A straightforward decision

I rarely make a surgical decision on the first visit, but his situation seemed so straightforward that I decided to make an exception. He also wanted to proceed quickly, as he was frustrated by his limitations. As I walked out the door to grab the pre-operative letter that describes the details of the fusion, he quietly said, “My son just died a few months ago.” I immediately turned around and sat down with him. His son had died from a massive heart attack. I let him know how sorry I was about his loss, and also told him that I was not comfortable with him making such a major decision in light of the situation. He agreed. I gave him the pre-op letter and asked him to return in a couple of weeks. I gave him a copy of my book, Back in Control, which is an excellent resource for dealing with stress, as well as chronic pain. A week later he called and told me that he really wasn’t into reading my book and just wanted to proceed with surgery. I asked him one more time just to glance through the book, as it does help with post-operative pain and rehab; and I signed him up for surgery.

The pre-op appointment

He came in with his wife for his pre-operative appointment to coordinate the final details around the operation. I wanted be sure that I was on the same page regarding the severity of the pain and his understanding of the procedure. He said, “I am feeling better. I have read some  of your book and think that maybe I should work through some of the issues around my son’s death.” We had a long conversation about the effect this degree of trauma can cause. He asked me if it was OK with me for him to delay his surgery for a while.

I saw him a month later and he had no pain in his back or down his leg. He was fully active and had just re-joined the gym. I asked him what seemed to be the most helpful strategy in resolving his pain. He had continued to read the book. However, I am well-aware that reading my book, or any book, is not going to take away pain. It requires some level of engagement. For him, it was awareness. Just understanding the links between anxiety, anger, trauma, and pain helped him make sense of the different emotions he was trying to process. He was also now talking to his friends about his loss, who were offering a lot of support. His whole demeanor had changed and he was now more concerned about how the situation was affecting his wife.

How do I decide who needs surgery?

It is becoming increasingly unclear to me what severity of pathology requires surgery to solve a given problem. His constriction around his 5^th lumbar nerve root was severe and he had a classic history that matched. Had I done the surgery, his leg pain would have resolved; but not his emotional pain. He now is moving forward, as his emotional pain is being addressed. His back and leg pain are gone. He did not have to undergo the trauma and risks of surgery. He will return to being a productive person and provide emotional support for his wife. Although, not the main reason, there was essentially no cost involved.

“I know when a patient is at risk for a poor outcome”

I have witnessed many stories that are similar to George’s; and I am more diligent in making sure that there not major life stresses occurring while making a final decision regarding surgery. There doesn’t need to be one specific event. More commonly people hit their breaking point from cumulative stress, and they don’t see a way out. Physicians almost uniformly feel that they can detect emotional distress in their patients. As I have been doing spine surgery for so many years, I feel like I am really able to detect patients with anxiety and depression in my clinic. However, research shows that physicians are correct in this regards only 25-43% of the time. It does not matter whether the doctor is a junior resident or senior staff physician. George’s story again reminded me that I cannot figure any of this out either. There is too much going on in the middle of a busy clinic – especially on an initial visit. (1)

Physical versus mental pain

The areas of the brain that interpret physical and emotional distress are located in close proximity to each other. (2) It also seems that there are abnormalities of a given person’s body that are not quite severe enough to cause pain. But when the pain threshold is lowered, in the presence of adversity, these specific areas can become symptomatic. As one of my workout buddies points out, “It is the weak area that lights up.” Prior pain circuits can also be activated.

There are hundreds of research papers documenting the link between anxiety and depression with pain, and poor outcomes with treatment. For many reasons, these factors are not being routinely addressed. The culture of medicine is geared towards performing procedures, and not on talking to you about other options or providing the necessary resources. It is critical that you have done everything possible to calm down your nervous system before you undergo a surgical procedure. In this medical environment, you will have to take on that responsibility.

1. Daubs, M, et al. Clinical impression versus standardized questionnaire: The spinal surgeon’s abilityto assess psychological distress. JBJS (2010); 92; 2878-2883.
2. Hashmi, JA et al. “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.” Brain(2013); 136: 2751 – 2768.

The post “My Son Just Died” first appeared on Back in Control.

The post “My Son Just Died” appeared first on Back in Control.

Artificial disc disaster

In 2005, Marsha had an MRI scan done that showed some mild degeneration of the discs in her lower back. These were normal for her age. A surgeon recommended she undergo two artificial discs at L3-4 and L4-5. They did not help her pain; in fact, she got worse. The discs buckled, and a year later they were removed at another hospital on the west coast. During this operation, surgeons went back in through her abdomen to remove these artificial discs. In this operation, the major blood vessels are attached to the discs. It is a very difficult procedure, and during the operation, her major vein, the vena cava, was torn. Her ureter (the tube from the kidneys to the bladder) was also torn. Both were repaired, but she was left with residual swelling of her feet due to the partial disruption of the vena cava. A year later, she had L5-S1 fused for ongoing low back pain. When she saw me, she still had ongoing low back pain, thoracic pain, and neck pain. Two other spine surgeons had recommended that she undergo a two-level fusion in her neck. The MRI of her neck was normal for her age, showing just some mild degeneration.

She desperately wanted to go back to work. Her husband was threatening to leave her. She was on drugs to wean her off narcotics but was having a difficult time. She was extremely motivated to get better, but she was also completely trapped by her pain and lacked a plan to solve her pain problem.

Why Surgery?

None of her surgeries were helpful or necessary. Yet the spine world was offering her only more surgery. I do not know the end of this story. I spent a couple of extra hours with her explaining the DOC protocol in detail. She did not want to engage in any of the concepts and continued to spiral downward, as I learned from a phone call a few weeks later.

It is upsetting to me that she has the three-level fusion in her lower back and residual swelling in her feet. If she had been able to engage in the structured rehab before any surgery, her potential would have allowed her to completely come back to normal. Now, she will have some permanent structural limitations and a high chance of permanently suffering from chronic pain. BTW, if she had chosen to pursue a healing journey, she could still have done well in spite of her multiple surgeries.

Two Years Later

I am writing this about two years after our visit.  I never heard another word from her.  There is a high probability that she went on to another operation.  The mindset that “surgery is the only solution” becomes its own irrational circuit.  I have found out that the longer I try to talk someone like this out of surgery, the less productive it becomes for both of us.  Often, the patient becomes extremely agitated and sometimes will progress rapidly into a rage. You cannot solve irrational anxieties by rational means.

I am a surgeon trying to talk you out of surgery

I am a spine surgeon who was paid extremely well to do surgery. I am not against performing spine surgery but I am strongly against operating on normally aging spines that have been documented to not be a source of pain. So, I’m trying my best to talk you out of surgery that has not only a low chance of helping you but that actually worsen your situation. If that isn’t even the slightest bit persuasive, you need to look very closely at your decision-making process. Right now, trying to break through this barrier is my biggest challenge.

Before you make the final decision to proceed with spine surgery, get to know your surgeon. If he or she doesn’t want to engage in a detailed conversation about it, then you need to look elsewhere. There is no turning back and a failed spine surgery can destroy your life. Also, I wrote a book, Do You Really Need Spine Surgery? that breaks down the decision-making into two factors – the anatomy and the state of your nervous system. The decision will become clear for you. Video: Get it right the first time.

BF

The post Marsha’s Three Unnecessary Spine Surgeries first appeared on Back in Control.

The post Marsha’s Three Unnecessary Spine Surgeries appeared first on Back in Control.

• Spine surgery is not an option if there is not a structural problem with matching symptoms.
• Back pain does not respond to surgery and it is often made much worse in the presence of untreated chronic pain.
• It is understandable why you might choose it as it seems definitive and you are desperate.
• Anger shifts your brain activity from the thinking to the survival regions. You cannot think clearly.
• Back pain is solvable with no risk and minimal resources. Don’t let your life be destroyed by a failed back surgery.

Imagine your life before the pain. Stop and visualize a day or period back then when you were just plain angry. What kind of a day was it? It wasn’t great. Now add the pain back into the picture and what you have – living hell.

One of the byproducts of anger is obsessing over negatives. With chronic pain, it is deadly. As the brain focuses on the pain, your nervous system becomes sensitized and the signal becomes stronger. (1) Then you’ll become even angrier. An endless cycle emerges, and you spiral downward. The other problem with anger is that your brain is producing inflammatory proteins called cytokines. This also creates a shift in the blood flow from the neocortex (thinking centers) to the lower levels of the brain (survival) and you simply cannot think clearly. It is critical to get your brain back “on-line” before making major surgical decisions.

I know you have pain, but what exactly are you looking for? When I ask that question in the clinic, the most common answer I hear is “ I just want to get rid of the pain.” I’m sure you want this too, but even if the pain disappears, will the rest of your life just come together and be great? Being pain free is just one of the things you need to live a stress fee, happy, and healthy life. It turns out that if you work on some of these other things, like learning to deal with stress, the intensity of your pain becomes reduced. (2)

Bonnie

Around 1990, I had a patient in her mid-thirties who had suffered a lifting injury at work. She was seeking another surgical opinion. She had a moderate curvature of her lower back that she had been born with. The term for the disorder is congenital scoliosis. Although there is a slightly higher chance of low back pain with lumbar scoliosis, I felt strongly that she should not have surgery. I reminded her that patients with straight spines have the same type of pain after a lifting injury. She was also under a lot of personal stress and extremely angry. She had not fully participated in a conditioning program. I talked to her for over an hour about why she should not have an operation. She wanted to have seven levels of her spine fused. This included her whole lower back and her thoracic spine. She was determined to go ahead with the surgery. I was unwilling to do it, so she proceeded to have another surgeon fuse her whole lower back.

Didn’t work

She returned to me two years later in a wheelchair because of ongoing severe low back pain. Although the fusion had not completely healed, it was stable. She had yet another recommendation to have the weak spot in her fusion surgically repaired. The success rate of making the fusion solid is high. We are able to remove the hardware, re-graft the area, replace the hardware, and obtain a solid fusion most of the time. However, the chances of relieving her pain were almost zero. Her pre-operative mental state had markedly deteriorated after two more years of pain. There was nothing that could be done to surgically relieve her suffering. The tragedy was that she could still have done well with a structured rehab approach.

This situation occurred before I knew much about comprehensive rehabilitation and the importance of calming down the nervous system. Her main reason for returning to see me was to undergo yet another operation. She could not let go of the idea that surgery was the definitive solution. The tragedy is that her pain was so solvable without surgery. I don’t know her final outcome, as she never returned. She was even less open to non-surgical options.

Surgery is a not definitive solution for chronic pain

This is a common scenario. A person has ongoing chronic mental and physical pain and is justifiably angry about the whole situation. A surgeon offers them an option, which seems like a way out a dark situation even though there is no data to support the procedure. (3) I don’t blame her since there doesn’t seem like a lot of other options and surgery seems to be a “definitive solution.” But an operation should have never been offered to her that has less than a 30% chance of success. With anger in full gear, no one thinks clearly and the downside of a failed surgery is not fully comprehended. Then when a given surgery fails they often pursue surgery again and again.

Her situation was one of the major reasons I quit my surgical practice. I could no longer watch people have their lives destroyed with surgeries that should not have been considered. The DOC Journey is a platform that presents proven medical treatments in a manner to optimize surgical outcomes or completely avoid surgery. My book, Do You Really Need Spine Surgery? Take Control with Surgeon’s Advice clarifies the issues around the surgical decision-making. It is a much bigger deal than you can imagine and people just can’t comprehend the downside of a failed spine surgery. It has the potential to destroy your life as you know it.

Don’t let anger alter your decisions about surgery – or about anything. I have a little mantra that I keep in the forefront of my mind, “No action in a reaction.”

1. Giesecke T, et al. “Evidence of augmented central pain processing in idiopathic chronic low back pain.” Arthritis and Rheumatism (2004); 50: 613-623.
2. Schiavon, CC et al. Optimism and hope in chronic disease: A systematic review. Frontiers in psychology (2017); 7: 1-10.
3. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.

The post Anger Altering a Surgical Decision first appeared on Back in Control.

The post Anger Altering a Surgical Decision appeared first on Back in Control.

Mark Owens’ Story

This is a video that we shot of Mark Owens, who wrote the Forward of my book. I’d like to give you some additional background to his story, both from his and my perspective. He is a PhD scientist who has spent his life addressing environmental issues. At age 29, driving a battered 3rd-hand Land Rover, he and his wife found their way into some of the most remote reaches of the Kalahari Desert of Botswana, and later, the Luangwa Valley of Zambia. There they conducted wildlife research on lions, elephants, hyenas and migrating antelope, and established model programs to protect these animals from commercial poachers while raising the living standards of indigenous people. After 23 years, he accomplished his vision, and his work still continues on through the structure he put into place and the local people he trained to carry it on. His story is reflected in his books, Cry of the Kalahari, The Eye of The Elephant, and Secrets of the Savanna .

Back in Idaho after more than two decades, he purchased and restored a large piece of land and its wetland in Idaho as a wildlife preserve for wolves, grizzlies and other wildlife. He also reversed much of the environmental damage done by indiscriminate ranching and logging practices. His commitment to making the world a better place is remarkable.

The horse accident, as he related in the Forward of my book, occurred while searching for grizzles on his ranch in the Cabinet Mountains of Montana, and his injuries were severe. A fractured spine represents severe trauma, but it isn’t nearly as painful as a crushed chest wall. After the surgery, he developed severe chronic pain for over nine years. Why?

My perspective 

Here are some points that I want to add to his remarkable story of healing.

Although this was a major injury, the usual post-operative course for a fractured spine is moderate to severe pain for a couple of weeks and then it usually resolves in about six weeks. From a surgeon’s perspective, he was the “ideal surgical candidate.” He was extremely motivated to get better, which is true for almost everyone in pain. However, there were a few details that were missed, and no one asked him the right questions.

First, he was under a large amount of stress. He left Africa after corrupt government officials and poachers had plotted his assassination for the third time.  And in Idaho, hunters and ranchers resented his conservation efforts on behalf of predators that they perceived as a threat to their domestic stock. Under less stress, it’s unlikely he would have developed such severe chronic pain. He’s really tough. Few people on this planet would have attempted what he accomplished in Africa.

Second, after he developed chronic pain from the first operation, a second one was performed to address degeneration at the lumbar 2-3 level just below his prior thoracic surgery. The surgeons performed a fusion with a known success rate of less than 30% for disc degeration. It has been well-documented that disc degeneration is not considered a source of pain.

Additionally, it has also been demonstrated that performing surgery in the presence of ongoing chronic pain of any kind, can induce pain at the new surgical site or worsen the pain at the surgical region. (1) His pain become dramatically worse.

Third, several surgeons had recommended surgically breaking his spine in two, re-aligning it and fusing him from his neck to his pelvis. One surgeon referred to the procedure as the “Blue Plate Special.” If a one-level fusion had made him worse, what do you think a 12-hour procedure with a high complication rate would have done to him? From my perspective, the decision not to recommend surgery was easy. His spine showed disc degeneration that was normal for his age. There was nothing to operate on.

Fourth, although he was not without some hope, he was quite skeptical and he didn’t really believe me that his pain was solvable, with or without surgery. The DOC project is not about believing in it or not. It is simply a framework that allows the patient to more clearly and readily sort out his or her scenario, and find a solution. The principles are universal and hold true regardless of how you feel about them. The key is to engage and move forward.

Fifth, his healing was dramatic, which many of my patients find discouraging because they don’t have an immediate response. Most people don’t, and I have observed that the process generally begins to create change over three to four months. Maybe one out of twenty people experience such a rapid response. The key is persistence.

Sixth, there are over 1000 research papers that document the effectiveness of expressive writing. (2) There is no debate that it improves mood, performance and lessens over 30 possible physical symptoms. The issue is how and why it works. Conversely, there is little evidence that a spine fusion is a solution for back pain. The success rate is less than 30% at two-year follow up and has never been compared to carefully structured non-operative care, such as the DOC program. (3) Unfortunately, insurances don’t cover most of the treatments that have been demonstrated to work.

Finally, his life wasn’t perfectly pain free after the initial healing. Unpleasant circumstances will cause your body to be full of stress chemicals, which increases the speed of nerve conduction and increases pain. (4) We worked through several major flare-ups together and eventually he acquired the skills to pull out of these flares on his own.

We have become close friends and we now support each other. Not only is he doing well over four years later, he’s thriving. The cost of healing was negligible for him and society. The risk was zero. I feel privileged that I was able to give back what I learned through my own ordeal with chronic pain. Watching people connect with their own healing capacity continues to be a remarkable experience.

Forward to Back in Control

1. Perkins FM and Henrik Kehlet. Chronic Pain as an. Outcome of Surgery. Anesthesiology (2000); 93:1123-33.
2. Smyth JM and James Pennebaker. Exploring the boundary conditions of expressive writing: In search of the right recipe. Br Jrn of Health Psychology (2008); 13:1-7.
3. Carragee EJ, et al, A gold standard evaluation of the “Discogenic Pain” diagnosis as determined by provocative discography. Spine (2006); 18:2115-2123.
4. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166–173.

The post Avoided a 12-hour Spine Fusion and is Free from Chronic Pain first appeared on Back in Control.

The post Avoided a 12-hour Spine Fusion and is Free from Chronic Pain appeared first on Back in Control.

Dorothy was a retired National Guard armed service member. Although she was not in the best physical shape, she was moderately active. Golf was her passion.

This is an example of a 12-level fusion from the 4th thoracic to the 3rd lumbar vertebra. Once the spine has healed, it is permanently stiff where it has been fused.

Nerve damage is often permanent

Two years earlier she had developed pain down her right leg and weakness of the muscles that elevated her right foot, a condition commonly know as “foot drop.”  She underwent a surgery called a laminectomy between her lumbar 3-4 and 4-5, to take the pressure off the nerves. Her leg pain quickly resolved, but the damage to the nerves causing the foot drop was permanent; so she wore a brace to keep her foot stable when she walked. Normally, foot drop cannot be reversed with any surgical procedure, since the damage has occurred inside the nerve.

Dorothy’s symptoms now consisted only of the persistent foot drop, and she was able to walk easily with the brace on her lower leg. Her spine was straight and she had no pain in her back or legs. I looked at her new MRI scan and it showed that the surgeon had successfully taken the pressure off the nerves to her foot. There was some generalized arthritis; but there is no correlation between spinal arthritis and back pain, as those of you who are familiar with my website have heard me say before.

Why??

If you are wondering, “Why would she need another surgery?” you are following a sound train of thought. We know that damage to the nerves causing foot drop is permanent, so how could more surgery help? Even if the prior surgeon had left some bone spurs behind, more surgery still would not improve the chances of the foot nerves regaining function.

We also need to weigh the implications and risks of the spinal fusion that was recommended for Dorothy:

• The surgery can take up to 10 hours.
• You are in the hospital for 5 to 7 days—longer if there is a complication.
• The complication rate is over 70%, with significant chance of problems such as infection, paralysis, blindness, hardware failure, screws damaging nerves, blood clots to the lungs, and death.
• The fusion takes around four months to heal.
• Your overall strength does not return for months.
• There is a 30% chance that the spine breaks down over the rigid rods.
• There is a chance that a fusion of this magnitude will cause long-term back pain.
• You lose all flexibility in the area of the spine fusion. Dorothy would lose much of her ability to twist (Think of her golf game) and it will be more difficult to perform simple tasks such as bending over to tie her shoes.

Benefits versus risks

I could go on about this operation and its downsides, because I perform it often—but only for tumor, infection, fracture, or if a patient is bent over and cannot straighten up. Words cannot describe how gratifying it is to return a person’s ability to stand up straight.  However, over my thirty-year career, I have gone through every possible complication with patients who have undergone this surgery. Eventually we reach a good result, but not without a fight.

I am careful to inform my patients of the risks involved with an eight-level fusion—not so much for legal reasons, but for them to understand the degree of commitment required of them to undergo the surgery. The benefits must outweigh the risks. Get it right the first time

For Dorothy, the risk was high and the benefit was zero. I recommended no further surgery.

The frequency of these operations has risen in the last few years. Be careful.

The post Eight-Level Spine Fusion? No! first appeared on Back in Control.

The post Eight-Level Spine Fusion? No! appeared first on Back in Control.

His tests and treatment were as follows:

• His lumbar MRI showed disc degeneration at every level but no instability.
• He had crippling anxiety including fairly frequent panic attacks.
• He was open to psychological care.
• I engaged him a structured rehab program, but essentially every request we made for biofeedback, psychological intervention, mindfulness/meditation, and back school was denied by Worker’s Comp—over and over again.
• I somewhat kept him on his feet by seeing him back every couple of weeks for about six months. We kept requesting care.  Even personal phone calls to his claims examiner were of no avail.

I referred him to a pain specialist that I have teamed up with, and he continued with a similar program but again with no support from Workers’ Comp.

• The patient still complained of severe crippling anxiety and was somewhat desperate for mental health care.
• I am not currently his treating physician but last week my colleague emailed me and asked me to re-evaluate him.
• It has been recommended to him that he have a two-level lumbar fusion for his degenerated discs.  My friend begged him not to pursue it.
• The patient is anxious, frustrated, and does not want to talk to me or anyone else.  He is now intent on pursuing surgery.

So look at this situation.

• We know that chronic pain increases anxiety and frustration, which exacerbates pain.
• Psychosocial stress is a better predictor of outcome than the surgical pathology.
• The return-to-work rate at one year from a lumbar fusion for low back pain in the State of WA is 15%.
• The patient has documented severe untreated anxiety.
• In addition to his baseline anxiety, interacting with the Worker’s Comp system has pushed him almost into a rage.
• The state still will not pay for any mental health resources
• They will pay for an operation that will cost them between 50-75 thousand dollars and has a re-operation rate between 15-20% within the first twelve months of the index operation.
• If he does not undergo surgery, his claim will be closed and he does not have the emotional capacity to compete in the work force.

I have no ability to intervene, as I am no longer his treating physician.  I realize that “this is not my problem.”  That is correct.  It is not my problem; it belongs to all of us.

Does anyone have any suggestions?

BF

The post It Really is Upside Down first appeared on Back in Control.

The post It Really is Upside Down appeared first on Back in Control.

One of the byproducts of anger is obsessing over negatives. With chronic pain, it is deadly. As the brain focuses on the pain, your nervous system becomes sensitized and the signal becomes stronger. (1) Then you’ll become even angrier. An endless cycle emerges, and you spiral downward. The other problem with anger is that your brain is producing inflammatory proteins called cytokines. This also creates a shift in the blood flow from the neocortex (thinking centers) to the lower levels of the brain (survival) and you simply cannot think clearly. It is critical to get your brain back “on-line” before making major surgical decisions.

I know you have pain, but what exactly are you looking for? When I ask that question in the clinic, the most common answer I hear is “ I just want to get rid of the pain.” I’m sure you want this too, but even if the pain disappears, will the rest of your life just come together and be great? Being pain free is just one of the things you need to live a stress fee, happy, and healthy life. It turns out that if you work on some of these other things, like learning to deal with stress, the intensity of your pain becomes reduced. (2)

Bonnie

Around 1990, I had a patient in her mid-thirties who had suffered a lifting injury at work. She was seeking another surgical opinion. She had a moderate curvature of her lower back that she had been born with. The term for the disorder is congenital scoliosis. Although there is a slightly higher chance of low back pain with lumbar scoliosis, I felt strongly that she should not have surgery. I reminded her that patients with straight spines have the same type of pain after a lifting injury. She was also under a lot of personal stress and extremely angry. She had not fully participated in a conditioning program. I talked to her for over an hour about why she should not have an operation. She wanted to have seven levels of her spine fused. This included her whole lower back and her thoracic spine. She was determined to go ahead with the surgery. I was unwilling to do it, so she proceeded to have another surgeon fuse her whole lower back.

Didn’t work

She returned to me two years later in a wheelchair because of ongoing severe low back pain. Although the fusion had not completely healed, it was stable. She had yet another recommendation to have the weak spot in her fusion surgically repaired. The success rate of repairing the fusion is high. We are able to remove the hardware, re-graft the area, replace the hardware, and obtain a solid fusion most of the time. The chances of relieving her pain, however, were almost zero. Unless the weak area of the fusion is unstable, my feeling is that surgery is not necessary. Her pre-operative mental state had markedly deteriorated after two more years of pain. There was nothing that could be done to surgically relieve her suffering.

This situation occurred before I knew much about comprehensive rehabilitation and the importance of calming down the nervous system. Her main reason for returning to see me was to undergo yet another operation. She could not let go of the idea that surgery was the definitive solution. The tragedy is that her pain was so solvable without surgery. I don’t know her final outcome, as she never returned. She was even less open to non-surgical options.

This is a common scenario. A patient has ongoing chronic pain. They are justifiably angry about the whole situation. A surgeon offers them an option, which seems likes a way out a dark situation even though there is no data to support the procedure. (3) I don’t completely blame her since a surgery should have never been offered to her. But the option is hard not to pursue since surgery seems to be a “definitive solution.” With anger in full gear, no one thinks clearly. The downside of failed surgery is not fully comprehended. Then when a given surgery fails they pursue surgery again and again.

Her situation was one of the major reasons I quit my surgical practice. I could no longer watch people have their lives destroyed with surgeries that should not have been considered. The DOC Journey is a platform that presents proven medical treatments in a manner to optimize surgical outcomes or completely avoid surgery. My book, Do You Really Need Spine Surgery? Take Control with Surgeon’s Advice will clarify the issues around the surgical decision making. It is a much bigger deal than you can imagine and people just can’t comprehend the downside of a failed spine surgery. It has the potential to destroy your life as you know it.

Don’t let anger alter your decisions about surgery – or about anything. I have a little mantra that I keep in the forefront of my mind, “No action in a reaction.”

1. Giesecke T, et al. “Evidence of augmented central pain processing in idiopathic chronic low back pain.” Arthritis and Rheumatism (2004); 50: 613-623.
2. Schiavon, CC et al. Optimism and hope in chronic disease: A systematic review. Frontiers in psychology (2017); 7: 1-10.
3. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.

The post Anger Altering a Surgical Decision first appeared on Back in Control.

The post Anger Altering a Surgical Decision appeared first on Back in Control.