With Anxiety at an All-Time High, Expect Even More Back Pain Victims

Investigative reporter Cathryn Jakobson Ramin, author of “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.” Photo by Jonathan Manierre.

First, a little background and a shameless plug. I’ve spent most of the last seven years writing Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. The book is a hybrid, combining deep investigative reporting with a personal narrative, charting my journey as I find my way from disability to function. In the process, I learned a great deal about how treating chronic back pain, which afflicts about 70 million Americans annually, came to cost $100 billion each year. That’s makes it a legitimate public health crisis. Until recently, I’ve shied away from calling it an “epidemic,” because you don’t “catch” low back pain, and the term “epidemic” implies the transfer of contagious or infectious disease. But lately, I’ve had to reconsider, because anxiety often engenders back pain, and today’s brand of anxiety is definitely contagious.

All of us have personal hot buttons, which, if pressed, trigger feelings we’d rather avoid. But in the light of recent events in the U.S., it seems to me that, as a population, we’ve entered what I call “The Age of Anxiety,” beset with the same sense of existential dislocation that W.H. Auden described in his book-length poem of that title. No matter what your political inclinations are, or where you stand on issues like nuclear war and healthcare, what’s in the news each day is enough to send many of us into paroxysms of doubt and muscular spasm.

For the past 40 years or so, stakeholders in the back pain industry have worked hard to persuade us that back pain reflects some failure or fragility of the physical structure of the spine, and therefore demands serious medical attention. In response, a vast business encompassing chiropractic treatment, physical therapy, spinal injections, pharmaceutical treatment, and spine surgery has emerged. There are more than 200 approaches to treating low back pain, and in medicine, that can mean only one thing: Not one of them is a clear winner. Most don’t even make it to the finish line.

This disparity has been evident for a couple of decades. But health care professionals who have dared to point out the folly of spending tons of money, while putting patients in harm’s way, have had a hard time of it. Starting in the 1990s, John Sarno (the Rusk Institute physiatrist who until his retirement practiced at NYU Medical Center), publicly scoffed at the notion that serial medical interventions were necessary or wise.

Instead, he insisted that cognitive and emotional factors, including unacknowledged rage and anxiety, led to muscular tension, which led to oxygen deprivation of soft tissues, which led to back pain. By the thousands, back pain patients read his books and absorbed Sarno’s ideas. Once they had acknowledged their emotions — for instance, virulent fury at a neglectful parent or a greedy ex-spouse— they recovered. There was no good way to explain why a patient, who had struggled for years with severe pain and disability, could read a Sarno book, or spend a couple of hours with the doctor himself, and return to living a normal life — except that nothing physiological had been amiss in the first place. Sarno’s colleagues at Rusk and elsewhere rolled their eyes at what they considered Sarno’s naive (and profit-destroying) approach, clinging determinedly to the Cartesian theory that the mind and body worked independently, while ordering ever-increasing numbers of interventions.

“Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.” Available May 9th.

In the past few years, multiple evidence-based trials, reported in peer-reviewed journals, have shown that chronic back pain has a strong emotional component, and that the brain regions involved in the experience of both pain and emotional distress — anxiety, anger, fear and feelings of isolation, among others — are closely allied. “Cognitive behavioral therapy” is an approved treatment approach that addresses this relationship, seeking to eliminate unhelpful habits like “fear-avoidance,” and “guarding.” (Much more about this in Crooked.) The more anxious you are, (even if anxiety is appropriate under the circumstances), the more likely you are to develop the painful muscle tension that Sarno described. For a more detailed examination of the relationship of emotions and chronic pain, take a look at the latest from filmmaker Michael Galinsky, a documentary called All The Rage.

Over the last year, several primary care physicians and a couple of ob-gyns have told me that back pain — always a top reason for a visit to the doctor — has climbed into the #1 position, with chronic insomnia and depression running only slightly behind. The state of affairs in Washington appears to have pushed some patients to the point where pain that used to be episodic and manageable has become insurmountable. Increasingly, patients are beseeching their physicians to order diagnostic MRIs, refer them to surgeons for procedures and to interventional pain management doctors for spinal injections, in the hope that someone in a white coat has a way to quell the pain, with little or no contribution from the patient. (This is basically never possible, but again, you’ll have to read Crooked to find out why.)

In addition, my psychologist and psychiatrist friends have observed that, in place of their usual explorations of childhood trauma, marriage and work issues, many patients have substituted a wild-eyed discourse on politics and the inevitability of the coming Armageddon. (Those who experienced emotional, sexual or physical abuse in childhood — any kind of bullying — are apparently the most likely to succumb in this particular way.)

How are we to handle this contemporary experience of existential dislocation? As tempting as it may be, as human beings, we can’t stop caring — or aching. If you’re suffering from back pain in conjunction with persistent fury and frustration, it’s probably because you feel like you’ve lost control over the world in which you live, as well as the future that you thought you were building for your children and grandchildren. That makes perfect sense, at least to me.

But, next time you get out of bed with a crook in your neck, or a backache, or with a twinge of sciatica, don’t rush to a chiropractor, or ask your doctor to order an MRI, or spinal injections, or to prescribe insurance-paid physical therapy. Instead, invite yourself and a friend to take a long walk in nature, in a place where Internet service is limited or non-existent. Do not, under any circumstances, discuss politics. Since such places are increasingly hard to find, plan to leave your smartphone in the glove compartment, and take along a printed trail map, so you can make it back to what we used to refer to as “civilization.”

At home, swallow your final dose of upsetting news and unnerving tweets immediately after dinner. Then leave your phone in the kitchen, turned off, before you tuck yourself in for the night, so you don’t wake up at 2 am, reach for it like you used to reach for a lover, and start scrolling and hyperventilating. Read a book that’s not in the least educational; if there was ever a time for escapist fiction, this is it. Before bedtime, don’t watch Homeland, or Scandal or Designated Survivor, because the worst scenarios the writers could think up are not nearly as bad as what is actually going on in Washington. Exercise daily, not because you’re keen on having a beach body by Memorial Day, but because regular exercise it is the surest path to retaining your sanity in trying times. And if you must watch the news while you’re on the treadmill, keep an eye on your heart rate, which may be soaring.