I write endlessly, it seems, about back pain — 2015, 2018 and now. I do this because by far, most patients who come to me have low back pain. I have said before that 30 million or more of us are chronically severely disabled because of low back pain, and 80% of us will experience back pain at some time during our life.

The cost of this seems astronomical to me, $100 billion or more each year, measured in terms of both direct medical expenses, as well as such things as lost work time, over 264 million work days. Even worse, back pain is the most common reason for long-term use of, and addiction to, opioid painkillers: oxycodone (OxyContin and Percocet), hydrocodone (Vicodin), morphine, codeine, and similar drugs.

To put the problem in perspective, while the United States has only 5% of the world’s population, we use 80% of the world’s prescription opioids. In addition, prescription opioids are related to 40% of all opioid overdose deaths.

Who’s to blame?

As Americans, we need to blame someone, and there are plenty of culprits for the current opioid crisis.

Doctors, for example, tend to overprescribe. That is, simply because they’re used to doing it, your doctor may prescribe a 30- or 60-day supply when six to 10 pills would do the trick. The problem here is that the unused pills sit around just waiting for some child or relative or visitor to take them and become tolerant and addicted.

We can blame, as well, the likes of Purdue Pharma, manufacturer of OxyContin. In spite of there being no evidence that OxyContin worked any better in controlling pain than older medications, Purdue mounted an aggressive, misleading marketing campaign. Very many physicians believed Purdue and started prescribing OxyContin in the false belief that they were helping patients.

About the same time as OxyContin was approved (1995), our third guilty party, the American Pain Society, decided that pain should be considered as the fifth vital sign after blood pressure, pulse, respiratory rate and temperature. Alas, however, while we can measure the first four objectively, there is only subjective assessment of pain.

In 2001, the health care accrediting and certifying Joint Commission published a guide sponsored by Purdue Pharma stating, “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.”

The list of guilty parties goes on and on; these are just the most egregious of the promoters of the overuse of opioids.

Striking a blow against the opioid crisis

So far, this column sounds like it’s about opioids, but it’s really about other ways to treat your back, and other, pain. It’s true that you may need surgery to fix what’s causing your back pain. In some cases, you may need pharmaceuticals, but consider suggesting to your doctor that over-the-counter nonsteroidal anti-inflammatories like aspirin, naproxen (Aleve), ibuprofen (Advil) or acetaminophen (Tylenol) may work as well as opioids.

In fact, there are many nondrug, nonsurgical approaches to pain management that are effective. I’ll consider here my own MYK system, as well as chiropractic and acupuncture.

Regardless of the reason for your pain, it’s likely that stress or injury has distorted your body and your nervous system alignment, causing impingement on nerves in your back and other systems. That is, when you are in pain, your system is out of balance.

These natural healing arts share an underlying goal, which is to correct and restore balance to your body and nervous system. Experience makes it clear that a body and nervous system in balance will be pain-free. Whereas they work by engaging your own body’s built-in ability to heal you, conventional allopathic medicine’s treatments are meant to dominate and suppress your natural healing processes.

By making these healing arts your first choice for pain relief, you are indeed striking a major blow against the opioid crisis.


I’ll start with the oldest, most time-tested healing art called traditional Chinese acupuncture. Around the beginning of the Neolithic age, 6,000 or so years ago in China, the first description of acupuncture was recorded in The Yellow Emperor’s Classic of Internal Medicine, Huang Di Nei Jing. At that time, very sharp stones were used, but now very fine needles have replaced them.

Acupuncture’s effectiveness is related to the Chinese discovery of a system of 12 vital energy pathways in your body; these are called meridians. Each meridian is associated with specific organs that are metaphoric equivalents of the anatomic organs of the same name. The acupuncture technique is to use needles to stimulate specific points along meridians that are associated with whatever symptoms you may experience so that they come into balance.

Some may feel that this seems a bit hokey, but traditional Chinese acupuncture has been effective for a very long time and was even recognized as a legitimate health care discipline by the National Institutes of Health in the 1990s.


Chiropractors use hands-on spinal manipulation, as well as other means, to align and balance your musculoskeletal structure, especially your spine. As before, the assumption is that being in balance will enable your body to heal itself. Manipulating your bony structure mobilizes your joints that have become restricted by injury or repetitive stress and allows the free flow of energy through your body.

Chiropractic treatments are generally short, with the patient fully clothed, and use no oils nor creams. On average, it’s likely to take as many as 10 treatments to effect a cure. They have been effective in pain relief from back pain, sports injuries and muscle strains. Other complaints include pain in the neck, arms and legs and headaches.

Healing arts often begin in the most unlikely ways. Daniel David Palmer was a philosopher of natural healing. In 1895, he accidentally noticed a vertebrae out of place in the back of his partially deaf janitor. Harvey Lillard said that he lost his hearing when he “moved the wrong way,” and heard a pop in his back. Palmer moved the vertebrae back in place, and Lillard’s hearing was restored. Two years later, Palmer started the first chiropractic school.


MYK, the myokinesthetic system, is a form of medical massage. Medical massage means simply that we use soft tissue techniques to address specific medical problems. It uses very precise, gentle stretch and stimulation of particular muscles to correct and balance your nervous system. This leads to changes in the organization of your nervous system and body to relieve pain.

MYK differs from classic massage in that treatments are short, 10-20 minutes, the patient is fully clothed, and no oils or creams are used.

MYK is useful in treating not only back pain, but many other bodily pains, as well. The techniques have now been extended to treat internal conditions like chronic headaches, acid reflux, digestion problems and many more.

MYK was developed in the early 1990s by a Kansas chiropractor who observed that when he moved the spinal bones into alignment, the attached muscles frequently would pull them out of alignment again. His discovery was that by treating the muscles instead of the bones, his treatments were more effective and lasted longer. On average, only three or four MYK treatments are needed.

How do you decide?

First, if you get a headache or a backache or any ache, and you’re used to taking an aspirin for it, and it relieves the pain, then you should probably continue to do that. And, it is never a mistake to see your doctor if the pain seems related to some serious condition.

That said, if the pain continues beyond briefly, consider trying one of the three healing arts I described above. They have all been shown to be effective in relieving a wide variety of external and internal conditions.

And again, thank you for striking a strong blow against the opioid crisis.

Bob Keller maintains a holistic practice in Newburyport. He offers medical massage therapy for pain relief and advice on muscular balance and diet, as well as psychological counseling, dream work and spiritual direction. Many patients call him Dr. Bob, but he is not a medical doctor. He can be reached at 978-465-5111 or bob@myokineast.com.

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