Excerpt for Healing Your Back Of Chronic Pain by , available in its entirety at Smashwords

Healing Your Back

Of Chronic Pain

Reversing Habitual Responses



Dr. Christopher Maloney, N.D.


Copyright © 2017

By Hygeian Publishing at Smashwords

All rights reserved.


DEDICATION



For all those patients who taught me about their pain. May you all be well and thank you.



TABLE OF CONTENTS


CONTENTS

1 WHY THIS BOOK?

2 BORN TO PAIN

3 NOT GETTING BETTER ON ITS OWN

4 PHYSICAL TREATMENTS THAT WORK

5 IT'S ALL IN YOUR MIND?

6 FROM MASSAGE TO REALIZATION

7 MAPPING THE BACK

8 MAPPING YOUR BACK

9 PUTTING IT INTO PRACTICE

10 TEN CHEAP BACK HELPERS

EPILOGUE

ABOUT THE AUTHOR

ENDNOTES



ACKNOWLEDGMENTS


I want to thank the tireless researchers who provide us with answers about our bodies. Thank you to Joe, my proofreader, business partner, and friend. Thank you to R, A, E, G, and my other patients who have read and commented on the book. I do listen and try to improve. To my family, my eternal thanks for bearing with me as I pour over medical texts. To my colleagues and teachers, you have taught me more than I can remember. And thank you, dear reader, for taking the time to care enough about your own back.


WARNING


This book is for informational purposes and is not intended as a substitute for the medical advice of physicians. The reader should consult a physician if they have any symptoms that may require diagnosis or medical attention. Be wise and take care of yourselves!


This ebook is licensed for your personal enjoyment only and may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to your favorite ebook retailer and purchase your own copy. Thank you for respecting the hard work of this author.

1 WHY THIS BOOK?


Congratulations on starting your journey away from chronic pain. Every journey begins with a single step, and you’ve taken that step by looking for this book and finding it. If you have chronic back pain, then this book is for you. It may help when nothing else has.

To be clear, nothing in this book replaces common sense. If you are in a car accident, please do not haul this book out of the crushed glove compartment and expect it to replace surgery. Get yourself patched up, and read this book only after your surgeons have stabilized your spine.

But if you’ve had multiple surgeries without success, then this book may be more helpful than one more surgery. Most surgeons know there is a decreasing return after initial surgeries, and will do additional surgeries reluctantly.

Many books on back pain focus entirely on exercise routines. So I assume you have access to those and may have tried some already. If you haven't, some of you may benefit from learning how to stretch the muscles of the back.

Instead of another physical treatment or set of exercises, we will talk in this book about habitual responses in the back. We will look at how habitual responses can trigger chronic muscle tension in the back, leading to pain. These responses may be to a physical cause, but they may also be generated by an emotional state or even by mental stress that leads to physical tension in the back. By helping you recognize these responses, we may completely resolve chronic back pain that has not been helped by other treatments.

We're talking specifically about back pain that has continued despite drugs and treatment, especially if you have more pain when you’re stressed. If you've read psychology books on letting go of stress, you may have tried to resolve your pain by telling yourself it is strictly mental. One famous back doctor has had some success with this mental model. But the mental model denies the reality that many pains worsened by stress also have physical triggers that are not under our conscious control. The conscious mind can work through the stresses you are aware of, releasing that tension. But unconscious, habitual stress may escape notice or be retriggered by movement, by familiar situations, or by simply having a similar emotional feeling.

For those of you who have doubts that anything will help your chronic back pain, let me tell you a story.

When she was young, Jane (not her real name) was in a terrible car accident. After mostly healing from the accident, Jane found herself still suffering with chronic back pain. It wasn’t quite bad enough for additional surgery, so she was sent out from the hospital with debilitating, agonizing pain. By the time she found me twenty years later, she’d been to every back specialist under the sun and had nothing to show for it except an addiction to painkillers.

The painkillers did help Jane with her pain, but they weren’t enough. She was on eight Oxycontin a day, the maximum her doctor would prescribe. Despite the drugs, she lived her life in a fog of pain. Before the accident, Jane had been thinking about college, maybe even becoming a doctor. But after the accident, she couldn’t focus. She had dropped out of college, married, and had children. So to the outside world she was coping with her pain. But every day she had to make a list of the things she was supposed to do, double check that she turned off the stove, and live in constant fear that she might forget to pick up one of her kids from school.

When I saw Jane, she was at the end of her rope. Conventional options had been exhausted long ago. She had heard about me from another patient, but was highly skeptical that anything we could do would help her. I looked at her lab reports, X-rays, and CT scan. Nothing in them showed any reason for her pain. Certainly nothing to justify a surgery.

So then I did something that most of her doctors had not done. I examined her back in detail with my hands.

Jane's whole back was a board, no flexibility anywhere. Imagine tensing your entire back, every muscle, and holding that tension all day and all night. That was her normal back tension. Of course that would hurt! Part of her pain was simply from muscle exhaustion.

As the back muscles tire, they switch from using oxygen to help burn sugar for energy to burning sugar without oxygen. Like a fire in the fireplace, the lack of oxygen means that the muscles burn less efficiently and that causes them to build up acid. The acid hurts if there’s too much of it in a muscle. The pain sensation you get in your arm from trying to hold a weight up for too long is from too much acid (metabolic acidosis). Jane’s entire back under constant tension burned like that all the time.

As we worked on Jane’s back together, she gradually released. Just feeling the release was enough to bring some tears of relief. Many of my patients no longer believe any relief is possible, so it can be emotional to hope for improvement again.

After several visits the back was mostly relaxed. We found one bone in the middle of her back that would pop out of place. It would happen every time she lifted anything or every time she felt stressed about her children. When her back went out of place, her muscles would spasm over the entire back to protect it from further damage just as they had after the original car accident so many years before. It was the root cause of the pain.

Unraveling Jane's specific pain and its triggers was the curative treatment, though it took some time to figure out everything that triggered her. After our work together, she was able to decrease her Oxycontin doses and eventually went off all medication. I haven’t seen her in some years now. At times her pain returns, but she’s able to deal with it without drugs. Her life didn’t become perfect, but she doesn’t have the pain she had before. By working with her body rather than trying to ignore it, she has found a path to relief.

Many doctors who work with chronic pain want to see you all the time. They need to treat you multiple times a week forever for the treatment to work. My best patients are those who I see for a period of months who learn how to heal themselves. I don’t need to see them again for years at a time, because they are able to resolve their own pain. These are determined people who have continued to pursue their paths to health long after others would have accepted pain as a daily companion. Together we’ve worked to find what works for them on a daily basis. I hope to give you the tools we’ve developed together, to help you understand and heal your pain.

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2 BORN TO PAIN


Just now, as I tilted myself in my chair, I felt three different pops in my upper back. It’s not uncommon for me to need to shift myself to let go of tension and pain a dozen or more times a day.

When I was twelve an enterprising chiropractor examined me and found a goldmine. My left side is shorter than my right, and my torso shows lowered ribs on the left side. He sold me a lift for my left foot, and prescribed weekly treatments for the rest of my life. If that wasn’t enough, I also had lordosis, an overly curved lower spine. My chiropractor told me it was due to weak stomach muscles, leading to hundreds of sweaty sit ups for years afterward. Add to that a compressed spinal fracture from high school, and there is no reason to think I wouldn’t live my life in pain or sucking down painkillers.

But I don’t. As I’m writing, I don’t experience pain.

It isn't because of my perpetual ongoing treatments. Within a few months I'd stopped chiropractic because it didn't help me much. I stopped the sit ups a bit later after straining my stomach muscles. In college, I finally dumped the lift for my left foot because it annoyed me and never looked back. Currently my back pain is managed by me and an occasional gentle massage.

Not that shoveling snow or overdoing running doesn’t cause me pain. I encounter pain and resolve it. It doesn’t linger or set up permanently in my body, because I use a wide variety of techniques to move beyond it.

My experience is not uncommon. Over the last two decades I've seen hundreds of backs. I’ve never seen a perfect spine, nor a perfect body. We all have our oddities that could explain any amount of pain. But one of the unspoken miracles of medicine is the number of people who “should” experience pain but don’t. On the other side is the nightmare of people who should be fine because there's nothing visibly wrong with them, but they are in agony.

In my radiology class, reading X-rays and CT scans, I remember looking at “normal” spines from patients without pain. Some of them had horrible breaks, poorly healed and teetering precariously on top of other bones like a tower about to fall. But they had no symptoms, no pain. Other patients showed me beautiful, nearly perfect X-rayed spines while they writhed in agony on the examination table. If the physical changes in the spine don’t determine physical pain levels, what does?

Treating myself for pain led to an interest in the pain of others. I moved from learning massage to going to premedical studies. When I looked at medical schools, I decided to attend a Naturopathic Medical School because that license would give me more freedom to explore both the causes and possible treatments for chronic pain.

I’ve spent the last dozen years working with patients who have taught me about their pain. What they’ve shown me is that the pain they feel is not in their heads, it’s in their backs. But that doesn’t mean it isn’t profoundly influenced by their habitual attitudes and responses toward that pain.

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3 NOT GETTING BETTER ON ITS OWN


One of the classic lies people with chronic back pain tell themselves is that their backs will improve with time. Many studies report that those suffering from back pain return to work or stop consulting their doctors after about a month. But follow-up studies show over half of those people continue to experience significant back pain.(1) So the patients are considered successes by the medical profession because they are back at work, but every day they are limited by pain that remains as their constant companion.

So what does happen over time with a chronic back problem? What increases with time is scarring, which tightens your back and can increase pain. Muscle tension also increases over time, which can cause your bones to lay down calcium deposits at areas of great tension. The X-rays pick up the calcium deposits, leading to diagnoses of bone spurs or degenerative joint disease in the areas of high tension. Once you have a bone diagnosis, chances are you will only get pain medication until the situation becomes bad enough to justify surgery.

But people with chronic back pain do remember that the pain was different or better in the past. As the years pass, many patients underestimate how much pain they were in before.(2) They’ll tell their doctors they only had a three or four pain on a ten point scale before, when the older records show that they reported an eight or a nine. So their memory of past pain fades in proportion to their current pain.(3) The pain doesn’t.

It can be protective of your sanity to pretend your pain wasn’t always this bad. If you’ve been to a specialist who has looked at your back and doesn’t think you’re a candidate for surgery, all you may be given is a prescription painkiller. Then you’re told to go home and “live with it.” Part of living with it is downplaying how much it hurts every day. You focus your life on getting through today, narrowing your focus and your willpower on overcoming today’s pain. No wonder yesterday’s pain seems less, and your pain from ten years ago is a distant, faint memory.

If you’ve managed to tolerate your pain, and deal with your pain on a daily basis in part by ignoring it, it can be very scary to face your pain fully again. Sometimes taking a long look at your life and the next ten years is not something you want to do when you’re struggling with today’s crises. So if you find yourself today unable to cope, read on but promise yourself that you’ll be gentle and take things at your own pace.

If you’re fed-up with the pain, and no longer want it to be the same tomorrow, then we need to work together today to lessen it. If you have been down this path before, you know that facing your pain can make it seem worse. Suddenly you’re aware of every twinge, every spasm. Even as I’m writing I can feel tension creeping up the right side of my neck. The awareness of pain can make it loom as large as a charging bull in our vision. But only by facing the bull can we ever hope to heal it.

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4 PHYSICAL TREATMENTS THAT WORK


As I was writing this book, the American College of Physicians came out with a new set of guidelines on using opiates for back pain.(4) After decades of piling on the drugs, the new standard is "just say no." They no longer recommend opiates for back pain. That's right, it's back to the lesser pain medications. Why? Because there is little evidence that the opiates help more, and good evidence that they are more addictive.

It's hard to understand just how big this shift is until you realize that opiates are the number one drug prescription in my state. They are overwhelmingly prescribed for pain, and nationwide back pain accounts for the majority of pain diagnoses. So we're talking about a huge shift; moving patients off opiates and onto...what?

The other common pain drugs, the nonsteroidal anti-inflammatory drugs (NSAIDS) like Advil or Tylenol, help a little with the pain. But presumably the reason people prefer the opiates is because they are better at helping with the pain. Another study came out recently saying that only one in six people taking NSAID drugs felt any benefit over placebo.(5) That leaves five of every six, about 80%, of chronic pain sufferers still suffering while taking NSAIDs.

When eighty percent of people with chronic back pain aren’t getting relief, they want some alternatives. And if opiates are no longer on the menu, what else is there? Is there good evidence that other things help more than NSAIDs with chronic back pain? Yes and no.


No One Truly Knows What Works.


Let's start by saying no one really knows for sure what will help, or what will help most with chronic back pain. Not your wise family doctor and not even an elite Ivy League back surgeon specializing in chronic back pain. Why? Because we have no standard tool for measuring back pain despite decades of pleas by doctors to come up with one standard.(6)

Today doctors are using sixty-six different measuring tools for pain and forty-four different measurements for disability. When you compare the different measuring tools to see if they are measuring the same things, they overlap only about ten percent of the time.(7) So one study on chronic back pain could say a treatment works, while another study using another measuring test says it doesn't work. Both can be right, because they're using different ways of measuring.

But surely some things work regardless of the measuring tool? If the tide is coming in, it doesn't matter which ruler you use to measure it. All of them will show that the beach is getting smaller. Are there treatments for chronic back pain that consistently show improvements across all the studies and measuring tests? No.

Surgery

You’d think back surgery would always work. Seriously. If I go in and saw away the bone around your pinched nerve, shouldn’t that nerve take a long, deep sigh, and stop hurting? But that’s not what we see. Back surgery often doesn’t do what it’s supposed to do for chronic back pain.

If you’re in a massive trauma, like skydiving without a parachute, ignore me and get yourself patched up with all the surgery you need. I’m talking to the people who’ve been patched up, given the “go home and live with it” prescription, and still can’t get through the day without lying on the floor moaning. These are the people who may not find relief from more surgery.

One standard type of surgery for chronic back pain has been spinal fusion. If that bone is hurting you, we'll screw it or glue it to the nearby bones so it doesn't move anymore. It sounds good until you start thinking about the nearby bones, which now need to take on extra load and movement. I've seen patients need one fusion after another. The current record I've seen personally is twelve fusions, each necessary because the previous fusion made the next joint of the spine unstable. At last the poor man gave up on surgery as a solution for his chronic pain. The medical research experts agree. A review of all the fusion studies now says that spinal fusion should no longer be used for chronic low back pain.(8)

But that doesn’t mean spinal fusion isn’t still being done or recommended to patients. There tends to be a ten-year delay from the time research comes out to the time doctors change their habits. Doctors are like anyone else; they don’t like to change what they’re doing, and they don’t tend to trust new studies that say they’re wrong.

But what about the most popular surgery for chronic back pain, a discectomy? A discectomy is cutting out the padding discs between the bones of a person's back. With trauma or constant use, the fluid discs between the back's boney vertebrae can tear and rupture, giving a clear X-ray reason to do surgery. Disc hurting? Take out the disc. No disc, no pain. Does it work? For a little while.

In the first few months, people in chronic pain felt better without their discs.(9) But that improvement didn't last for many patients. After about two years it was hard to tell in many patients who got the disc surgery and who did not based on pain levels.(10) Except the patients who'd had the surgery had more complications than those who did not. They spent more time in the hospital and needed more medical care.

In response to the poor outcomes from full disc removal, a newer, less intrusive surgery is being tried. It just removes the little fragments of the torn disc without taking out the whole disc. So far, the little fragment removal gets about the same result as the full disc removal.(11) In other words, short term relief, but with decreasing results over time.

Chiropractic

If not surgery, you’d think that chiropractic adjustments would always work. Again, you’ve got a bone out of place in your back, pinching a nerve, and the chiropractor pushes it back in place. Shouldn’t the nerve heave a sigh of relief? But, over time, chiropractic works about as well as other physical treatments for chronic back pain. It's helpful short-term but not long-term.(12)

If you’re like me, the chiropractic pop lasts all of twenty minutes. By the time you’re walking out the door, you can already feel the bone edging its way out of place. That doesn’t mean that chiropractic isn’t helpful for sudden minor trauma. When I do something that puts my ribs or neck out, having someone pop me back into place is great.

Patients also tend to prefer chiropractors because they communicate more with patients, taking more time than most MDs.(13) Individual results may vary, as they do with MDs and DCs. Good caregivers are wonderful, and short-term relief is much better than none. So by all means continue any care that is helping, just don't expect it to resolve all your pain over the long term.

Massage

My personal preference is for massage over chiropractic, and studies say it may or may not be as effective. One study I found puts the effect of a good massage at longer than a year. Other studies found no long term effect.(14) Many back pain sufferers have experienced a range of different treatments, and should definitely add massage to other bodywork as a possibility for short term relief.

Other Physical Body Workers


We could go on: Osteopaths, Physical Therapists, Occupational Therapists, Ergonomic Specialists, Rolfers, and Sports Teachers, can all be effective short-term for back pain. They may use any number of physical treatments, including acupuncture, various massage machines, stretches, ointments and lifestyle changes.

All these interventions may be helpful short-term, less so long-term. Purely physical interventions all work primarily on rearranging the muscles around the nerve, and that relief tends to be temporary. But temporary relief is still far better than no relief.

Cutting Nerves

But what about intense, last-ditch interventions? Forget disc surgery. Who hasn't wanted at times to just have them inject that nerve and kill it? Or cut it out? And here we should see a definite, conclusive long-term result. Right?

If I go into your back and inject your nerve with an anesthetic that tells it to stop hurting, then we would assume that would take care of your back pain. Injecting a painful nerve with an anesthetic did help prevent the need for surgery, but only short term. Long term, people still got surgery at about the same rate.(15)

Forget injections. Just cut the nerve! Cutting the nerve - denervation - would seem to be the ultimate pain-ending solution. Except when it's not.


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