I gotta admit that I just don’t get it. Perhaps it’s my overly narrow world-view, or perhaps it’s my lack of imagination, but I really don’t get it. Let me explain.

I’ve got this horrid pain in my back and leg. It’s searing, aching, gnawing. My foot is numb, but still hurts. It tingles, feels heavy, and it’s weak. Sometimes it feels like electricity is jumping through it, sometimes like little worms are crawling in it. Being a curious person, I look for ways to explain this.

I’m sure this horrid crawling feeling could be explained thusly:

Perhaps there are actual worms crawling beneath my skin. Other people have that:

I can see a black minature snake like creature swimming in my bath with red fibers, blue fibers, black hairs, brown small insects, black specs and white crustations/twirled up fibers,lice looking larvae that I can see literally come out of my arms, legs, etc., without permanent exit damage to my skin.

Or maybe it’s something more complex, like a disturbance in the flow of Qi:

The most common imbalance in acute sciatica is qi and blood stagnation in the back channels. But it is also important to treat the underlying imbalance, which may be causing the qi and blood to stagnate.

Or could it be a subluxation, you know, “the silent killer”? According to chriropractic philosophy:

When subluxations occur, chiropractors use specific techniques to return the vertebrae into their proper positions or mobilize them so they can move freely. These techniques are called spinal manipulations or adjustments. During an adjustment, the vertebra is freed from the misaligned position and returned to the proper position in the spinal column. Once performed, the adjustment allows the body to heal and maintain homeostasis.

Hmmm…I suppose I’ll find out if I really have a subluxation when I have my MRI on Tuesday.

This is my problem. It seems everyone has a theory as to what causes back and leg pain, whether it be disturbed Qi, Morgellons syndrome, or vertebral subluxation complexes. Of course there is another theory as well. According to “real” doctors, there is a nerve that exits my spine between the L5 and S1 vertebral bodies, and sometimes an intervertebral disc can rupture,

exerting pressure on the nerve, causing symptoms in the specific areas innervated by that nerve. And the real doctors don’t think that it’s just the physical pressure:

Pain is also believed to be mediated by inflammatory mechanisms that involve substances such as phospholipase A2, nitric oxide, and prostaglandin E. These mediators are all found in the nucleus pulposus itself. Phospholipase A2 has been found in high concentrations in herniated lumbar discs; this substance acts on cell membranes to release arachidonic acid, a precursor to other prostaglandins and leukotrienes that further advance the inflammatory cascade. Additionally, leukotriene B4 and the substance thromboxane B2 have been found to have direct nociceptive stimulatory roles.

How am I to know who is right?

Here we have several competing theories to explain my back pain. Some would say only one could be correct. Others might say that each is a different way of correctly explaining the same thing. Let’s examine common arguments for these explanations.

The worms: sure, it sounds crazy to me, but who am I to diminish someone else’s subjective experience? The answer is quite simple. Subjective experience helps to describe the subjective feelings, such as pain, fear, and anxiety. It doesn’t help explain cause. It seems rather implausible, based on my knowledge of the real world, that parasites are crawling under my skin, despite the fact that it feels that way. Also, I’ve seen a lot of back and leg pain, and not once has it been caused by parasites. When patients are imaged in the MRI or CT, or go to the operating room, worms isn’t what we find.

The Qi: This sounds like a good explanation. The idea is thousands of years old, and apparently quite popular. Unfortunately, age and popularity are not valid criteria for judging medical ideas. Yes, the idea of “qi” is thousands of years old, but a thousand years ago, people didn’t live very long. A thousand years ago, our understanding of the human body and its diseases was limited to vague ideas of spirits, curses, gods, and other superstitions that did not rely on any understanding of anatomy or physiology. People didn’t know causes, and couldn’t prevent or cure disease (but some physicians had made inroads into properly describing diseases). In fact, these ideas have been largely abandoned in their countries of origin. People in China who have access to proper health care choose the same “western” medicine that we use here in the States every day. A study of the history of medicine really helps here. Vesalius the anatomist, who sketched pictures of what really exists inside people; William Harvey, who described the circulation of blood, a real, tangible substance that performs a real, measurable function. A history of Qi will be much less interesting, since it is invisible and unmeasurable, two qualities it shares with other non-existent substances.

Suluxation: I do not think it means what you think it mean. Chiropractors subscribe to the theory of “vertebral subluxation”. This differs from the medical definition considerably. An orthopaedic (real) subluxation is a painful partial dislocation of a vertebral body. A “chiropractic subluxation” is an asymptomatic misalignment or a “vertebral subluxation complex” thought to be a cause of disease. The mechanism posited is usually the blocking of nerve impulses from spinal roots, or some such nonsense. Such a subluxation has never been proven to exist. When I have my MRI tomorrow, we may or may not find a prolapsed disc (I think we will) but we certainly won’t find a vertebral subluxation, which is what a chiropractor would likely treat in me.

When different theories are in competition to explain an phenomenon, we should probably judge them by their plausibility and by their ability to properly describe the real world and to make predictions. Since there are no actual worms in my skin (which the MRI will confirm) that’s off the table. Since no one can measure Qi prove that it even exists, or even show that it is manipulable, that’s out. Since subluxations, in the chiropractic sense, don’t exist, that’s out.

I guess I’m stuck with my disc bulge. That’s a drag. Nerve compression due to a prolapsed disc is painful, and is treated with physical therapy, which is time consuming and sometimes painful. It also isn’t always successful. But it has the benefit of relying on our best knowledge of reality, medical and otherwise. It doesn’t require us to make up unmeasurable energy fields, invisible parasites, or non-existent anatomic abnormalities.

Reality is hard. Science is hard. And my back hurts. Still, I’ll take reality, thanks.