Why Isn’t There a Safe and Effective Treatment for Neck or Back Pain?
Surgeries often have a variety of risks that patients do not learn about until after they’ve had the surgery and experienced those complications, which is a huge problem since you can’t “undo” a surgery. For this reason, patients are often advised to seek out a second opinion on if a proposed surgery is really necessary, how likely it will be to benefit them, and what potential risks they face from it.
In turn, spinal surgeries are by far the most common surgery I am consulted about, and likewise something I have become increasingly skeptical of as the years go by. Unfortunately, since spinal surgeries are one of the most profitable areas in medicine, there has been a general reluctance by the medical field to seriously consider if their risks outweigh their benefits or if safer and more effective alternative exist.
What Causes Spinal Pain?
One of the most common reasons patients see their doctors is for spinal pain. Yet, despite trillions having been spent on it (e.g., in 2016, 134.4 billion dollars was spent on neck and low back pain in the USA) the majority of these patients are stuck with chronic pain, and frequently experience significant side effects from the treatments they receive to temporarily alleviate it.
Since pain is typically one of the greatest motivations for a patient to seek care, I often wonder if the current state of affairs exists because too many parties cannot afford to lose all the money to be made from pain management.
Note: Cures that threaten lucrative markets are frequently suppressed by the medical industry. One of the most well-known examples occurred during COVID-19, where off-patent drugs (e.g., hydroxychloroquine, ivermectin, fluvoxamine and nitazoxanide) were repeatedly demonstrated in clinical to be highly effective in treating the infection, but could never receive an approval (or EUA) for that use.
Instead a variety of unsafe and ineffective products (e.g., remdesivir and the mRNA vaccines) were pushed onto the market so a lot of money could be made off of them.
Typically, to manage pain, one of the following can be done:
- Fix what is generating the pain so the pain no longer exists.
- Fix an exacerbating factor which is worsening the existing pain.
- Provide a systemic therapy that reduces pain in the body but does not treat the source of the pain.
In turn, when it comes to spinal pain, I feel each of these is not done correctly.
Spinal Pain Generators
In my experience, the following things are the most common causes of pain in the spine, particularly in the neck and low back (lumbar) spine:
• Tight muscles — This is one of the most common pain generators. Sadly, I find it is rarely recognized and physical therapists (who would typically be responsible for addressing this) in general tend to focus on strengthening weak muscles rather than stretching or releasing tight muscles.
Note: Trigger point therapy, especially when performed with a local anesthetic (e.g., lidocaine), is often extremely helpful for chronically tight muscles, and more importantly, is still utilized by many doctors across the world (which I believe resulted from the remarkable success Janet Travell had in treating President Kennedy). I consider the book on that subject to be one of the most informative things that has been written on the subject of musculoskeletal pain.
• Something being out of place — This requires an adjustment and often correcting the lifestyle habits that create the issues (e.g., too much sitting or staring at a screen).
Commonly a patient will have a short leg which distorts the entire spine, and once this is corrected with an adjustment or an appropriately placed foot-lift, the patient will experience a dramatic improvement in their pain (especially you use the arms placed in front of the body to muscle test for the correctly sized foot-lift).
Note: There is significant variability in how spinal manipulation is performed. In some cases, it is remarkably helpful, in some cases it provides a temporary benefit, and in other cases, it can make things worse. For this reason, I have found it is very important to send your patient to the correct practitioner.
• A disc herniation — Although this is not the most common cause of spinal pain, it will be discussed throughout the article.
• Ligamentous laxity of the spine — This is often the primary cause of spinal arthritis, spinal muscle tightness, disc bulges and disc herniations.
• Some type of disease process in the spine (e.g., a fractured or weakened bone) — This is the least common cause to come across and can sometimes be treated with appropriate nutritional support (but in other cases requires surgery).
Additionally, I frequently find that:
• Trapped emotions and certain emotional response patterns (e.g., habitual emotional contractions) can significantly exacerbate chronic pain conditions.
Note: Dr. Sarno argued that unresolved emotional trauma triggered “tension myositis” (back pain from tight muscles) which needed to be treated with psychotherapy. His approach helped a lot of people (and thus had a large following), but likewise did not work for many others (including some of my patients). I attribute this both to psychotherapy not always being sufficient to release a trapped emotion and emotions not being the only cause of back pain.
• Chronic inflammatory conditions (e.g., mold toxicity, lyme disease, spike protein injuries) often significantly worsen existing pain patterns.
• Over-activation of the sympathetic (fight or flight) nervous system alongside under-activation of the parasympathetic (rest and relaxation) nervous system exacerbates pain in a manner similar to what is seen from a chronic inflammatory state.
Note: A common effect of unresolved trauma is an over-activation of the fight or flight nervous system.
• Scars (such as those created by surgeries) can frequently generate significant autonomic dysregulation (e.g., too much sympathetic activation) and pain in the body. For example, one patient I saw with a COVID-19 vaccine injury had multiple spinal surgeries (due to a complication from their original neck fusion).
These surgeries caused chronic issues for the patient which became dramatically worse (to the point the patient became effectively disabled) after they received the vaccine (severe inflammation at the site of a previous surgery is a common side effect of the COVID vaccines), and their symptoms dramatically improved once the scar was treated with neural therapy.
• In many cases, chronic pain is associated with altered processing of pain in the brain — something which in many cases I suspect is due to a microstroke injuring the thalamus (the part of the brain that dampens pain signals as they reach the brain).
In turn, a variety of approaches exist for addressing the brain’s increased sensitivity to pain signals (e.g., IV ketamine therapy is one of the most popular ones now), and when used appropriately, I have seen many of these approaches work wonders for chronic pain patients.
Systemic Treatments of Spinal Pain
Since a variety of different things can cause spinal pain and it can be quite time consuming to entangle what the issue is, physicians typically prefer to either prescribe a pill to treat it, or to refer the patient to someone else. Sadly, each of these leaves much to be desired.
For example, an extremely common story I hear is a patient requesting a pain medication from a doctor (as they have some type of debilitating pain), the doctor refusing to prescribe it (as doctors — who used to be penalized for not prescribing opioids — now get in trouble for prescribing them too frequently) and instead sending the patient to regular physical therapy.
This is often quite challenging for the patient to get to (e.g., it’s far away or they don’t have a car), but if the patient is able to make it to PT, typically it doesn’t help them (sometimes it actually dramatically worsens the pain), which in turn either leads to more PT referrals or being sent to a spinal surgeon.
Note: Some PTs consistently help their patients, but these PTs are hard to find. I believe this is due to both the training PTs receive not focusing on the most effective ways to treat musculoskeletal pain and the insurance based model of PT prioritizing checking boxes (for insurance reimbursements) rather than helping patients.
When medications are considered, typically four types are utilized: NSAIDs, Tylenol, Gabapentin (or Lyrica) and Opioids. Unfortunately major issues exist with each of them.
In the case of NSAIDs (e.g., ibuprofen or naproxen), they often appear to reduce the pain, but since that benefit is temporary and only offers a partial improvement, this leads to patients taking large amounts of the medications (as people will understandably do whatever they can to get out of pain). This is often quite problematic as NSAIDs are toxic, especially at higher dosages. Many in turn have argued NSAIDs are amongst the most dangerous drugs prescribed in America as:
NSAIDS are the most common drug class that results in a hospital admission for a drug reaction (typically for heart attacks, bleeding, strokes and kidney failure).
NSAIDs are well-known for causing kidney damage. For example one large study found NSAIDs increase the risk of kidney disease by 20%, another study found that they increased the risk between 68% – 154% (depending on the NSAID), and many studies (e.g., this one) have found individuals with chronic kidney disease (CKD) are typically long-term NSAID users, with the likelihood of NSAID use increasing with the severity of CKD.
For this reason, kidney doctors (nephrologists) often order their patients to discontinue NSAID use, and non-nephrologists rarely question this decision.
Note: While NSAID kidney damage is a huge issue, I was unable to find a good estimate on how many people died as a result of this side effect since CKD is a progressive disease rather than one that causes sudden deaths (the closest was a study that found NSAIDs, depending on the type, increased the risk of someone with CKD then dying by 36% – 61% — but this does not account for all the people who develop CKD from NSAIDs).
NSAIDs are well known for causing heart disease (and in some cases strokes). The most infamous examples of this were Merck’s Vioxx and Pfizer’s Celebrex, both of which were NSAIDs designed to cause less gastric bleeding — which unfortunately also made them more likely to cause heart attacks and strokes. Since the drugs made a lot of money (as pain management is highly lucrative), Pfizer and Merck covered this up.
Eventually the truth came out and Vioxx was withdrawn from the market (although recently the industry has started working to bring it back). When it was all said and done, just from heart attacks and strokes, Vioxx was estimated to have killed 120,000 people, while Celebrex (which was never taken off the market) killed 75,000.
Note: The year Vioxx was pulled (2004), Merck’s CEO received a $36 million bonus. Following losing over 5 billion dollars in lawsuits, Merck then pivoted to creating the disastrous (but incredibly profitable) HPV vaccine. In turn, much of the playbook Merck developed to push its unneeded and incredibly dangerous vaccine onto the market was then copied throughout the mRNA vaccine roll-out (e.g, very similar fraud occurred during the clinical trials).
Sadly, Vioxx and Celebrex are not the only NSAIDs that kill. For example, in a study of 83,677 patients who had had a single heart attack (making them be at high risk of another one), taking an NSAID was found to increase the risk of a second heart attack or death by approximately 50% (with the exact risk depending on the NSAID — diclofenac increased the risk by 326%).
Similarly another study of 107,092 patients who were hospitalized for heart failure (and then recovered enough to be discharged) found that taking an NSAID increased their subsequent risk of dying by 22% – 108% (depending on the NSAID), often due to NSAID associated heart failure or a heart attack.
The largest study I found that attempted to assess the risk of an NSAID causing a heart attack in the general population found taking NSAIDs for any period of time increased the risk of a heart attack by 24% – 58%.
NSAIDs are well known for causing gastric bleeding, something which is often fatal. In 1999, it was estimated that over 16,000 Americans were killed as a result of NSAID gastric bleeds (along with many more being hospitalized but surviving) — so it is likely between 10,000 – 20,000 Americans are killed each year from this complication.
Note: NSAIDs also damage the small intestine, but since we can rarely peek inside there (whereas the stomach is easy to see with a scope), and damage there rarely results in a fatal bleed (as there is not abundant stomach acid), this complication of NSAIDs is often goes unrecognized.
For decades, there has been a well-known link between NSAIDs and intestinal webs (strictures that prevent the passage of food through the small intestines) while more recently advances in diagnostic technology have shown that 50% of chronic NSAID users have damage there (which is termed “small bowel enteropathy”).
This often leads to chronic health issues, because once the mucosal lining of the small intestine becomes damaged, pathogenic substances (e.g., plant lectins, undigested protein, or inflammatory components of bacteria) can easily pass from there into the bloodstream — and many have argued this leakage is the root cause of chronic illness in the Western World.
NSAIDs cause a variety of other severe health issues as well, best illustrated by them being one of the most common classes of drugs to be pulled from the market (e.g., multiple NSAIDs were withdrawn for causing severe liver damage). For example to quote Peter Gøtzsche:
A variety of less obvious side effects also occur. For example, NSAIDs impair ligaments repairing themselves after an injury, so since they are frequently given after things like an ankle sprain, a chronic weakness forms in the area which some evidence suggests predisposes it to further injuries.
Fortunately, the dangers of NSAIDs at last are being gradually acknowledged by healthcare authorities around the world (e.g., the FDA has gradually strengthened its warnings that NSAIDs cause heart attacks and deaths). Nonetheless, they are still given out like candy for every ailment imaginable, doctors rarely withdraw patients from them, and since many can be purchased without a prescriptions, overdoses of them are inevitable.
Peter Gøtzsche has provided one of the best summaries of this tragic situation in his book Deadly Medicine and Organized Crimes. Amongst other things he noted that:
• Trials alleging the benefit of NSAIDs are frequently intentionally deceptive and frequently create the illusion of a benefit where none exists. What this means is that many patients ruin their lives with drugs that did almost nothing for them in the first place.
• With Vioxx, Merck knew early on the drug would cause fatal heart attacks, but chose to doctor their studies so this was not visible to the public. To hide the heart attacks, Merck did not disclose many that occurred its trial, and midway through changed the trial protocol so the heart attacks would be monitored for over a much shorter duration (whereas the benefits Merck wanted to show like reduced gastric bleeds were monitored for a much longer time).
This was clearly fraudulent, but nonetheless given a pass by the FDA — the data the FDA received showed Vioxx doubled the risk of a heart attack, but at the time of approval the FDA ultimately stated that it lacked ‘complete certainty’ that Vioxx increased cardiovascular risk.
Finally, as you might imagine, once Vioxx was approved Merck began illegally pushing for it to be used to treat every illnesses under the sun, which resulted in many people who had no reason to take their drug being killed by it.
Note: Dr. Mercola was one of the earliest people to recognize the obvious risks of Vioxx, but despite his large following and how clear the risks were, his warning went unheeded. I share this example to illustrate just how resistant the medical industry is to considering science which gets in the way of its bottom line.
• Likewise, when the New England Journal of Medicine received Vioxx’s pivotal study (which was clearly fraudulent), rather than address this, they chose to publish it (which in turn allowed Merck to market Vioxx to America since the NEJM had endorsed it).
Then, despite more and more evidence accumulating that Merck’s NEJM paper was fraudulent, NEJM refused to retract the article or issue a correction, and it was only 6 years later when Vioxx was withdrawn and lawsuits were working their way through the legal system that NEJM chose to issue a “statement of concern.”
It should hence come as no surprise that NEJM received a lot of money from Merck — 929,400 reprints of the article were purchased (this is a common way Pharma pays off journals) netting NEJM approximately $800,000, and in that year NEJM’s owner made $88 million.
Note: It is likely many other payments were also made to NEJM or to its editors (which is also a common industry practice), but unfortunately, that financial information is not available to the public.
The story of Vioxx is important because an almost identical thing happened with the Pfizer vaccine. Like Vioxx, it was clear from the start the vaccine would be dangerous and that the vaccine trials were doctored to conceal that risk.
Yet, NEJM and the FDA ignored those issues and instead published a glamorous appraisal of the new product, and even after a deluge of evidence showing that Pfizer’s trial was fraudulent (including numerous whistleblower testimonies), neither NEJM or the FDA did anything about it (rather they doubled-down on the value of the vaccines).
Finally, now that the market for the mRNA vaccines is starting to sour (e.g., only 2% of America elected to receive the most recent booster), admissions are gradually appearing indicating in the medical literature that the vaccines are in fact dangerous and frequently cause heart damage.
This is quite similar to how Vioxx is now considered to be one of the worst drug disasters in history, but until it was pulled from the market (and no more money could be made from it) it was very hard to discuss its toxicity.
It is hence regrettable that we did not listen to the warnings of NEJM’s editor-in-chief in 2004 that the medical journals are corrupt and cannot be trusted. Had we done so, there might have been more skepticism towards NEJM’s infamous trial that extolled the safety and efficacy Pfizer’s vaccine and was embraced with a cult-like devotion by the entire medical community.
As Tylenol is one of the only other over-the-counter pain killers, it is frequently used in a very similar manner to NSAIDs, and overall is a safer option (but still typically not sufficient to alleviate significant pain). Unfortunately, the drug has two major issues.
The first is that one of its potential metabolites is quite toxic to the liver. At lower doses, minimal amounts of this metabolite are produced (and that which does is neutralized by the liver) but at higher doses, much more is and it frequently overwhelms the livers ability to safely metabolize it (via glutathione), which ultimately leads to significant liver damage.
Since people often take excessive doses of Tylenol (e.g., to reduce pain), liver failure is a far too common side of the drug and presently 56,000 emergency department visits, 2,600 hospitalizations, and 500 deaths result each year in the USA as a result of Tylenol toxicity.
Secondly, Tylenol works by suppressing fevers (which is another common reason why people take it). Since the body uses fevers to combat illnesses, suppressing them can lengthen..