In otherwise healthy children, adolescents, and young adults, we get more requests for help to respond to headaches, stomach aches, and back aches than any other problem.
Clearly, these painful experiences can indicate that serious disease may be present, but in the vast majority of situations, they are part of a poorly understood but well-established fact: every person who has ever lived has experienced at least one of these, and for many people, all three.
No one knows why healthy, normal people all experience headaches, or stomach aches, or back aches. There are no shortage of theories. Some are garbed in the cloaks of science- this or that function of the head, the stomach, the back, creates the experience of pain. Some theories derive from the metaphor of stress- it’s the omnipresent tentacles of the stress of modern life that make our heads ache, our stomachs hurt, and our backs spasm. For others the answers are sought in explorations of energy imbalances, inflammatory diets, and dozens of other theoretical frameworks.
Now, as mentioned, rarely these symptoms can indicate that a physical abnormality, or a disease is present, and it is our job to detect those events from the steady background of the universal incidence of these experiences.
Some clues help distinguish the usual from the unusual.
Here are a few examples:
- For headache: waking the person up at night, associated with changes in function (ability to walk, talk, move), lasting an unusually long time, related to an injury, unusual severity
- For stomachache: mucus in the stool, persisting diarrhea, blood in the stool, vomiting, weight loss, related to an injury, unusual severity
- For backache: numbness in limbs, pain shooting from the back down the legs, loss of function (ability to walk, stand), related to an injury, unusual severity
But let’s take a moment to consider the far more common situation, for all three of these experiences of pain, that they might occur in someone who has no underlying physical injury or disease or abnormality.
A recent study reported in the Times (http://nyti.ms/2dMN0xo) included a truly astounding observation.
Of those children and adolescents who were treated with a placebo, a pill that had no medication in it, 61% experienced relief from their headaches, and not by just a bit, but they experienced over 50% relief of the symptom.
The study was seeing if an older antidepressant, amitriptyline, or topiramate, a newer anti-seizure medication, worked to reduce headaches in kids. These drugs only delivered substantial relief at the 52-55% range. Placebo did as well and even better.
But for me, the key finding of this study was that any intervention clears about 50% of the burden of headaches in children and adolescents, even just saying your doing something and then not doing anything.
The fact that 50% of all women and 40% of all men have migraine headaches, and that even more people have headaches of some type or another and that so many of us experience stomach aches and backaches tells me that there is something about being human that leads to these three painful experiences. We have no idea what that is, but more and more we are coming to see that it is a normal part of human life. The fact that placebo treatment out performed some powerful drugs, and did so well, giving great relief to nearly 2/3 of people with headaches, seems to be very consistent with this notion that headaches can indeed be part of normal life.
A similar trend is seen in the management of back pain. The most striking results of studies over the years on back pain demonstrate that rest and time out perform every other treatment option. That is, back pain come and go. There are of course many exceptions, and again it is the responsibility of good doctors to determine which back aches indicate underlying diseases or conditions. But if it is determined that one’s back pain is not due to an injury, or medical condition, nothing beats rest and time. Not surgery, not muscle relaxants, not injections.
Again, this observation fits with the notion that there is something about how we evolved, how our bodies work, that create these very common experiences of headache and backache, and the same can be said about stomach aches too.
- There are very few, if any, people who go through life without having at least one headache, one stomach ache, or one back ache. This makes these painful conditions and experiences part of the normal adventure of living.
- Of course, each of these pains can indicate illness, injury, mild or severe. It is important if signs of something different about them show up, or even if you simply wonder or worry, to ask us to find out if there is an underlying condition.
- It it turns out, as it often does, there is not, that the headaches, or stomach aches, or back aches belong to the shared experiences across humanity, it is important to know that we have little knowledge of what truly causes these experiences to occur. Therefore, treatments that involve no treatments, such as placebo, continue to outperform most drugs, and other interventions.
The bad news is that all of us will almost certainly have a headache, stomachache, or back ache.
The good news is that in the vast majority of such eventualities, this does not indicate something is wrong.
And the best news is that if nothing is wrong, the headache, stomach ache, and back ache goes away, all on its own, as well as with any help from us.
To your health,
Dr. Arthur Lavin