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

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

#301

Post by bluGill »

a2tech wrote: post #257
CogitoCogito wrote: post #190

Earlier quoted context omitted.

> 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…

I wish people would be less cavalier with throwing around gastric bypass as a general obesity fix. I know many people that have had gastric bypass, and have considered it for myself as an obese man. You will absolutely lose weight with gastric bypass. Full stop. And usually a ton of weight. Which is good! And the surgical complications have fallen way down over time. Those are the good bits. The BAD bits that aren't…

The only person I know who had Gastric bypass complains that she cannot eat more than one doughnut at a time anymore. Which is to say if you don't fix your eating it won't help. If you fix your eating you won't need it (though it might be easier to stop afterwards).

It is possible I know more than one person who has had gastric bypass, if the rest have not told me about it.

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

#302

Post by gumby »

blister wrote: post #273

Anecdote of one: I was diagnosed with Stage 4 Hodgkins Lymphoma two years ago. My _only_ symptom at the time was pretty severe back pain, which is unusual for lymphoma. After treatment and remission a year later, I still had the severe back pain. The cancer pain management doctor I was seeing was perfectly happy to keep prescribing godlike levels of opiods. (50+ mg of oxycodone on top of 30+ mg of slow-release morphi…

> I had to pay for several weeks of PT out of pocket because my insurance did not consider it important. They would prefer to shell out $500+ dollars every month to see a pain management doctor and continue taking pills.

Of course you could easily have sold those pills to pay for the PT :-)

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

#303

Post by joelrunyon »

thenomad wrote: post #219
joelrunyon wrote: post #55

Earlier quoted context omitted.

The problem with doing exercises is it's not as simple as a pill or a surgery - it's a lifestyle change. Don't want to spam HN with this as I mentioned it earlier, but this is one of the issues we're trying to address with http://MoveWellApp.com - which is basically a personal mobility coach.

Quick note here: an Android app would go a long way to encouraging takeup in the HN crowd, I suspect. I'm already a big fan of mobilisation exercises, so my thought process went "sounds great - where do I download?"..."iPhone only. Meh. Oh well." I know you're working on it, just wanted to give you some feedback to help prioritise.

Thanks - we're working on it.

We usually build iOS first for the reasons outlined here - https://impossiblex.com/ios-first/

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

#304

Post by joelrunyon »

scrollaway wrote: post #149
joelrunyon wrote: post #53

Earlier quoted context omitted.

Piggybacking on this - basic mobility exercises can free up a lot of your muscles from regular pain. You end up doing this a lot when you go see a physical therapist. This was part of the reason we bootstrapped our app - MoveWellApp.com - to give people easy-to-understand routines to stay mobile and pain free at home. It's a free download at http://MoveWellApp.com/download for iOS, so if you have any specific feedbac…

No comment to its quality, but it's pretty ballsy to piggy-back on a thread talking about a $100B/yr industry being "mostly a scam" to promote your app :)

Except instead of charging hundreds of thousands for pills or surgery, we're showing people how to do basic exercises at home for free.

Take a look at the app for 5 seconds ;)

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

#305

Post by peetle »

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.

Think of all the physiological responses attributed to nervousness (e.g. before public speaking): muscle tension, raised heart rate, sweating, need to urinate/defecate, insomnia, nausea.

Given that, why are we so convinced that our mind (i.e. our prefrontal cortex, seat of "high level" thinking) _couldn't_ be the cause of persistent inflammatory pain? Do not ideas and stressors persist in our mind, just as pain might?

Sarno's simple thesis is that stress in our daily life could, in fact, be the underlying trigger for inflammatory pain. The mere realization of this, for many people, can resolve chronic pain problems that last years and are resistant to treatments that assume the cause of the issue is structural.

Here's a success story from one of the creators of EtherPad (acquired by Google) on his recovery from wrist pain (diagnosed as RSI) from reading Dr. Sarno's book:

http://www.rsipain.com/success-story-severe-forearm-pain.php

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

#306

Post by mathw »

tome wrote: post #231
0xbear wrote: post #35

Earlier quoted context omitted.

Your muscles are locked in spasm because they’re insufficient to carry the load. The long term solution to that is not acupuncture, it’s building up those muscles through exercise, and in particular through training with free weights.

Well yeah, but it's no good lifting weights with muscles that are locked in spasm.

Indeed.

My physiotherapist's approach is to engage in a variety of horribly painful activities to get those muscles to unlock, and then teach you how to do the exercises that will help you stop it happening again.

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

#307

Post by seanwilson »

sn9 wrote: post #173
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.

Why on earth would you assume any lay audience would have an up-to-date knowledge of the state of research in any given field in which they are not a working researcher?

I'm assuming that hackers that expect things like benchmarks for software performance claims who are then also skeptical enough to point out microbenchmarks aren't meaningful to be more skeptical than the average person. I don't have up-to-date knowledge about back pain or other medical topics but I know enough to be skeptical of certain claims and to ignore anecdotes.

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

#308

Post by mathw »

charris0 wrote: post #172

Had back pain (lower back and neck) for years, mostly I think due to being tall and poor desk posture. I used to spend a lot of money at the chiropractor/osteopath, and while they do give relief I don't see them as a long term solution. That said, I think they can be valuable for acute episodes. What cured my back pain is Yoga. Not overnight, not over a week, but months of adding strength and flexibility to body as a…

I think there are a lot of people with back problems (definitely not all of them though) particularly desk workers (and not all of them either) who have a lot of their issues down more to a lack of core strength than anything else. Yoga, from what I have been told, is pretty awesome for core strength.

It's something I'm working on in physiotherapy, because although I went to see her because I was having horrendous knee problems (now in full retreat thanks to some very simple, well-chosen exercises), she looks more holistically than that and identified some back issues as well. More exercises.

The back ones are harder to do though, and don't seem to be as effective, but I'll be bringing that up at my next visit.

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

#309

Post by dahart »

rebuilder wrote: post #241
pif wrote: post #171

Earlier quoted context omitted.

> 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…

Regarding the hunger problem - is increasing calorie consumption a viable option? A physically active male with significant muscle mass can fairly reasonably find himself needing about 3000 kcal a day without having to be a pro athlete. Would becoming much more active and gaining lean mass help, or would the amount of food needed to feel sated just increase?

I tried that theory for 20 years, and it didn't work for me. I've always been active, playing lots of sports and going to the gym regularly, hiking, biking, running, etc.. Unless I'm counting calories, I always compensate for exercise by eating more. I finally realized exercise alone wouldn't help me lose weight.

In general, you probably can't get rid of a little hunger. If you want to lose weight and be in a calorie deficit, you might be 500 calories short. If you add 1,000 calories of exercise, and 1,000 calories of food, you're still 500 calories short, and still likely to experience hunger.

I feel stupid for how long it took me to "see" my own evidence. Like many people, I have a mental aversion to paying extreme attention to what I eat, to eating less, and to counting calories. The very idea of doing that is off-putting, and I didn't notice how subconsciously strong that mental aversion is until recently. It wasn't easy, but I did the hard mental work before I started the diet. Once I got going and formed some new habits, I didn't have to think about it much. One of my mental tricks was to realize that a little hunger is exactly how I'm supposed to feel. Rather than focusing willpower on combating my hunger and reminding myself not to eat, I came to the realization that not being hungry at all is the bad state, that is the feeling I have when I've eaten too much. Being a little hungry is a good thing.

Counting calories worked for me relatively quickly, and it worked regardless of whether I was exercising (as long as I tracked my exercise calories too.) It took less time than exercising, and it helped me see the differences more clearly between losing weight and getting strong. Those are two mostly different things. There's some cross-talk between them, but the main way to target each of them is different. Gyms all advertise weight loss, but now I see gyms as a place to get strong, and eating less as the way to lose weight.

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

#310

Post by seanwilson »

DanBC wrote: post #181
seanwilson wrote: post #80

Earlier quoted context omitted.

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.

Thanks for the link. I'm not claiming to be an expert so can you explain what the values here mean? How significant an improvement are these numbers and how do they compare to just doing nothing?

> It had moderate effect compared with non-acupuncture care for musculoskeletal pain (standardised mean difference [SMD] 0.55, 95% confidence interval [CI] 0.51 to 0.58), osteoarthritis (SMD 0.57, 95% CI 0.50 to 0.64) and headache (SMD 0.42, 95% CI 0.37 to 0.46).

Also, the comparisons to acupuncture vs sham acupuncture...is this implying that acupunture has some validity (meridians etc.) or just that the sham wasn't convincing enough? Why would acupuncture perform better when meridians have no scientific plausibility?

I've no doubt an elaborate procedure such as acupuncture produces a strong placebo effect but something that isn't better than a placebo shouldn't be considered as working in my opinion.

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