help" sustain "real pain" in places you think it to be. He also makes it clear that the advice "it's all in your mind" is just not going to help and only an insult to the sufferer.

If I understand correctly, he does not exclude physical examinations and advises to go through scans to determine anything serious and attend immediately. For the rest, he outlines the process by which, your brain can trick you into "induce real pain" and sustain real pain.

Any kind of relaxation or - a) reading the book = understanding the process b) relaxation/ meditation which takes away your concentration away c) letting out your aggression on some contact sports etc., can help.

Re: The $100B per year back pain industry is mostly a hoax

#189

Post by DanBC » Wed, Jul 05, 2017, 7:34 AM UTC

erentz wrote: post #81

seanwilson wrote: post #45

I thought this community would be more scientific...instead of anecdotes I'd rather see links to rigorous studies e.g. showing acupuncture or chiropractors work especially since these two forms of intervention have been subjected to decades of research already, have no plausible scientific basis and claim to treat many more things besides back pain. They should be held to the same standards as other medicine.

It's disturbing. I suspect most of this community would be anti-anti-vax (pro-vax?). And if one were to suggest on this forum that "I vaccinated my child and they got autism, therefore vaccines cause autism", they would be met with the appropriate skepticism. But in this thread people are professing "I had acupuncture and got better, therefore acupuncture works" and somehow that's considered defensible.

Yes, it's a shame that this thread is full of both quackery and anecdotal evidence.

However, don't rush to condemn acupuncture as a treatment for long term pain. Here's one recent analysis showing advantages over placebo: https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...

Re: The $100B per year back pain industry is mostly a hoax

#190

Post by CogitoCogito » Wed, Jul 05, 2017, 7:35 AM UTC

pif wrote: post #171

taneq wrote: post #144

Earlier quoted context omitted.

Weight loss isn't "known intractable". Physically it's very simple, if an overweight person is physically prevented from eating too much, they'll lose weight, just like physically it's very simple to quit addictive drugs. And the drug analogy is a good one, because just like quitting drugs, you can't quit overeating (barring the aforementioned option of someone physically preventing you from doing so - which is liter…

> Weight loss isn't "known intractable". Indeed, weight loss is "simple", as you said. The problem arises when you have managed to get to your target and you realize that, short of amphetamines or similarly dangerous drugs, there is no known way to keep your weight stable with an acceptable life quality . Obese people are not stupid when they choose to keep eating; they've just learnt by experience that, unless you s…

> there is no known way to keep your weight stable with an acceptable life quality.

Firstly, why does your weight need to be stable? Personally I tend to go on yearly (maybe biennially) cycles with shifts between 170 and 195 pounds. Basically I force myself to get down in the weight (my weight-loss method is to restrict calories pretty dramatically). After that I will have eating habits that tend to keep me low for a while, but over time as I go back in my regular eating style (I am naturally a bit of glutton), I'll usually go back up in weight. After that the cycle starts again. I think that this is a much easier approach than trying to stick to a target weight. It also allows you to "live" (most people don't want to count calories forever).

Secondly, what is an "acceptable life quality"? Like I said, I lose weight by restricting calories greatly. This leaves me pretty much constantly hungry for a couple months, but I quickly am able to just push it into the background mentally and accept it. For me this is acceptable. But yes if basically any approach that _works_ is considered _unacceptable_ to you, you're basically screwed. (I don't want to sit on a high horse. You might have stress in life or obligations that make it basically impossible for you to be productive and hungry for a couple months, so I can totally understand my method as being unacceptable to many.) In the end, you do need to figure out how to take action somehow, or you'll never solve the problem.

> By the way, surgery actually looks like an option.

Yeah most don't realize how extremely successful gastric bypass is. It's way more successful on average than any popular weight-loss routine. Obese people should seriously consider the possibility. It can be life-changing.