My wife has had sciatica for some time and eventually a bit of surgery. The doctor gave exactly the caveats you mention: yes, we can see an issue on the MRI but many people have that and no pain. Her main problem these days is having few positions in which to sleep that are compatible with managing the sciatica AND the GERD that resulted from taking pain killers for too long.
But the real connection is that her PhD thesis at Brandeis was on the epistemology of pain (written long before the sciatica).
If you think the causality is tricky, trying to define what kind of thing pain is -- where does it reside -- is equally challenging.
Her thesis work was what brought us together. I saw her reading Dan Dennett's "Why you can't make a computer that feels pain" in Brainstorms, a book those of us in AI were quite familiar with and fond of, and one thing led to another.
As you put a subheadline in your post which led me to believe you would also write about another axis of pain often neglected when searching for relief: In many cases, there are emotional occurences to be analyzed as well.
This goes off the scientific approach and into spirituality, so I'm guessing this could be a rather uncomfortable path for you to tread on. As you wrote your drive to writing about it is the need to learn, I'm daring to put this here for you to investigate as well:
For any pain I encounter, I usually also check out the web catalogue of www.sanateysana.com, offered by a Peruvian consultant I met on my travels. There you can search for a health issue and read about possible connections to pending work on emotional topics in one's life.
Here's what the website proposes to think about when faced with back pain on L5:
"L5 = I can wonder what happens in my life when the fifth lumbar vertebra L5 is affected. Would I have by chance an attitude of contempt or laziness towards a person or a situation? I may live a little jealousy, disgust, frustration, but nevertheless I already have a lot, life has spoiled me and I have difficulty in recognizing it. My life is tinged with lust (at all levels) and I must learn to appreciate what I have, and to cultivate my interpersonal relationships: I have difficulty especially on the affective level to be authentic and to feel good because deep inside me, I live a great insecurity and I have difficulty in expressing what I live. Therefore, I will have a tendency to be somewhat depressive as I will frequently pass from one spouse to another without knowing too much why this is happening, feeling “right” within what I am living. I will invent all kinds of scripts and my attention will always be focused on the small anodyne details, which will prevent me from moving on and moving on to something else. A certain bitterness may overshadow my life and prevent me from enjoying it. I learn to savor each passing moment and appreciate all the abundance that is part of my life. A bad state of L5 can cause pain in my legs, from my knees to my toes."
In your case and from my tele-interpretation of your current life situation, here's my guess for some conflict potential:
Having just become a father for the first time - and thus being offered a relation-ship in which by nature you are not "the first choice" of the infant could lead to having to deal with an unexpected form of jealousy.
Becoming successful with your modern form of individually funded publication (substack) yet at the same time remaining to be a "classic" academic, scientist and teacher could lead to troubles accepting the good fortune coming your way when science in general is having a hard time.
Both sound to me like perfectly good triggers for an alteration of your subconscious concept of who you are. If this is not addressed through conscious thought, might lead to a physical reaction of your body.
Thanks for sharing! As a cognitive scientist I'm quite open to the mind/body connection here (especially with respect to something as complex as back pain), and a number of people have reached out to share suggestions about related work (e.g., John Sarno's work on back pain). While the specific accounts you described don't really resonate strongly with me I do think looking at things like stress and anxiety is a very important component of the problem.
I did this for a living for decades and wound up having a discectomy myself after months of conservative therapy. This is an excellent summary of the problem. I would only add a couple of things. If there is real loss of function such as leg weakness or loss of bladder control surgery might be more urgent. Also oral steroids are a good option and are more effective than NSAIDS. Usually worth a try for sciatica if they are not contraindicated by some other problem. Finally there are a variety of surgical options. For a simple ruptured disc a microdiscectomy through a very small incision is pretty safe and can be done on an outpatient basis. Nice job.
This is helpful, thanks! Unfortunately the oral steroids didn't work out for me, but it's good to know that a microdiscectomy is quite safe and can be done in a day. I'll edit the post to reflect that.
Interesting is that there has never been a controlled study of oral steroids as far as I know. Many years ago I tried to do one and my application for an IND was denied because there were no animal studies. Of course there is no animal model for disc disease and I’m not sure how one would quantify pain on an animal if there were such a model. Oh well. They are pretty standard practice anyway and have been for decades.
Morning Sean. I have a question. I am working on a book on the history of information transfer (speech, writing, printing, coded info, and now). I am a historian and have some tech background but it would be helpful to have someone better informed to read through my AI chapter. Can you suggest someone who might help me out? Jack McCallum.
I'd be happy to read it, for one. But someone better equipped than me would be Brian Christian, who wrote the Alignment Problem (which features a great chapter on the early history of neural networks). I don't know him personally but you might try reaching out?
Thanks for diving into this a bit. It's fascinating how pain, on the one hand, interrupts your thinking/writing and, on the other hand, propels it, makes it urgent and necessary; this too, to me, is part of epistemology – the things that drive our need to know. The collective knowledge of cancer patients is, in some sense, half of the total weight of that which is known about the condition, i.e. the experiential kind that is so hard to measure, quantify, and evaluate and therefore neglected to a large extent by science.
Considering your normal output of content, it'd be interesting to hear your thoughts on the intersections of LLM-ology in therapeutic settings with the experience of something like sciatica. We know doctors can be sloppy and are too busy and won't really hear our story et cetera, but what about their sense of observation, attention, their ability to probe and, not least, get an overall impression of the patient, compared to AI models? We might be black boxes to some extent to a doctor, even with access to MRIs and experience from centuries of dissections and evaluations, but at the end of the day the 'architecture' of the agent doing the testing (physician) is equivalent to that of the object (patient), which should count for something apart from the obvious elements of sympathy and ability to relate. And isn't the experience of pain a classic topic in the ethics of consciousness? It's a captcha test taken at face value since pain can't be objectively measured. Even if it's posed in fine print to people everywhere by insurance companies, "prove that you suffer", is a hard one if a clear and direct demonstration is required.
(Personal note: had sciatica (herniated disc, L5/S1, left leg symptoms, looked worse than yours on the MRI) that started out mid August 2023, got worse and had to seek pain relief at emergency room. Couldn't believe they would even mention surgery at that point. Continued to worsen, though. Had two steroid injections some 3-4 weeks apart in late fall but didn't help much. Ended up getting surgery in mid December. With physical therapy and gym I was back to normal 3-4 months later. I can still feel the leg if I bend my head down toward my toes in the morning but that's about it. Was out in Yosemite hiking in September with a 40lbs pack – no problem. I work standing up most of the time since, figuring that's what started it: writing papers sitting down).
Really interesting observation re: pain being both a distraction and an epistemological motivation.
I think I agree with your point that there's probably something important about the shared experience of being human for treating patients with back pain. In principle that's what I really like about McGill's emphasis on individualized assessments and treatment plans: nothing is one size fits all. Of course, in practice many aspects of medical treatment are standardized across patients—which can be both good in some cases, but which does sometimes leave patients feeling like their care isn't really being personalized to their specific problems.
I'm sorry to hear you went through something similar (or worse) but very glad you're doing better now!
My wife has had sciatica for some time and eventually a bit of surgery. The doctor gave exactly the caveats you mention: yes, we can see an issue on the MRI but many people have that and no pain. Her main problem these days is having few positions in which to sleep that are compatible with managing the sciatica AND the GERD that resulted from taking pain killers for too long.
But the real connection is that her PhD thesis at Brandeis was on the epistemology of pain (written long before the sciatica).
https://philpapers.org/rec/MORTTP-3
If you think the causality is tricky, trying to define what kind of thing pain is -- where does it reside -- is equally challenging.
Her thesis work was what brought us together. I saw her reading Dan Dennett's "Why you can't make a computer that feels pain" in Brainstorms, a book those of us in AI were quite familiar with and fond of, and one thing led to another.
Sorry to hear about your wife's sciatica (as well as the medication-induced GERD). Hope she can get some relief!
That's a wonderful story about how you met, though. Thank you for linking her dissertation—I will check it out!
My favorite video on back pain:
https://youtu.be/cbEEndKQCsw?si=EqiDah2Ya4Q-YIcx
This is great!
As you put a subheadline in your post which led me to believe you would also write about another axis of pain often neglected when searching for relief: In many cases, there are emotional occurences to be analyzed as well.
This goes off the scientific approach and into spirituality, so I'm guessing this could be a rather uncomfortable path for you to tread on. As you wrote your drive to writing about it is the need to learn, I'm daring to put this here for you to investigate as well:
For any pain I encounter, I usually also check out the web catalogue of www.sanateysana.com, offered by a Peruvian consultant I met on my travels. There you can search for a health issue and read about possible connections to pending work on emotional topics in one's life.
Here's what the website proposes to think about when faced with back pain on L5:
"L5 = I can wonder what happens in my life when the fifth lumbar vertebra L5 is affected. Would I have by chance an attitude of contempt or laziness towards a person or a situation? I may live a little jealousy, disgust, frustration, but nevertheless I already have a lot, life has spoiled me and I have difficulty in recognizing it. My life is tinged with lust (at all levels) and I must learn to appreciate what I have, and to cultivate my interpersonal relationships: I have difficulty especially on the affective level to be authentic and to feel good because deep inside me, I live a great insecurity and I have difficulty in expressing what I live. Therefore, I will have a tendency to be somewhat depressive as I will frequently pass from one spouse to another without knowing too much why this is happening, feeling “right” within what I am living. I will invent all kinds of scripts and my attention will always be focused on the small anodyne details, which will prevent me from moving on and moving on to something else. A certain bitterness may overshadow my life and prevent me from enjoying it. I learn to savor each passing moment and appreciate all the abundance that is part of my life. A bad state of L5 can cause pain in my legs, from my knees to my toes."
In your case and from my tele-interpretation of your current life situation, here's my guess for some conflict potential:
Having just become a father for the first time - and thus being offered a relation-ship in which by nature you are not "the first choice" of the infant could lead to having to deal with an unexpected form of jealousy.
Becoming successful with your modern form of individually funded publication (substack) yet at the same time remaining to be a "classic" academic, scientist and teacher could lead to troubles accepting the good fortune coming your way when science in general is having a hard time.
Both sound to me like perfectly good triggers for an alteration of your subconscious concept of who you are. If this is not addressed through conscious thought, might lead to a physical reaction of your body.
Thanks for sharing! As a cognitive scientist I'm quite open to the mind/body connection here (especially with respect to something as complex as back pain), and a number of people have reached out to share suggestions about related work (e.g., John Sarno's work on back pain). While the specific accounts you described don't really resonate strongly with me I do think looking at things like stress and anxiety is a very important component of the problem.
I did this for a living for decades and wound up having a discectomy myself after months of conservative therapy. This is an excellent summary of the problem. I would only add a couple of things. If there is real loss of function such as leg weakness or loss of bladder control surgery might be more urgent. Also oral steroids are a good option and are more effective than NSAIDS. Usually worth a try for sciatica if they are not contraindicated by some other problem. Finally there are a variety of surgical options. For a simple ruptured disc a microdiscectomy through a very small incision is pretty safe and can be done on an outpatient basis. Nice job.
This is helpful, thanks! Unfortunately the oral steroids didn't work out for me, but it's good to know that a microdiscectomy is quite safe and can be done in a day. I'll edit the post to reflect that.
Interesting is that there has never been a controlled study of oral steroids as far as I know. Many years ago I tried to do one and my application for an IND was denied because there were no animal studies. Of course there is no animal model for disc disease and I’m not sure how one would quantify pain on an animal if there were such a model. Oh well. They are pretty standard practice anyway and have been for decades.
Yep, from what I’ve read lots of people do seem to respond positively to them!
Morning Sean. I have a question. I am working on a book on the history of information transfer (speech, writing, printing, coded info, and now). I am a historian and have some tech background but it would be helpful to have someone better informed to read through my AI chapter. Can you suggest someone who might help me out? Jack McCallum.
That book sounds really interesting!
I'd be happy to read it, for one. But someone better equipped than me would be Brian Christian, who wrote the Alignment Problem (which features a great chapter on the early history of neural networks). I don't know him personally but you might try reaching out?
Thanks. Obviously I had hoped you would look at it. I’ll get back in a bit. Still revising.
Thanks for diving into this a bit. It's fascinating how pain, on the one hand, interrupts your thinking/writing and, on the other hand, propels it, makes it urgent and necessary; this too, to me, is part of epistemology – the things that drive our need to know. The collective knowledge of cancer patients is, in some sense, half of the total weight of that which is known about the condition, i.e. the experiential kind that is so hard to measure, quantify, and evaluate and therefore neglected to a large extent by science.
Considering your normal output of content, it'd be interesting to hear your thoughts on the intersections of LLM-ology in therapeutic settings with the experience of something like sciatica. We know doctors can be sloppy and are too busy and won't really hear our story et cetera, but what about their sense of observation, attention, their ability to probe and, not least, get an overall impression of the patient, compared to AI models? We might be black boxes to some extent to a doctor, even with access to MRIs and experience from centuries of dissections and evaluations, but at the end of the day the 'architecture' of the agent doing the testing (physician) is equivalent to that of the object (patient), which should count for something apart from the obvious elements of sympathy and ability to relate. And isn't the experience of pain a classic topic in the ethics of consciousness? It's a captcha test taken at face value since pain can't be objectively measured. Even if it's posed in fine print to people everywhere by insurance companies, "prove that you suffer", is a hard one if a clear and direct demonstration is required.
(Personal note: had sciatica (herniated disc, L5/S1, left leg symptoms, looked worse than yours on the MRI) that started out mid August 2023, got worse and had to seek pain relief at emergency room. Couldn't believe they would even mention surgery at that point. Continued to worsen, though. Had two steroid injections some 3-4 weeks apart in late fall but didn't help much. Ended up getting surgery in mid December. With physical therapy and gym I was back to normal 3-4 months later. I can still feel the leg if I bend my head down toward my toes in the morning but that's about it. Was out in Yosemite hiking in September with a 40lbs pack – no problem. I work standing up most of the time since, figuring that's what started it: writing papers sitting down).
Best of luck getting better.
/j
Really interesting observation re: pain being both a distraction and an epistemological motivation.
I think I agree with your point that there's probably something important about the shared experience of being human for treating patients with back pain. In principle that's what I really like about McGill's emphasis on individualized assessments and treatment plans: nothing is one size fits all. Of course, in practice many aspects of medical treatment are standardized across patients—which can be both good in some cases, but which does sometimes leave patients feeling like their care isn't really being personalized to their specific problems.
I'm sorry to hear you went through something similar (or worse) but very glad you're doing better now!