End Your Back
Pain Like an expensive but temperamental sports car, the
human spin is beautifully designed and maddeningly unreliable. If you are a
living, breathing human being, you have probably suffered the agony of back
pain. And as long as people continue to lead overweight, sedentary and stressful
lives, the number of sufferers is unlikely to go anywhere other than
up. As it does, armies of new back-pain sufferers, many
desperate and even disabled, will seek relief. When they do, they’ll quickly
discover just how complicated their problem really is, with its mystifying mix
of physical symptoms and psychological underpinnings. The reality is that the
agony will often go away on its own — impossible as that may seem when you are
writhing (痛苦扭曲) on the kitchen floor. The Great Pain Mystery
Back pain can originate anywhere in the elaborate spinal architecture.
Degenerated discs (椎间盘), which many lead to herniation (突出) and compressed
nerves, are a common problem. Then there those wrenching pain provoked by muscle
injuries, which can drop grown men to the floor. What’s most mysterious about
back problems is the frequent disconnect between anatomical defects and pain.
Unlike blood pressure and cholesterol (胆固醇), which could be measured with arm
cuffs and blood tests, lower-back pain has no objective way — the volume of
tears the intensity of a grimace — to be gauged. Many times,
the precise cause of pain remains unknown. Imaging tests found that two people
with herniated discs can lead radically different lives: One spends his days
popping painkillers, the other waltzes through life. In a well-known study,
researchers checked 98 healthy people: Two-thirds had abnormal discs even though
none complained of pain. The real issue is why some people have a mild backache
and some have really crippling pain. In another research, experts compared a
group of patients who reported back pain with a control group who did not. Close
to two-thirds if the pain patients had cracks in their discs, so-called
high-intensity zones, or HIZs. But so did 24 percent of the
non-complainers. The answer has as much to do with the mind as
with the body. In the HIZ study, the best predictor of pain was not how bad the
defect looked, but the patient’s psychological distress. Depression and anxiety
have long been linked to pain; a recent Canadian study found that people who
suffer from severe depression are four times more likely to develop intense or
disabling neck or low-back pain. At New York’s Hospital for Special Surgery,
psychiatrist Gregory Lutz says he often sees men who have two things in common:
crippling sciatica (坐骨神经痛) and an upcoming wedding date. The problem in their
back, possibly a degenerated or herniated disc, likely already existed, says Dr.
Lutz, but was intensified by the pre-marriage jitters. Spine Surgery
Breakthrough Pain is pain, and many want a quick fix and
that means surgery. Spinal-fusion surgery, one of the most invasive and costly
forms of therapy (about ＄42,000) has more than doubled in the US since 1993, to
about 350,000 in 2003. Discectomy, which is done less invasively, has also
spiked to 342,000 surgeries per year. But these procedures don’t work for
everyone. The increase in all spinal surgery has been promoted
in part by technical advances promising better outcomes. Perhaps the most
intriguing new development is the artificial cobalt-chrome disc. In October
2004, the US Food and Drug Administration (FDA) approved the first such disc,
the Charite, for patients with degenerative disc disease. The three-piece device
has a sliding medical-grade plastic core sandwiched between two metal plates,
which allows the spine to move. It is believed that, such discs, like knee
replacements, will give patients more mobility than traditional fusion surgery.
And they will get out of bed a lot sooner too. The key is to be very specific
and very careful about patient selection. Not everyone who has disc degeneration
should have an operation. Alternative Treatments
Doctors, worried that too many patients seem willing to go under the
knife, are now looking for simpler, more effective ways to treat one of the most
vexing problems in medicine. For more and more people with back pain,
alternative therapies are the way to go. Chiropractic care
(指压疗法), the most popular nonsurgical back therapy, is booming, with 60,000
chiropractors practising in the US today. Some happy clients visit their
chiropractors more often than their hair stylists. Experts generally agree that
the treatment, which involves manipulation of the joints and tissues of the
spine, is safe for the lower back. It provides modest benefits equivalent to
those of conventional treatments. Massage has an increasing
number of proponents, and research shows it can help knead ont (揉掉) persistent
pain. Steven Smith, a physical therapist at the Schuldt Performance uses massage
on back-pain sufferers to loosen up muscles and increase blood flow. It’s not
exactly a spa-like experience, though. "You’ve got to get in there deep to break
the pain." Acupuncture (针灸) is also popular. The first large
trial of the practice is now conducted at New York’s Integrative Care Center,
where therapist push the tiny needles into the patients. Acupuncture seems to
stimulate the release of feel-good endorphins, has a cumulative effect. Patients
describe a lingering euphoria, a nice happy state whether you’ve got a back
problem or not. An Integrative Approach Jordan, a
long-term back-pain sufferer, tried every wacky thing out there. "Faith healing,
hanging from the ceiling, clicking my heels together and wishing I was home, you
name it, I’ve done it." Last year, feeling especially distressed, he tried
biofeedback, a technique that trains him to distance himself from the pain. "I
never get rid of the pain, but these treatments provide some relief." says
Jordan. If patients’ attitudes can help the pain, can more
creative thinking among the experts improve the odds of beating it Dr.
Eisenberg, head of Harvard Medical School’s Osher Institute, is spearheading an
National Institutes of Health-funded pilot program to find out. A diverse group
of 25 specialists meet regularly to educate one another on how they diagnose and
treat back pain. They intend to see if there is a more efficient,
multi-disciplinary way to attack the problem, and to make it cost-effective
too. No wonder there’s a flood of interest in alternative
medicine. Even New York’s Hospital for Special Surgery opened a
complementary-medicine center four years ago. Now about 13,000 patients a year,
many with bad back, see its rehab specialists, massage therapists and
chiropractors, as well as taking yoga and tai chi classes any noninvasive
approach they can find to relieve the pain. Can Rage Ruin Your
Back Dr. Sarno, a professor at New York University School
of Medicine, believes almost all back pain is rooted in bottled-up feelings.
Samo explains how repressed rage and anxiety can stress the body, eventually
manifesting itself as muscle spasm (抽搐), nerve dysfunction, numbness and pain.
Recovery begins with recognition the connection between the body and the mind.
"Pain is created by the brain to make sure the rage doesn’t come out." says
Sarno. But skeptics say Samo is offering a placebo (安慰剂), which could miss the
true cause of the pain. After centuries of agony, humanity could
certainly use some relief. But more important than the success of any treatment
is the good news that back-pain sufferers and doctors are embracing bold new
ways to think about the most exquisite and frustrating work of art: the
spine.
(1,270
words) The autho feels ______ about humanity’s final victory in the century-old battle against back-pain.