Hacker News Reader

Comment by kuboble | Hacker News Reader

I'm suffering from severe chronical lower back pain.

> Yet approximately 90% of patients with CLBP cannot identify any clear specific cause or origin of their pain.

Same here.

More than once in my life I seemed to not feel any pain unless my injury get to the point of damage preventing proper physical operations.

It feels like I was doing something wrong and didn't get feedback from my body until it was too late.

Learning from this article about correlation between lower back pain and with lower brain volumes in pain-related brain areas strikes home.

View on HN

You might have heard about this or tried it, but if not: There's some very promising studies from last year regarding treatment of CLBP that doesn't seem to have a physiological cause[1]. This type of "treatment" helped me turn around my backpain (both upper and lower) which had been getting worse and worse over ~6 months (not very long, I know), and after a few months I was virtually pain free.

This type of therapy is not new, but it's only very recently that proper big and reputable studies have been done. Most people don't even need to see a professional, reading online and doing it on your own is enough for the majority (including me).

[1]: https://www.colorado.edu/today/2021/09/29/how-therapy-not-pi...

Have there been any studies comparing the brains of people who derive pleasure from pain vs people who don’t? I wonder if this could be related? Some people seem to have “trained” their brains not to recognize pain signals as unpleasant. Or (because I imagine they still feel pain) maybe they can even decide when and which pain signals are pleasant vs unpleasant? I wonder if people who enjoy BDSM are any more or less likely to suffer from chronic pain than the rest of the population.

This is an interesting article. I would like to hear more information about how the therapy is actually done. This reminds me of techniques like Edmund Jacobson's "Progressive Relaxation". I'm also reading a book called, "A Headache in the Pelvis", which claims that essential to healing is this idea that we must learn to properly relax and accept the pain we feel. I've found it hard to collect actual instruction about how to do this though.

Yeah I'm very curious to know how this Pain Reprocessing Therapy (PRT) from the article is done.

I haven't read the book you mentioned, but I'd say from my personal experience a physical yoga practice helps teach you to properly relax into what can sometimes be extreme discomfort. I remember when I first started practicing, whenever we'd get to long holds of poses (e.g. splits, pigeon, ustrasana), my body would start panicking and want me to come out of it immediately. But if you just keep bringing your awareness to the breath and meditate through the sensations that arise, the body starts relaxing and accepts where it's at.

I can imagine the PRT therapy probably includes some subset of the four foundations of mindfulness [1].

[1] https://en.wikipedia.org/wiki/Satipatthana

See my reply to denvaar for an example!

It has much in common with mindfulness I'd say, with some extra "simplified" techniques and learnings. It's easy to dismiss this type of therapy (even more so before there were studies on it), but the mindset changes which it advocates are very wholesome and are likely to increase quality of life even if it would fail to lessen the pain, so there's very little to lose!

Sounds quite similar! Alan Gordon (who treated the patients in the study) has a free program online[1] which goes through the ideas behind PRT (though it doesn't call it PRT in there, I think that term is much more recent).

[1]: https://www.tmswiki.org/forum/painrecovery/

If you found the article interesting you might want to look into Explaining Pain (EP). Teaching patients about pain is a common approach in treatment and there is some clinical evidence that better understanding can make pain easier to manage or even reduce the experience of pain (e.g. https://pubmed.ncbi.nlm.nih.gov/14690673/).

I think society should have preventive instructions because indeed there are subtle shifts we can't yet notice until too late. Regular full body exercise may improve things (improve proper mechanical use, diffusion of efforts, preserving sensitive articulations like discs).

I think regular full body exercise has been preached to me my entire life.

Because it works. A strong core and regular movement does wonders for preventing a lot of back pain. Obviously an overuse (someone lifting all day) or acute injury is different, but for the common office worker, exercise gets amazing results.

I agree with this. One of the best things I've done last year was signing up to a powerlifting gym and working through all the basic movements (from a long warmup to compound movements) with a professional trainer. It did wonders for my lower back.

Likewise. I used to have chronic back pain sitting. Consistent deadlifting seems to have fixed that.

Ah deadlifting. Undeniably one of the best movements there is... Until you irreversibly damage your spine.

Spine problems from weights are no joke here for sure - been there, done that. That's why I emphasised on the professional trainer in the original post. Technique and staying within your limits are really important to avoid any injuries.

Any good resources (videos, books) about this ? I'm in ~rehab so I'm used to take it slow, and be very careful about the mechanics and cardiac limits, but I sure want to know more.

I wish this trope would go away. Can you hurt yourself picking things up, especially if you pick them up incorrectly? Yes. Can you hurt yourself trying to pick something up beyond your limits? Yes. But neither of those requires DLs to happen, and shouldn't stop people from learning how to properly pick something up from the ground. People also don't need crazy weights to make the deadlift useful[1].

Too often people avoid DLs because 'they don't want to hurt their back', w/o realizing they are setting themselves to get hurt later. Years of DLs mean I instinctively pick up everything with good form. Meanwhile my friend hurt his back by awkwardly picking up his toothbrush that fell on the floor...

[1] I heard a measure once that for non-workout people, a good rule of thumb is to be able to easily and correctly KB squat and DL ~#45-#50 - the average weight of a toddler.

My motivation for seeking help from a different physical therapist was so I could pick up my infant without gritting my teeth from the pain in my lower back. Practicing lifts, which I'd never done before, using my core muscles made a huge difference; I felt hopeful again, and was much more functional.

It's mentioned in mine but not really integrated deeply. It could be spread with a tiny bit of marketing (TV, street ads, more outdoor devices etc). Unlike qigong/taichi in asia.

Someone mentioned it below, but the books by Dr. Sarno might help. My buddy had chronic back pain and was able to clear it out completely with his methods.

About 10 years ago, I started having really bad low back pain and could barely get out of bed some mornings. Different doctors told me different things. I tried chiropractic, acupuncture, stretching - nothing was helping. Then I came across one of Sarno's books. I was very skeptical, but I found that within 20 pages, he had described my situation to a tee. I followed the advice in the book and was back to running and yoga within a week, and was lifting weights again a couple weeks later.

Sarno's books and theories are a bit outdated at this point, but we now have people like Howard Schubiner and Nicole Sachs, and things like Curable.

[1] https://pubmed.ncbi.nlm.nih.gov/34586357/ [2] https://podcasts.apple.com/us/podcast/the-cure-for-chronic-p... [3] https://www.curablehealth.com

Also very related to the study I linked in another response, though under the guise of pain reprocessing therapy (PRT). An interesting read if you want to know more about the latest scientifical progress on this type of therapy!

Reply on news.ycombinator.com