D****R
发帖数: 6053 | 1 DAVID GREENE, HOST:
On a Monday, it's MORNING EDITION from NPR News. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep.
Today in Your Health, we report on the most common reasons people go to the
doctor: back pain. More than 1 of every 4 adult Americans say they've
recently suffered a lower back pain, and that figure is on the rise.
Billions of dollars are spent every year treating that problem. But many
specialists say less medical treatment is usually more effective.
As part of our occasional series, Less is More, NPR's Richard Knox and Patti
Neighmond take a closer look.
PATTI NEIGHMOND, BYLINE: Let's start with a cautionary tale about how not to
deal with back pain. It involves a guy who knows what he's talking about.
DR. JERRY GROOPMAN: I suffered back pain almost 20 years.
RICHARD KNOX, BYLINE: Doctor Jerry Groopman is a Harvard cancer specialist
who writes about medicine for The New Yorker. When I went to see him, he
told me his story. Thirty-two years ago, he was a young marathon runner when
back pain struck. He says it was a bolt from the blue.
GROOPMAN: I couldn't run. It was difficult to sleep. And I was totally
fixated on it. I wasn't confined to bed but I was hobbling around.
KNOX: Groopman wanted the problem fixed right away. So he found a surgeon
who removed a damaged disc, but he still had pain. Then, one day during
brunch at a friend's house, something happened that would change his life.
GROOPMAN: I stood up from a chair and just had an explosive electric shock
through my lower back. Basically, I fell to the floor and couldn't get up.
KNOX: his previous pain was severe but this was over the top. Groopman could
hardly move.
GROOPMAN: And I was so desperate after almost three weeks that I've found a
neurosurgeon and orthopedist who said you have spinal instability, will fuse
you, and in three weeks you'll be playing football.
NEIGHMOND: In a spinal fusion, surgeons weld together adjacent vertebrate
with a bone graft. It's an increasingly common operation.
KNOX: But for Groopman, doing more made things worse.
GROOPMAN: I woke up from the surgery in excruciating pain and basically
could hardly move my legs. And I remember the orthopedic surgeon coming by
and saying, well, I don't know why you're having so much trouble and so on.
He said, but, you know, if it doesn't get better in a few weeks we could re-
operate.
NEIGHMOND: In fact 1 in 5 patients who have surgery for back pain do end up
having more surgery. For some, like Jerry Groopman, it doesn't help at all.
And yet, surgery for back pain has been on the rise for the past two decades
, along with other treatments such as steroid injections and use of opioid
painkillers.
Dr. Richard Deyo is a professor of evidence-based medicine at Oregon Health
Sciences University.
DR. RICHARD DEYO OREGON HEALTH SCIENCES UNIVERSITY: Certainly, there is good
reason to think that we are overprescribing painkillers, overprescribing
injections, overprescribing back surgery.
KNOX: Deyo says one reason invasive treatments for back pain have been
rising is MRI scans. These detailed, color-coded pictures show a cross-
section of patients' spines are a technological tour de force. But they can
be dangerously misleading.
UNIVERSITY: Seeing is believing. And, gosh, we can actually see degenerated
discs, we can see bulging discs. We can see all kinds of things that are
alarming.
KNOX: That is, they look alarming. But they're most likely not the cause of
the pain. Lots of people who are pain-free actually have terrible-looking
MRIs. So being less aggressive can sometimes bring more benefit.
NEIGHMOND: Now, surgery can help for certain conditions such as a herniated
disc with lead paint called sciatica. But most age-related back pain usually
can't be fixed with surgery.
Dr. Jim Rainville is a rehab specialist at New England Baptist Hospital in
Boston. He says research is showing that the problems often have nothing to
do with the mechanics of the spine, but with the way the nervous system is
reacting.
DR. JIM RAINVILLE: It's a change in the way the sensory system is processing
information, so that normal sensations of touch, sensations produced by
movements, are translated by the nervous system into a pain message. That
process is what drives people completely crazy who have back pain because so
many things induce discomfort.
KNOX: It's a totally different way of thinking about pain. Normally, pain is
an alarm bell that says: Stop what you're doing right now or you may hurt
yourself. But for some people that pain is a false signal. It's not about
looming danger; it's actually caused by hypersensitive nerves.
Rainville says many patients with chronic back pain get stuck in an endless
loop of pain.
RAINVILLE: In about 25 percent of people, the sensitization of the nervous
system persists.
NEIGHMOND: Some people may be genetically prone to it. But Rainville
discovered these patients can actually learn to ignore this pain.
(SOUNDBITE OF A CROWD)
LISA CHILDS: Let's warm up first on the rotary torso, just to get you going.
NEIGHMOND: Lisa Childs is a physical therapist at a back pain boot camp
Rainville developed. She's teaching back pain patients how to rethink their
pain.
CHILDS: I'm just going to ask you, is it easy, moderate, difficult?
JANET WERTHEIMER: Moderate.
NEIGHMOND: Childs is working with 61-year-old Janet Wertheimer, whose had
severe back pain on and off for 10 years. Most people with chronic back pain
couldn't imagine doing what Wertheimer's doing - using her back to lift 100
pounds of lead weights.
CHILDS: Do you feel like you could do five pounds more or 10 pounds?
WERTHEIMER: You can try 10 and I'll see what happens.
(SOUNDBITE OF WEIGHTS)
WERTHEIMER: And if I can't make it, I'll go back to five.
CHILDS: OK.
WERTHEIMER: Oh, that did hurt.
CHILDS: OK.
NEIGHMOND: Wertheimer has a slight twinge in her back. But Child's says that
's OK. She's building strength. And along the way, she's learning not to be
afraid of the pain.
WERTHEIMER: It is learning not to fear the pain, learning that you can live
with pain. Understand what that pain is, but then put it aside.
NEIGHMOND: Eventually, after a few months, most patients in Rainville's boot
camp and similar programs find that the pain lessens and sometimes even
goes away.
KNOX: Even patients like Jerry Groopman, whose back pain was worsen by
surgery, can unlearn their pain. For years after his spinal fusion, Groopman
was never without back pain. He tried a long list of things without success
. Then a friend suggested he see Rainville. Groopman was skeptical but he
decided to give Rainville's boot camp a try.
GROOPMAN: He was really tough. And he said to me, you are worshiping the
volcano god of pain. And I thought, what is this about?
KNOX: Rainville explains.
RAINVILLE: In primitive cultures, if you lived near a volcano and the
volcano started smoking and looking like something was going to happen, well
, it was obvious because gods were mad at you. And you'd start doing silly
things - sacrificing chickens or goats or whatever, thinking that that would
appease the gods.
KNOX: In a strange way, Rainville says, people with chronic back pain do
something very similar.
RAINVILLE: Oh, my god, I better sacrifice this. They stop playing golf or
they stop playing on their softball team, or they stop their running, and
then they're really careful of carrying groceries. And they keep putting
things on to this altar, thinking that that's going to change the situation.
NEIGHMOND: Patients get so afraid of pain that they do anything to avoid it.
But for most people it doesn't work. Instead, they just lose strength and
flexibility. And remember, this kind of pain is a false signal. It doesn't
mean you're going to do permanent damage if you don't stop.
KNOX: Eventually, that message sank in with the skeptical Dr. Groopman.
GROOPMAN: It took about two months for me to really buy in that this was the
way to go.
KNOX: Sometimes, like when he bent over to pick up a plastic crate filled
with lead weights, he had a flare-up of back pain. But the therapist talked
him down from it.
GROOPMAN: Just let it go. Don't pay attention to it.
KNOX: Basically, doing is believing.
GROOPMAN: Doing is believing. And after about nine months, I was basically
without any back pain.
NEIGHMOND: It doesn't work that well for everyone. Janet Wertheimer still
has some back pain. But now she says boot camp she can pretty much do
anything she wants - ski, mountain hike, walk her dogs. And the pain? Most
of the time, she says, she blocks it out and moves on.
I'm Patti Neighmond.
KNOX: And I'm Richard Knox, NPR News.
(SOUNDBITE OF MUSIC)
INSKEEP: It's MORNING EDITION from NPR News.
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authoritative record of NPR's programming is the audio. | G***G
发帖数: 16778 | 2 I am learning.
Hope I can read more articles like this every day here.
the
Patti
【在 D****R 的大作中提到】
: DAVID GREENE, HOST:
: On a Monday, it's MORNING EDITION from NPR News. I'm David Greene.
: STEVE INSKEEP, HOST:
: And I'm Steve Inskeep.
: Today in Your Health, we report on the most common reasons people go to the
: doctor: back pain. More than 1 of every 4 adult Americans say they've
: recently suffered a lower back pain, and that figure is on the rise.
: Billions of dollars are spent every year treating that problem. But many
: specialists say less medical treatment is usually more effective.
: As part of our occasional series, Less is More, NPR's Richard Knox and Patti
| D****R
发帖数: 6053 | 3 Get NPR news by listening and reading. It has been my favorable radio for
past ten years.
http://www.npr.org/
For advice, look at
http://www.uexpress.com/dearabby/
【在 G***G 的大作中提到】
: I am learning.
: Hope I can read more articles like this every day here.
:
: the
: Patti
| T*****u
发帖数: 7103 | 4 it is in your head...it is in your head...it is in your head...it is in your
head...it is in your head...it is in your head...it is in your head...it is
in your head...it is in your head...it is in your head...it is in your head
...it is in your head... |
|
