Three years ago I posted a few words on ‘bad backs’. Taking issue with the lay diagnosis of a ‘bad back’, I made the case for building up core strength by carefully and relentlessly exercising key muscles such as the abdominal obliques, rectus abdominis, psoas, transverse abdominis and the pelvic floor muscles. It’s more work than taking a pill or having surgery but it can gradually produce excellent results in patients who are motivated.
Meanwhile the market which naturally addresses less motivated people, is awash with quick cures, fancy machines (presumably they do the work for you) and other miraculous (but unproven) treatments. Because the results of tests often do not correlate with pain levels, the ‘psychology of back pain’ has been in vogue for many years. John Sarno wrote a number on the psychological approach to back pain in the 1990s and for a short while the psychological approach to back pain was in vogue. Surgery for back pain was never out of fashion and on the whole not too evidence-based either. Nevertheless the mysterious ‘Case of the Bad Back’ continues to bamboozle doctors and Conan Doyle, a medically qualified doctor himself isn’t around anymore to help. Today’s Daily Telegraph heralds a new addition to the ever-growing literature on the subject. With a nifty title, Back to Life, it re-explores psychological approaches to ‘bad backs’.
As a whole person orientated doctor, I agree that almost every illness has a psychological component, which if addressed appropriately, can help the physical component. Backs are no exception and no ‘special case’ either. If you have back pain, by all means explore psychological remedies, do CBT or other counselling but don’t be fooled by the title of the article in the Daily Telegraph : Could counselling help you beat back pain? While I agree that empathic counselling can ‘help’ almost any medical condition, my advice to sufferers of back pain is to get good instruction on strengthening your core abdominal muscles and keep doing a tough and boring 15-20 minutes a day or even every alternate day. Your persistence will be rewarded and your wallet will not be raided.