Disclaimer: I’m not a doctor. If your back hurts, go see one. If they tell you they can’t find anything wrong with you, but you know your back still hurts like the dickens, consider what happened to me:
I was twenty-five years old when I threw my back out. I was working on boats at the time. On this particular job, I was leading a fleet of several dozen boats for the annual Richard Bertram Summer Cruise, which is when new boat owners follow one another through the Bahamas for a week. As the fleet captain, I led planning and weather sessions over spread-out charts to show the other captains where we would head and what to be cautious of. I fixed broken air conditioners, stopped one boat from sinking, and most importantly — I set up the margarita machine in every port of call.
The margarita machine was this massive cooled ice swirler thingamabob that we stored in the lazarette of our lead yacht. It took two people to pick up the margarita machine. Unfortunately, only one person could fit in the lazarette. I was young, dumb, with more muscles than sense, so I would go in, crouch down, pick up this machine that weighed more than I did, and waddle out with it, hunched over.
The third or fourth time I did this, I heard a pop in my back, and I went down like someone who’d had eight margaritas. I’d never felt pain like this before, not with broken bones, nothing. I spent the rest of the cruise crying, stooped over, staggering around, laying out on the deck, putting fenders under my lower back, anything to make it stop. Everything I tried made it worse. I couldn’t sleep. I could barely see through the agony.
And so began my decade of debilitating and chronic back pain.
Episodes could come on from turning my head too fast. From a long road trip. From sitting on a wooden stool for half an hour. From seemingly anything. A few times, the pain got so bad that I couldn’t get out of bed. I couldn’t move. Any attempt to stir caused paralyzing and torturous pain. Once, my wife had to wrestle me out of bed, me muffling my screams, as she helped me to the bathroom. I had at least three episodes like this a year. Some of these episodes lasted weeks or even months.
Three years ago, I was out here in Colorado for the holidays with a friend who happened to be a doctor. (A chief medical examiner in Manhattan, no less.) Never shy about asking him for advice on my ailments, I told him about my back pain (I was having an episode at the time). He said something that really pissed me off. My doctor friend told me all of my pain was in my head.
If you are like I was back then, you aren’t reading this sentence. You’ve already laughed and walked away. That’s what I did. Fortunately, this was a dear friend, and he was persistent. (He is also the smartest person I’ve ever known in person, which made his advice hard to ignore.) With this mixture of caring and brilliance, he wore me down. It took a year, but I started listening. I did some research. I discovered that quite a few really smart people agree with this theory.
One of the foremost is Dr. John Sarno at NYU, author of The Mindbody Prescription. Again, if you’re like me, you’ve already walked away just after reading the title to that book. Maybe like me you are an avowed skeptic, a rationalist, someone who does not believe in what can’t be proven. I am all of these things. Which gets in the way of me understanding some of the very real and bizarre things in the cosmos, like quantum mechanics. The world is not entirely rational. Take the placebo effect.
You’ve heard of the placebo effect, I’m sure. It’s our mind’s ability to affect the efficacy of medical treatment. It is most common in studies of chronic pain, but it shows up often enough (and is real enough) that every drug trial has to take the placebo effect into account. The effect is so powerful that one of the early researchers to study the placebo stumbled upon its powers almost by accident and could barely believe what he was seeing.
His name was Henry Beecher, and he was a medic in WWII. Running out of morphine in the field — and with more soldiers in need of treatment —Henry resorted with desperation to something he’d read about once: the power of lying to his patients. He gave them saline injections (salt water), and told them it was morphine. Many of his patients relaxed and felt no pain, even as Beecher removed their limbs and performed invasive surgery. I repeat: He cut off limbs after giving soldiers a shot of saltwater!
I was thinking about Beecher one day while lying in bed with my back “out.” I also thought about what my friend had told me in Colorado the previous year. He told me he too had suffered from back pain for over a decade. He tried everything. Finally, he cured his recurring chronic back pain after meeting with Dr. John Sarno at NYU, who convinced him that it was all in his head.
Here’s the cool thing about curing my back pain (and probably, curing yours): I didn’t have to go to a seminar, buy a book, or spend a single penny to get better. I just read study after study on this issue until I let go of my skepticism and doubt. I told myself that my back wasn’t physically injured. I told myself that the pain was in my head.
And then I got out of bed.
It was hard at first. I staggered around a bit. I was still pissed at my friend for belittling what I knew to be a very real physical injury with a very specific margarita-machine cause. I was still pissed at what I felt to be victim-blaming. What I felt to be callous and cruel dispassion. A waving away of what had plagued me for over ten years. But I was sick of the pain, and I had read enough bizarre historical accounts to begin to doubt my pigheadedness. And just like that . . . the pain went away.
There are quite a few theories as to what’s going on with chronic back pain. They don’t all agree. They might all be wrong! But they all get one thing right: For most sufferers of chronic pain, there is no physical cause. People go in and get scans, which show nothing. Doctors aren’t sure what to do, so they prescribe pain meds. But the actual locus of the pain is where all pain signals both begin and end: in the brain. (This doesn’t mean backs can’t be injured, just that the vast majority of cases reveal no physical injury to explain the pain.)
If you think that’s wonky, keep in mind that amputees often feel their ghost limbs itching. The itch isn’t on the skin, it’s in the brain. That signal just points back to the location of the itch, where some stimuli caused the initial firing. But signals can fire without any stimuli at all. When you dream, you are “seeing” with your eyes closed, often in color, and often with sound. The world we experience is pieced together by our brains, and we don’t do a very good job of it. We get a lot wrong. Including not knowing that we get any of it wrong.
An excellent overview of psychosomatic pain in the British Journal of Psychiatry suggests that recurring chronic pain often has a real and legitimate origin (such as my margarita-machine injury) but that subsequent incidences are simply a case of fearing re-injury. Many studies link anxiety and stress to chronic back pain. Other researchers have found that back pain plagues those who think of their backs as fragile and easily injured. Those who think of their backs as okay and resilient to injury avoid pain. The miracle is that those in the former group can simply decide to join the latter group. That’s what my friend did. That’s what I chose to do.
I tackled my back pain in several ways. First, I told myself that the pain was far worse than any real injury. This lowered my anxiety about the pain. The first day I tried this, the results were astounding. No medicine. No gadgets. Just a restructuring of my thoughts. “The pain is worse than anything going on in my spine,” I told myself. “I don’t have a slipped disc. I don’t need surgery. My body is protecting me from something that isn’t even amiss.”
My second attack was to reduce the stressors in my life. I stopped worrying so much about . . . everything. I reduced my workload. No more 18-hour days, 7 days a week. I set up an auto-responder on my email account and stopped trying to reply to every single thing. I spent less time staring at my computer and more time with family, more time taking pictures and breathing deeply.
I stumbled upon this study out of Northwestern University, where researchers were able to PREDICT with 85% accuracy which patients would develop debilitating back pain from an initial sensation of injury. 85% prediction rate! The indicator was crosstalk between two areas of the brain that deal with emotions and motivational behavior. One of these is the nucleus accumbens, which instructs the rest of the brain on how to interpret and respond to the outside world. Just as we can have auditory and visual hallucinations, so too can we get our perceptions of pain wrong.
What is likely occurring is a nasty feedback loop. The emotional response triggers a protective pain response, which heightens the emotional response, over and over. Breaking this loop requires calming the emotional response. This often happens by way of placebo, which is why thousands of people swear to thousands of varying (and often contradictory) cures for back pain. Inversion, heat, cold, compression, elevation, acupuncture, massage, yoga, etc. Anything convincing enough to believe that the pain should be going away often works.
Once that feedback loop is severed, you feel better. But the more you suffer from the pain, the more heightened and attuned your emotional response becomes for future attacks. This is what happened to me and what has happened to so many others. And it isn’t just back pain. Various pain fads have swept populations like viruses. Carpal tunnel outbreaks have been found to have psychosomatic origins. All it takes is the conviction that part of our bodies are fragile, to fear that pain, and then to have a slight or even imagined twinge. And then it’s on like Donkey Kong.
To understand how this happens, watch Lorimer Mosely’s TED talk. He’s got the science behind what’s going on when we feel pain. Every time, no matter what’s happening, the sensation of pain is in your head. And the majority of times, there’s nothing at all wrong with your back:
The last thing I did to completely cure myself of debilitating back pain was to exercise more intelligently. I strengthened all the little muscles that are easy to ignore. I stretched more. Because the fewer twinges I had, the fewer times I had to convince myself nothing was wrong. And along the way, I convinced myself that I was making my back stronger. Which makes me invulnerable to lower back pain. Because it’s all in my head.
More reading, if you want: