Stabbed in the Back

Confronting Back Pain in an Overtreated Society

Nortin M. Hadler, M.D., Nortin M. Hadler M.D.

• Publisher: The University of North Carolina Press
• Year: 2009
• Print ISBN: 9781469642253, 9780807833483
• eBook ISBN: 9780807898543
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Nortin M. Hadler knows backaches. For more than three decades as a physician and medical researcher, he has studied the experience of low back pain in people who are otherwise healthy. Hadler terms the low back pain that everyone suffers at one time or another “regional back pain.” In this book, he addresses the history and treatment of the ailment with the healthy skepticism that has become his trademark, taking the “Hadlerian” approach to backaches and the backache treatment industry in order to separate the helpful from the hype.

Basing his critique on an analysis of the most current medical literature as well as his clinical experience, Hadler argues that regional back pain is overly medicalized by doctors, surgeons, and alternative therapists who purvey various treatment regimens. Furthermore, he observes, the design of workers' compensation, disability insurance, and other “health” schemes actually thwarts getting well. For the past half century, says Hadler, back pain and back pain–related disability have exacted a huge toll, in terms of pain, suffering, and financial cost. Stabbed in the Back addresses this issue at multiple levels: as a human predicament, a profound social problem, a medical question, and a vexing public policy challenge. Ultimately, Hadler’s insights illustrate how the state of the science can and should inform the art and practice of medicine as well as public policy. Stabbed in the Back will arm any reader with the insights necessary to make informed decisions when confronting the next episode of low back pain.

INDEX

Page numbers in italics refer to figures and tables

• Abbott Laboratories, 77
• Abelson, Reed, 88–89, 90, 92
• Accident Insurance Law (1884), 96
• Accidents. See Whiplash-associated disorders
• Active sick leave, in Norway, 121–22
• Actuarial business model, 127, 153
• Acupuncture, as placebo, 59–60, 60
• Acute regional backache, 39–54;
  • causes of, 40–45;
  • vs. chronic regional backache, 39–40;
  • evidence-based treatment of, 46–48;
  • futility of imaging in, 41, 44–45;
  • guidelines for treatment of, 48–53, 52
• Adaptive illness behaviors, 30
• Adelaide, 81
• Administrative law judges (ALJs), 132–33
• Adverse illness behaviors, 120, 122, 127
• African Americans, workers’ compensation for, 125, 137
• Age: back pain and, 17, 18, 24;
  • changes in spine and, 40, 41, 44, 45, 105;
  • of chiropractic patients, 71;
  • disc and, 78, 79
• Agency for Health Care Policy and Research (AHCPR), 50–51, 70
• Agency for Healthcare Research and Quality, 51, 125
• Aggressive treatment, 26–27, 73–74
• Allez Spine, 89
• Almshouses, 94
• Alphatec, 89–90
• Alternative medicine: for backache, 63–71;
  • history of, 64–66;
  • seductiveness of, 27
• Altruism, 93–94
• AMA. See American Medical Association
• American Association for Labor Legislation (AALL), 103
• American Chiropractic Association, 67
• American College of Physicians (ACP), 51–53, 52
• American College of Physicians’ Journal Club, 46, 146, 156
• American College of Rheumatology, 31
• American Medical Association (AMA), 50, 67, 89, 116, 136
• American Osteopathic Association, 65, 66
• American Pain Society (APS), 51–53, 52, 120
• Analgesia, opioid, 123–24, 127
• Andersen, J. H., 110
• Andresen, Elena, 125
• Angina, 149
• Animal life, 33
• Annals of Internal Medicine, 137
• Annuloplasty. See Intradiscal electrothermal annuloplasty and nucleotomy
• Annulus, 78, 79
• Arm, regional musculoskeletal disorders of, 59–60, 60
• Arthritis, rheumatoid, 30–31, 120, 133, 159–60
• Arthroplasty, disc, 90–92
• Articular process: inferior, 43;
  • superior, 43
• Artificia...

Table of contents

• Cover Page
• Stabbed in the BACK
• Copyright Page
• CONTENTS
• FIGURES AND TABLES
• PREFACE
• ACKNOWLEDGMENTS
• INTRODUCTION
• ONE Three Marks of the Past on the Backs of the Present
• TWO Oh, My aching Back
• THREE The Pall of Persistence
• FOUR Doc, My Back Is killing Me
• FIVE The Quest for a Better Way; Or, My Name Is Nortin and I’m a Placebo?
• SIX Invasion of the Spine Surgeons
• SEVEN Backbreaking Work
• EIGHT The Straw That Broke the Camel’s Back
• NINE If You Don’t Know Where You Are Going, All Roads Will Get You There
• NOTES
• ABOUT THE AUTHOR
• INDEX