It is an almost universally held concept among surgeons and patients that a
specific structural lesion is usually the source of pain. If that lesion can be identified and
repaired, the pain will resolve. This seems plausible. It seems likely in light of the
intensity of back pain that a diagnostic test ought to be able to identify the source of
intense pain and point to a solution.

During my first seven years of practice it was my assumption that if a patient had
experienced low back pain for six months then it was my role to simply find the anatomic
source of pain and surgically solve it. I was diligent in this regard. The test I relied on
most heavily was a discogram. It is a test where dye is injected into several discs in your
lower back. If the patient’s usual pain was produced at a low injection pressure it was
considered a positive response. The only patients I did not fuse were those who did not
have a positive response or had more than two levels that were positive. I performed
dozens of low back fusions and felt frustrated when I could not find a way to surgically
solve my patients’ low back pain.

I have a physiatrist friend, Jim Robinson, who is a strong supporter and
contributor to the DOCC project. From 1986 to 1992 we both served on the Washington
State Worker’s Compensation clinical advisory board in regards to setting standards for
various orthopedic and neurosurgical procedures. Our discussions were based on this
assumption that there always was an identifiable “pain generator.” It was just a matter of
figuring out what test was the best one to delineate it. We did not think in terms of
structural versus non-structural sources of pain. We knew about the role of psychosocial
stress but did not fully appreciate how large a role it played.

You are not a machine. Machines cannot experience pain. They do not have pain
fibers, a nervous system, emotions, hormones, or memory. There is nothing in the
mechanical world that remotely resembles the pain experience. Unless there is a specific
identifiable structural problem, you cannot take yourself to the “body shop” and have
your pain removed.