Primum, Non

Dolors & Sense

by Sanford Rose

KISSIMMEE Florida—(Weekly Hubris)—12/19/11—The doctor’s first duty is, of course, Primum non nocere. Do no harm.

In many cases, doing no harm means doing nothing at all, which, being hard on the revenue stream, is rarely an option.

Yet it often should be with respect to back problems.

We all have these. The cumulative lifetime incidence of back ailments approaches 90 percent.

Old people such as I are notorious sufferers. It used to be thought that aging infallibly equated with back pain. The intervertebral discs shrink or desiccate with age, rendering it more likely that the nuclei of those discs will break through their fibrous encasings or rings and spill out to impinge upon nerves.

Alternatively, if the discs don’t shrink from interior desiccation, they shrink because osteoporosis—the triumph of osteoclasts (bone-destroying cells) over osteoblasts (bone-building ones)—causes an erosion of the vertebral end plates, leading to a sinking of the discs and a concomitant decline in their average height.

To make matters worse, in an effort to compensate for the loss of support from non-performing discs, the bones that help glide the spine, called the facets, lengthen and thus increase the degree of nerve impingement.

Result: a lot of misplaced structures crowding the spinal canal and causing inflammation.

And pain.

Reach for the aspirin and the heating pad. Buy the magical creams.

They don’t work: call the doctor.

“You need to see an orthopedist. Or, better yet, go to a pain clinic.”

At the pain clinic you confront an anesthesiologist with an entrepreneurial bent and two hands that seem to be rubbing each other obsessively.

“We’ll give you an injection of corticosteroids—in fact three of them.”

“What are those?”

“They’re a synthetic form of an anti-inflammatory chemical produced by the body.”

“What are the side effects?”

“They weaken tendons and promote osteoporosis.”

“Hold on. You’re going to give me an injection of something that my body produces anyway and in a form that can weaken my bones, the prior weakening of which may have been the cause of the pain I already have?”

“I wouldn’t put it that way, but that’s roughly correct.”

“Is there any way I can get my body to do the job on its own—to produce more natural anti-inflammatories and the surplus of osteoblasts over osteoclasts that will rebuild the bones.”

“Well, now that you mention it, if you lift enough weight, it will stimulate the expression of something called Interleukin-6, which is both an inflammatory and an anti-inflammatory peptide, and that in turn will recruit Interleukin-10, which is a purely anti-inflammatory soldier. And if you study how gradually to impose the right loads on the bones, they will regenerate and thicken.”

“So, I can solve my problem by doing exactly what people think causes that problem—putting stress on the back.”

“In the long run, yes.”

“Then, why am I here? You don’t look like a personal trainer.”