I hurt my back in a horseback riding accident two years ago. I ended up with chronic low back pain that no one could figure out. I went to doctor after doctor. I had one test after another. When they couldn't figure out what was wrong, I was told that it was all in my head. I finally found someone who would do surgery. I'm much better now. Why does this run around happen to so many people (myself included)?

Effective health care is still a very inexact science. Sometimes it is more art than science. And when it comes to chronic low back pain (LBP), we just don't always have the answers.

There is a curious phenomenon that has been noted over and over. People with no back pain whatsoever can have X-rays and MRIs or CT scans that look like they should have problems. And some patients with severe, constant LBP can have perfectly normal looking imaging results.

No one really knows how to interpret this information. Except to say that either way (changes or no changes) imaging studies alone cannot be relied upon to make a diagnosis.

More and more, we are moving from a biomedical model to a biopsychosocial model of health care for patients with chronic LBP of unknown cause. The biomedical model focuses on the patient’s signs and symptoms. It was assumed that there was some disease or pathology present. Treatment was directed toward this disease process.

Over time it became clear that this model didn't bring about the desired results. The pain persisted and without a known cause. Then in 1977, the biopsychosocial model was put forth. Instead of looking at mechanical and pathologic changes, it was suggested to pay attention to the patient's social and psychologic factors.

Now, 30 years later, there still isn't strong evidence of lasting effects on chronic LBP using this approach. Sorting out each patient's unique factors can take time and many visits to multiple health care professionals.

Surgery is usually a last resort because there isn't enough evidence that this approach works well enough to subject the patient to the trauma and expense. Your success in finding the right treatment for you is cause for celebration!

Bradley K. Weiner, MD. Spine Update. The Biopsychosocial Model and Spine Care. In Spine. January 15, 2008. Vol. 33. No. 2. Pp. 219-223.

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We are all different

As Dr Weiner points out, we are all different. Some peoples back scans should show that they have a problem but they feel fine. Others may show up fine on the x-rays and have pain. The pain is not felt by the spinal vertebrae or the skeletal structure directly in most case. It is usually felt by the nearest nerve that is being pressed on. So although some people backs may look out on an x-ray, if this is not pressing on their nerve, they will be pain free. I think the worst kind of slippage that can occur in the spine is a slip with rotation of more than 30 degrees. Inevitably if this is the case you more than likely will feel pain. People also have different psychological sensitivity to pain. For instance with irritable bowel syndrome people can become more aware of their digestive movements when they are stressed and this can have the effect of amplifying the pain. Others have much worse digestive disorders however if their stress levels are low they may not feel the pain. Pain management is an art of its own.
Tennis Elbow Brace

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