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

#311

Post by seanwilson » Wed, Jul 05, 2017, 3:52 PM UTC

DanBC wrote: post #184

seanwilson wrote: post #76

Earlier quoted context omitted.

> 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...

> 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.

Obviously I think long term pain should be taken seriously but I would prefer people used existing scientifically backed treatments instead of promoting pseudoscience which definitively does lead to deaths (e.g. see the anti vaccination movement).

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

#312

Post by pbhjpbhj » Wed, Jul 05, 2017, 3:57 PM UTC

thenomad wrote: post #220

thesunny wrote: post #28

I haven't posted in a while but had to jump in on this. I had very bad back pain before my first daughter was born. I wanted to be able to carry my daughter when she was born so I decided to try everything, whether I believed it would work or not. I had massages, shots injected directly in the back, manipulation, and basically lots of different doctors and specialists. Nothing worked. Since I said I'd try everything,…

One thing I've definitely learned about musculoskeletal problems is that you shouldn't discount apparently unscientific treatments if they seem to work. There's a lot we don't know about how that particular system functions, and things like acupuncture seem to fit into that. That's not to say the explanations they give for why things work are accurate, but the treatment itself seems to work sometimes. I'm not advocat…

My friend had acupuncture on the NHS for severe back pain (prolapsed disc, ensuing sciatica) which left her with no relief and some pretty severe bruising. So whilst non-invasive clearly there is potential for problems. Only painful for a couple of days though and relatively superficial; so probably worth trying.

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

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Post by pbhjpbhj » Wed, Jul 05, 2017, 4:07 PM UTC

nradov wrote: post #205

shakermakr wrote: post #163

Earlier quoted context omitted.

Running is terrible for the lower back. Every time you stride you send shock waves up your legs that decompress in the lower spine. I switched to elliptical training. As you don't lift your feet, impact free. Swimming is also fantastic for the back of course. Evidence: had a microdiscetomy 4 years ago, lots of rehab, and now pain free. Every doctor said don't run!

Humans evolved to run. Running is good for your lower back, provided you run with proper form and aren't already injured.

What's proper form? Front foot or heel strike?

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

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Post by 0xbear » Wed, Jul 05, 2017, 4:15 PM UTC

mathw wrote: post #306

tome wrote: post #231

Earlier quoted context omitted.

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.

That's pretty much what I did, modulo the physiotherapist. I would lift, get punished for it with brutal back pain, wait for a few days for it to subside, then do it again. I was free of back pain within a month.

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

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Post by tootie » Wed, Jul 05, 2017, 4:26 PM UTC

tarr11 wrote: post #64

tootie wrote: post #50

Earlier quoted context omitted.

Jogging or long walks is the one thing that causes back pain for me.

Consider your shoes, more supportive shoes may help on long walks. I over pronate, and when my sneakers are at all worn down, I start to have back pain. Also, jogging or running would often make things much worse for me.

I overpronate badly and do carefully choose my shoes to support that. But, if I just avoid being on my feet for too long at a stretch I never get back pain.

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

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Post by rebuilder » Wed, Jul 05, 2017, 4:37 PM UTC

dahart wrote: post #309

rebuilder wrote: post #241

Earlier quoted context omitted.

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…

I should have been a bit more explicit - I meant life after weight loss. The problem was apparently that maintaining a healthy weight requires being perpetually hungry. I was wondering if being able to afford 3 solid meals and some snacks without gaining weight would help with that appetite issue.

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

#317

Post by steanne » Wed, Jul 05, 2017, 5:13 PM UTC

pyromine wrote: post #180

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'm a healthy athletic 20 year old and I was having back pain for a while, and when I finally went to the doctor they suggested it may just be an imbalance in the strength of different muscles in my back that I didn't properly train for the sports I participate in. Gave me some exercises, and a month later back pain was all gone and my back felt stronger, with better posture. Crazy what can be done when you just have…

yes! this. the problem is, there are a lot of people that are told to lose weight to cure back pain, they lose enough weight for it to alter their posture, and they experience new back pain. of course it's temporary, and if their doctor had told them about it ahead of time and offered appropriate physical therapy when it happened they'd work right through it, but that doesn't seem to happen. all they know is the doctor told them to lose weight for their back pain but losing weight made it worse, so they stopped.

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

#318

Post by panglott » Wed, Jul 05, 2017, 5:26 PM UTC

vonmoltke wrote: post #280

panglott wrote: post #254

Earlier quoted context omitted.

It's not mere availability of food. Obesity rates vary quite widely across OECD countries; the US is at 35%, France/Italy/Spain are at about 5-10%, Korea is below 4%. Overeating is a stress response for a lot of people, and overeating often occurs among people in high-stress situations. The US is a country that tolerates a very high level of poverty, inequality, and insecurity, and this results in high obesity rates…

Where are your numbers from? According to Wikipedia's summary of a 2014 WHO report the US is at 33.7%, France is at 24%, and the major Anglo nations in between. There is not nearly the disparity between the US and the rest of the world you claim. Source: https://en.wikipedia.org/wiki/List_of_countries_by_Body_Mass...

The claim that France/Italy/Spain had obesity rates of 5-10% was a misread of the charts, where I should have said 10-15%. But the OECD reports pretty wide discrepancies among developed nations. http://www.oecd.org/els/health-systems/49716427.pdf http://www.oecd.org/health/health-systems/46044572.pdf

Here's the 2017 update; France and Spain have topped 15%, but Italy dropped below 10%. http://www.oecd.org/health/health-systems/Obesity-Update-201...

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

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Post by slr555 » Wed, Jul 05, 2017, 5:29 PM UTC

deelowe wrote: post #137

slr555 wrote: post #135

The thing is, when you've seen one back problem, you've see one back problem. The spine is a maddeningly complex assembly of bone, nerves, cartilage, articular surfaces, vasculature, packed tightly, subjected to immense forces, and articulable is many directions. It is a miracle of evolutionary engineering and a miserable failure. We needed to crawl longer before we stood up and walked as a species. I have been throu…

I'd love some help. How did you find someone who could actually give you some sort of prognosis/diagnoses? Mine just say either "more PT" or "here's some pills." Neither work. My disc is budged and it seems like moving the wrong way will trigger 2-3 days of intense pain and immobility. No one seems to offer any suggestions on how to fix it. Is it fixable? I don't know... P.S. the back pain industry is a sham, but the…

I am sorry to hear your in pain. I know how debilitating it can be.

Hospital for Special Surgery in NYC is consistently ranked number 1 in orthopedics in the US. They have spine surgeons and neurosurgeons who excel in implementing mechanical solutions. Perhaps I should have mentioned first that the pain clinic at HSS is fabulous for diagnostics and they are extremely conservative when it comes to opioids.

Getting a proper diagnosis is essential. I was diagnosed incorrectly for years before learning my underlying problem was a spondylolisthesis. Appropriate imaging studies (x-ray, MRI, CT, myelogram as needed) read by superb radiologists will get you a clearer picture of what is really going on.

Surgery may or may not be required. It all depends on the cause. If your doctor recommends diet and exercise/PT be relentless with your implementation of the program (being mindful of what your body tells you).

Finally I would have to say that my sister who is an MD helped me realize one very important thing. The susceptible human back gets "tweaked" from time to time. If your back goes into spasm for a couple of days once in a while (and deelowe I am speaking more generally here than of your specific circumstance) you could spend tons of time running it to ground, when it the long run a form of radical acceptance may bring greater peace of mind. Accepting - I am a person whose back fails me from time to time forcing me to be debilitated for a few days may be less anxiety provoking and frustrating. Good doctors can help you decide what option is best. As Aaron Sorkin said in the Steve Jobs meeting, and I think it applies to all of us, accepting "I am not well made" can be useful to all of us.

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

#320

Post by slr555 » Wed, Jul 05, 2017, 5:45 PM UTC

rargulati wrote: post #151

slr555 wrote: post #135

The thing is, when you've seen one back problem, you've see one back problem. The spine is a maddeningly complex assembly of bone, nerves, cartilage, articular surfaces, vasculature, packed tightly, subjected to immense forces, and articulable is many directions. It is a miracle of evolutionary engineering and a miserable failure. We needed to crawl longer before we stood up and walked as a species. I have been throu…

Would love to learn more about the activities or structural issues that led to getting the surgery. Also, what were the types of things you heard over 10 years (or treatments you attempted) before getting the surgery? Basically, would love to hear your story / more details here - thanks :)

My ultimate correct diagnosis was a cluster of a few interrelated issues. Bilateral defects in the pars interarticularis around L4-L5 led to chronic degenerative changes at that level as well as a grade one spondylolisthesis. This was coupled with sclerotic changes in a spinal canal that was congenitally narrow leading to impingement.

My earlier incorrect diagnoses included many of the usual suspects. Bulging disc, piriformis muscle entrapment/impingement, muscle strain, somatization etc.

Treatments attempted included injections, muscle relaxers, tens unit, NSAIDS, opioids, PT, and other things like spinal cord stimulators were recommended but not implemented.

2011 and 2013 fusion, laminectomy, foraminotomy, discectomy, placement of hardware.

And the story has a happy ending. Scuba, hiking, touring all successfully re-integrated into life. Hopefully it will last a lifetime but all this taught me that every pain free day is gravy.