Connect with us

Science

Opinion: That pain in your back? It's really a pain in your brain

Published

on

Opinion: That pain in your back? It's really a pain in your brain

As a chronic pain sufferer, I sometimes surprise people by telling them that my pain doesn’t have a physical cause. It’s a mind-body thing, I say, related to stress and emotions. To many, this sounds like admitting to being a little bit crazy. And when I up the ante by suggesting they’ve probably had this kind of pain too, some become outright angry, interpreting my words to mean their pain is “all in their head.”

All of which makes a new study published in the Journal of Pain a big deal. It offers robust evidence that the overwhelming majority of chronic back and neck pain cases — among the most common chronic pain complaints — come from the mind, despite the fact that most diagnoses cite a physical cause, such as bulging disks or bone spurs.

In the new study, doctors assessed 222 consecutive pain patients at an orthopedic care clinic in Louisiana — everyone who showed up, as long as they could complete a questionnaire. Just 12% showed evidence of a structural problem as the root of their pain. Eighty-eight percent, on the other hand, had what the researchers call “primary pain,” which refers to symptoms generated by neural circuits in the brain rather than by “structural” damage to the body.

Based on this and prior research, the authors believe that a process in the brain initiates the non-structural pain. The sensations could be the residual pain from a bodily wound that healed but didn’t notify the brain. Or the brain may have generated pain in the absence of any injury, perhaps in an effort to protect the patients from emotional wounds by occupying their attention with physical sensations instead.

The role of the brain and emotions in producing pain has long been known, and it has been validated by neuroimaging that shows that the brain processes physical pain and emotional distress in the same regions. Observational studies indicate that people feel more pain when primed with negative emotional stimuli. And additional research has shown that therapeutic interventions that help patients understand and reinterpret their pain can significantly reduce the symptoms. The theory is that pain is a danger signal, so as we come to feel safer and less threatened, our nervous systems shift out of fight-or-flight mode, and stop firing the pain signals.

Advertisement

As a result, scientists now believe that all pain is essentially brain pain. The idea is that just as the brain generates sensory experiences such as vision and hearing, it also generates pain by consulting our memories, expectations and emotions, as well as whatever physical inputs our nerves may sense, and creating pain when it determines we are under threat. While our nerves detect sensations, it’s the brain that decides if we’ll experience them as pain.

The implications for healthcare are profound. Chronic pain is among the top reasons people seek medical care. More than 1.5 billion people worldwide suffer from chronic pain, including 50 million to 100 million Americans. For the most part, these patients are spending billions of dollars pursuing physical treatments. If the cause is non-physical, the money is wasted and the suffering only mounts.

And not only are we failing to alleviate the pain, we are creating dangerous side effects that include the opioid crisis as well as surgeries that may be unnecessary and can leave patients worse off.

Of course, sometimes chronic pain does have a physical cause, and distinguishing between when it does and doesn’t is crucial. To address this key challenge, the researchers at the Louisiana clinic devised a rule-out/rule-in diagnosis method that should be adopted far and wide.

The process starts with a thorough patient exam and review of scans to rule out physical causes of the pain. There is a nuance: Just because an anomaly — a squished disk in your back, for example — shows up on a scan, it is not necessarily the cause of pain. As the study explains, research repeatedly shows that the majority of people without pain show similar anomalies. In other words, doctors diagnosing the source of chronic pain need to be aware of the poor correlation between scary scans and pain.

Advertisement

The rule-in process further clarifies whether a patient has structural or mind-body pain. It consists of taking a detailed history of the patient’s pain and life. Doctors need to know if prior treatments that should have resolved structural causes have failed; if treatments associated with a placebo response brought relief; if a patient’s history contains significant stress or adversity; if they have other ailments associated with mind-body causes (headaches, gut and bladder conditions, fibromyalgia, chronic fatigue, tendonitis and more can have such associations). And they need to know if the pain is inconsistent — does it move around in the body or come and go; is it triggered by biologically irrelevant stimuli like the weather, smells or sounds? These variables don’t track well with structural causes.

The process may sound a bit subjective, and it is. But no more than any other diagnostic approach. Medicine is not an exact science, and doctors must act on imperfect information. “We deal in probabilities,” said Dr. Howard Schubiner, lead investigator of the Louisiana study and a clinical professor at Michigan State University College of Human Medicine. Using the careful criteria developed for the study offers as well-grounded a basis for action as anything: “When there is strong evidence using these criteria, a physician can be confident that what they’re seeing is a mind-body problem.”

The existing medical paradigm assumes a physical cause for most chronic pain. The findings in the Louisiana study suggest that’s often wrong.

Fortunately, my pain is much improved after years of pain education and good therapy helped my brain dial down my nervous system. Everyone deserves access to this new pain paradigm. And that requires ending the stigma still associated with mind-body symptoms, and understanding them as a universal human condition, not as the lot of people who are a little bit crazy.

Nathaniel Frank is the director of the What We Know Project at Cornell University’s Center for the Study of Inequality. He is writing a book about mind-body pain to be published by Mayo Clinic Press.

Advertisement

Science

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

Published

on

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

The American Cancer Society’s 2026 Cancer Statistics report, released Tuesday, marks a major milestone for U.S. cancer survival rates. For the first time, the annual report shows that 70% of Americans diagnosed with cancer can expect to live at least five years, compared with just 49% in the mid-1970s.

The new findings, based on data from national cancer records and death statistics from 2015 to 2021, also show promising progress in survival rates for people with the deadliest, most advanced and hardest-to-treat cancers when compared with rates from the mid-1990s. The five-year survival rate for myeloma, for example, nearly doubled (from 32% to 62%). The survival rate for liver cancer tripled (from 7% to 22%), for late-stage lung cancer nearly doubled (from 20% to 37%), and for both melanoma and rectal cancer more than doubled (from 16% to 35% and from 8% to 18%, respectively).

For all cancers, the five-year survival rate more than doubled since the mid-1990s, rising from 17% to 35%.

This also signals a 34% drop in cancer mortality since 1991, translating to an estimated 4.8 million fewer cancer deaths between 1991 and 2023. These significant public health advances result from years of public investment in research, early detection and prevention, and improved cancer treatment, according to the report.

“This stunning victory is largely the result of decades of cancer research that provided clinicians with the tools to treat the disease more effectively, turning many cancers from a death sentence into a chronic disease,” said Rebecca Siegel, senior scientific director at the American Cancer Society and lead author of the report.

Advertisement

As more people survive cancer, there is also a growing focus on the quality of life after treatment. Patients, families and caregivers face physical, financial and emotional challenges. Dr. William Dahut, the American Cancer Society’s chief scientific officer, said that ongoing innovation must go hand in hand with better support services and policies, so all survivors — not just the privileged — can have “not only more days, but better days.”

Indeed, the report also shows that not everyone has benefited equally from the advances of the last few decades. American Indian and Alaska Native people now have the highest cancer death rates in the country, with deaths from kidney, liver, stomach and cervical cancers about double that of white Americans.

Additionally, Black women are more likely to die from breast and uterine cancers than non-Black women — and Black men have the highest cancer rates of any American demographic. The report connects these disparities in survival to long-standing issues such as income inequity and the effects of past discrimination, such as redlining, affecting where people live — forcing historically marginalized populations to be disproportionately exposed to environmental carcinogens.

Dr. René Javier Sotelo, a urologic oncologist at Keck Medicine of USC, notes that the fight against cancer in Southern California, amid long-standing disparities facing vulnerable communities, is very much about overcoming educational, cultural and socioeconomic barriers.

While access to care and insurance options in Los Angeles are relatively robust, many disparities persist because community members often lack crucial information about risk factors, screening and early warning signs. “We need to insist on the importance of education and screening,” Sotelo said. He emphasized that making resources, helplines and culturally tailored materials readily available to everyone is crucial.

Advertisement

He cites penile cancer as a stark example: rates are higher among Latino men in L.A., not necessarily due to lack of access, but because of gaps in awareness and education around HPV vaccination and hygiene.

Despite these persisting inequities, the dramatic nationwide improvement in cancer survival is unquestionably good news, bringing renewed hope to many individuals and families. However, the report also gives a clear warning: Proposed federal cuts to cancer research and health insurance could stop or even undo these important gains.

“We can’t stop now,” warned Shane Jacobson, the American Cancer Society’s chief executive.

“We need to understand that we are not yet there,” Sotelo concurred. ”Cancer is still an issue.”

Advertisement
Continue Reading

Science

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

Published

on

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

As the state continues multiyear marathon discussions on rules for what residents in wildfire hazard zones must do to make the first five feet from their houses — an area dubbed “Zone Zero” — ember-resistant, the Los Angeles City Council voted Tuesday to start creating its own version of the regulations that is more lenient than most proposals currently favored in Sacramento.

Critics of Zone Zero, who are worried about the financial burden and labor required to comply as well as the detrimental impacts to urban ecosystems, have been particularly vocal in Los Angeles. However, wildfire safety advocates worry the measures endorsed by L.A.’s City Council will do little to prevent homes from burning.

“My motion is to get advice from local experts, from the Fire Department, to actually put something in place that makes sense, that’s rooted in science,” said City Councilmember John Lee, who put forth the motion. “Sacramento, unfortunately, doesn’t consult with the largest city in the state — the largest area that deals with wildfires — and so, this is our way of sending a message.”

Tony Andersen — executive officer of the state’s Board of Forestry and Fire Protection, which is in charge of creating the regulations — has repeatedly stressed the board’s commitment to incorporating L.A.’s feedback. Over the last year, the board hosted a contentious public meeting in Pasadena, walking tours with L.A. residents and numerous virtual workshops and hearings.

Advertisement
  • Share via

Advertisement

Some L.A. residents are championing a proposed fire-safety rule, referred to as “Zone Zero,” requiring the clearance of flammable material within the first five feet of homes. Others are skeptical of its value.

With the state long past its original Jan. 1, 2023, deadline to complete the regulations, several cities around the state have taken the matter into their own hands and adopted regulations ahead of the state, including Berkeley and San Diego.

“With the lack of guidance from the State Board of Forestry and Fire Protection, the City is left in a precarious position as it strives to protect residents, property, and the landscape that creates the City of Los Angeles,” the L.A. City Council motion states.

Advertisement

However, unlike San Diego and Berkeley, whose regulations more or less match the strictest options the state Board of Forestry is considering, Los Angeles is pushing for a more lenient approach.

The statewide regulations, once adopted, are expected to override any local versions that are significantly more lenient.

The Zone Zero regulations apply only to rural areas where the California Department of Forestry and Fire Protection responds to fires and urban areas that Cal Fire has determined have “very high” fire hazard. In L.A., that includes significant portions of Silver Lake, Echo Park, Brentwood and Pacific Palisades.

Fire experts and L.A. residents are generally fine with many of the measures within the state’s Zone Zero draft regulations, such as the requirement that there be no wooden or combustible fences or outbuildings within the first five feet of a home. Then there are some measures already required under previous wildfire regulations — such as removing dead vegetation like twigs and leaves, from the ground, roof and gutters — that are not under debate.

However, other new measures introduced by the state have generated controversy, especially in Los Angeles. The disputes have mainly centered around what to do about trees and other living vegetation, like shrubs and grass.

Advertisement

The state is considering two options for trees: One would require residents to trim branches within five feet of a house’s walls and roof; the other does not. Both require keeping trees well-maintained and at least 10 feet from chimneys.

On vegetation, the state is considering options for Zone Zero ranging from banning virtually all vegetation beyond small potted plants to just maintaining the regulations already on the books, which allow nearly all healthy vegetation.

Lee’s motion instructs the Los Angeles Fire Department to create regulations in line with the most lenient options that allow healthy vegetation and do not require the removal of tree limbs within five feet of a house. It is unclear whether LAFD will complete the process before the Board of Forestry considers finalized statewide regulations, which it expects to do midyear.

The motion follows a pointed report from LAFD and the city’s Community Forest Advisory Committee that argued the Board of Forestry’s draft regulations stepped beyond the intentions of the 2020 law creating Zone Zero, would undermine the city’s biodiversity goals and could result in the loss of up to 18% of the urban tree canopy in some neighborhoods.

The board has not decided which approach it will adopt statewide, but fire safety advocates worry that the lenient options championed by L.A. do little to protect vulnerable homes from wildfire.

Advertisement

Recent studies into fire mechanics have generally found that the intense heat from wildfire can quickly dry out these plants, making them susceptible to ignition from embers, flames and radiant heat. And anything next to a house that can burn risks taking the house with it.

Another recent study that looked at five major wildfires in California from the last decade, not including the 2025 Eaton and Palisades fires, found that 20% of homes with significant vegetation in Zone Zero survived, compared to 37% of homes that had cleared the vegetation.

Continue Reading

Science

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Published

on

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Dr. Arnold Gilberg’s sunny consultation room sits just off Wilshire Boulevard. Natural light spills onto a wooden floor, his houndstooth-upholstered armchair, the low-slung couch draped with a colorful Guatemalan blanket.

The Beverly Hills psychiatrist has been seeing patients for more than 60 years, both in rooms like this and at Cedars-Sinai Medical Center, where he has been an attending physician since the 1960s.

He treats wildly famous celebrities and people with no fame at all. He sees patients without much money and some who could probably buy his whole office building and not miss the cash.

Gilberg, 89, has treated enough people in Hollywood, and advised so many directors and actors on character psychology, that his likeness shows up in films the way people float through one another’s dreams.

The Nancy Meyers film “It’s Complicated” briefly features a psychiatrist character with an Airedale terrier — a doppelganger of Belle, Gilberg’s dog who sat in on sessions until her death in 2018, looking back and forth between doctor and patient like a Wimbledon spectator.

Advertisement

“If you were making a movie, he would be central casting for a Philip Roth‑esque kind of psychiatrist,” said John Burnham, a longtime Hollywood talent agent who was Gilberg’s patient for decades starting in his 20s. “He’s always curious and interested. He gave good advice.”

Since Gilberg opened his practice in 1965, psychiatry and psychotherapy have gone from highly stigmatized secrets to something people acknowledge in award show acceptance speeches. His longtime prescriptions of fresh food, sunshine, regular exercise and meditation are now widely accepted building blocks of health, and are no longer the sole province of ditzy L.A. hippies.

Beverly Hills psychiatrist Dr. Arnold Gilberg, 89, is the last living person to have trained under Franz Alexander, a disciple of Sigmund Freud.

(Robert Gauthier / Los Angeles Times)

Advertisement

He’s watched people, himself included, grow wiser and more accepting of the many ways there are to live. He’s also watched people grow lonelier and more rigid in their political beliefs.

On a recent afternoon, Gilbert sat for a conversation with The Times at the glass-topped desk in his consultation room, framed by a wall full of degrees. At his elbow was a stack of copies of his first book, “The Myth of Aging: A Prescription for Emotional and Physical Well-Being,” which comes out Tuesday.

In just more than 200 pages, the book contains everything Gilberg wishes he could tell the many people who will never make it into his office. After a lifetime of listening, the doctor is ready to talk.

Gilberg moved to Los Angeles in 1961 for an internship at what is now Los Angeles General Medical Center. He did his residency at Mount Sinai Hospital (later Cedars-Sinai) with the famed Hungarian American psychoanalyst Dr. Franz Alexander.

Among his fellow disciples of Sigmund Freud, Alexander was a bit of an outlier. He balked at Freud’s insistence that patients needed years of near-daily sessions on an analyst’s couch, arguing that an hour or two a week in a comfortable chair could do just as much good. He believed patients’ psychological problems stemmed more often from difficulties in their current personal relationships than from dark twists in their sexual development.

Advertisement

Not all of Alexander’s theories have aged well, Gilberg said — repressed emotions do not cause asthma, to name one since-debunked idea. But Gilberg is the last living person to have trained with Alexander directly and has retained some of his mentor’s willingness to go against the herd.

If you walk into Gilberg’s office demanding an antidepressant prescription, for example, he will suggest you go elsewhere. Psychiatric medication is appropriate for some mental conditions, he said, but he prefers that patients first try to fix any depressing situations in their lives.

He has counseled patients to care for their bodies long before “wellness” was a cultural buzzword. It’s not that he forces them to adopt regimens of exercise and healthy eating, exactly, but if they don’t, they’re going to hear about it.

“They know how I feel about all this stuff,” he said.

He tells many new patients to start with a 10-session limit. If they haven’t made any progress after 10 visits, he reasons, there’s a good chance he’s not the right doctor for them. If he is, he’ll see them as long as they need.

Advertisement

One patient first came to see him at 19 and returned regularly until her death a few years ago at the age of 79.

“He’s had patients that he’s taken care of over the span, and families that have come back to him over time,” said Dr. Itai Danovitch, who chairs the psychiatry department at Cedars-Sinai. “It’s one of the benefits of being an incredibly thoughtful clinician.”

Not long after opening his private practice in 1965, Gilberg was contacted by a prominent Beverly Hills couple seeking care for their son. The treatment went well, Gilberg said, and the satisfied family passed his name to several well-connected friends.

As a result, over the years his practice has included many names you’d recognize right away (no, he will not tell you who) alongside people who live quite regular lives.

They all have the same concerns, Gilberg says: Their relationships. Their children. Their purpose in life and their place in the world. Whatever you achieve in life, it appears, your worries remain largely the same.

Advertisement

When it’s appropriate, Gilberg is willing to share that his own life has had bumps and detours.

He was born in Chicago in 1936, the middle of three boys. His mother was a homemaker and his father worked in scrap metal. Money was always tight. Gilberg spent a lot of time with his paternal grandparents, who lived nearby with their adult daughter, Belle.

The house was a formative place for Gilberg. He was especially close to his grandfather — a rabbi in Poland who built a successful career in waste management after immigrating to the U.S. — and to his Aunt Belle.

Disabled after a childhood accident, Belle spent most of her time indoors, radiating a sadness that even at the age of 4 made Gilberg worry for her safety.

“It’s one of the things that brought me into medicine, and then ultimately psychiatry,” Gilberg said. “I felt very, very close to her.”

Advertisement

He and his first wife raised two children in Beverly Hills. Jay Gilberg is now a real estate developer and Dr. Susanne Gilberg-Lenz is an obstetrician-gynecologist (and the other half of the only father-daughter pair of physicians at Cedars-Sinai).

The marriage ended when he was in his 40s, and though the split was painful, he said, it helped him better understand the kind of losses his patients experienced.

He found love again in his 70s with Gloria Lushing-Gilberg. The couple share 16 grandchildren and seven great-grandchildren. They married four years ago, after nearly two decades together.

“As a psychoanalyst or psychiatrist ages, we have the ability, through our own life experiences, to be more understanding and more aware,” he said.

It’s part of what keeps him going. Though he has reduced his hours considerably, he isn’t ready to retire. He has stayed as active as he advises his patients to be, both personally (he was ordained as a rabbi several years ago) and professionally.

Advertisement

For all the strides society has made during the course of his career toward acceptance and inclusivity, he also sees that patients are lonelier than they used to be. They spend less time with friends and family, have a harder time finding partners.

We’re isolated and suffering for it, he said, as individuals and as a society. People still need care.

Unlike a lot of titles on the self-help shelves, Gilberg’s book promises no sly little hack to happiness, no “you’ve-been-thinking-about-this-all-wrong” twist.

Psychiatrist Dr. Arnold Gilberg, 89, authored "The Myth of Aging: A Prescription for Emotional and Physical Well-Being."

After 60 years working with Hollywood stars and regular Angelenos, Gilberg is ready to share what he’s learned with the world.

(Robert Gauthier / Los Angeles Times)

Advertisement

His prescriptions run along deceptively simple lines: Care for your health. Say thank you. Choose to let go of harmless slights and petty conflicts. Find people you belong with, and stop holding yourself and others to impossibly high standards.

“People have the capacity to self-heal, and I have become a firm believer in that. Not everyone needs to be in therapy for 10 years to figure it out,” he said. “A lot of this is inside yourself. You have an opportunity to overcome the things and obstacles that are in you, and you can do it.”

So what is “it”? What does it mean to live a good life?

Gilberg considered the question, hands clasped beneath his chin, the traffic outside humming expectantly.

“It means that the person has been able to look at themselves,” he said, “and feel somewhat happy about their existence.”

Advertisement

The best any of us can hope for is to be … somewhat happy?

Correct, Gilberg said. “A somewhat happy existence, off and on, which is normal. And hopefully, if the person wants to pursue that, some kind of a personal relationship.”

As it turns out, there is no housing in happiness. You can visit, but nobody really lives there. The happiest people know that. They live in OK neighborhoods that are not perfect but could be worse. They try to be nice to the neighbors. The house is a mess a lot of the time. They still let people in.

Somewhat happy, sometimes, with someone else to talk to.

It is that simple. It is that hard.

Advertisement
Continue Reading
Advertisement

Trending