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in all its permutations, costs the United States roughly $100 billion a
year, more than is spent annually to treat cancer, coronary artery dis-
ease, and AIDS (acquired immunodeficiency syndrome) combined.
On a per capita basis, other nationschief among them, the United
Kingdom, Australia, Canada, Germany, Sweden, Denmark, the Neth-
erlands, China, and South Koreaalso pay hefty bills.
When I did my first Internet search, I had no idea that Id spend six
years studying this topic. Nor did I realize that in the interim, proce-
dures that, for decades, had been upheld as the gold standard in spine
care would be relegated to the dusty and crowded shelves of misguided
medicine. Spine surgeons go-to procedurelumbar spinal fusion
would be discredited, primary care doctors would find that theyd
launched a prescription opioid epidemic, and interventional pain
physiciansthose who perform epidural spinal injectionswould be
faced with evidence that their shots didnt work. Federal prosecutors
would punish device manufacturers for selling spinal instrumentation
that was inadequately tested. Painkiller manufacturers and the U.S.
Food and Drug Administration would be found tucked into bed with
each other, working the drug approval process without regard to pa-
tients best interests. As the story evolved, the journalist in me relished
each appalling revelation. As a patient, however, I felt as if Id barely
avoided stepping off the curb in front of a bus. Many people, I real-
ized, were not so lucky: They got caught in a relentless loop, and were
commonly harmed in the process. As one mother, whose most recent
episode of back pain commenced when she bent forward to hand her
toddler a lollipop, wrote in an e-mail, In an effort to resolve my back
problems, Ive had a host of ridiculous medical encounters over the
last few years, some confusing, some offensive, some harmfuland I
feel completely upside down and unclear about how to best find help.
My goal with Crooked is to set the back pain industrys offerings in
their proper context, so that patients have the information they need
to make good decisions; to know what works sometimes, what works
rarely, and what can cause harm. With luck, I will spare you the side
effects of optimism bias: the very human proclivity to seek out in-
formation that supports your own views, while ignoring that which
Introduction: A Terrible Affliction[ 3
work and why, before moving to partII, where I tell you what experts
say you need to know in order to get on the road to recovery. Or, as
I suspect will be the preference of many long-suffering chronic back
pain patients, you can reverse that plan and dive right into part II,
jump-starting your return to function before heading back to read
part I.
Successful rehabilitation is never passive: It requires sweat, per-
sistence, and a lifetime of hard work. Although it wont be easy or
quick or painless, by the time you finish this book, youll know how
to avoid therapeutic dead ends. No matter what youve heard, back
pain is not the unsolvable enigma of modern medicine. So stand by:
Youre about to learn what it takes to win this game.