On Monday night, 26-year-old Luigi Mangione was charged with the murder of UnitedHealthcare CEO Brian Thompson. Following his name’s release, both journalists and online investigators found his social media accounts. Notably, Mangione’s posts on Reddit suggest he was struggling with a medical issue known as spondylolisthesis.

He was actively engaged in a subreddit focused on spondylolisthesis, a condition wherein a vertebra in the spine slips out of place, typically causing significant lower back pain.

Using the username “Mister_Cactus,” Mangione made a post linked to a GitHub page he created, but his Reddit account was disabled on Monday. This raises questions about what spondylolisthesis entails and whether it may have influenced the actions of the accused shooter.

In August 2023, he shared in the r/spondylolisthesis subreddit: “After my spondy worsened last year, it was devastating for me as a young athlete. All I could find online suggested I would suffer from chronic pain and be stuck in a desk job. This portrayal was terrifying, misleading, and took a toll on me until I discovered that most spinal fusion surgeries are actually quite successful.”

Understanding Spondylolisthesis

Spondylolisthesis occurs when a vertebra in the spine slips forward, most frequently affecting the lower back. Symptoms may include numbness, hamstring tightness, pain radiating to the thighs, and worsening lower back pain while standing or walking.

This condition is classified as isthmic spondylolisthesis and affects about 4-8% of the population, being particularly more common among males compared to females.

It differs from a slipped disc, which happens when spinal tissue protrudes between the vertebrae. Overactivity can cause spondylolisthesis, often seen in athletes like gymnasts, football players, and weightlifters who regularly extend their lower backs. Also, genetics may play a role; some individuals may be born with vertebrae that are more prone to fractures, as noted by the American Academy of Orthopaedic Surgeons.

Diagnosing spondylolisthesis involves a physical examination and imaging tests like X-rays, CT scans, or MRIs. Low-grade spondylolisthesis is the most common form, whereas high-grade spondylolisthesis may necessitate surgery to relieve severe pain.

Can Spondylolisthesis Be Treated?

Symptoms of spondylolisthesis may improve with rest, non-prescription pain relievers like NSAIDs or acetaminophen, corticosteroids, prescribed anti-inflammatory medications, physical therapy, and wearing a back brace for spine support, as per the Cleveland Clinic.

For those with high-grade spondylolisthesis or severe pain impacting movement that hasn’t responded to non-surgical methods, spinal fusion surgery may be recommended.

This surgical procedure realigns the vertebrae, while another option is spinal decompression, which alleviates pressure on the sciatic nerve.

However, spinal fusion can lead to reduced mobility or flexibility, as two vertebrae heal into a single structure. Although many experience significant pain relief following the surgery, this can limit physical activity levels and increase the possibility of complications.

Impact of Chronic Pain on Mangione

R.J. Martin, the owner of the co-living space Surfbreak in Honolulu where Mangione resided for about six months, told the New York Times that Mangione’s back injury affected his romantic relationships.

Shortly after moving in, Mangione participated in a surfing lesson but experienced such debilitating pain that Martin had to replace his mattress, according to the Times.

“He understood that dating and being physically intimate were not feasible due to his back problems. It broke my heart when he told me that,” Martin recounted.

Chronic Pain Affects Millions in the U.S.

Close to 51.6 million adults in the U.S. (20.9%) deal with chronic pain, and 17.1 million (6.9%) endure high-impact chronic pain. This type of pain, lasting for three months or longer, can severely affect an individual’s quality of life, emotional wellbeing, and ability to perform everyday tasks.

Most individuals with chronic pain report feeling dismissed by healthcare providers, as Dr. Tina Doshi, a pain expert at Johns Hopkins University School of Medicine, previously mentioned. Many patients are told their pain is imagined or just “in their heads,” despite scientific evidence indicating differing brain activity levels in those experiencing chronic pain.

In a post on July 29, 2023, Mangione shared that he had been experiencing bladder and genital pain, in addition to back pain and sciatica after his injury. His hip muscles had tightened “to compensate for the injury,” putting pressure on his nerves, although a doctor had not verified this based on his MRI results.

Untreated pain can lead to feelings of helplessness or depression, which affect an estimated 35-45% of individuals with chronic pain. Moreover, mental health issues and stress can aggravate various types of pain, including back pain, creating a challenging cycle where pain can lead to anxiety and stress, which, in turn, heightens pain levels.

Limited or no access to health insurance

These complications can worsen situations and restrict patients from receiving the necessary healthcare.

In the wake of Brian Thompson’s tragic killing, many Americans affected by the healthcare system have shared their struggles with chronic pain and their attempts to obtain medical assistance.

“This is truly a shocking incident,” commented Tahneer Oksman, a professor in the communications department at Marymount Manhattan College in New York. “Yet, it also provides a chance for individuals to express their frustrations regarding long-standing issues that have troubled many.”