Endeavors magazine: Standing Up to Back Pain

Stabbed in the Back: Confronting Back Pain in an Overtreated Society. By Nortin M. Hadler. University of North Carolina Press, 190 pages, $26.

Nortin Hadler, physician and professor of medicine, is a troublemaker. In two previous books, he skewered a herd of medicine’s sacred cows and advised us all to stop running to the doc for every routine ache and pain. In his third book, Stabbed in the Back, Hadler’s quarry is lower-back trouble. Be warned: If you think your lumbago is a bona fide medical problem, you may decide that Hadler himself is a royal pain, afflicting a region of the anatomy just south of the lower back.

Sure, some of us do sustain real injuries in car wrecks, falls, and (in my case) ill-advised moves at the gym. These injuries and various rare diseases have well-defined physical causes and can be diagnosed and treated. But the vast majority of complaints about back troubles result from what Hadler calls “regional” lower-back pain, in which the symptoms have no discernible physical cause. This kind of back pain, he says, is simply “an intermittent and recurring experience of normal living.”

It’s not that Hadler is callous to those of us who suffer. He does want to help. But when he is certain that drugs and surgery won’t work and may in fact do more harm than good, he says so. He also strenuously objects when he believes that drug companies are inventing new diseases to peddle medications we don’t need. Such is the case, he says, for the catch-all category of aches and pains known as fibromyalgia, which Hadler calls “a social construction rather than a disease.”

Citing dozens of research studies to make his case, Hadler argues that people troubled with lousy jobs, bad marriages, and various other afflictions tend to feel bad generally, and some of their misery gravitates toward their lower backs. Does this mean that back trouble is all in our heads? No. We feel actual pain, along with the unsettling suspicion that something is wrong with us. So we head to our doctors’offices to relieve both the pain and the uncertainty.

This middle-age migration to the clinic runs up the nation’s health-care tab as it gives our backaches legitimacy for the sake of disability benefits and an excused absence from heavy lifting. And even if we feel reassured when a doctor examines us, x-rays our spines, and prescribes something, in most cases we’ll be no better off physically than we were when we first hobbled into the clinic, Hadler says.

His advice? Get a grip and get on with our lives. Yes, this may just tick you off. But if you’re good and riled at Nortin Hadler, maybe you’ll forget about your aching back.

For a story about Nortin Hadler’s first book, The Last Well Person: How to Stay Well Despite the Health-Care System, see “Leaving Well Enough Alone,” Endeavors, Winter 2005.