As a spine surgeon, who has been practicing surgery for over 30 years, I have attacked top-level fellowship spine problems with a fury. Convinced that I could help almost anyone in pain with definitive intervention such as surgery, I began to notice an inconsistency between the success of my surgeries and its benefit to the patient. Why, I would ask myself, that even with the best performed surgery, did patients have complications? It took me eight years to understand that surgery was just one specific tool in treating a complex pain problem and it’s not for everyone.
Here are some of my insights:
- You can only fix what you can see. Surgery should only be performed for an anatomic problem that is clearly seen on an advanced imaging study and the symptoms must match. Operating on pain rarely works and has been shown to induce or create more pain up to 40% of the time.
- Even with a clear-cut (pun intended) surgical problem the research shows you must first address all other aspects of pain in order to optimize your chances of a good outcome. This includes:
- Getting adequate sleep
- Calming the nervous system by decreasing:
- Depression
- Anxiety
- Fear-avoidance
- Anger
- Stabilizing mood-altering medications
- Physical conditioning
- Life outlook
- If you are of the opinion that you simply want an operation and refuse to address these other issues, I will not be your surgeon. It would be completely irresponsible of me to allow you to decrease your chances of a successful outcome and expose you to the risk of increasing your pain, knowing that you have not addressed the core issues. It’s because of this that failures I had years ago are now a very rare occurrence.
- You are the only one who is experiencing the pain. If your pain is mild and tolerable – I suggest that you do not undergo surgery.
Outside stresses affect the body’s chemistry and perception of pain. I have never made a decision to do surgery around the time of a major loss. Many situations are indescribably awful. You will not do well. I see you as a whole and complete person and do my best to discover what’s happening in all areas of your life.
It’s been fascinating and unexpected that many of my patients with severe narrowing of the spinal canal, called spinal stenosis, have cancelled their surgeries as their pain decreased to the point where it was not worth the risk of performing surgery. In my first book, Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain, I recommended surgery more aggressively if a patient was suffering from chronic pain. It seemed logical to me that he or she could not tolerate additional stress of a symptomatic bone spur. But since then, we now know that the chronic pain circuits are already fired up and that the additional stress of surgery frequently increases the pain. Enough patients have gone pain free without surgery that it is becoming somewhat challenging to sustain an elective surgical practice.
One of the most disheartening situations I see is when patients have damaged spines as a result of multiple failed surgeries. When I look at the original scans they frequently reveal a normal spine for his or her age. One woman spent over 20 years in a wheelchair from her spine breaking down over a low back fusion. Much of my practice is to salvage what I can. Rarely can I get them back to normal, however, without having prior surgery, I have seen many patients not only return to full function, but become more active than they ever have been.
Surgery is only one tool that can solve a specific structural problem. It is rarely “the definitive solution.” Don’t let anyone place a knife in your back until you understand chronic pain. And most important take back control of your own care.
Dr. David Hanscom is a leading orthopedic spine surgeon at the Swedish Neuroscience Institute in Seattle, WA. Though he believes that surgery and medication have a role, he knows that these standard courses of treatment aren’t what’s needed to treat chronic pain. Instead he provides the framework so the patient can find his or her solution allowing them to live free of pain, forever. His method, which transforms all kinds of pain, including back, neck, arthritis, fibromyalgia, and migraines, is explained in BACK IN CONTROL A Surgeon’s Roadmap Out of Chronic Pain. Website: www.backincontrol.com