I put this article on my forum a while ago and was reminded it might be helpful here. In particular, note they talk about a Dr Sarno toward the end. I think his work is groundbreaking and his book "The Mind Body Prescription" a must read for those who suffer chronic pain, in particular back pain, but he covers other common pain syndromes.
http://www.msnbc.msn.com/id/4767268/site/newsweek/
The Great Back Debate
Is massage better for you than surgery? As millions of Americans seek relief from this ancient ailment, doctors are trying simpler, less invasive ways to end the agony
By Claudia Kalb
April 26 issue - Stop rubbing your sore back for a minute and take a quick tour of Mother Nature's engineering masterpiece: the human spine. Pretend you are Alice, so tiny you can climb among the muscles, nerves, bones and ligaments that make up the very core of your body. Crawl down the 24 vertebrae that encase and protect the spinal cord, from the cervical spine to the thoracic area to the lumbar region, that pesky lower back. Note the 23 rubbery white discs: the cartilage inner tubes that cushion the vertebrae. Observe the dozens of spinal nerves threading out from the cord between the bones. Poke the bands of muscle that wrap and support the bony column. Now focus on the tugs and thuds of daily life. The quick bend when you pick up your sobbing 2-year-old, the pounding of your feet as you run to catch the bus, the steady pull of your untoned belly, the dull pressure as you sit bleary-eyed in front of your computer, the sudden twist of your golf swing. Feel, too, the constant emotional stress we all live with: worries about aging parents, the kids' SAT scores, an IRS audit, mayhem in Iraq. Finally, imagine (or recall) that knife-in-the-back moment when something suddenly goes wrong with all that gorgeous spinal anatomy: Owwwwwww!
Like an expensive but temperamental sports car, the human spine is beautifully designed and maddeningly unreliable. If you're a living, breathing human being, you have probably suffered the agony of back pain. Eighty percent of Americans will battle the condition at some point in their lives, making it the No. 2 reason for doctor visits (after coughs and other respiratory infections). Already, back-pain sufferers cost this country more than $100 billion annually in medical bills, disability and lost productivity at work. And as long as we continue to lead overweight, sedentary and stressful lives, that number is unlikely to go anywhere but up.
As it does, legions of new back-pain sufferers, many desperate and even disabled, will seek relief. When they do, they'll quickly discover just how complicated their problem really is, with its mystifying mix of physical symptoms and psychological underpinnings. The reality is that the torment will usually go away on its own—impossible as that may seem when you're writhing on the kitchen floor. But pain is pain, and Americans, especially baby boomers, want a quick fix. The result: spinal-fusion surgery, the most costly (about $34,000 a pop) and invasive form of therapy, has spiked dramatically—77 percent in the United States between 1996 and 2001. But many of these procedures simply don't work. Doctors, worried that far too many patients seem far too willing to go under the knife, are now actively looking for simpler, more effective ways to treat one of the most vexing problems in medicine. "We've come to the point where we have to think out of the box," says Dr. David Eisenberg, head of Harvard Medical School's Osher Institute, where he is studying nonsurgical alternatives like massage and acupuncture. "The time is now."
Back pain can originate anywhere in the elaborate spinal architecture. Degenerated discs, which may lead to herniation and compressed nerves, are a common problem. Then there are those wrenching spasms provoked by muscle, tendon and ligament injuries, which can drop grown men to the floor. What's most mysterious about back problems is the disconnect between anatomical defects and pain. Unlike blood pressure and cholesterol, which can be easily measured with arm cuffs and blood tests, lower-back pain has no objective way—the volume of tears? the intensity of a grimace?—to be gauged. In many cases, the precise cause of pain remains unknown. Imaging tests have found that two people with herniated discs can lead radically different lives: one spends his days popping painkillers, the other waltzes through life like Fred Astaire. In one well-known study, researchers sent 98 healthy people through an MRI machine: two thirds had abnormal discs even though none complained of pain. In other research, experts compared a group of patients who reported back pain with a control group who didn't. Close to two thirds of the pain patients had cracks in their discs, so-called high-intensity zones, or HIZs. But so did 24 percent of the noncomplainers. "The real issue," says Dr. Eugene Carragee, the study's lead author and director of Stanford's Orthopaedic Spine Center, "is, why do some people have a mild backache and some have really crippling pain?"
The answer, Carragee and others believe, has as much to do with the mind as it does with the body. In the HIZ study, the best predictor of pain was not how bad the defect looked but the patient's psychological distress. Depression and anxiety have long been linked to pain; a recent Canadian study found that people who suffer from severe depression are four times more likely to develop intense or disabling neck or low-back pain. At the Integrative Care Center of New York's Hospital for Special Surgery, physiatrist Gregory Lutz says he routinely sees men who have two things in common: rip-roaring sciatica and an upcoming wedding date. The problem in their back, possibly a degenerated or herniated disc, probably already existed, says Lutz, but was intensified by the ole premarriage jitters.
In 2001, 250,000 spinal-fusion procedures were performed, most of them to treat disc problems. When they're young and healthy, discs are plump with water, which keeps them hydrated and buoyant—the perfect consistency to work as shock absorbers for the vertebrae. But over time, the daily stress of walking, sitting, twisting and just plain aging dries them out "like grapes that turn into raisins," says Dr. Nick DiNubile, an orthopedic surgeon at the University of Pennsylvania.
DATA BANK: Taking Care of Your Back _
As discs deteriorate, their tough outer shell weakens. One swing on the tennis court or even just lifting a briefcase can burst the interior gel through the casing, like jelly squishing out of a doughnut. The result is the infamous herniated disc. Some go unnoticed, but when a disc bulges against one of the two long sciatic nerves, which run from the spinal cord down the leg, the pain can be excruciating. Teri Klein, 45, describes it as going through childbirth "for all three of my kids at once."
Photographer Nancy Newberry vividly remembers the "kunk, kunk, kunk" she heard seven years ago when she slipped on some stairs at the Bronco Bowl arena in Dallas. After two years of persistent pain, she was floored by a searing jolt as she bent over during a photo shoot. She tried painkillers, hot and cold ultrasound therapy, cortisone injections, electrical muscle stimulation and a year of physical therapy. Nothing much helped. Frustrated, cranky and crazy from pain, Newberry reluctantly gave in to surgery. Doctors removed a cracked disc, then fused her vertebrae together with a bone graft. Five years later, the pain is duller but it lingers, and Newberry still keeps a stash of painkillers in her medicine cabinet. "I'll never be the same as I was," she says.
Fusion surgery was originally designed to treat serious instability or deformity of the spine. Over the past 10 to 15 years, the patient pool has gradually expanded to include more run-of-the-mill disc problems like Newberry's. The increase in all spinal surgery has been prompted in part by technical advances promising better outcomes. Perhaps the most tantalizing new development is the artificial cobalt-chrome disc, which could be FDA-approved as soon as next year. Dr. Jeffrey Goldstein, a spine surgeon at NYU-Hospital for Joint Diseases, has inserted dozens of the implants into patients as part of a nationwide clinical trial. He believes the discs, like knee replacements, will give patients more mobility than traditional fusion. And they'll get out of bed a lot sooner, too. The key, he says, is "to be very specific and very careful about patient selection. Not everyone who has disc degeneration should have an operation."




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