Wednesday, March 9, 2011

DAY 157 - It Came Out of Nowhere

Patient: (with distress) Doctor, I have no idea what caused this back pain. It came out of nowhere.

Doctor: That’s got to be upsetting, to be experiencing pain that seems to have been unprovoked.

Conversations like this are common in my practice. They start out interesting, and become even more so.

Early on, with each patient, I suggest that nothing comes out of nowhere; that there are many happenings that we don’t understand, and influences that we can’t see, but all events are brought about by related phenomena. For a thoughtful doctor, it is usually not difficult to begin to solve the mystery of the surprising back pain.

Given that stress is pervasive, and a known cause of back pain, I always bring it up as a probable contributor. Most of us, through adaptation or mental blocking, keep stress and its effects from our consciousness. Many people don’t imagine that the recent death of their sibling, and the associated feelings, could directly contribute to the initiation of back pain. In our culture, understanding that the chronic stress of a rotten job, an unhappy relationship, or an ill child, could cause back pain, is not common. The tendency is to be surprised when an ongoing input finally causes a sudden and overt change; in this case, pain.

An interesting part of our cultural understanding of the effects of stress, is that we actually do know and appreciate that chronic stress can, and reasonably should cause back pain, in others, but find it difficult to accept that it would be true for us.

We have a tendency to think that one must DO something, like lifting a heavy object, to cause back pain. We are less apt to think about the effects of what we DON'T DO. Patients, confused about the cause of their pain, rarely offer that they have not been going for walks regularly, have not stretched in six months, or have not had a salad in the past week. They never mention the bowel movement that they haven’t had for 3 days.

Further off the American radar as a cause of back pain, is food allergy, even though it may be the most common. Most of us have never heard that eating a food such as dairy products for years, or decades, could chronically provoke ones immune system, causing focal inflammation and tissue damage in muscles and joints, and ultimately pain in the back. Pain caused in this manner may not come out of nowhere, but those who have never even heard that foods can cause back pain, are always blindsided.

Most back pain is caused by long-term, combinations of stress, poor diet, lack of sleep, lack of aerobic exercise, lack of stretching, and food allergies; not from falling down a flight of stairs while moving a grand piano. But without the necessary perspective ... back pain can appear to come out of nowhere.

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