by Carolyn Noel, Webmaster – PAINS Project

A few weeks ago, I read an article entitled, “The $100 billion per year back pain industry is mostly a hoax” which discussed the release of a new book about back pain. As a person who has lived with back pain for over 15 years after a devastating automobile accident, I bristled at the following quote from the author.

People in pain are poor decision-makers. – Cathryn Jakobson Ramin, author of Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery

As you can imagine, as someone who has lived with pain for so many years, I took offense. I found the facts mentioned in the article to be accurate – such as the 65% failure rate for spinal fusions – but, in my opinion, the conclusion that all back surgeries are “unnecessary” seems to be a stretch.

People in pain are desperate for relief from the pain and that makes them willing to try treatments with a lower success rate. I don’t call that poor decision making but rather a lack of options which leads to willingness to try anything that has the possibility of providing relief. Everyone I know (and after working for many years in chronic pain support groups, I know a lot of people who live with pain) who has had a spinal fusion ends up fusing the vertebrae above and/or below as they weaken as well. I can’t see myself ever agreeing to do it even if it had been recommended for me. But, I do understand how people in horrible pain, desperate for relief would try just about anything to get better. Is it a “poor decision” when you’re in severe pain 24/7 for years on end and limited in just about everything you want to do to decide to try something that you’re told has a chance to help?

The article also suggested that exercise will fix most people. After 15 years, I’ve learned that there is no such thing as a magic cure that works for most people. Each person’s case is much too complicated for that and requires a comprehensive approach geared toward the individual patient.

Always the Pollyanna in the room, I decided that perhaps the article did not accurately reflect the tone of the book and I should give this another chance, so I purchased the book and began reading.

Crooked is divided into two major parts. Part 1 details all of the conventional treatments currently available to treat back pain. From surgery to injections and pharmaceutical treatments, each chapter discusses in great detail what is involved in the treatment and gives numerous stories of how each treatment has failed. The author is a very talented writer and explains the various treatments in layman’s terms that are easily understood.

As I read, I began to notice a pattern in these chapters. They detailed the procedure, gave examples of patients who had been harmed by the treatment and then pointed out how much money is spent on those treatments each year — and either directly or indirectly accusing those health care providers with engaging in these treatments solely for financial gain. There were definitely some extreme cases where doctors were defrauding the system, but the implication is that everyone is just out to make a buck.

Part 2 of the book details the author’s research into such treatments as cognitive behavioral therapy, physical therapy, exercise programs and Feldenkrais. This section of the book had a different tone. There are positive stories about the people helped by these treatments, including the author’s successes, and, while the cost for treatments, such as $95/session with 2-3 sessions per week for a personal trainer, were mentioned, there is no implication that these practitioners were just “in it for the money.”

I learned a lot of detail about all of the treatments mentioned in the book and I definitely recommend it to anyone interested in reading about the history behind these treatments and how they are performed today — in words that a layperson can understand. However, I do differ with the author on the conclusion that most people just need exercise to “cure” their back and that many of the conventional treatments are useless. If there’s one thing I’ve learned over the years, it’s that there’s no such thing as a universal cure-all for chronic pain.

I congratulate the author in finding something that has helped her to conquer her pain. I also consider myself to be a conqueror; after five years in a wheelchair, I am able to walk again. With no insurance and no money, I had to figure things out myself and found that massage therapy helped me to regain much mobility. You can read more of my personal story at “Chronic Pain: The Importance of Telling Our Stories.” I still live with chronic pain which severely limits my mobility and ability to do the things I would like to do – but – I remain hopeful that as I continue my search I will find additional things that will help me.

One of the most important tools in the arsenal of a person fighting the battle with pain is hope. I choose to look at those offering both conventional and alternative treatments as doing so out of a desire to help.

As Pollyanna would say,

“When you look for the bad, expecting it, you will get it. When you know you will find the good—you will get that….”