When Cathryn Jakobson Ramin had a riding accident as a teenager, she couldn’t have foreseen that it would leave her with chronic back pain for decades.
“I spent a summer working with horses,” she says, “and was too embarrassed to admit I’d fallen off and hurt myself. So I sort of carried on, hoping that the pain in my hip would go away by itself. It didn’t.”
For the next three decades, Jakobson Ramin, an investigative journalist based in California, learnt to live with chronic lower back pain, developing sciatica during her first and second pregnancies. Her back regularly “locked up” when she tried to exercise. “Over the years, I tried everything, from massage to chiropractic therapy,” she says. “But nothing helped.” Until, that is, she discovered a back whisperer — someone to help her manage the pain, about which more later. Her years of suffering will be familiar to many in mid-life. According to 2014 research from the University of Queensland’s School of Population Health, nearly one in 10 of the global population suffers from chronic back pain. It is estimated by Backcare, a medical charity, that back pain costs the United Kingdom £5 billion (Dh25.65 billion) every year in disability payments, with 40 per cent of Britain’s over-50s suffering persistent aches.
An entire industry aimed at the problem has grown up, with innumerable treatments available, from surgery and pain medication to more holistic but often ineffective remedies and tools, such as acupuncture, lumbar belts, magnets and, yes, “back whispering”. But as anyone who has suffered back pain will probably confirm, there seems to be no magic bullet.
Jakobson Ramin’s latest book, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, explores the many ways sufferers are misled to believe they can cure or at least treat their condition. Now 61, she uses her own experiences to go into the details about which therapies do actually work.
“I tried everything I knew of,” she says. “A decade ago, I decided I needed heavy-duty medical support.”
After trying and failing to find a conventional surgeon who could help her, in 2008, Jakobson Ramin underwent “laser spine surgery” at a specialised back pain clinic, in which bone was drilled away under a mild (“twilight”) anaesthesia. “At the clinic,” she says, “I found myself observing the dozens of other patients who were trying everything they could to cure their back pain. We all came from different walks of life with different stories, but we had wound up here and were not getting better. At first, the procedure seemed to have made a difference. But once my nice cocktail of strong painkillers and steroids wore off, my back pain became worse. The nerve seemed more inflamed than ever.”
In Crooked, she recounts a different intervention in each chapter. “Most people with chronic lower back pain have epidural steroid injections, but I discovered there is no evidence these provide more than the most brief benefit. In fact, over time, repeated doses of steroids can damage bone, soft tissue, the heart and the brain. Meanwhile, the outcomes for spinal fusion surgery, a common procedure in the United States, are unacceptably poor.”
Even before opioid prescription caused an epidemic of overdose and deaths, Jakobson Ramin was alarmed by the way physicians doled out addictive painkillers, starting with co-codamol, which is a combination of acetaminophen and paracetamol, and is often a “starter drug”, leading to much stronger extended-release opioids that are even more dangerous. “It’s very easy for physicians to prescribe these, as it saves them time and resources. But we’re now seeing the devastating outcomes of over-prescribing.”
Moreover, the Cochrane Collaboration, an independent research organisation, found that there were no clinically significant benefits for opioids over non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. And a UK investigation found that patients who were prescribed daily opioids were more disabled at the end of the six-month trial than when they started.
Not all of what she learnt was so depressing. As part of her research, Jakobson Ramin met Jeremy Fairbanks, consultant orthopaedic surgeon of Oxford University Hospitals, who refers patients to a chronic pain rehab facility to learn how to self-manage their back pain, and get back in shape. After interviewing him for her book, Jakobson Ramin went back to the US and found herself a back whisperer — a physical therapist who prescribed an exercise routine that she still follows.
“It was the worst thing to be told you had undergone surgery that was both unnecessary, and likely destructive. But since following this exercise routine I am more on top of my pain than I have ever been.”
Over time, Jakobson Ramin’s squad of back whisperers — rehab, postural and ergonomic specialists, cognitive psychologists and experts in meditation and kinesiology — left her convinced that outwitting back pain requires changing your attitude, from “victimised” to “in control”.
“It’s hard to say that to someone who cannot move, but when pain is chronic, its generator is not in the spine, but in the brain. Treating that condition with exercise and cognitive behavioural therapy is now widely recognised as the only evidence-based approach.” It means developing a consistent personal exercise regime, one that gets you moving again — which is where the back whispering comes in. To get on the road to recovery, look for a strength-training programme — “or if you are severely deconditioned, opt for something gentle that will get you moving, like the Alexander Technique or the Feldenkrais Method”.
The practitioner who can stop you thinking of yourself as disabled by back pain is worth their weight, she says: “After physicians have told you for years that ‘if it hurts, don’t do it’, it’s crucial to realise that “hurt does not mean harm.”
“There is a huge problem with people taking sick leave, getting on to the sofa and staying there. It is a terrible waste of lives. People are put on the poverty line, and families and futures are destroyed, because they don’t believe that it is safe for them to get moving again.
“You are going to hurt while you go through treatment — I know myself that it is no picnic. But the opportunity cost of not climbing out the other side is not acceptable.” She adds: “Back pain is not the unsolvable enigma of modern medicine, but successful rehabilitation takes sweat, persistence and a lifetime of hard work.”
Four exercises for a better-back ‘good morning’.
- Stand with your feet slightly apart and arms folded in front of your chest.
- Bend your knees a little and bend your hips to get your back flat and parallel to the ground while sticking your bottom out.
- Breathe out on the way down, in on the way up.
- Repeat 10 times.
Arm and leg raise
- On the floor, on all fours, place your hands shoulder width apart and your knees slightly apart (arms and thighs should be vertical).
- Stretch one arm forward in front while stretching the opposite leg out behind.
- Repeat 10 times
Cat’s pose
- Arch the back, at the same time, look down at the floor.
- Then lower the stomach towards the floor, hollowing the back while looking up.
- (If you are pregnant, you should not do the second part of this exercise. Instead, keep your back straight.)
- Repeat 10 times.
Knee raises
While in the all fours position draw alternate knees to the opposite elbow.
- Return to the original position.
- Repeat 10 times and do the same with the other leg.
— The Telegraph Group Limited, London, 2018
Victoria Lambert is a journalist specialising in health and medical matters.
