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Exposing the ‘Crooked’ Back Pain Industry

A new book's author says some common solutions can do more harm than good


Aching back? Count yourself among the 62 million American adults searching for a cure. After spending decades and thousands of dollars on treatments for her chronic back pain, investigative journalist Cathryn Jakobson Ramin found a larger problem in the world of spine health.CROOKED: Outwitting the Back Pain Industry and Getting On the Road to Recovery

Her six-year quest is chronicled in a new book, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. Ramin traveled the globe, served as a guinea pig for multiple therapies, and interviewed more than 600 patients, doctors and therapists, all linked to the $100 billion-a-year industry. In the end, she found that what ultimately worked for her was intensive, directed exercise.

Ramin recently talked with Next Avenue about the book. The interview, edited for length and clarity, appears below.

Next Avenue: What do you want readers to take away from your book?

Cathryn Jakobson Ramin: Caveat emptor. Before you decide to put your faith in any provider, look extremely closely at that provider’s record. If you get sent for an MRI a couple of days after back pain with no intention of having surgery, ask why you are going for that MRI, because the only use for an MRI is for preparation for either surgery or an epidural steroid injection. And if you are thinking of having an epidural steroid injection, ask yourself why, because the evidence is they are not effective in most cases.

You are not going to find someone who will fix you. You will be the fixer.

Consider the possibility that your back pain is closely related to anxiety and tension. We have a lot of that right now. We’ve always had a lot, and we have a lot more.

You describe a personal diagnosis called “degenerative disc disease.” That sounds incredibly frightening.

Scary. And when I heard that the first time and the second and the fifth time, I was very, very scared. It sounded bad. It sounded like doomsday, and I thought we were going to have to widen the doorways to the bathrooms, so that I could get in in a wheelchair.

No one said to me, ‘That really sounds terrible, but it isn’t, so just don’t worry about it.’ Instead, the doctor’s receptionist said, in a very serious tone of voice, ‘You really need to come in right away so we can talk about next steps.’ I thought, ‘Oh, God, really?’ I was about 51 or 52, and I thought this just can’t be happening.

But what I learned over the years was this diagnosis is nonsense, because everybody has degenerated discs in their spine. It’s just how it works, and also, it’s very much a marketing term and a way to sell surgery.

Perhaps the most shocking statistic in your book was regarding your poll of 100 doctors.

This was a question posed to spine surgeons: ‘Would you have spine surgery?’ [Specifically lumbar fusion or disc replacement surgery.] And resoundingly, in this group, all said ‘No,’ except one. Now, that should tell you all you need to know.

You connect the dots between the spike in back pain and the opioid epidemic.

There is an extremely clear correlation. What happened was doctors felt compelled to prescribe opioids to patients who were suffering. And the drug companies were right behind that, pushing that all back pain should be treated immediately with opioids.

You indict many of the big players in the back pain arena. One of them is chiropractors. Thirty-five million Americans see chiropractors. They’re going to be shocked by that indictment.

I assume the chiropractic folk will be quite upset. If you just developed back pain, there’s evidence that one to two sessions with a chiropractor may help you. More than that, there’s absolutely no evidence for it, and anyone who has gone to see a chiropractor knows there are very few chiropractors who want to see you for one to two sessions. The moment you come through that door, you are told that, for maintenance purposes, you need to come very, very regularly for a very, very long time, maybe forever. And there is no evidence at all for that.

What’s your practical advice for back pain sufferers?

People want to be fixed. They are always looking for the person who can fix them, or the procedure or the drug. The bad news here, or maybe it’s good news, is that you are not going to find someone who will fix you. You will be the fixer. You will be the one who develops the intensive exercise program that is going to allow you to escape from this.

And it’s not only intensive exercise. It’s changing the way that you think about back pain. Do you think that if you get up and move and exercise that you will damage yourself? Very, very, very unlikely. So, we’re talking about a very structured, intensive exercise program.

You probably are going to need what I refer to as a ‘back whisperer’ to help you get through it, because back pain patients cheat. They cheat all the time. They do the thing that looks like the thing they think they were told to do, but because their muscles tend to be weak, they avoid using them. That’s why you typically need some help, someone to push you, keep you focused, prevent cheating.

And that’s what a back whisperer is?

Yes. And that is not your sweet little trainer from a gym who says, ‘OK, it hurts, well, we’ve got to stop.’

Staying on the topic of exercise, you write the machines in health clubs aren’t going to work, stretching may not work.

There’s a lot of misinformation that I dispel. Personal trainers say things like, ‘We gotta strengthen your core.’ They’re assuming that core means your abdominal muscles. Well, that is not going to solve your back problems, because back problems stem from very weak glutes, weak thighs and weak low back muscles, the stabilizing ones. Those are the ones that need to be worked.

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