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Friends of the 26-year-old charged with killing the chief executive of UnitedHealthcare have said he was dealing with back issues that led to sometimes debilitating pain.
The idea that a back injury might disrupt a young man’s life is no surprise to doctors who treat people in pain every day.
“Their lives are just kind of turned upside down,” said Dr. Jacob Joseph, a neurosurgeon at University of Michigan Health specializing in spine injuries.
Roughly 16 million adults in the United States experience persistent back pain that gets in the way of daily activities. Back pain is among the most common medical problems in the country. It is also the leading cause of disability worldwide, according to the World Health Organization.
The suspect in the killing, Luigi Mangione, posted multiple times in a Reddit community dedicated to discussions about spondylolisthesis, a sometimes painful condition that occurs when a vertebra in the spine slips out of alignment. He wrote that his “spondy went bad” when he was 23 and said he had undergone spinal fusion surgery in July 2023. He also described other ongoing health issues, including brain fog.
Experts interviewed for this story spoke only broadly about back pain. The current status of Mr. Mangione’s health, including his back issues, is not clear.
Beth Darnall, a professor of anesthesiology and perioperative and pain medicine at Stanford University School of Medicine, said that back pain can affect every aspect of a person’s life: emotional well-being, sleep, work, social life and the ability to complete household chores. Even just sitting in a chair can be a struggle for someone with back pain.
“Stuff that we do that almost doesn’t even register in our mind for most people becomes like a battle,” said Dr. Joseph.
That impairment can be isolating, experts said. One friend told The New York Times that Mr. Mangione had felt that he could not date because of his back pain.
“Even the most basic things — if someone is having trouble just moving and doing everyday activities, they’re really going to be limited in engaging socially,” said Sara J.T. Guilcher, an associate professor at the University of Toronto who specializes in spinal cord injury and pain research. Even if they are able to spend time with other people, patients can be “in so much pain that they’re not able to be present” and enjoy interacting with others, Dr. Guilcher said.
That may be one reason so many people with back pain struggle with their mental health. People with back pain report disproportionately high levels of depression and distress, compared with the general population.
“There’s so much interplay” between mental health, brain health and the physical impairment that can come with back pain, Dr. Guilcher said.
While there are treatments for back pain, they don’t always work for every patient. For some people, the pain can persist for so long that patients feel a “creeping hopelessness” that it will never get better, Dr. Joseph said.
“People can hear really pejorative types of statements like, ‘Pain’s all in your head’ or ‘It’s not real,’” Dr. Darnall said. “Well, of course pain is real.”
Doctors treat back pain using a variety of methods, including physical therapy and medications. “It’s rarely addressed with just one type of an approach,” Dr. Darnall said.
Providers sometimes deliver steroid injections to help minimize discomfort. Patients with certain spinal injuries might undergo surgery to decompress nerves or stabilize the spine. People may also turn to treatments like chiropractic care, massage or electro-acupuncture, which some studies have suggested can provide modest relief from chronic back pain.
However, some of the treatments themselves, including painkillers and surgery, can exacerbate back pain, said Dr. Wellington Hsu, an orthopedic spine surgeon at Northwestern Medicine.
“It’s very difficult to predict how someone will react to having surgery, and having trauma to your back as a result of surgery can sometimes lead to even worse pain,” he said.
The American Academy of Orthopaedic Surgeons has advocated limiting the use of opioids for back issues because the drugs can be addictive and may be no more effective than over-the-counter medicines in certain circumstances. One study found that the use of opioids did not significantly affect how much moderate to severe chronic back pain interfered with participants’ daily life over the course of a year.
To help patients cope with the emotional aspects of back pain, doctors also sometimes recommend therapy.
“People with chronic pain can experience better quality of life,” Dr. Guilcher said. “But they need the appropriate support.”
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