Stabbed in the Back: Confronting Back Pain in an Overtreated Society

221 Pages·2009·1.74 MB·English

by  Nortin M. Hadler

Stabbed in the Back
HADLER, Stabbed in the Back, final pages
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N o r t iN M. H a d l e r, M.d .
Stabbed in the
kcab
back
Con fron ting
BaCk Pain i n an
overtre ated
SoCiet y
the univerSity of north C arolina PreSS chapel hill
© 2009
the university of
north carolina press
all rights reserved
Designed by Courtney Leigh Baker and set
in Whitman and urw Grotesk by Rebecca Evans
Manufactured in the United States of America
The paper in this book meets the guidelines for permanence
and durability of the Committee on Production Guidelines
for Book Longevity of the Council on Library Resources.
The University of North Carolina Press has been a member
of the Green Press Initiative since 2003.
Library of Congress Cataloging-in-Publication Data
Hadler, Nortin M.
Stabbed in the back : confronting back pain in an
overtreated society / Nortin M. Hadler.
p. cm.
Includes bibliographical references and index.
isbn 978-0-8078-3348-3 (cloth : alk. paper)
1. Backache — Popular works. i. Title.
rd771.b217h33 2009
617.5ʹ64 — dc22
2009019737
cloth 13 12 11 10 09 5 4 3 2 1
a lifetime in medicine is a rare privilege. I am trusted to bring to
the bedside the highest of intentions and a most highly informed understand-
ing of the limits of certainty. For the degree that I am physician, I owe much
to mentors, colleagues, patients, and students. I have aspired to repay each in
devotion and gratitude. The degree to which I am a complete physician results
from the support, understanding, nurturing, and love of my wife, Carol. We
have walked through life, hand in hand, for nearly forty-five years.
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Contents
Preface xi Acknowledgments xiii Introduction 1
1 Three Marks of the Past on the Backs of the Present 5
2 Oh, My Aching Back 12
3 The Pall of Persistence 22
4 Doc, My Back Is Killing Me 38
5 The Quest for a Better Way; Or, My Name Is Nortin
and I’m a Placebo? 55
6 Invasion of the Spine Surgeons 72
7 Backbreaking Work 93
8 The Straw That Broke the Camel’s Back 113
9 If You Don’t Know Where You Are Going,
All Roads Will Get You There 139
Notes 163 About the Author 189 Index 191
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Figures and tables
Figures
1 The predicament of regional low back pain 15
2 Radiographs of the lumbar spine 42
3 Detailed diagrams of the spine 43
4 Results of the University of North Carolina Trial of
Spinal Manipulation 69
5 Cross section of a spine 78
6 Cross section of a vertebral disc 79
7 Alternatives available to a person faced with regional back pain 111
8 Processing the predicament of regional low back pain 114
9 The process of determining disability for a worker with
regional low back pain 119
Tables
1 Associations with Prevalent Low Back Pain in the 2002
National Health Interview Survey 18
2 Psychological Factors Associated with Prevalent Back Pain
in the 2002 National Health Interview Survey 20
3 Multivariate Analysis of the Relationship between Persistent
Musculoskeletal Pain and Sociodemographic Characteristics
in the Southeast England Postal Survey 24