What Causes Back Pain?

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Rob Lewine/CORBIS

A common back-pain surgery works no better than a faked surgical procedure, according to a study released today in the New England Journal of Medicine. But the setback for the treatment may raise new questions about what really causes back pain.

The procedure, vertebroplasty, is often given to patients who’ve fractured part of their spine. Medical cement is injected into the vertebra, and the process is supposed to relieve pain by stabilizing the bone

In fact vertebroplasty did relieve pain in this new study. But so did a dud surgery with no cement, and with no attempt to do anything to stabilize the bone. When patients from both the treatment and control groups were compared (patients had not been told which surgery they received), members of both groups claimed to feel similar improvements in movement and similar pain relief. What’s not not clear is why: whether long-term relief comes from the anesthetic that’s used in the quick procedure, or from some other unknown byproduct of surgery — or simply from lofty patient expectations, one giant placebo effect.

It’s all more evidence that pain is a complex phenomenon. Pain is common and debilitating, but often seems to have no real cause that can be treated. It can persist long after a physical wound seems to have healed. In fact, with today’s new finding, there is mounting evidence that pain is just as much a matter of the mind as it is a matter of the body.