My biggest takeaways:
Back pain has spawned industries - For the prospective consumer, remember: Every stakeholder wants and needs your business.
The order in which typical back pain patients usually make their way through the system:
Chiropractors and Physical Therapists
MRI - getting an image
Epidural Steroid Injections
Lumbar Spinal Fusion
Some more cutting edge surgical procedure?
Opioids - chronic opioid therapy
The conventional technique for treating back pain is to see it as a purely structural problem, but back pain is as much an emotional problem as it is a physiological one. In terms of its ability to generate stress-related ailments... Migraines, abdominal pain, insomnia, clinical depression. Dread, fear, hopelessness...
One of the central emotional issues of chronic back pain is the fear of back pain. Like Franklin Delano Roosevelt said, ‘The only thing we have to fear is fear itself.’ Fear of being disabled by the pain, fear of having your life interrupted. Pain causes distress, which causes muscles to tighten, which causes more pain. Lots of times, back pain is a bad feedback loop.
The problem [is] a fight-or-flight response gone awry. Another term for this is ‘central sensitization,’ which refers to the transformation of acute pain due to injury or incident into chronic pain no longer tethered to a specific situation. So back pain is not only a physiological problem, not only an emotional problem, but back pain is also a learning problem.
If back pain takes you to a primary care doctor, you are likely to get lots of pain pills, and maybe a physical therapy referral. If you go to a chiropractor, you will have spinal manipulation.
What you probably won't get:
Psychological counseling [even though half of patients say they struggle with depression]
A recommendation of exercise [more than half report that their doctors had never recommended exercise]
Intensive Functional rehabilitation, combined with cognitive behavioral therapy [despite evidence that this approach produces superior results in chronic back pain patients]