[HN Gopher] Novel mind-body program outperforms other treatments...
___________________________________________________________________
Novel mind-body program outperforms other treatments for chronic
back pain
Author : yasp
Score : 301 points
Date : 2021-11-27 03:13 UTC (19 hours ago)
(HTM) web link (www.bidmc.org)
(TXT) w3m dump (www.bidmc.org)
| visarga wrote:
| I tried mindfulness for back pain and it worked, for a short
| while, while I kept on meditating daily. But it was a struggle.
| In the meantime I discovered that taking Ca + Mg supplement does
| away with my pains. No doctor was able to give me this hint, I
| discovered it by mistake when I took an effervescent pill.
| [deleted]
| 0134340 wrote:
| Calcium worked for you? It's not been my experience nor some
| others. I've heard it explained that since calcium is needed
| for nerve transmissions, pain can be worse if you take excess
| Ca. It's all anecdotal but I feel like my back pain is worse
| when taking Ca supplements.
| visarga wrote:
| In my experience Mg helps me relax and sleep better and Ca
| relieves the pain. I feel 10 years younger.
| austincheney wrote:
| Whenever I have severe back pain my go to solution is a bunch of
| magnesium citrate. This won't work for most people as it's an
| extreme laxative, but it doesn't work that way for me.
|
| Magnesium is a mineral nutrient tasked with the transfer of
| oxygen from blood to cell tissue. Insufficient magnesium is the
| primary reason for muscle tissue distress. Upping magnesium
| intake will allow muscle relaxation and healing in the case of
| stress. Magnesium citrate appears to be an extremely soluble form
| of magnesium in the body. It also relieves constipation from
| which lower back pain is a symptom.
| brandonmenc wrote:
| Plug for the book that helped me. Evidence-based self-treatment
| from an expert spine researcher. If you've ever heard of the
| "McGill Big 3" exercises, this is the guy.
|
| https://www.backfitpro.com/books/back-mechanic-the-mcgill-me...
| crehn wrote:
| TL;DR:
|
| > Psychophysiologic Symptom Relief Therapy (PSRT) is designed to
| address underlying stressors and psychological contributors to
| persistent pain as well as conditioned pain responses and fear
| avoidant behaviors.
|
| Good to see research into this. I've definitely had enduring pain
| relief by a deeper change in mindset.
| generalenvelope wrote:
| I've injured (ie: resulted in reduced physical performance) my
| back numerous times lifting weights.
|
| The first couple times it scared the life out of me, and I
| suffered in moderate to severe pain for a week or two, unable to
| put my shoes on. Even went to the ER and the doc basically said
| "I dunno" and offered muscle relaxants.
|
| I later stumbled upon some content from Austin Baraki and Jordan
| Feigenbaum (their company is Barbell Medicine) when
| rehabilitating a back tweak, and it changed my life. I learned
| about pain science and developed so much self efficacy that if I
| experience pain I don't even think of seeing a doctor at first
| (assuming certain red flag symptoms aren't present).
|
| Recently I tweaked my back and was incredibly effective about
| recovery thanks to these guys. In about a week I could squat
| 100kg+ discomfort free (!).
|
| I highly recommend Austin's article regarding the "bio-psycho-
| social model" for pain:
| https://startingstrength.com/article/aches-and-pains And the
| barbell medicine youtube channel for content on pain, nutrition,
| and training, regardless of if you personally do resistance
| training - though I highly recommend that as well. It's
| invigorating to see yourself briefly injured squatting, and
| through reassurance & load/exercise management recovering almost
| entirely in a matter of days.
| andy_ppp wrote:
| A lot of anxiety in these comments! I had the opposite issue to a
| lot of people here; it wasn't a psychological health issue
| causing it, it was caffeine that I'd tolerated well most of my
| life before. I stupidly drank some caffeinated tea before
| watching Dune which made the whole experience terrifying!
| [deleted]
| patmcc wrote:
| People are incredibly reluctant to believe that ailments might
| actually be partly or mainly psychological. Chronic fatigue,
| fibromyalgia, chronic lyme disease, back pain, are all things
| that sincere people truly are suffering from...that may be mainly
| psychological/psychosomatic but lots of people refuse to consider
| it. Probably due to the general dismissal of mental illnesses and
| being told for years "it's all in your head". I think partly,
| people with these conditions are sometimes accused (or think
| they're being accused) of malingering; I don't think that's the
| case very often, I think they legitimately feel the symptoms they
| report, but the root cause may be in the mind/brain rather than
| the rest of the body.
|
| Yes, some back pain is due to repetitive stress injuries or
| physical structures out of place or whatever. But as this study
| shows, looks like it has a strong psychological component as
| well. I suspect we'll (some day) get better treatments for all
| the things I mention, if mental illness stigma ends and they can
| be honestly considered from all possible causes.
|
| Edit: to be clear, I'm not saying that _all_ cases of back pain
| or CFS or whatever are psychosomatic - just that it shouldn 't be
| dismissed, especially when the treatments are relatively low-
| risk.
| andy_ppp wrote:
| I knew a guy who had an extremely stressful job and a bad skin
| condition, it cleared up as soon as he left. The brain and body
| are extremely connected.
| atom_arranger wrote:
| All pain is psychological.
|
| I imagine for most people with back pain there is a physical
| component, they didn't have back pain as children, but if we
| had full control of the brain we could turn off the pain
| sensation if it's not useful.
| asadkn wrote:
| There can also be physical issues that can be masked
| psychologically. You can train your brain to ignore and mask
| many pains and aches and dull them down. IMHO, managing pain
| can definitely be done psychologically, at least to some
| extent.
|
| Being too aware of the pains, obsessing over them, and being
| anxious and stressed definitely aggravate the conditions in my
| experience. Having an otherwise healthy balanced life in terms
| of work, relationships etc. with healthy amount of stress,
| makes some of the ailments very manageable or a non-issue.
| bserge wrote:
| I mean, technically all pain is in your head. Because the brain
| processes it.
|
| If one can learn to ignore it, well... Good? Just go on until
| you literally become disabled, I guess.
|
| I ignored the _ridiculous_ fatigue from hypothyroidism for
| years.
|
| It was my hands looking like someone slashed them a dozen times
| with a knife, bleeding to the point of having to wear gloves in
| late spring that led me to finally get medication.
| [deleted]
| intricatedetail wrote:
| Many doctors believe what you say and dismiss patients as
| psychosomatic if they can't find anything obvious. Sometimes
| they refer them to psychiatrists or insinuate they are drug
| seeking. It's a disgrace. This treatment from health
| "professionals" almost drove me to suicide. Actually my own
| research got me into a path of finding out I have a rare
| disease and I had to pay private consultants to help with
| diagnosis. Only then and a threat of lawsuit got the doctors
| treat me seriously and I actually got help.
| cpncrunch wrote:
| What is the disease?
| pfortuny wrote:
| Also, being psychosomatic does NOT mean they are ficticious,
| which is a widespread opinion.
| denvaar wrote:
| My dad has been fighting cancer for the past 13-ish years. He
| recently told me that he's expected to live another six months
| or so because he has ran out of treatment options. Though we've
| known for most of these past years that his cancer is terminal,
| I feel like him telling me the news set something off inside of
| me.
|
| Starting shortly after the time of hearing this news, I started
| to feel subtle, hard-to-pinpoint discomfort near my tailbone &
| perineum (sorry, TMI). I went to the doctor multiple times, had
| all types of exams and scans, but everything was coming back as
| "normal". My symptoms got worse as weeks went on, and I became
| incredibly anxious, though I was not able to recognize it as
| "anxiety".
|
| At the peak of all this I found myself having what I would
| assume was an anxiety or panic attack. I could not control my
| breathing, started sweating, feeling like I was about to pass
| out. My wife was able to calm me down by helping me breath. I
| would break down crying on the phone trying to schedule doctors
| appointments (I'm 30 years old). I was unable to sleep at all
| for several days in a row even though I felt completely
| exhausted. Had to take time off (Incredibly thankful for
| coworkers/managers who were understanding) Chest pain,
| digestive issues, etc.
|
| It's been a weird few months, but I finally think (hopefully) I
| am starting to get back to my "normal" self. The experience has
| taught me at least a couple things:
|
| - Mental / emotional heath is something that is taken for
| granted. Now I have a new perspective on the importance of
| trying to maintain it and want to be understanding toward
| others.
|
| - I think some (all?) of my symptoms were definitely related to
| what was going on in my life, and how things played out as I
| tried to fix them. This is hard for me to wrap my head around,
| but really I have found no other logical explanation.
| seer wrote:
| So sorry to hear what you were going through. My partner had
| something similar due to the stress from the pandemic. What
| helped her the most was actually a regular psychiatrist
| appointment.
|
| Did you do something specific when you took your time off and
| saw your symptoms disappear? Curious what helped you the
| most.
| denvaar wrote:
| When I took time off it was simply because I could not
| function in any meaningful way.
|
| - Anxiety medication (I feel hesitant taking this and
| question if it helps or not. Hard to know.)
|
| - Talked to a therapist weekly (now doing monthly)
|
| - Yoga weekly
|
| - Forced myself back into a regular exercise routine. I
| love exercising, but I had fallen out of my routine.
|
| - Modified my diet and eating habits. I track everything I
| eat now. Still experimenting with this.
|
| - Focused, deep breathing for 5 to 10 minutes three times a
| day.
|
| - I think time in general helped me heal.
| TriNetra wrote:
| The Black Lotus app [0] is an incredible help to deal with
| mental issues related to stress, anxiety and lack of
| focus/mindfulness.
|
| Personally, I have used it twice successfully to come out of
| sudden mental anxiety I found brewing in myself.
|
| Thoughts are also a form of energy - if they don't get
| channelized or remain unspent in your
| subconscious/unconscious, they can create mental problems.
| Meditation and related activities, prescribed as part of the
| RARE framework of this app, help in cleaning these otherwise
| overlooked corners of our mind.
|
| 0: https://www.blacklotus.app/
| patmcc wrote:
| So sorry to hear about your dad and your symptoms, that
| sounds very tough. I'm very glad to hear you're feeling
| closer to your "normal" self, I hope that continues.
|
| Anxiety/stress/panic attacks are no joke. I think a lot of us
| in technical fields discount the "mind" - "it's a brain, it's
| just a meat computer" - and while I don't ascribe any
| supernatural aspect to it, the brain/mind can have really
| powerful impacts on the body.
| weiliddat wrote:
| Just to chime in, it's not only people who work in
| technical fields. I had similar symptoms (chest/back pain,
| lethargy) from stress from the pandemic + overwork a year
| ago. And I studied psychology and knew that these things
| could happen, but when it first happened to me I thought I
| had heart problems (not likely since no familial history +
| obvious lifestyle risks). It went away as soon as I quit
| and went for some therapy, not because I didn't like the
| job, but there was no way for me to mentally get away from
| it.
| mmaunder wrote:
| That's a powerful story. I'd encourage you to try yoga. Do
| the Beachbody 3 week yoga retreat. Then continue doing one of
| the final "flow" routines every day. It's 30 mins and is very
| accessible. It cured my chronic back pain and has eliminated
| anxiety about a range of things. After 4 years of doing this
| its also left me with an insanely strong core and great
| flexibility.
| danielbarla wrote:
| From my own (anecdotal) experience, stress most definitely
| plays out in physical ways in your body. Throughout the day
| or night, you can be tightening muscles without knowing it.
| They can eventually fatigue and set off a chain of other
| muscles compensating for it, etc. They can even cramp up in
| ways that they push on nerves, resulting in nerve-pain
| symptoms. It's all fairly logical, but for some reason
| there's this preconception that there is absolutely no
| linkage between our bodies and minds, which makes people look
| everywhere else first. The worst cases tend to be cyclical,
| where your worsening symptoms add to your stress, which leads
| to more symptoms, etc.
|
| The caveat is that sometimes, it's not just stress. You
| shouldn't neglect your symptoms, if they persist.
| bsrhng wrote:
| That is unfortunately the case with me and it took me
| several years to start realizing that prolonged stress can
| result in this cascading effect where muscles tightening
| can distort your body slightly. This in turn can put strain
| on muscles initially unaffected which can themselves become
| locked because you cannot release the initial strain. By
| the time I started realizing it I couldn't answer anymore
| the question what it feels like for my body to be relaxed.
| pjc50 wrote:
| The canonical book on this that people recommend is "The
| Body Keeps The Score". I should probably get round to
| reading it.
| leonroy wrote:
| I read the book after a recommendation on this site in
| fact. It was eye opening to say the least how conditions
| like ADHD, PTSD, childhood trauma, anxiety and depression
| have both psychological and physiological effects. Some
| of which are surmountable (trauma in adult hood) whereas
| early childhood trauma can leave long term physical
| changes to the brain and body making it something that
| has to be managed.
|
| The first 2/3 of the book is very illuminating the last
| 1/3 a little polemic on healthcare policy and funding.
|
| Enlightening book all in all.
| lostdog wrote:
| > People are incredibly reluctant to believe that ailments
| might actually be partly or mainly psychological.
|
| There are two simple reasons why people don't want their
| ailments to be psychological.
|
| First, there are no real tests for determining if something is
| psychological or physical. Doctors just test for some stuff,
| and if the tests come back negative or inconclusive, they just
| explain it away as "psychological." You can never be sure
| whether you have a physical problem or whether your doctor is
| just lazy.
|
| Second, the medical system just gives up on you if the issue is
| psychosomatic. There are no treatment protocols that work, so
| agreeing that something is psychological is just having your
| case tossed on the trash heap to be ignored.
|
| Modern medicine does have a light side and a dark side. On the
| light side are known ailments with known tests and treatments.
| On the dark side is everything fuzzy and uncertain. Doctors
| HATE being faced with ambiguity, and patients know that if
| their case falls into the dark side that treatment and recovery
| are hopeless.
| goodpoint wrote:
| > there are no real tests for determining if something is
| psychological or physical
|
| This is not true. Also, even if it was true, it's not a
| reason not to treat a patient.
|
| > the medical system just gives up on you if the issue is
| psychosomatic
|
| Both pain killers and psychiatric drugs are often
| overprescribed in some countries, especially US, as the
| health system is focused on profit.
| alisonkisk wrote:
| Therapy is 10x as profitable as drugs.
| amelius wrote:
| > There are two simple reasons why people don't want their
| ailments to be psychological.
|
| Another reason is that most people find it scary if someone
| starts tinkering with their psyche. I honestly think that
| every therapy should start with strategies to overcome this
| fear.
| hdjjhhvvhga wrote:
| > Second, the medical system just gives up on you if the
| issue is psychosomatic. There are no treatment protocols that
| work, so agreeing that something is psychological is just
| having your case tossed on the trash heap to be ignored.
|
| Maybe it's because we need to change our approach to
| psychotherapies in general. The reason psychology as a whole
| is not considered hard science is because replication is hard
| and in some cases impossible (good luck finding subjects who
| haven't heard about the Stanford prison experiment today).
| Why don't we accept this is just the way it works. That some
| therapies will work for some people and won't work at all for
| others (or might even make their symptoms worse). That
| therapy needs much more time than a pill to work - instead of
| hours, we're talking weeks and months, possibly years. That
| the evaluation of the results always has an element of
| subjectivity: sure, you can measure some physiological
| aspects, but there is always the internal component of well-
| being.
| casion wrote:
| However, quite dangerously, those ailments are also often
| misdiagnosis's.
|
| Fibro was a misdiagnosis for me, and I nearly died because I
| accepted it and worked on a psychological and rehab program
| rather than continue to pursue symptoms.
| cpncrunch wrote:
| What was your eventual diagnosis?
| casion wrote:
| Autonomic neuropathy.
| cpncrunch wrote:
| So how was that diagnosed, and what is the treatment that
| saved your life?
| xwowsersx wrote:
| Yeah, part of the problem is in the wording too. It's incorrect
| to say "it's all in your head" because this makes it sound like
| the person experiencing the pain is just imagining it or that
| it's entirely a construct of their mind. What Sarno points out
| is that there might be some underlying physical issue at play,
| but it's the extent of the pain that has a psychological
| component to it. As an example, two people can have the same
| exact x-ray of their back showing some alignment or other
| issue. One person will experience extraordinary pain and the
| other barely any at all. The fact that this is left unexplained
| by chiropractors (who are mostly kooks IMO), for example,
| should be a big red flag. How can it be that people who are
| supposedly experts in this field cannot explain for a basic a
| discrepancy like this?
|
| I think the right way to open people up to this is to
| acknowledge and validate their pain, that it's real (not "in
| your head"), but have them consider that the mind-body
| connection could explain more than perhaps they had previously
| realized. If you start out the gate with "it's all in your
| head", not only in this not correct, but it turns the person
| off because it sounds dismissive and pseudo-scientific.
| codingdave wrote:
| Except that it is all in our heads, ultimately. Pain is a
| sensation in our brains, based on inputs from everything
| else. That "everything else" is often our physical nerves,
| but can also be everything else going on in our heads. If
| someone needs to meld the idea of psych-driven pain with
| physical pain, trying to deny that they come together in our
| heads can backfire. It is more important to focus on what we
| even mean by pain being "real", and that it being in our
| heads does not invalidate it in the slightest. It is real,
| and there are more paths to recovery to explore.
| giantDinosaur wrote:
| You couldn't have picked a worse example than CFS to include in
| that list - a syndrome that for decades was dismissed as
| psychosomatic, and that many people (read: most notably medical
| professionals) today still dismiss as such, despite the
| evidence that no, actually there's some kind of physical
| dysregulation going on (probably triggered in many cases by a
| viral infection.)
| silisili wrote:
| Interestingly...well to me, at least, I went to the doctor
| for being constantly tired when I was younger. The doctor
| asked how many friends I had, I said oh a few, then diagnosed
| me with depression and recommended an antidepressant. I left
| and never went back.
|
| Two or so years later I got a long term girlfriend, who told
| me I quit breathing in my sleep and gasped for air.
| Obviously, this is something you don't even think of
| yourself.
|
| I didn't go on CPAP, but did see an ENT who did a couple
| sinus surgeries and put me on steroids for chronic sinus
| inflammation. That treatment changed my whole life. The
| fatigue disappeared immediately.
| AuryGlenz wrote:
| Similar experience for me except the root cause was low
| testosterone (probably ultimately caused by a traumatic
| brain injury).
|
| I kept telling them the only damned thing I was depressed
| about was how tired I was.
| silisili wrote:
| That was exactly my sentiment! Crazy how many doctors
| look for the easy way out. Glad you also found your cure.
| ethbr0 wrote:
| That was almost my exact experience with a former
| girlfriend, except my advising her about sleep apnea.
|
| I was amazed no one had mentioned it to her before, as she
| had quite lengthy pauses and then gasps after them, all
| night! Scared the hell out of me, until I finally said
| something, and she went for a sleep study.
| silisili wrote:
| It's so wild. The first time I woke up to her hitting and
| shaking me, she was visibly disturbed by it as I'm sure
| you were. And here we are our whole lives not even
| knowing we are doing it!
| patmcc wrote:
| I would say that "dismissing" something as psychosomatic is
| the type of "oh it's all in your head" bullshit that, yes,
| has happened far too much in the history of ailments like CFS
| (and still happens today, I'm sure). And I'm completely
| against that.
|
| But at the same time, I know people with CFS who refuse
| treatment like CBT, antidepressants, counselling, getting
| more regular exercise, on the grounds that it _must_ be a
| viral /bacterial infection, or genetic, or autoimmune. Those
| things are all possible and should be researched - but so
| should the idea that it's partly or largely a mental illness.
| And there may well be physical dysregulation - that can be
| caused by the brain in many ways.
| texasbigdata wrote:
| Regular exercise makes it worse because of PEM [1], and
| graduated exercise therapy is contra indicated [4] because
| their ATP energy system doesn't fully work [2]. You could
| cripple them by forcing progressive exercise dogmatically.
| Talk therapy is no longer recommended [2] and many
| antidepressants are not effective [3].
|
| If you read the book Why Zebras Get Ulcers by Sapolski
| there's this story about the African farmer who has his cow
| die, and can no longer farm or support his family after.
| Sapolski says in America you'd give antidepressants, in
| Africa you'd just chip in and buy a new cow.
|
| No offense, and as respectfully as possible while getting
| the point across, but you're being a dick to your friend.
| These people bounce between doctors for years [5] because
| there's no FDA approved diagnostic test, with a hyper
| complex disease that's literally debilitating to them do
| you really think you can drive by diagnose and they just
| missed completely obvious and first pass treatment options?
| Your comment is the "I could build it in a weekend"
| response to ShowHN.
|
| Edit: note, I believe in somatic experiencing of symptoms,
| as described in the link to this threads article. For
| example there's quite a few stories in the biography of
| Chairman Mao [6]of high status officials suffering
| "neurotic crises" and requiring bed bound recuperation,
| arguably because of the repressive environment they lived
| in. But ME/CF is completely different.
|
| 1. https://www.cdc.gov/me-cfs/healthcare-
| providers/clinical-car...
|
| 2. https://www.mayoclinicproceedings.org/article/S0025-6196
| (21)...
|
| 3. See dots in bottom left quadrant for Paxil/Zoloft/etc
| etc. https://www.researchgate.net/figure/CureTogethers-
| page-on-ch...
|
| 4. https://me-pedia.org/wiki/Graded_exercise_therapy quote:
| " Graded exercise therapy (GET) is a form of physical
| therapy for the treatment of chronic fatigue syndrome (CFS)
| where physical activity is gradually increased over time.
| It is a treatment that was offered to ME/CFS patients in
| the UK by the National Health Service (NHS) as specified in
| the NICE guidelines from 2007-2021, but the recommendation
| was removed by the 2021 NICE guidelines because of high
| rates of harm."
|
| 5. https://www.omf.ngo/what-is-mecfs/ quote " People with
| ME/CFS often go years before diagnosis, and 90% of
| sufferers have never been properly diagnosed."
|
| 6. https://www.amazon.de/Mao-Biographie-Alexander-V-
| Pantsov/dp/...
| cpncrunch wrote:
| >ATP energy system doesn't fully work
|
| No, that hasn't been proven. If you look at the Fluge and
| Mella study that you're referncing for this, you'll see
| that the scatter graphs overlap, so the evidence isn't
| terribly convincing. Also, the downregulation of the
| pyruvate link step that they found is consistent with
| increase glucocorticoid receptor activity (the stress
| system).
|
| >Talk therapy is no longer recommended
|
| That's a pretty skewed review you posted. All the
| evidence points to CBT being effective for CFS. Certainly
| it can hurt patients when applied improperly, such as
| forcing patients to ignore exacerbation of symptoms. But
| that doesn't mean it is all bad.
| patmcc wrote:
| I think you're reading more into my comment then is
| there. I didn't say anything about forcing progressive
| exercise or GET, CBT may not be widely effective but
| there are other forms of talk therapy not mentioned in
| your links, and your CureTogether link is self-reports,
| which also shows meditation as one of the most
| successful. And I'm a bit offended, you know nothing
| about my relationship to those in my life with CFS, I
| obviously don't tell them "it's all in your head, get
| some exercise", I just wish they'd be more open to
| different possibilities.
|
| I think CFS is likely a complex ailment, probably really
| several different things grouped together because of
| similar symptoms. Some of the people with what we call
| "CFS" may have some kind of post-viral syndrome, some may
| have a genetic disease, some may have
| depression/anxiety/stress, some may have a combination. I
| think the real error is stated pretty well in one link I
| found (somewhere in one of your links): "We now have
| evidence confirming what millions of people with this
| disease already know, that ME/CFS isn't psychological," -
| to say outright that a disease that isn't yet well
| understood is absolutely not psychological is
| _dangerous_. CFS isn 't measles or diabetes, we simply do
| not know the full cause(s) yet, period.
| intricatedetail wrote:
| How do they measure success of the talking therapies?
| Because I know people who just buy cannabis on the black
| market and won't tell doctors about it - they improve but
| not down to the therapy. They attend talk therapies out
| of fear of being discharged. It's a huge waste of
| resources. Nobody I know got helped by these.
| texasbigdata wrote:
| Ok fair on tone. Apologies.
|
| First you're opining on what the disease is? It's
| actually the converse to your preposition: it's a giant
| symptom cluster (50+) and no one generally believes it's
| multiple diseases lumped together. Read the Mayo paper.
|
| The rest of your comment has a logical fallacy which
| renders it moot: do they have a diagnoses, yes/no? If
| yes, then your "try other things" and "maybe it's
| psychological" comments make no sense and are refuted
| clinically. It's like saying "is your computer turned on?
| No? Ok, it's probably a software bug. Let's just be open
| to possibilities and not be close minded here."
|
| Also a) you're assuming they didn't try therapy. And b)
| "they'd be open to more possibilities"...like what
| specifically? The self reports is 20k data points and
| they got bought by 23andMe; but we could pull PubMed and
| get to the same result. Nothing seems to work and more
| importantly other than a believed onset from a post-viral
| infection, there's no known even rudementary
| understanding of how it works. Clinically there's no
| known above zero effectiveness non-"say no to everything"
| modality. What do you suggest these people that have
| spent 2 to 3 years probably trying everything imaginable
| attempt?
|
| Like it's so straight forward. Try talk therapy for a
| year and then try anti depressants. Oh it didn't work
| across a gigantic cohort? And the scientific community
| generally agrees psychological isn't a recommended
| approach? Very Donald Trumpian to say "who knows who
| knows, let's keep an open mind here" with no backing on
| data to stand on other than an intrinsic belief regarding
| a clinical topic.
|
| You're suggesting a high rate of false positives. The
| links show an expected 91% of false negatives (I'm
| assuming due to the sheer difficulty of diagnosis) and
| literally no comment of false positives. Not clear how
| you can defend that assertion.
| cpncrunch wrote:
| The Mayo paper seems to be quite slanted against
| psychological aspects.
|
| There is quite a lot of research, and it shows that both
| stressful life events and viral infections tend to be
| triggers. (We know that viral infections are
| physiologically stressful, in that they activate the HPA
| axis).
|
| There is also an abundance of evidence that psychological
| therapy and multidisciplinary rehabilitation helps
| patients. So this definitely isn't just laziness in
| saying "maybe it's psychological".
| ianai wrote:
| Few things are worse than a doctor denying care because of
| such denialism.
| cpncrunch wrote:
| I managed to recover from ME/CFS 20 years ago (with no
| symptoms since). It was entirely through
| psychological/behavioural changes that I was able to recover.
|
| >actually there's some kind of physical dysregulation going
| on
|
| The only replicated findings are with the HPA axis (the
| stress system). There are some studies pointing towards
| impaired mitochondrial respiration due to reduction in the
| link step between pyruvate and the TCA cycle. However, if you
| take a quick look on google scholar, you'll see that that
| link step is downregulated by the glucocorticoid receptor
| (the stress system again), so that would seem to be the
| likely cause.
|
| There are also some studies showing reduced work capacity
| after repeat CPET. But again, the HPA axis influences CPET
| performance, so that is a possibility there as well.
|
| The point is: just because there is "physical dysregulation"
| doesn't mean it can't be caused by stress or psychology. That
| is literally how the brain works (if it didn't, we wouldn't
| be alive and conscious). Psychology is intrinsically linked
| to the immune system, HPA axis, autonomic nervous system.
| Psychological stress has been repeatedly shown to cause
| neuroinflammation, cyyokine release, impairment of the
| parasympaethetic nervous system, to name a few.
| texasbigdata wrote:
| Further, here is landmark position paper from Mayo from mid
| 2021 [1] on ME/CF. It's an absolutely brutal disease:
| absolutely no cure, no treatments, give or take 5% chance
| of ever beating it, and almost 50% of people are house or
| bed bound for the rest of their life and even more can't
| work.
|
| Graduated exercise (run 1 mile today, 1+X tomorrow) and
| talk therapy (CBT, etc) have been contra indicated for a
| few years now and the former can actually make the
| condition worse.
|
| For something first diagnosed in 1958 (but observed since
| 1889/1880/1917, and also medieval times) to have absolutely
| no progress or even a unifying theory of how it works while
| it's believed to impact up to a million Americans is
| absolutely baffling.
|
| ME/CF is a total beast and monster of a disease. That's why
| the suicide rates are so high.
|
| [1] https://www.mayoclinicproceedings.org/article/S0025-619
| 6(21)...
| cpncrunch wrote:
| >5% chance of ever beating it
|
| If you actually read the paper where that 5% figure comes
| from (Cairns,2005) you'll see that it is for untreated,
| naturalistic recovery. Looking at recovery after
| treatment (e.g. MRT) the figures are more like 30-35%.
| Heck, even the Rituximab trial resulted in 38% remission
| at 4 year follow-up just due to the placebo effect!
| DanBC wrote:
| Only some forms of graduated exercise are contra-
| indicated. It's important to note that exercise is still
| a feature of effective treatment for ME/CFS.
| texasbigdata wrote:
| Thanks.
| tomByrer wrote:
| Good info!
|
| + Bruce Lipton's "Cell membranes are brains" theory. https:
| //youtu.be/3tZ513NeSIc?list=PL2S-_LNXy9Vx24_o9zSTF6MAD...
|
| Also noteworthy: one of the top co-morbidities for COVID-19
| is anxiety. https://youtu.be/iY98nuD3Bco?list=PL2S-_LNXy9Vx
| 24_o9zSTF6MAD...
| Klinky wrote:
| > We considered 2 exposures of interest: 1) specific
| underlying medical conditions and 2) the number of
| conditions. We captured data on both exposures by using
| ICD-10-CM diagnosis codes from inpatient or outpatient
| hospital records in PHD-SR from January 2019 up to and
| including a patient's first inpatient encounter for
| COVID-19. We used 1 encounter with an ICD-10-CM code to
| establish the presence of an underlying condition because
| few patients had multiple encounters in this hospital
| database. We excluded 3 ICD-10-CM codes (ie, oxygen
| support, dependence on a ventilator, and tracheostomy)
| listed during the patient's COVID-19 encounter because
| they could be part of COVID-19 treatment.
|
| ...
|
| > To further differentiate underlying conditions from
| acute complications of COVID-19, a panel of physicians
| (K.K.W., W.M.K., H.G.R., B.B., N.T.A., J.M.N.) classified
| the 314 CCSR categories into "likely underlying" (274
| categories; eg, asthma); "indeterminate," which could
| include underlying or acute complications or both (29
| categories; eg, cardiac dysrhythmias); or "likely acute"
| (11 categories; eg, acute pulmonary embolism).
|
| Am I reading this correctly that they are determining
| "likely underlying fear and anxiety disorder" from a
| single ICD-10 code that was likely generated at the time
| of admission for severe COVID-19? If that's correct, it
| seems rather flawed at determining if these people had an
| actual underlying anxiety condition or if the anxiety was
| due to severe COVID-19 symptoms(moderate to severe
| difficulty breathing, lack of sleep, lack of food/fluids
| and pain).
|
| https://www.cdc.gov/pcd/issues/2021/21_0123.htm
| glasscannon wrote:
| Something I only discovered recently is how much of an impact
| sustained mental stress/anxiety can have on your body. It puts
| your body into a state of fight or flight, which eventually
| wears you down. It's a very valid root cause to look for in
| diagnosis.
| cameronh90 wrote:
| I agree with all of this but just to add, the pain can indeed
| be a real physical issue directly caused by mental health.
|
| For example, anxiety often causes muscle tension and bad
| posture which can lead to real mechanical pain causing issues.
| I suffer from panic attacks and they are a very physical
| experience. My temperature stops regulating itself properly and
| I get GI problems. This is likely an indirect consequence of
| the adrenaline surge, but there are other known and theorised
| ways that your mental state can influence your body.
| gameswithgo wrote:
| You are unwittingly just promoting yet another form of back
| pain snake oil and there is already plenty. If I had fallen
| into the idea that my back pain was "just in my head" I would
| have gotten no where. I encourage anyone suffering to get an
| MRI as early as possible so at least you know what is wrong.
| Doctors and chiropractors will regularly misdiagnose you. There
| are lots of ways a back can go bad and everyone has their pet
| advice which probably doesn't apply to you.
| ethanbond wrote:
| Get an MRI _and_ consider that psychological stress can have
| physiological or physiological-seeming consequences.
| lukas099 wrote:
| > I encourage anyone suffering to get an MRI as early as
| possible
|
| Tons of people will have worse outcomes after getting an MRI,
| as it will reveal a physical abnormality that would have been
| symptomless otherwise.
| jfengel wrote:
| The brain is involved in all pain. The fact that the brain can
| help fix it doesn't mean it's psychosomatic. It just means you
| can interrupt the process at some place other than where the
| damage is.
|
| Chronic pain is aggravatingly hard to trace to the source.
| Maybe it's psychosomatic, maybe it's not. Calling it
| psychosomatic causes stigma -- it implies that it's fake and
| their choice. But they do want to get better.
|
| It's more than just thinking yourself healthy. It requires some
| counterintuitive ways to create new pathways. It's great that
| there is more research showing an improved way.
| Klinky wrote:
| Sample size of 35 and mindfulness is not novel or new. It
| probably does help some people. However, a huge grain of salt
| should be taken with any diagnosis illness/disease being due to
| stress or psychosomatic. Some doctors immediately jump to this
| after doing very little due diligence and diagnostics. It
| should be a diagnosis of absolute last resort.
|
| Stanford does have a CFS clinic investigating pathogen-related
| causes[1].
|
| 1. https://med.stanford.edu/chronicfatiguesyndrome.html
| kranner wrote:
| This is not mindfulness. They actually compared against a
| mindfulness-based treatment (MBSR) and found their method
| performed significantly better.
| Klinky wrote:
| They literally have you go through "Worry Less, Live More:
| The Mindful Way Through Anxiety Workbook", so it's at least
| building off of it in some way. Mindfulness with a pain-
| oriented focus is not new.
|
| Looking at their patient groups on Table 1, it seems MBSR
| and Usual Care had participants with more spinal injections
| and surgical interventions. MBSR and Usual Care have higher
| "Pain bothersomeness" scores and "Roland Disability
| Questionnaire Scores" at the start.
|
| It's a very small-scale pilot study. I am very skeptical
| it's not a ploy to try to sell his books.
| ndynan wrote:
| Agreed, sample arms were n=11 or 12.
| cpncrunch wrote:
| >It should be a diagnosis of absolute last resort.
|
| No, it should be equal.
|
| >Stanford does have a CFS clinic investigating pathogen-
| related causes[1].
|
| They haven't come up with anything, and their scientists are
| problematic: Montoya getting fired for sexual harassment, and
| Davis saying that anyone who doesn't think CFS has a
| molecular basis is a fool.
| Klinky wrote:
| >No, it should be equal.
|
| Okay, what is the consistent testing/diagnostic methodology
| that accurately measures stress and psychosomatic impact
| across patients?
|
| Typically it is going to be a diagnosis of exclusion. If
| you think you're diagnosing someone with
| stress/psychosomatic causes before comprehensive testing,
| imaging and/or specialists visit have been done, then
| you're jumping the gun, and potentially adding further
| stress to the patient as they try to follow a regimen that
| has little effect at helping their condition.
|
| I was not aware of the Stanford CFS clinic drama.
| cpncrunch wrote:
| Yes, the doctor should explore all possible causes with
| the patient. Tests can be done, and the doctor can also
| discuss stress. That is generally how it is done. Quite
| often in these cases there will be no final diagnosis.
| Klinky wrote:
| That sounds a lot like a diagnosis of last resort.
| Especially if the best tool available for measuring
| stress is a yes/no question to the patient and a
| 5-question anxiety questionnaire. Hardly definitive
| evidence of stress/psychosomatic causes, especially if it
| comes back "negative".
| cpncrunch wrote:
| There is no "stress" diagnosis test. It can never be a
| definitive diagnosis. The patient just needs to consider
| it.
| watwut wrote:
| > are all things that sincere people truly are suffering
| from...that may be mainly psychological/psychosomatic
|
| The back pain being cause by physical issues is not exception.
| The doctors and physiotherapists that wrote articles I read,
| had talks I has seen and the ones people I know visited never
| mentioned that. Instead, they recommended to fix the posture a
| set of "exercise" routines for rehabilitation. They also
| explained back damage as a mechanism.
|
| And those actually worked. Back pain can be very often helped,
| if you fix posture and do rehabilitation. It is not exception
| for it to be purely physical.
|
| The moment you claim it is psychological, the people who have
| fixable mechanical issue, won't get any help. And that help,
| quite apparently, actually makes difference. And not just with
| back pain.
| BeetleB wrote:
| There are different kinds of back pains, and for a few years
| I had them on and off, and it very likely was posture
| related. The first time I tried a good lumbar support my pain
| almost disappeared while using it. It was such a relief that
| even now, a decade later, I have that lumbar support for all
| the chairs I sit in - home or work - even when I'm pain free.
|
| However, my pain was unusual (did not fit the usual symptoms
| people normally have). There are other types of back pains.
| Sarno was always insistent that a physiological cause always
| be investigated, and if one is found, to treat it
| accordingly. Absent that, he would recommend a psychological
| approach. One thing he highlighted that I've anecdotally
| found to be true when discussing with others[1]: The pain
| often disappears near/after retirement. And almost all
| physiological problems get worse with age - not better.
|
| Me personally: Sarno's approach didn't work with other pains
| (ones he claims are within the scope of this type of pain). I
| don't know what the cause is - doctors never found anything
| and physical therapists have told me they've never dealt with
| my types of pains. Maybe it is psychological, but I must
| emphasize: Sarno's approach didn't work for me.
|
| [1] A former boss is an example. He said he had severe back
| pain on and off for so many years - had to take time off from
| work, etc. Nothing really worked. But eventually, in his mid
| 50's it went away and he doesn't know why. He's near
| retirement (senior guy with money), kids all grown up and
| graduated from college (or near graduating). Once a lot of
| his life worries got resolved, so did his pain.
|
| His story is fairly common.
| watwut wrote:
| > Sarno was always insistent that a physiological cause
| always be investigated, and if one is found, to treat it
| accordingly. Absent that, he would recommend a
| psychological approach
|
| That is much different the what post I responded to claims
| tho. Or what title claims too. The comment I responded to
| frames these issues being primary about psychological being
| and then maybe some few exceptional people having physical
| cause. And even that is supposed to have strong
| psychological component as well.
|
| This is quote:
|
| > Yes, some back pain is due to repetitive stress injuries
| or physical structures out of place or whatever. But as
| this study shows, looks like it has a strong psychological
| component as well
|
| What you say in your cment is "when all attempts to find
| and fix physical issues failed, remaining patients have
| more luck trying psychological treatment then physical one
| again".
|
| Which is much weaker claim. It does not imply that
| psychological is strong component nor that only some back
| pain is cause by physical. It implies some of it, when you
| exclude all known physical causes, might be psychological.
|
| [1] This here is pure speculation. The changes you
| described affect also lifestyle and behavior, not just
| stress. That story does not prove original issue was
| psychological, it just shows we can't always tell what the
| cause was.
| BeetleB wrote:
| Fair enough, but do you have any actual evidence that
| actual physiological causes are the majority? 2 people I
| know have bad back pain due to car accidents. For
| everyone else, no clear source of the back pain has been
| found. Occasionally they point to issues with herniated
| discs or pinched nerves, which makes sense, but from what
| I've read, most people who have such conditions do _not_
| suffer chronic back pain, which makes it a dubious cause.
|
| My PCP doesn't bother treating back pain that isn't due
| to an obvious injury. He said that in his decades of
| looking into it, he's observed:
|
| 1. None of the treatments out there show good evidence of
| actually working vs a placebo.
|
| 2. While it often recurs, each episode almost always
| resolves on its own.
|
| He does not believe it has a psychological cause - he's
| just frustrated with the current state of medicine
| regarding it and doesn't want his patients to go through
| a treatment believing they're actually treating the
| underlying condition. He will prescribe whatever the
| patient asks for (pain killers, physical therapy, etc).
|
| The only time he pays attention is when the pain extends
| to the legs, which is the minority of the times.
| silisili wrote:
| I was one of them. I thought panic attacks were some stupid
| made up thing for weak people, same with anxiety and the rest
| of them. Then it happened to me. And it affected so many things
| you wouldn't believe, from chest pains to fatigue to brain zaps
| to esophogal tremors to stool color even.
|
| I will gladly eat crow, I'm only admitting as much because I
| understand how easy it is to dismiss psychosomatic ailments.
| When you don't have any to worry about, it's nearly impossible
| to begin to comprehend. I liken it to ghosts...some folks swear
| they've seen or experienced them, but I don't see how it's
| possible. I half expect to be proven wrong on that, also.
| fsloth wrote:
| I believe ghost sightings are real - but caused by visual
| system trying to map inconclusive/limited information to
| something it already has a pattern for, and once a pattern
| (no matter how absurd) is found, it latches onto it.
|
| AFAIK what we "percieve" of the world is anyway a
| hallucination produces by our brain based on sensory input.
| And particular conditions can mess this up briefly.
|
| I've seen things twice that weren't there and realized what
| was going on only when got closer. First was when in the
| middle of the night I saw through a half open door my son (1
| y at the time) walking in a room - I entered the room, and
| realized it was not plausible he could have been where I saw
| him a second a go. I backtracked what I saw and realized
| there was play carpet with road patterning on the floor, plus
| miscellanious kids stuff on the background. It was nearly
| pitch black. From my pov the scene mapped to my son in my
| visual system, and then it maintained this pattern just long
| enough for me to "see him walking".
|
| Second was when I during a normal day observed what only
| could be two crows fighting or mating on a small tree. I got
| close. Really close. Then it suddenly 'stopped' being two
| crows and I realized it was just a black plastic bag
| fluttering in the wind.
|
| I have no idea how to teach people of the fragility of our
| cognition in a way that would not involve a pathology as you
| had - realizing fragility of psyche is real similarly as
| death is real - but I feel realizing this would make people
| more emphatic towards all sorts of problems our fellow humans
| have.
| jwally wrote:
| This?
|
| Pareidolia (/,paerI'doUli@, ,pe@r-/;[1] also US:
| /,pe@raI-/)[2] is the tendency for perception to impose a
| meaningful interpretation on a nebulous stimulus, usually
| visual, so that one sees an object, pattern, or meaning
| where there is none.
|
| https://en.m.wikipedia.org/wiki/Pareidolia
| kayodelycaon wrote:
| People have a lot of difficulty understanding things they
| haven't experienced.
|
| This leads to a number of people treating other people's
| behavior as if they were doing it. If the only reason they
| would not be successful is laziness, then everyone who
| doesn't succeed is lazy.
|
| To them, it isn't fair that other people get stuff "for free"
| when they had to work for it.
| the-dude wrote:
| For us : https://en.wikipedia.org/wiki/Eating_crow
| playpause wrote:
| It's odd that "all in your head" means "not a serious problem"
| or "you can fix it by yourself".
|
| It seems to me that a problem being located in the
| head/brain/mind is, almost by definition, particularly
| difficult to fix, let alone to fix without external guidance.
| rgrmrts wrote:
| I'm following along this thread in a desperate attempt to find a
| solution. I've been struggling with chronic lower back pain for
| almost 2 years now. Unfortunately, 2 years of many different
| physical therapists and doctors (nerve blocks + cortisone shots)
| later there's little to no improvement for me (except being able
| to just deal with the pain/ignore it a bit better).
|
| I wish I could attempt these mind-body treatments but I do have a
| physical cause. Almost complete sacralization of L5-S1 and
| bulging disc pressing on nerves. The worst part is I thought a
| physiological cause would make back pain easier to treat, alas it
| does not. Surgeons discourage spinal fusion surgery - a well
| regarded spinal surgeon told me odds of surgery improving my pain
| were worse than a coin flip.
|
| I've also read a bunch of commonly recommended books like back
| mechanic and 8 steps to a pain free back and they both did
| nothing for me. I continue to do core exercises and everything
| else 2 years of therapists suggested to no avail.
| callmekatootie wrote:
| Have you tried this -
| https://www.youtube.com/watch?v=4BOTvaRaDjI. I found it on
| reddit and it's been absolutely amazing for my back.
| rgrmrts wrote:
| I have not but I'll give it a go. Thanks for sharing!
| DoreenMichele wrote:
| I will second fasting as something to try. There is also a
| comment about taking calcium and magnesium. You might try that
| as well, plus possibly B vitamins and getting the right dietary
| fats.
| rgrmrts wrote:
| Thanks for the reply! I've very consciously changed my diet
| to one where I pay attention to nutritional content, but yeah
| I'm sure nutrition has an impact.
|
| I mentioned in another response that I'm very skeptical of
| fasting doing anything. I'm open to being wrong but I don't
| see how fasting could possibly undo real damage to my spine
| and make the bulging disc stop pressing on nerves.
| [deleted]
| generalenvelope wrote:
| I highly recommend Barbell Medicine's content. Their youtube
| channel has tons of videos with science backed information for
| training and dealing with pain, specifically back pain.
|
| Austin Baraki is an advocate for the biopsychosocial model of
| pain that the parent post is effectively evidence of. I would
| love if more people read his "Aches and Pains" article:
| https://startingstrength.com/article/aches-and-pains It
| contains a lot of surprising information regarding the efficacy
| of common treatments for pain - and r great argument for why
| pain is more complicated than a or b being out of alignment.
|
| My advice would be to learn as much about pain, self efficacy,
| catastrophizing, the nocebo effect, etc. from the Barbell
| Medicine crew - and if you have the money do a pain and rehab
| consultation with them. I sincerely think their team is THE
| best in the world.
| rgrmrts wrote:
| Thanks for the suggestion, I'm open to reading another book
| so I'll give it a shot.
| seer wrote:
| First off - fasting, like 10 days water fast kinda thing.
| Generates new stem cells that can fix neurological problems,
| massively reduces inflammation.
|
| Lifespan book by Dr. Sinclair does a deep dive on that.
|
| Next swimming/yoga/qigong - make your muscles be able to better
| support your spine. Standing desks also help a lot in that
| regard if you can handle them.
|
| It's surprising how much crude tools like that can help
| inflammation/pain problems. It's usually not just the movements
| themselves, it is the whole culture of mindfulness around it.
| You get to spend more time being at peace with yourself, as
| well as meeting a lot of people who do it too and encourage
| you. And that helps a ton as well.
|
| I've seen several people embark on those paths with
| "untreatable" problems with good results, but it might be
| important that this is not treated as panacea - we don't want
| to end up like Steve Jobs.
|
| I personally think fasting is incredibly powerful medical short
| and longterm tool. And the rest is more psychological one,
| still very powerful too.
|
| I went to wing chun mostly because of the martial arts
| training, but did qigong too because it was expected in the
| peer group. I've found that even if the explanations of "why"
| it worked were clearly bogus (blocked energy pathways -
| earth/fire/air kinda things) the motions themselves and the
| culture around them was incredibly soothing. Now I myself
| didn't suffer from illnesses but I did meet several people
| there who mentioned turning to it as a last resort, with
| positive results. Maybe it's survivorship bias but I'd recon
| its still effective.
| rgrmrts wrote:
| Thanks for the response. I've been doing yoga, swimming is
| not something I've tried. Agreed on how crude tools can be
| effective, I've already made lots of changes (I only use a
| standing desk).
|
| I'm very skeptical of saying being effective, but am open to
| being wrong. I'll check out that book, alleviate the rec!
| BeetleB wrote:
| > Almost complete sacralization of L5-S1 and bulging disc
| pressing on nerves.
|
| I have no idea what this is, but the one thing I would have you
| ask yourself (or the doctors) is: How many people who have this
| physical condition you have are in back pain.
|
| From what I've read, for example, that most people with
| compressed nerves/slipped discs do _not_ have chronic pain. If
| you give a doctor an X-ray of a typical slipped disc, they will
| not be able to predict which ones had back pain and which didn
| 't.
| rgrmrts wrote:
| Yeah, good question. I really don't know but my guess would
| be no based on how little most specialists actually know
| about this stuff
| reincarnate0x14 wrote:
| Been there. Unfortunately once a disc is damaged and starts
| bulging, it never really can get better. It's odd they
| discouraged a fusion or disc replacement, obviously I don't
| know the specifics of your situation, but it was a immediate
| off-switch to all the pain for me. Did the full gamut of other
| things including several specious medication recommendations
| that had me switch doctors several times they were so awful.
| Steroid injections were a minor relief but not much.
|
| Sadly my US insurance at the time was a right bunch of horrible
| cunts and refused to cover a disc replacement, only a fusion,
| but after years of suffering I felt 10 years younger once I was
| back on my feet hobbling around for rehab.
| rgrmrts wrote:
| Well none of the doctors have even discussed disc
| replacement, only fusion.
|
| I hear you on the insurance front. I've had "good" insurance
| this whole time but I'm still several tens of thousands of
| dollars more broke now
| ranger_danger wrote:
| Going on well over 10 years now with my pain... spinal stenosis
| and degenerative disc disease. I had an L4-S1 laminectomy and
| it only helped for 1 year. I've tried all the other stuff you
| mention as well like cortisone shots, branch blocks, physical
| therapy, chiropractic, acupuncture etc. and practically nothing
| helps, even tried basically all of the currently available CBD
| and THC variants... only thing that always works is really hard
| narcotics like oxy that I don't want to take for obvious
| reasons. I can walk on my own for maybe 10 minutes max before I
| just can't take the pain anymore.
| Tomte wrote:
| My summary regarding the book was:
|
| "Listen to your doctor! It's not a good idea to chase miracle
| cures. But trying this book on top of what your doctor tells you?
| I can't see anything wrong with that. You're not harming
| anything. You're not refusing conventional medicine. If it works
| for you, great. If not, you have lost ten bucks and two hours of
| your time." (https://backpain.2uo.de/)
| zuj wrote:
| Talking of mind-body, recently tried floating(sensory deprivation
| tank). While I haven't really experienced anything amazing in my
| first session, I can see the potential. There is something in
| there and I can feel it will provide help in alleviate some of my
| physical and mental problems.
| m0zg wrote:
| If you don't have bulging discs or other severe pathology, the
| easiest way to fix your back is to train the posterior chain via
| low bar barbell squats. Start light, work slowly up to your body
| weight, you don't have to go much further, but you can if you
| want to. Most men should be able to handle at least 1.5x their
| lean body mass after a couple of years of very mild training,
| added by balanced nutrition. Train 3x a week. Your back problems
| will resolve in a month. Most people's back problems are caused
| by atrophy of back stabilizer muscles, which, in turn, is caused
| by not using them and sitting hunched over at their desk all day.
|
| Doctors will _never_ advise this, but it works. I couldn't even
| bend over without any weight, and had to lie down on the floor in
| the office sometimes it was so bad. I also had RSI in my wrists
| to the point I couldn't sleep some nights. After I started
| training with a barbell it all went away never to return. I know
| 4 people who followed my advice and did the same thing, and their
| back problems resolved as well. Best of all, you don't have to do
| it all the time, once you develop quality musculature there, the
| effect lasts for years with little upkeep. Although you should
| keep it in shape, of course - it's better for you, and increased
| muscle mass is good for weight loss, too (a lot of people think
| they have back problems, but they really have a huge chunk of fat
| hanging on the front of their body and it's pulling on their back
| and destroying their knees, too).
| jamesknelson wrote:
| This treatment is based on the work of Dr John Sarno - who I
| first heard of here on HN almost 10 years ago. And of all the
| wonderful things I've discovered on HN, Dr Sarno's work is
| probably the one that's had the biggest positive impact on my
| life.
|
| When I first heard about his approach to chronic pain, I was
| pretty skeptical. But I'd tried everything else to solve my
| debilitating RSI, and nothing else had worked despite only being
| in my early 20s, so I was willing to give it a try. 6 months
| later, I was back working pain-free after being out of action for
| 2 years.
|
| As patmcc mentions, people can be incredibly reluctant to believe
| that physical pain can have psychological causes. And in many
| cases, there _are_ underlying physical issues, so this should
| certainly not be your first approach to treatment. But if you've
| tried everything and nothing works, I encourage you to take a
| look at Sarno's work. It made a world of difference for me and
| for many others.
| Mizza wrote:
| I'll also throw my hat in here, I got the book after a
| recommendation from HN. I'm glad it's moving in from the
| fringes.
| xwowsersx wrote:
| Same, though I did not hear about Dr Sarno from HN. Healing
| Back Pain is an incredible book. It is sad to see so many
| people who are close to me suffering from back pain spinning
| their wheels to find relief -- surgery after surgery,
| chiropractor after chiropractor. The connection between the
| experience of pain and the psychological dynamics that Dr Sarno
| elucidates is so critically important. I recommend his book to
| everyone who experiences persistent back pain.
| ramraj07 wrote:
| One point to make is to not use the word psychological or
| "head". That still triggers people to think we're saying
| they're just imagining it. The best explanation I've seen
| wasnin Reddit where the person said its circuits in your brain
| that cause the pain but not your muscles. This is amazing since
| it clearly communicates that yes it's in your head but no it's
| not your fault.
| 2OEH8eoCRo0 wrote:
| Same. I tell everybody to read Sarno's book, back pain or no.
| It's a short read and even if it doesn't help with one pain it
| will probably help with something else.
|
| With that said, other than my girlfriend, nobody that I have
| recommended it to has actually read the book. They get
| defensive.
| geewee wrote:
| Approximately the same story here. I'd had debilitating upper
| back pain for 4..5 years, gotten MRI's and a plethora of scans
| and nothing seemed off. Every time I got physical therapy it'd
| last for a few hours and then the pain would be back.
|
| I tried accepting that it was more of a mental than a physical
| ailment, and although it was difficult and took multiple tries,
| I'm now finally pretty much pain-free for a few years after
| having tried _everything_ for years on end.
| tchock23 wrote:
| Same experience here. I recall hearing about him on HN a long
| time ago and read his book, which I attribute to helping
| alleviate chronic back pain.
| pillefitz wrote:
| same here. Heard it on HN, saved my career, and since then try
| to spread the word in real life or online disussions.
| sjg007 wrote:
| Improving your core abdominal strength is the main treatment for
| back pain. There are some PT exercises like bird dog, crunches,
| and superman that will help as well as some stretches. You also
| want to sleep in a neutral position and walk about as much as you
| can.
|
| Most are caused by muscle strain when lifting or doing something
| with your back in a weird position. I think you get continual
| muscle spasms as well. So the nerves are irritated, the muscles
| contract and it gets painful so you have to basically get the
| muscles to relax.
|
| Sometimes the muscles along the hips can be involved as well and
| figuring out a way to stretch them will help. Chiropractors like
| to realign them.
|
| Keeping up your core strength is apparently the best option
| though.
| peterbozso wrote:
| For my fellow chronic lower back painers out there: over the
| course of many years I tried many things (always staying in the
| confines of modern medicine). There's certainly no magic bullet,
| but finally this book (which I have no financial incentives to
| promote) brought me a long lasting solution:
|
| https://www.painscience.com/tutorials/low-back-pain.php
|
| The whole thing certainly worths a read, since the goal of the
| book is to make you understand your condition and give you relief
| partly through that. But for me, the single most important
| thought of the book is "the issue is (almost) always with the
| tissue". If you have chronic (lower) back pain and you feel like
| you have tried everything, I recommend learning and applying
| self-massage regularly. Combined with other important,
| conservative treatments (physiotherapy, yoga, swimming, workout,
| etc.), it did wonders for me and I hope it will for others with
| similar problems.
| rgrmrts wrote:
| Did you have any MRIs that showed actual damage? That's the
| boat I'm in. I've tried a lot of things and nothing has worked
| so far. I'm happy to give another book a shot, but everything
| else I've read so far has not been applicable.
| peterbozso wrote:
| Yes, I have multiple scans of a semi-herniated (not fully
| herniated, but thinned and a bit bulging) disc in the lower
| end of my spine, but it's far from being in the state of
| needing surgery. My solution was (with the help of the book)
| to identify and treat my trigger points. Regular swimming and
| bodyweight exercises also helped/helps me a lot, but they
| help more with reducing the number of painful episodes, not
| making the pain go away when I have it. I can do that only
| with massage.
| rgrmrts wrote:
| Gotcha. I've been slowly adding weight training to my
| treatment plan, I really should find a pool... thanks for
| the response!
| kranner wrote:
| The program referred to above, PSRT, is based on John Sarno's
| work. In his book Sarno stresses that physical causes to
| chronic back pain must be ruled out first. He only treated
| patients with his mind-body awareness methodology after
| investigations had ruled out physical causes.
|
| By the way, I can highly recommend this documentary on Sarno
| (paywalled):
|
| https://vimeo.com/ondemand/alltherage
| peterbozso wrote:
| Understood! As I noted in my comment, the book I recommend
| also stresses the importance of the fact that most chronic
| back pain is "all inside yor head" and tries to give some
| relief by making you understand and ruling out most of the
| possible non-psychological sources for such pains. I
| highlighted the self-massage thing only because next to
| understandting my condition, that was the single most
| important tool the book gave me to deal with the non-
| psychological components of my pain. But this might not have
| been totally clear from my comment above, I am sorry for
| that!
| loceng wrote:
| Had you changed your diet at all during your journey to
| problem solve the pain?
| peterbozso wrote:
| I drastically reduced the amount fat I eat, but I did
| that to accommodate my partner's new diet, not entirely
| voluntarily. :)
| kranner wrote:
| Not GP but personally I have found limiting caffeine
| consumption to help a lot with back pain. More than one
| cup of coffee (12g of beans) seems to result in
| exacerbation of any minor back pain I may have on that
| day. I also now take a day or two off from drinking any
| coffee after a few days of consumption. With this change,
| more sleep and some light stretching on some days I no
| longer have back pain. Oh, I also moved to a firm
| mattress.
| kranner wrote:
| Oh, I was agreeing with your remark regarding the issue
| almost always being in the tissue!
| peterbozso wrote:
| I see now! Sorry, it was way too early in the morning. I
| shouldn't comment before coffee... :)
| loceng wrote:
| I'm currently lining up a surgeon to do a nerve decompression
| surgery, which took me 1.5 years to find a surgeon who even
| does the surgery, for what took me 15 years to learn on my own
| is something called piriform is syndrome - for which no other
| doctor or specialist even looked into relating to "sciatica"
| pain for which it can mimick; it's no wonder many people suffer
| without resolution, most doctors don't seem even look at known
| possibilities.
|
| The mind can also be strong, so it seems you may be able to
| teach some people who's mind isn't too disabled or interrupted
| by their pain level to engage more strongly to overcome and
| mask pain signal(s) coming from their body and therefore "heal"
| it simply with mindfulness.
| cupcake-unicorn wrote:
| While this is exciting work, I'm really terrified that the
| efficacy of this treatment will cause doctors to jump on this
| modality for a number of disorders it's not really suited for, as
| what is happening with CBT. There are a number of treatments that
| are great if done with the right intent, but when they go into a
| mass treatment setting it loses connection with the humanistic
| portion. I could see doctors jumping to over prescribe this for
| pain or other conditions without listening to the patient or
| worse blaming the patient when the treatment didn't work for
| them, which is basically what's happening when say someone with
| physiological issues gets suckered into doing CBT for insomnia.
|
| I do think it's important we take these holistic approaches to
| pain relief but the medical institution and worse yet insurance
| will bungle this in the US and I'm scared for that :( But glad to
| learn of it since I can get a copy of John Samo's book.
|
| Another treatment that has shown anecdotal success for chronic
| pain is Internal Family Systems therapy. I feel like that one
| would be a lot harder to mess up.
| charles_f wrote:
| I can so relate to the bi-directional relationship between low
| morale (anxiety, depression) and pain. Feeling down makes me feel
| pain in my teeth, and vice versa.
|
| On a side note, I had a lot of back problems till I lost 30
| pounds and didn't have any anymore. I gained another 10 since
| then and it's coming back
| janimo wrote:
| Sarno's book, mentioned in other comments was also on YC's
| reading list a while ago:
| https://blog.ycombinator.com/ycs-2017-summer-reading-list/
| throwawaymanbot wrote:
| For me I have to ask, do psychopaths have less pain? If they have
| less pain and thus less supposed wear and tear... does this mean
| they live longer?
| david422 wrote:
| I had some chronic back pain for a while. I went to see a
| specialist and they basically told me - hard to diagnose, the
| discs in the back do degrade over time, the primary solution is
| to strengthen other muscles, especially core muscles, to support
| it.
|
| I went to PT for a while and basically exacerbated whatever the
| issue is - badly. However, I took prednisone. This solved the
| issue temporarily, but allowed a reprive so that I could do
| muscle strengthening exercises.
|
| This solved my issue for about 5 years until recently with COVID
| and kids and I stopped working out. Now the issue seems to be
| resurfacing.
|
| I do think the primary solution is to work out more and
| strengthen my body.
| godDLL wrote:
| I've gotten through something like that.
|
| The solution should be to rebuild your body, using strengthened
| core to support yourself after. The rebuild starts with
| autophagy, which is achieved by fasting.
|
| To get into 3 days every three weeks (which is what you'll need
| to clean up old tissue, to have place for new tissue) you'll
| want intermittent fasting. IF will normalize your perception of
| hunger.
|
| After a couple of months of eating only after 14:00 and before
| 16:00 you'll be ready to go into a three-four day water fast.
| You stretch when you fast, and you exercise every other day in
| the week coming off of a fast.
|
| In four months from your first three day water fast you'll know
| you want to keep it up. I did.
|
| Don't go beyond four days of fasting, no matter how good you
| feel after day two. The idea is to give your body direction,
| not to force it into a condition. Don't overdo it.
|
| Cheers!
| marmoto wrote:
| "However, common therapies such as surgery and steroid injections
| intended to address physical origins of back pain have not been
| clearly proven to work in randomized clinical trials"
|
| vs.
|
| "To assess whether PSRT can reduce symptoms and pain-related
| anxiety in patients with non-specific chronic back pain, Donnino
| and colleagues enrolled 35 participants"
|
| 35 participants ...
| PaulKeeble wrote:
| Like most psychology findings there will also be issues
| reproducing the results as well. It is a bit of a common
| occurrence to get these big calls around how people don't need
| pain drugs anymore while all the recipients of these new
| treatments are crying out in pain on support forums across the
| globe. It never seems to actually work.
| ethbr0 wrote:
| I'm assuming this is the research in question:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476063/
| hirundo wrote:
| "The novel intervention ... is based on an idea pioneered by the
| late John Sarno, MD"
|
| John Sarno's book "Healing Back Pain" saved me from truly
| agonizing torture and made me functional again in just a few
| hours, though I went to it with extreme skepticism. It's great to
| see formal research being done on this approach.
| weird-eye-issue wrote:
| Wish I could say the same. It did nothing for me
| 300bps wrote:
| When I had carpal tunnel syndrome 10 years ago someone on HN
| recommended the Harvard RSI program that follows Sarno's
| technique.
|
| http://www.rsi.deas.harvard.edu
|
| It took work but it literally cured me. Went on to use the same
| techniques for back pain and haven't had that in many years.
| pitched wrote:
| > _Keep wrists above the pad, and tilt the kbd downward._
|
| TIL! This is the opposite of what I've been doing to date.
| raindropm wrote:
| That image made me think about all those fancy 'thicc'
| mechanical keyboard on Youtube. My wrist hurt just seeing
| the video. Low profile keyboard FTW!
| BeetleB wrote:
| If you had that particular type of pain, it will become
| "obvious". You'll feel the pain of maintaining the wrist
| flat, and the pain will be less in that posture.
|
| Same with my back pain and lumbar support. Once the lumbar
| support gave me relief, I could easily tell which
| chairs/couches were terrible for the back as the bad ones
| would give instant pain.
| 1121redblackgo wrote:
| Same. Some folks who I love and owe unending appreciation to,
| that are doing public outreach and education for this in 2021,
| are Nicole Sachs and Dan Buglio. Their youtube channels,
| podcasts, and websites, and the guidance and experience
| therein, saved my life.
| ranger_danger wrote:
| what's the secret without having to read a whole book?
| papandada wrote:
| Dr Sarno 12 Daily Reminders
|
| The pain is due to TMS, not to a structural abnormality
|
| The direct reason for the pain is mild oxygen deprivation
|
| TMS is a harmless condition caused by my repressed emotions
|
| The principal emotion is my repressed ANGER
|
| TMS exists only to distract my attentions from the emotions
|
| Since my back (replace with whatever pain you've got) is
| basically normal there is nothing to fear
|
| Therefore, physical activity is not dangerous
|
| And I MUST resume all normal physical activity
|
| I will not be concerned or intimidated by the pain
|
| I will shift my attention from pain to the emotional issues
|
| I intend to be in control-NOT my subconscious mind
|
| I must think Psychological at all times, NOT physical.
| mebiles wrote:
| ok thank you this. To all the people that has doubted their
| own pseudo science skepticism every time this book comes up
| here at HN- you may be relieved as it doesnt work if you
| have a structural cause for the pain.
| kranner wrote:
| Sarno started with first ruling out physical causes with
| checkups and investigations. Only after that did he
| attribute pains to TMS, only if conventional treatment had
| not cured the pain.
| 1121redblackgo wrote:
| Yeah a common phrase is to "rule out the life
| threatening, then rule in mind-body disorder."
| curioussavage wrote:
| The idea is basically that your brain/subconscious creates
| pain and other health problems as a coping mechanism.
|
| If I remember correctly the solution was basically to learn
| about that and acknowledge it and do exercises like tell your
| mind/body thank you for looking out for me. It I don't need
| that. Go to psychotherapy and other stuff.
|
| I'm definitely a partial believer in the ideas. Read about it
| decided to stop going to chiropractors after doing so for
| over a decade due to often severe neck and back pain and now
| 2 years later I am virtually neck and back pain free. While
| doing nothing, in fact while eating worse, not exercising ,
| being stressed out, bad posture etc. I just decided that it
| was psychosomatic and it eventually went away.
| [deleted]
| someelephant wrote:
| Same. And yet so many people are unwilling to take the leap of
| faith. It's sad because the same thinking patterns that cause
| them to avoid Sarno likely lead to a lot of grief in other
| areas of their lives.
| csee wrote:
| It's the scientism mindset which is common among technical
| types. Anti-woo errs into a more dogmatic dismissal and
| closed mindedness towards anything not backed by multiple
| large RCTs and consensus among experts.
|
| I think a balance is in order. It's good to explore things
| that don't have conclusive evidence with an open mind while
| maintaining a degree of healthy scepticism. If it improves
| subjective well-being then it works for all practical
| purposes. Whether that's all placebo doesn't even matter at
| that point.
|
| Rigorous epistemology != a good approach to self-help.
| Barrin92 wrote:
| I'm about as far away from the scientism mindset as one can
| get but I don't think that's really the reason. To assume
| that someone can solve a debilitating problem that affects
| millions in hours by selling you a book is probably in 99%
| of cases a scam.
|
| And the subjective well being point isn't so simple as
| well. If there really is a physical problem the placebo
| isn't a treatment but masks symptoms, which is counter-
| productive long term. Plenty of people pour substantial
| money into alternative medicine that doesn't address their
| illnesses because they feel subjectively better for a
| while.
| csee wrote:
| This is where the healthy skepticism part comes in. Going
| all out woo or quack isn't what I'm suggesting, and I'd
| agree that that's even worse than being too closed
| minded. Crystal healing doesn't work and people shouldn't
| try it.
|
| But if something sounds sort-of plausible, has some
| tentative but low quality evidence, and it's low cost and
| low risk, and it's not going to distract you from more
| proven treatments, then just try it out and see if it
| works. A small handful of people won't even go that far
| because of dogmatically orthodox thinking, and those are
| the people I'm addressing.
|
| > To assume that someone can solve a debilitating problem
| that affects millions in hours by selling you a book is
| probably in 99% of cases a scam.
|
| If it's psychosomatic pain, there's legitimate scope for
| a self-help book to actually improve things for them.
| Also why wouldn't we expect practitioners who have been
| hands on with clients for 20 years to not have picked up
| some useful tricks that didn't make it into peer reviewed
| studies? I feel like your statement here is too heavy on
| the skepticism, even though you're right that there are
| loads of books that are quackery. There can be learned
| wisdom built up through practice that isn't peer
| reviewed.
| tomByrer wrote:
| I haven't read the book, but am familiar with the story.
| The pain origins don't need to be "psychosomatic" for the
| mind to override it; the pain may be real.
|
| The back surgeon interviewed patients long after back
| surgery. They reported some help, but some pain /
| discomfort remained. He looked at Xrays of painful vs
| pain-free, & found Xrays looked very similar. That's when
| he started teaching 'pain management'.
|
| IMHO teaching 'pain management' would be helpful for all.
| Could prevent some surgeries, but even if they got
| corrective surgery, the self-help management could still
| prove useful.
| timmytokyo wrote:
| There are hundreds if not thousands of quack cures for
| every ailment under the sun. How else, other than
| scientific process, is one to separate the wheat from the
| chaff?
|
| You say "crystal healing doesn't work and people
| shouldn't try it." Why not? Aren't you being closed-
| minded? How is crystal healing any worse than any other
| scientifically unsupported remedy?
| csee wrote:
| There's a spectrum between crackpottery and solidly
| evidence-backed consensus treatments. The middle of that
| spectrum:
|
| - The existing evidence, although positive, may be low
| quality, or preliminary.
|
| - The treatment is advanced by some otherwise legitimate
| practitioners, even if it isn't consensus mainstream.
|
| - The treatment has been used safely in traditional
| medicine for a long time, and simply hasn't been studied
| yet in a scientific framework.
|
| - The promoters aren't transparent crackpots, and don't
| use empty buzzwords like "quantum".
|
| - Any proposed mechanisms at least make some basic sense
| and don't break the basic principles of physics and
| biology, and aren't clear woo.
|
| What I am saying is that if a treatment ticks some of the
| above boxes and is safe, then give it a go. They're less
| likely to work, but the expected value is high because
| the costs are low.
|
| Crystal healing ticks none of these boxes and therefore
| can be discarded with more confidence, since the expected
| value is low, even though it's true we can't be
| absolutely certain that it doesn't work.
| BeetleB wrote:
| > It's the scientism mindset which is common among
| technical types.
|
| Interestingly, Carl Sagan, in his book _The Demon Haunted
| World_ , discusses physical ailments arising purely from
| the brain and in passing points out that there are reasons
| to believe back pain is one of them.
|
| The book is a fantastic read, because for some reason many
| people in the pro-skeptic movement recommend the book,
| despite the fact that _quite a bit of the book is critical
| of skeptics!_
| 01100011 wrote:
| I think a clear distinction needs to be made between something
| which is 'all in your head' and something which is driven by your
| internal psychological state(which, surely, can be influenced by
| other physical sources, but I digress).
|
| In my experience with back pain(which varies a bit, due to
| several types of back pain), I believe most of my issues stemmed
| from my psychological state and were not "in my head". First off
| the back is poorly evolved for modern, upright, bipedal life, so
| it's not surprising that it would be a common source of issues
| for modern man. That said, there are still patterns and behaviors
| one can learn, and which do not necessarily develop automatically
| during childhood, which can allow the back to function without so
| many issues(See Stuart McGill and others. i.e. hinge at the ball
| joints, limit loaded spinal flexing, etc). Further, there are
| psychological states, stress, sadness, depression, which can
| affect posture, specifically thoracic posture, which contribute
| dramatically to back pain.
|
| Since learning better movement patterns and becoming aware of my
| psychological connection to my posture, I have, at 46 and after
| years of pain, been able to vastly reduce my chronic back pain.
| Another big piece of this was improving my proprioceptive senses
| as well. When I did manage to improve my posture, it felt quite
| wrong, both because of the proprioceptive sensations as well as
| how it felt out of alignment with my moods(i.e. it's odd to puff
| out your chest when you're depressed).
|
| "Modern posture", with excessive thoracic curvature, rounded
| shoulders, and overall "turtle"/"protective"/"insecure" (all my
| terms for myself) posture is a major component of spinal pain,
| even into the lumbar region. Obviously back pain is complex and
| many folks have other issues than I have experienced, but I think
| it's worth mentioning that sometimes the mind _is_ the issue but
| that the issue is not in the mind.
| 1121redblackgo wrote:
| https://www.youtube.com/channel/UC_o_MGVac1_ijjIeig37zVQ
| pdoege wrote:
| Yeah, I suffered through this. "We all have aches and pains",
| "Don't catastrophize", etc.
|
| Turns out I had a chunk of spinal disc the size of my little
| finger impinging on my spinal column.
|
| I think that this "mind-body" stuff is woo. Drugs work. Physical
| therapy works. Woo doesn't.
|
| However, woo is really cheap. And it offloads the blame onto the
| victim.
| friedman23 wrote:
| I used to think about things exactly in the same terms as you
| do, rejecting anything that didn't have "strong" scientific
| backing in peer reviewed journals. I considered things like
| meditation complete bullshit quackery and because of this
| cynical view I ignored things that could have given me
| significant help at the time I needed them.
|
| Of course when you eventually hit rock bottom you try
| everything available and then I realized that ignoring all
| "non-scientific" evidence is not the correct way to evaluate
| things.
| csee wrote:
| Why are you assuming that there is no such thing as
| psychosomatic pain just because yous isn't? Such an unjustified
| leap.
| colordrops wrote:
| It's woo to call anything that doesn't fit into your personal
| model of reality as woo.
| watwut wrote:
| I had similar experience a couple of times. It is about the
| mind or you are lazy or exaggerating until eventually actual
| physical cause is found by random. And it makes massive
| difference.
|
| And then you find out the fix was available all along. But,
| they would have to take your issues seriously instead of just
| dismissing it and blame your brain.
| GoodOldNe wrote:
| The corresponding author on this is a very serious scientist,
| most of whose work is in metabolic resuscitation and cardiac
| arrest. It's cool to see him applying his skills to this
| leading cause of disability and suffering. I guarantee you it
| isn't just "woo".
| dang wrote:
| You're of course welcome to share your experience here, but
| please don't call names ("woo"). It's against the site
| guidelines because it significantly degrades discussion. We can
| all make our substantive points without such swipes.
|
| https://news.ycombinator.com/newsguidelines.html
| [deleted]
| pikma wrote:
| So how do you interpret the results of this study? Patients who
| went through what you call "woo" did report less pain.
| stillblue wrote:
| He does not. He was misdiagnosed therefore "woo" is bullshit.
| Sound logic If I've ever seen one.
| dang wrote:
| Please don't be snarky or take HN threads further into
| flamewar. We're trying for the opposite here.
|
| https://news.ycombinator.com/newsguidelines.html
| wfme wrote:
| Completely disagree. If the "woo" you describe is so
| ineffective, placebos wouldn't be a thing. Sure, there are
| problems that may require some kind of invasive treatment, but
| there are also a lot that we seem to include in that group that
| can be treated with much less invasive procedures.
|
| David Epstein touches on this here [0]: "A unique study at five
| orthopedic clinics in Finland compared APM with "sham surgery."
| That is, surgeons took patients with knee pain to operating
| rooms, made incisions, faked surgeries, and then sewed them
| back up. Neither the patients nor the doctors evaluating them
| knew who had received real surgeries and who was sporting a
| souvenir scar. A year later, there was nothing to tell them
| apart. The sham surgery performed just as well as real surgery.
| Except that, in the long run, the real surgery may increase the
| risk of knee osteoarthritis. Also, it's expensive, and, while
| APM is exceedingly safe, surgery plus physical therapy has a
| greater risk of side effects than just physical therapy."
|
| [0] https://www.propublica.org/article/when-evidence-says-no-
| but...
| watwut wrote:
| Placebos don't fix issues, if they would, we would sell half
| placebo pills to save money. They sometimes have some
| temporary effect.
|
| If placebos worked, we could not use then to gage treatment
| effectiveness in trials. And treatment passes trial only if
| it does _better_ then placebo.
| weregiraffe wrote:
| >>If placebos worked, we could not use then to gage
| treatment effectiveness in trials.
|
| What? The reason placebos are used in trials is because
| they work.
| watwut wrote:
| The treatment is considered working when it produces
| better results then placebo. When the treatment is
| undistinguishable from placebo, then the conclusion of
| trial is that "improvements are result of chance rather
| then treatment".
|
| Placebo is used so that patients, doctors and anyone else
| is not affected by their expectations/wishes of whether
| treatment should or should not work.
|
| The whole point is to measure actual physical
| improvements. You can't replace real treatment by
| placebos and expect them to have the same results -
| clinical trials are done so that this is guaranteed to
| not work with drugs that passed them.
| discordance wrote:
| 50 years ago I'm sure regular doctors would laugh at the idea
| of treating anxiety disorders with meditation instead of meds,
| electroshock or whatever.
|
| Is there not enough space for both the Woo and our usual
| western methods?
|
| The patient journey could be: diagnosis, imaging, woo (if
| appropriate), physio, chiro and if need be, surgery.
| weird-eye-issue wrote:
| Well, in my experience meditation alone was not effective at
| all for my anxiety.
|
| Actual doctors (in the US and in SE Asia) put me on
| medication for it and that was effective.
|
| I don't think many "regular doctors" are telling people to
| just meditate for their anxiety...
| s1artibartfast wrote:
| Surely you can respect that not all solutions are based in
| pharma or surgical intervention.
|
| Take depression for example. Some people might have a
| chemical imbalance. Some might be in terrible marriage or
| struggling with other trauma.
|
| The idea here is pretty simple and not particularly crazy:
| Some people have problems that can be solved best with
| treatment other than drugs or surgery.
| weird-eye-issue wrote:
| It's usually a combination of things. For me, my anxiety
| was causing me to not do things that could have
| ultimately helped me have less anxiety. Meditating didn't
| cure that. I had to go on meds to get over that initial
| anxiety and now I don't need the meds as much
|
| Sure meditation can help some people but I don't think
| it's as effective as a lot of people seem to think
| glasscannon wrote:
| Not all pain is associated with an existent physical injury.
| For example I had tears in my achilles last years which have
| since healed but I still feel pain when I walk. Look into
| fibromyalgia and nociplastic pain if you want more info. The
| tldr is that our bodies can react to danger/injuries by
| increasing our pain sensitivity, which means that minor
| activities which pre injury caused no pain can later cause
| debilitating pain even when physically healed. This is why pain
| is now being explored through a biopsychosocial lens.
| glasscannon wrote:
| As someone with fibro/nociplastic pain, it's great to see more
| emphasis being placed on the non-biological drivers of pain.
|
| I'm currently building a platform to address pain more
| holistically. If you're interested in chatting feel free to reach
| out.
| nickhodge wrote:
| More "pray the pain away" bullshit.
| seibelj wrote:
| My back pain began at the tender age of 16. I have a few
| impinging discs in my lower back that "the cure (surgery) would
| be worse than the disease". The only thing that has consistently
| made me feel better is high intensity workouts and core strength.
|
| I'm in extremely good shape but still in a lot of pain, but
| luckily that hasn't stopped me.
| stillblue wrote:
| Can you elaborate? I'm in a similar boat and I've tried
| everything. I can't workout too much cos the back pain gets
| really worse after that. What do you mean when you say "high
| intensity workouts"?
| seibelj wrote:
| Core strength training like planks and squats, also biceps
| and legs, bench press, essentially lifting in all forms -
| except anything that is related to bending over. I don't do
| any exercises that involve bending or leaning forwards if it
| doesn't involve using the bench for support. Also a lot of
| cardio.
|
| In terms of work I'm a software guy and WFH, I rotate between
| standing, sitting, and laying throughout the day. Sometimes I
| work on the floor. Basically I work until I start to feel
| sore then I switch positions.
| generalenvelope wrote:
| If you are interested in training, and especially if you
| experience pain while doing it, I cannot recommend Barbell
| Medicine enough. Specifically: "4 Steps For Managing Pain in
| the Gym" https://www.youtube.com/watch?v=mdwj5ORPmX0
|
| Austin is a professional doctor/coach/lifter and an expert on
| the topic. The lesson I linked corresponds to this article:
| https://www.barbellmedicine.com/blog/pain-in-training-
| what-d...
|
| Aside from paying for a pain and rehab consultation with the
| Barbell Medicine team - I'd recommend posting on their forum:
| https://forum.barbellmedicine.com/ You can find many examples
| of people in similar situations receiving professional advice
| from their staff free of charge.
| [deleted]
| Ozzie_osman wrote:
| > However, common therapies such as surgery and steroid
| injections intended to address physical origins of back pain have
| not been clearly proven to work in randomized clinical trials.
|
| This is a terrifying statement.
| generalenvelope wrote:
| You should check out this article:
| https://startingstrength.com/article/aches-and-pains many
| conventional methods of treatment don't have the efficacy you
| might expect.
|
| As an aside - strength training when combined with knowledge of
| the biopsychosocial model, self efficacy, not-catastrophizing
| (the things Dr's Baraki and Feigenbaum preach) has changed my
| life.
| jjtheblunt wrote:
| Is it just that "randomized clinical trials" can not exist for
| definitive actions like surgery or steroids, as there's nothing
| that can play the role of placebo?
| pseudalopex wrote:
| Sham surgery for some procedures. Saline for injections.
| mrestko wrote:
| No, there have been sham controlled trials of surgical
| interventions before, they're just rare. One example is
| kyphoplasty.
| cpncrunch wrote:
| There have been a few:
|
| https://en.wikipedia.org/wiki/Sham_surgery#Examples
| ranger_danger wrote:
| I had back surgery and it only helped for 1 year. I can't
| explain that one either...
| helge9210 wrote:
| Bloodletting was still a thing a hundred years ago. Medical
| science went far since then, but not too far.
| todd8 wrote:
| Sometime in 1990 I injured my back. I still remember the details.
| The injury was caused by a strong sneeze while I was bent over
| picking up a briefcase. In a single second, I couldn't stand, I
| couldn't get up off of my knees. It was really quite bad. I went
| to a few doctors and got advice, but it was more along the lines
| of it looks like degenerative disk disease. In a few weeks the
| pain went away and my back felt completely normal.
|
| I am posting this in the hope that some HN reader will find it
| useful.
|
| Since that original "injury" other seemly small stresses on my
| back, especially when leaning over or twisted to one side can
| trigger this sharp sudden onset persistent back pain. Even
| sleeping in the wrong bed while traveling can cause me problems.
| The strange thing is, it goes away on its own after a few weeks
| and then I feel fine. If I was a yoga practitioner I would
| believe that yoga was curing it, if I went to a chiropractor then
| I would believe that chiropractic was curing my back, and if I
| was a meditator then I would believe that meditation was curing
| my back. Back issues like mine get better on their own after a
| few weeks, this explains why there is such a wide range of
| "cures" for back problems in general despite the wide variety of
| causes, some of which won't "get better" on their own.
|
| Of course I've been to doctors, and the radiological diagnosis is
| degenerative disk disease, but I think this is common for any
| person with back pain and no obvious physical cause. Everyone
| thinks they know what is wrong. And I think that some of them are
| right and some of them are wrong.
|
| I don't believe that it has anything to do with my psychological
| state. I've been through many stressful events in my life and had
| to work and live under high levels of mental pressure, I've been
| happy, sad, frustrated on and off over the years--most people
| have. These states are not correlated in the least with the onset
| of my back pain. On the other hand, recovery could be affected by
| one's psychological state, being able to relax the back muscles
| so that back can heal requires some ability to deal with the
| mind-body issues and the anxiety causes by pain.
|
| I had a trainer that was always stressing functional fitness.
| This definitely didn't seem to be useful and was sometime
| injurious. Throwing medicine balls again a wall and doing every
| exercise one handed while balancing on one leg weren't helpful.
| The issue for me was the twisting that was encouraged by this
| training philosophy. Simply keeping fit and keeping my weight
| down were much more helpful.
|
| The best advice I got was from a consultation with a
| neurosurgeon. This physician was trained to do back surgery but
| uniquely also treated patients with alternative therapies when
| surgery wasn't clearly indicated. She encouraged me to take
| vitamin D, omega-3 supplements, and curcumin to reduce
| inflammation. This has been helpful to me, reducing the
| frequency, severity, and duration of my back problems. Consulting
| with her also reduced my anxiety over pain and this might be
| mitigating the severity of the episodes.
|
| Golf -- the was very bad for me, an hour at the driving range
| could produce debilitating pain that made walking even with a
| cane almost impossible. I was just learning--maybe I was doing it
| wrong.
|
| Running and jogging -- these didn't seem to bother my back at the
| time I was doing it. I was able to train for and run marathons
| and even a wild cross country obstacle course race. I'm not a
| great runner, but I was able to place well in my age group. What
| I found was that marathon training is time consuming and leads to
| some muscle imbalances. My lower back (and upper body too) got
| weaker because my exercise was just running. The tightness in my
| lower back from hours of running also gave me concern and
| occasional, brief, but significant discomfort in my lower back.
| Overall though, I didn't feel that my back bothered me any more
| than the typical running overuse injuries, like planter
| fasciitis, knee pain, or IT band pain afflicting my fellow
| runners. I was able to finish all of the marathons I started
| training for (training takes around 7 months if you already do a
| bit of jogging). I hope this encourages people to remain active
| if their back pain is like mine (I understand that there are many
| types). I do wonder if so much running could be hard on the
| disks, does anyone know?
|
| Brazilian Jujitsu -- I had to give it up. I never got hurt, but I
| felt it was the sort of thing that a senior citizen with back
| problems should not be doing.
|
| Sitting and sleeping -- surprising to me was that thick memory
| foam mattresses that was supposed to be good for backs (Tempur-
| Pedic back in the 90s) bothered my back while a very firm
| mattress on top of a solid platform didn't. For the sake of my
| spouse, I found that one of the Casper mattresses works for both
| of us.
|
| Some chairs are great, and some end up causing me back issues.
| The _Zero Gravity Recliner_ is great, but now they seem very
| pricey. I got my unmotorized one years ago. When I have a bad
| episode of pain, sitting in it is one of the only ways I can get
| relief.
|
| I use an adjustable height standing/sitting desk with a _Motion
| Stool_ by UPLIFT. The adjustable desk helps me be things just
| right, and I 've discovered that chairs like the Motion Stool,
| while requiring some getting use to, allow me to work for hours
| at my desk without discomfort.
|
| It's really terrible to be in bad back pain, but for me, I've
| found some adjustments to my lifestyle have allowed me to be very
| happy and to hold off on employing more drastic measures for
| thirty year so far.
| kmarc wrote:
| Thanks for the very detailed breakdown of activities and
| experiences with them. I could relate to some of those.
|
| As a counter point, my back problem was chronic for 2months and
| didn't magically go away by itself.
|
| I was skeptic about physiotherapy only would help, but after a
| week I had real improvement.
|
| I guess I'm in the box "if I did physio, I'd believe that
| helped me". However, as long as I was waiting until it goes
| away itself, nothing happened, or it degraded even worse.
|
| Everybody is different, my advice is, instead of reading random
| internet healing pro-tips, go to an expert.
| todd8 wrote:
| Yes, there seem to be many different causes and just as many
| random internet tips. I'm glad you figured out how to help
| your back.
|
| My daughter injured her back, she's a competitive power
| lifter; I was worried because of my own experiences. The
| causes and successful remedies of her pain were completely
| different than mine, and her back is now healed.
|
| Go to an expert indeed!
| sambroner wrote:
| It appears I am younger than you (late 20's), but this is my
| experience. I spent 11 months with extremely challenging back
| pain and sciatica that started the day after snowboarding with
| lower back tightness. Luckily I had a doctor that encouraged me
| to wait a year (a year!) on surgery and the injury resolved 3
| weeks before the surgery date.
|
| Had I been less patient, I would have been on my 8th
| doctor/experiment/magic cure and that would have received all
| the credit.
|
| Golf & Baseball - very challenging.
|
| Running - Not a problem, which surprised me. I ran the NYC
| marathon 3 weeks ago and felt better than ever. BUT I can feel
| a definitive reduction in lower back strength, so I've started
| spending more time on core exercise.
|
| Familiar athletic movements - Totally fine. Basketball,
| throwing a football, etc all seem to be fine as long as I keep
| my body under control.
|
| Awkward athletic movements - Wrestling, new sports... basically
| anything awkward that requires twisting is bad. Seems obvious
| when written like this, but many sports can surprisingly fit
| the bill (Soccer, Volley ball serves, bowling, archery, etc)
|
| Sitting and Sleeping - Every once in a while my SO and I sit
| down at a restaurant and I have to bail out. There are some
| chairs that just do not work with my back and trigger sciatica
| in 10-15 minutes. Very confusing, but luckily she's quite
| forgiving.
| tacon wrote:
| The back pain-industrial complex is an incredible web of
| interlocking interests where no part has an incentive to really
| cure anything long term. The canonical expose of this system is
| the recent book "Crooked: Outwitting the Back Pain Industry and
| Getting on the Road to Recovery"[0], where a seasoned
| investigative reporter surveys the entire industry in detail.
| She gave a nice summary on this podcast[1]. And she has a
| detailed section on the breakthrough ideas of Dr. Sarno, and
| how he was ignored for decades.
|
| The book is in three sections. The first section is a very
| depressing history of back surgeries and devices attached to
| the back, that almost uniformly fail after a few years, leaving
| the patients worse than they started. The second section covers
| various exercise and bootcamp approaches, including the MedX
| lumbar extention machine invented by Arthur Jones, who also
| invented Nautilus machines with adjustable strength curves via
| cams. The MedX lumbar machine was the only device that could
| isolate and recruit the inter-vertebral muscles, which have
| been shown to be weak in patients with lower back pain. The
| machines came in a medical version[2] and an exercise
| version[3]. The back pain industry saw that the medical machine
| was working much too well and cutting into their income, so
| they had insurance companies stop paying for "exercise"
| modalities, and that approach died. The third section of the
| book is on the wide range of body manipulation techniques, like
| pilates, etc.
|
| [0] https://www.amazon.com/Crooked-Outwitting-Industry-
| Getting-R...
|
| [1] https://informfitness.com/podcast/50-outwitting-back-pain-
| ca...
|
| [2] https://youtu.be/Ao1CkBbe2nw
|
| [3] https://youtu.be/1Z-FyeG7pqY
| mylons wrote:
| i have kyphosis (moderate) and scoliosis (mild). i had
| debilitating pain at times and thought I'd need surgery. I
| was lucky and ran into doctors that wouldn't give me pain
| meds and insisted I not pursue surgery. Finally in my early
| 30s read Crooked and took up weight lifting, very slow
| progression, empty bar for each olympic lift. my back feels
| _amazing_ now. I never get pain anymore and have a new
| obsession.
| prox wrote:
| Look up "foundation training" , by Dr. Goodman, it's a
| different way of moving and looking at back injuries. Helped me
| a lot!
| mawise wrote:
| Is that the same as the book: "True to Form: How to Use
| Foundation Training for Sustained Pain Relief and Everyday
| Fitness" by Eric Goodman?
| prox wrote:
| Same person indeed. For me it did a lot of good.
| marcosdumay wrote:
| I have some back pain that increases when I drink too much
| coffee (for a few days). Stress intensifies it, but not nearly
| as much as coffee.
|
| Interestingly, walking and running improves it too, this one
| looks like unanimous here.
|
| Unusual exercises increase the pain a lot, but unless there is
| some extreme level of twisting, the pain decreases as the
| exercise gets familiar.
|
| Also, for chairs, I found that the most relevant feature is a
| correct sized seating depth. That's actually a large problem,
| because the size is standardized in labor conventions so every
| chair seems to have the same.
| [deleted]
___________________________________________________________________
(page generated 2021-11-27 23:02 UTC)