The quick reading of Philippe Bazard’s book pushes me to a new post on the subject. The reductions made by laymen are staggering. Bazard reminds me of Freud, who wanted to make his Oedipus complex the engine of the neurotic dysfunction of the unconscious. Bazard, on the other hand, makes stress and anxiety the engine of back pain. Therefore, stand up. Be a warrior! Just get rid of it to find a painless back. What is it? Isn’t this too much the profile of the anxious? Don’t look for excuses. Take your destiny into your own hands. Hard or soft? Alternate! Alternate!
If you should only remember one thing from the origin of back pain, it is thatit is multi-staged. Multi-stage is multi-factorial, but the factors do not mix at the same level. They occupy independent floors: biological, anatomical, neurological, unconscious psychological, conscious, social.
Their independence is only relative. For example, parental education, a social factor, has a major influence on the physical development of the child. Pushed or not in sports, he approaches adulthood in a very different body. To understand your back pain is to analyze the tiered causes but also to build the history. The temporal dimension is the most important. There was a ‘before’ to back pain. Arbitrarily set it an ‘after’. In the meantime, what has happened?
Bazard begins by denigrating biological and anatomical levels. For him only 10% of back pain has really physical causes. Supporting meta-analyses. The problem is that even if they respect statistical rules, these meta-analyses are worthless. The studies are not suitable for multi-factorial conditions. Their statistical power collapses as soon as the number of criteria increases. If in addition we can not mix them for this story of floors! The same meta-analyses find no effectiveness in rehabilitation, osteopathy, interventional radiology, surgery. These sometimes expensive and aggressive techniques would therefore be useless? Despite excellent individual results? Why don’t they emerge in the numbers? Mainly becauseno study has the necessary power. Tens of millions of spinal painkillers would have to be recruited and examined on the most intimate floors, including those to whom they do not have access (unconscious) to get something out of them. Rather than acknowledging their impotence, overly pretentious authors publish negative results then used by people like Bazard, and patients are tasked with finding the final solution within themselves.
What is pain? At the very bottom of our floor, it is an excited sensory sensor in a fabric. Simple irritation or frank lesion. The intensity of the stimuli commands a protective reaction. Left alone, the fabric repairs itself and the excitement subsides. Except in chronic pain, where the sensor becomes a celebrity. Because it is stuck in a scar, or between joint surfaces. Or the fiber connecting it to the central nervous system is itself attacked. Soft, the nerve loses in the face of the hard. But it enters and walks in the vertebral canal, a kind of chain of wagons that undulate and telescope during the incessant movements of life.
This incessant excitement rises to the central nervous system. How is it treated there? The signal is dressed with a multitude of successive interpretations, as if it went to the tailor then the make-up artist and finally the master of ceremonies. At the very top he presents himself on the conscious stage in various appearances, from the simple unpleasant sensation to the morally unacceptable suffering. These floors strongly impregnated with personality give its identity to back pain.
At the bottom of this staging the signal appears similar in everyone. At the top it became a personal expression. The psychological treatment of pain therefore has a major importance, as Bazard indicates. But this does not mean that evil would be self-created in the psyche. There is always sensory excitement. The dysfunctions sit at one or more stages of its treatment. This is where the investigation begins.
The first floor to be examined is anatomical. Isn’t there a conflict between the sensor and a joint structure? This medical and osteopathic investigation is never completely completed. The nerve fiber can be irritated at any point in its path and indicate its termination as the injured place. Thus the designated site is not the seat of the problem. Overexcited nerves recruit neighboring fibers, establish abnormal connections. Chronic pain diffuses, becomes widespread, concealing its origin. Some important neurological crossroads, such as the coccyx or the base of the skull, are (poorly) known as a source of constant polyalgia.
That most back pain has never been properly examined is a reality. Inapparent, of course, in meta-analyses. However this argument is too used by the painful to refuse to examine the other floors. “I surely have a problem that medicine hasn’t seen.” Additional examinations are piling up. When they do not show an obvious and consistent lesion, you have to go to: “There is surely a problem that I have not seen”.
Medicine tends to offer only an anatomical diagnosis. Therapists are aware that pain is misinterpreted but do not have the slightest model to follow in this area. This is the ink bottle. Everyone advises with their own beliefs, their own experience of life. Let’s try to be a little more systematic.
There is a biological stage of pain. Genetics makes us different. Some people are physiologically more sensitive than others. Everyone can judge themselves, depending on what others say about habitual stimuli, little or very sensitive. This estimate must be traced back to memories of early childhood, before disruptive events could alter this sensitivity. No reason to feel guilty about genetic hyperesthesia. To live with it requires making it a personal normality.
There are unconscious stages of pain. Misfires are possible long before stimuli are declared ‘pain’. In “neurotonics” reflex loops add irreducible contractures to joint irritation. Vicious circle that leads to chronicity before any psychological consideration.
Floor after floor, the mind adds layers of meaning to the pain. Intimate layers, connected to the image of the self, then social layers, connected to the collective symbolism of pain. In some cultures pain should not be exposed. It ostracizes you. You learn to hide it. To tell the truth, its devaluation really reduces it. But this is not the case in contemporary Western cultures, which have launched the slogan “No one should suffer anymore”. Nameless idiocy that despises the essential information constituted by pain. But the entire organization of care is now imbued with this slogan. Claiming to be suffering provides attention and secondary benefits. A major utility of pain today is to improve its place in society. It makes it possible to reduce the arduousness of tasks, to change positions, or even to stop working. It provides pensions, wage supplements, a more noticeable existence. Back pain, by its frequency and low correlation with objective examinations, makes it easy to enter a universe of easy benefits. The most insoluble cause of pain. Its owner has no interest in abandoning it.
This phenomenon must be seen as an unconscious pragmatism rather than a conscious perversion. The painful signal is there, is not invented. Simulators are rare. It is the subjective treatment of pain that is distorted. More profitable to say it strong than weak. Those who traffic in it rarely have advantageous social positions. From their point of view it is a restoration of balance in a universe that does not treat them properly.
Before reaching this point, the person’s story presented, potentially, a series of dysfunctions. Body misunderstood by inadequate physical education. Self-image broken by disappointing schooling. Repetitive professional task established by the company. Pre-digested leisure. No opportunity for self-observation to take height. Or if she does, she comes back disappointed. She then focuses on a more accessible celebrity: that of the painful. Anxiety is not the cause of back pain but the consequence of a slump: prison of habits, powerlessness to reorient one’s environment. Who is free to freely dispose of his week? Every moment is occupied by a routine, starting with that of refusing the slightest unpleasant action, even when it can transform the future life.
To improve your back pain is to draw the building and write, on each floor, what works normally or not. Starting at the bottom. Let us not examine the psychic treatment of a problem before judging its physical severity. If it is weak, let’s not stay at the bottom. Let’s take the height.
In order not to let evil dominate, let us raise our consciousness a few floors.