A back pain scapegoat is a medical condition that is implicated in causing painful symptoms, but actually is innocent of all blame. Medical science has taken advantage of many extremely common spinal abnormalities to create armies of walking wounded. The perpetuation of the nocebo effect caused by these scapegoat conditions is another prime cause of the back pain epidemic.
This is a complicated topic, since back ache can truly be caused exclusively by structural issues in some cases, but in the majority of instances, these very same structural irregularities are not the source of pain.
How to know whether a diagnosis is a scapegoat or a valid problem is never crystal clear. However, what is clear is the fact that most medical associations have taken notice of the lack of correlation between structural aberrations and the incidence of pain and have therefore warned doctors never to assume that atypical diagnostic imaging findings explain the occurrence of dorsopathy.
This is a very positive step forward after so many years of medical science propagating the idea of these same structural scapegoats as the incorrect reasons for most chronic pain.
A scapegoat is something that takes the blame, even though it is innocent. When it comes to back pain, unenlightened and profit-driven doctors have vilified many conditions that are mostly asymptomatic.
These innocent conditions fall into 2 basic categories:
The first are conditions that never caused any pain to begin with. The patient complains of suffering and the doctor simply assumes the pain is being caused by the diagnosed abnormality. This is a classic example of misdiagnosed back pain.
The second type of scapegoat condition is one that causes pain and then heals. The patient continues to experience symptoms from some other physical or psychological cause, but the continuation of the symptoms is still blamed incorrectly on the scapegoat condition.
Either way, the patient loses, since without a identifying the real source of symptoms, all treatments utilized will fail.
Herniated discs are the most common spinal scapegoat. Herniated discs are so common that they are almost considered normal. This is especially true as we age. Many people have them and do not even know it. Herniated discs do not always cause pain. In fact, the vast majority of mild to moderate disc pathologies are known to be innocent. Even the problematic discs rarely cause pain for more than a couple of months. Long-term and unresponsive pain is the most common abuse of the much maligned discs as a scapegoat condition.
Facet syndrome is easy to diagnose and hard to disprove as the source of pain. This makes it another excellent condition on which to blame chronic symptoms. At least in this case, some degree of pain is more likely, since the condition involves actual changes in the spinal bones. However, research has shown that the vast majority of patients with the physical changes associated with facet joint syndrome will have no symptoms whatsoever.
Osteoarthritis in the spine sounds so frightening, but is rarely to blame for severe dorsal pain. Some chronic dull pain is possible, but to blame acute bouts of disabling pain on common spinal arthritis is usually a true scapegoat situation.
Spinal stenosis is a common scapegoat condition for elderly back pain patients. Some amount of stenosis is completely normal to experience as we get older. It is rarely responsible for serious ongoing pain conditions, unless the narrowed spinal canal is actually compressing the spinal cord or one or more nerve roots.
Spondylolisthesis is not as commonly diagnosed, but is very typical to use as a scapegoat condition. Most patients live for a long time with this condition and never even know that they have it. They get an exam and a mild to moderate vertebral slippage is discovered. The poor patient suffers a nocebo effect, since the doctor fails to tell them that the condition is rarely symptomatic. This makes spondylolisthesis another pawn of the back pain industry.
One of the more common causes of all chronic pain is the mindbody process. However, psychological back pain is almost never blamed as the cause of any symptomatic expression. How can medicine constantly blame conditions that have been proven to rarely be the actual cause of ongoing pain, yet completely ignore the condition that actually causes many cases of chronic back pain?
It makes no sense. That is unless you factor in the economic motivations of profitable back pain treatments. Hey people, don’t forget we are talking about big money here.
Drug companies pay doctors billions to prescribe their products.
Surgery is big business.
Patients who get better are only part time customers. Patients with chronic conditions return again and again and again.
I am not telling you anything you do not already know. Think about it...
Luckily, times are changing rapidly and now the diagnosis and treatment of mindbody disorders is on the rise worldwide. While still not given the attention they deserve, psychoemotional pain conditions will eventually earn their share of treatment and this should help to finally reduce the incidence of chronic symptoms and possibly even begin to put an end to the horrific back pain epidemic.
Doctors are not evil. They are (mostly) not money hungry soulless individuals. The majority of healthcare workers really want to help their patients. The problem lies in their training and education. Maybe I should rephrase that to read, their lack of training and education in psychological pain conditions and modern accepted diagnostic protocols. Many doctors were educated decades ago. Times have changed quite a bit.
Some back pain scapegoats are simply misdiagnosed when other structural problems are the real culprits. In these cases, the doctor is simply inept and should go back to medical school to learn more or maybe consider a less responsibility-filled vocation.
Other patients diagnosed with scapegoat abnormalities are suffering from mindbody pain syndromes. Medical training has not prepared doctors to deal with these psychosomatic conditions, so what are their options? They want to help. They want to find a reason for the pain, so they will have a chance to cure it.
The pain is real. The patient is suffering. A scapegoat condition exists.
It is easy to put the pieces of this puzzle together to see why these back pain scapegoats have become an epidemic problem.
I see progress on this topic with more doctors realizing the mistakes of past history, but there are far too many who continue to embrace these old and outdated methods of care simply out of ignorance, or worse still, the desire to place profit over logic.