The video discusses the psychological trauma that often accompanies lower back pain. The speaker shares personal experiences with patients and friends who have suffered from debilitating back pain and the challenge of understanding the interplay between mind and body. They narrate two stories, one about a patient contemplating suicide due to their pain being dismissed as psychological, and another about a former police officer whose career was derailed by a pamphlet on living with back pain. Both cases highlight the importance of understanding the mechanism of pain and empowering patients to address it. The speaker emphasizes the need for a thorough evaluation and providing patients with strategies to address the underlying cause of their pain.
Key Insights
- Psychological trauma often coexists with lower back pain.
- Patients with lower back pain may struggle to differentiate between mind and body, making it difficult to provide effective help.
- MRIs do not reveal the mechanism of pain, which can lead to frustration and misdiagnosis.
- The story of a patient contemplating suicide highlights the serious psychosocial challenges faced by individuals with chronic pain.
- A patient’s demonstration of pain mechanism can help a clinician identify the root cause of the pain.
- Case studies show that empowering patients with knowledge and a strategy to address the pain mechanism can lead to long-term pain reduction.
- A patient’s experience with the healthcare system, such as receiving a pamphlet instead of personalized care, can greatly impact their morale and treatment outcomes.
- The key is to empower patients by showing them the mechanism of their pain and providing tools to mitigate the cause.
Transcript
Let’s pivot for a moment to talk a little bit about the amount of psychological trauma that exists in patients with lower back pain. Specifically, I’m thinking about some of my own patients or friends who have experienced debilitating lower back pain. Personally, I find great comfort in the fact that my own injury in 2000, which was long-lasting and debilitating, eventually healed, and I am pain-free today. This gives me confidence that I can handle small recurrences without getting overwhelmed.
However, I have great empathy for those who do not have this knowledge and confidence. Sometimes, I struggle to help such individuals because I cannot distinguish between what is a physical problem and what is a mental issue. There is a significant interplay between the mind and body in these cases. Can you speak more about this phenomenon and provide guidance on how we can assist these patients?
I am much more aware of the point you’re making now compared to 30 years ago. Let me share a story to illustrate this issue. Often, patients come to me after having visited various clinicians who were unable to identify the mechanism of their pain, particularly through MRI scans. One patient said to me, „Hi doc, I hear you’re different. I’ve been everywhere, visited pain clinics, and was given narcotics. Now they are telling me the pain is in my head. I can live with physical pain, but if the pain is in my head, that means I’m crazy and don’t deserve to live. I’m giving you two weeks, and if nothing changes, I’m going to end my life.“
This highlights the significant psychosocial challenge and the impact of the healthcare system on individuals. It is not uncommon for patients to come to me feeling suicidal. So, I decided to approach the patient differently. I asked him to show me the movement that caused his pain, something no clinician had ever asked him to do before. I explained that it was the only chance I had to understand his pain, considering his history with multiple clinicians.
I used my instrumentation, including muscle electromyography (EMG) and a 3D motion spine monitor, to evaluate him. He performed the movement, and at one point, I heard a small cavitation or pop sound from his back, which indicated a trap of the sciatic nerve. It was clear that he was in a bad way. I laid him down on a table and tried to provide some decompression. I understood the mechanism of his pain and instructed him on what to do for the next three days, urging him not to do anything silly.
I kept in touch with him, checking on him multiple times to ensure he followed the instructions. When he returned, we reviewed the data that showed that as he performed the movement, his muscles were stiffening and stabilizing the joints. However, at the moment he reached the top dead center of the movement, he completely relaxed his muscles, resulting in a clunk sound and the trapping of the sciatic root. The pain was intense during this phase.
I then asked him to push my fingers out harder while maintaining the muscle tone. We went through this process, and within a minute, keeping the tone and talking to me, he reached the top dead center without the clunk sound. It took about four months for the ache to subside, but he never experienced another clunk or trapping sensation. Ten years later, he brought his daughter to me for back pain, grateful for the improvement. He shared that he never had another acute episode after the coaching session.
Some may find this story hard to believe, but it illustrates the transformation that can occur when someone truly understands the mechanism of their pain and has a strategy to address it. It is a process of education and empowering individuals to take control.
I would like to share one more story from my lecture in England. There was a man who appeared clinically depressed, slumped down with his knees together. During the break, he approached me and said he used to be a police officer but injured his back. The healthcare system only provided exercises that caused more pain, and they eventually gave him a pamphlet on how to live with his back pain. That pamphlet destroyed him, as he realized he would have to live with pain for the rest of his life without anyone ever showing him the actual problem. I showed him the spot procedure, and he immediately experienced relief and became emotional, realizing what the healthcare system had done to him.
These stories demonstrate the importance of understanding the mechanics of pain and empowering individuals to address the underlying causes. By doing so, we can help them build a robust foundation for pain-free living.
