Health & Fitness

Back pain strikes nearly 80 percent of all adults, yet its causes are not fully understood.

A growing cadre of doctors and scientists now believes that chronic back pain is a disease of the nervous system, not the spine. This breakthrough has opened the doors to new kinds of treatments that could banish back pain forever.

In its darkest moods, the demon lurking in Marc Sopher’s back made it almost impossible for the family doctor to carry on with his daily routine. It would pound his lower back, sending dull throbs of pain up his spine, and then fire sharp bolts of pain down one leg and then the other. At first, Dr. Sopher tried to ignore the pain. He assumed that he’d strained something in his spine, perhaps herniated a disk or pinched a nerve. “I’m a traditionally trained physician,” he says. “I started taking some anti-inflammatories and I waited for my back to heal.” But the demon wouldn’t go away. When holding meetings, he’d have to stand up and stretch his back. When driving, he’d have to stop and get out of the car to ease the tension in his spine. When reading bedtime stories to his kids, he’d have to lie on his stomach. There was no anatomical explanation for the extremity of his pain. “I tried to soldier on the best I could,” he says. “I honestly believed I’d be living with pain for the rest of my life.”

The majority of people with back pain (estimates run as high as 90 percent) will get better within seven weeks with little or no medical treatment. The body heals itself, the inflammation subsides, and the nerve relaxes. These people go back to work, pledging to avoid the sort of physical ­triggers that caused the pain in the first place. About 10 percent of patients don’t get better. Their pain gets worse and worse: It is chronic. One day, these people find themselves lying supine on the floor, wondering what they did to deserve such agony.

Today, Dr. Sopher, who lives in Exeter, New Hampshire, no longer has back pain. He has slain his demon. When I meet him, he’s drenched in sweat, having just run eight miles and played a game of tennis. Later, he’ll ride his bike. His short hair is salted with white—Dr. Sopher is 46—and he still has the taut body of a young athlete. But Dr. Sopher wasn’t healed by conventional medicine. He didn’t undergo surgery or get epidural injections or take painkillers. Instead, Dr. Sopher is one of the thousands of patients suffering from chronic back pain who got better by treating his mind.

He learned to think differently about his pain, and that’s when his pain went away. This narrative might sound suspicious—there’s no shortage of phony treatments for chronic back pain—but a growing body of scientific evidence supports it. Chronic back pain is now predominantly seen as a disease of the nervous system, not the spine. It’s a problem suited for psychologists and neuroscientists, not surgeons. The best treatments are often the least invasive.

America is in the midst of a back-pain epidemic. The numbers are staggering: There’s an 80 percent chance that, at some point in your life, you’ll suffer from severe back pain. Treating back pain costs about $26 billion annually and it currently accounts for 2.5 percent of our country’s total health-care spending. If worker compensation and disability payments were taken into account, the cost would be even higher.

The conventional medical treatment for back pain follows a predictable script. After the patient is interviewed and given a physical exam, he or she undergoes a series of diagnostic tests. This normally includes x-rays, CT scans, and MRIs. The end result is an astonishing array of detailed anatomical pictures. Doctors no longer need to imagine the layers of tissue underneath the skin. Now they can see everything.

Unfortunately, all this seeing has limited results. After undergoing the full range of diagnostic tests, 85 percent of patients suffering from lower-back pain still don’t receive a precise diagnosis. The pain can’t be pinpointed; there are just too many moving parts. Instead, their suffering is parceled into a vague category, such as lumbar strain or spinal instability. But even when a patient is given a specific structural diagnosis, it’s not clear how meaningful the diagnosis actually is. Look, for example, at herniated disks, one of the most common “causes” of back pain. A 1994 study published in The New England Journal of Medicine imaged the spinal regions of 98 people with no back pain or back-related problems. The pictures were then sent to doctors who didn’t know that the patients were not in pain. The end result was disturbing: Eighty percent of the pain-free patients exhibited “serious problems” such as bulging, protruding, or herniated disks. In 38 percent of patients, the MRIs revealed multiple damaged disks. The disconnect between “disk degeneration” and back pain increases with age: More than 80 percent of people over the age of 60 who don’t have any back pain still demonstrate significant disk degeneration. These structural spinal abnormalities are often used to justify expensive treatments like surgery, and yet nobody would advocate surgery for people without pain. In the latest clinical guidelines issued by the ­American College of Physicians and the American Pain Society, doctors were strongly recommended not to “obtain imaging or other diagnostic tests in patients with nonspecific low back pain.” In too many cases, the expensive tests proved worse than useless.