This is an intriguing, mystifying subject but I have found numerous examples of back pain resolution concurrent with eradication of gastroesophageal reflux symptoms. Ten years ago I encountered the first example of dramatic back pain relief in a patient in his early 60s, disabled as a result of persistent pain following lumbar laminectomy. He realized subsequent to the surgery that he had limitations which, if exceeded, brought on significant worsening of his back pain condition. After the process of adjusting the dosage of his medication to successfully control atypical GERD symptoms he came to the office with pain in his forearms. He reported he had been using a "weed whip" in preparation for a visit from an out-of-state relative and had used the apparatus for several hours breaking only for lunch and then resuming activities after lunch for another several hours. He awoke next morning with severe pain in both of his forearms, and thus presented to the office. I was shocked when I heard the history considering the fact that he had previously reported limitations of 15 to 20 min. doing this particular behavior; if he exceeded these arbitrary limits his back pain progressed to the point of being insufferable. He stated, "My back doesn't bother me anymore. I can do almost anything I want to, it doesn't hurt anymore". Needless to say I was shocked. I cautioned him about being too physically aggressive, due to the danger of aggravating his pre-existing back pain. He continued to have dramatic relief and increased exercise tolerance as he reported shoveling gravel and in the winter months shoveling snow. After discussions with the late Dean of the College of Osteopathic Medicine at Michigan State University, Dr. Allan Jacobs, the conclusion was he no longer suffered from piriformis muscle spasm mediated through sacral segments 2,3,4. I have seen, on numerous occasions, individuals discontinue muscle relaxants and other pain relieving medications, including narcotics, since they were no longer needed. Generally, pain relief has been an anecdotal finding since people come to me with with problems such as rhinitis, sinus issues, headache, chest pain, coughing, throat clearing, and asthma. If they have pain, it often improves concurrently with resolution of atypical GERD symptoms. Remember, GERD is caused when digestive secretions migrate from the stomach and intestine back into the esophagus.The vagus nerve is richly invested in the lower esophagus and goes into "alarm mode". The vagus nerve communicates with the brain and the spinal cord to coordinate bodily functions and contributes to your automatic pilot (autonomic nervous system). This information thus continues on through the spinal cord as the craniosacral nervous system. Data departs from the spinal cord at sacral cord levels 2,3,4. As unusual as it seems or sounds, it appears that many people with back pain are experiencing muscle spasm as a result of regurgitation and reflux of digestive contents into the esophagus stimulating the vagus nerve. The vagus nerve commands tissues to produce mucus, vasodilate, extravasate and cause smooth muscle contraction. It thus appears that the piriformis muscle, innervated by sacral segments 2,3,4, can be influenced (adversely) into chronic spasm and pain as a result of regurgitation of digestive contents. On several occasions I have seen measureable, in some cases dramatic, eradication of pain, (including back pain) with successful treatment for extra esophageal manifestations of atypical GERD.