• 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.

She had undergone a major low back surgery and came to me with unrelenting pain in her left leg. As I re-worked her up, I realized that there was still a lot of nerve compression left from the prior surgery. Fortunately, after re-doing her surgery, her pain disappeared, but she was not moving forward like I had anticipated. She was extraordinarily pleasant and had a “life of the party” personality. I could not figure out what might be holding her back. Our conversations began to center around anger and she really felt that she was not angry. However, every time I mentioned her prior surgeon’s name she would become quite agitated.  One day she brought in the following letter from the surgeon.

The Letter

Dear Ms. “_____,”

I must advise you that you are beginning to wear your welcome thin.

I am fully aware of the stress that having major surgery will put one under. I also realize that individuals that do not feel well are not always at their best in terms of interpersonal relationships. However, you have been substantially difficult to care for thus far since your surgery last week, have stayed in the hospital substantially longer than other patients your age with similar problems, and have complained very steadily about the inadequacy of pain medication despite doses that are far in excess of what I usually administer.

I attempted to explain all of this in a very lengthy conversation. I advised you that I know that your pain tolerance was low, and that you would therefore not likely be able to gain the degree of relief that one would typically associate with narcotic medication. Having said that, I increased your doses yet again.

It would seem self-evident that a person who has had such difficulty with pain management would therefore make certain that the first thing accomplished after discharge was obtaining the prescriptions that I wrote for you. Yet tonight at almost 9:00 pm, I received a call from the answering service stating that you had a problem filling your medications.

Any additional nonsensical or adolescent behavior will be greeted with discharge from my care. Make no mistake about it, I have fired patients before, and you are not immune. By copy of this letter, I am notifying worker’s comp that thus far I have had difficulty getting you to follow simple instructions. Please make a better effort to be as good a patient to me as I am trying to be physician to you.

Sincerely,

Dr. “X”

I get it. In addition to being frustrated about her employer being negligent in causing her injury, she then had a surgery that did not go as well as planned. Then her surgeon scolded her when she was seeking relief from the pain that should have been relieved with the surgery.

I am sympathetic to her plight. But life rarely is easy. Surgeries fail. You are not always treated the way you deserve. No matter how legitimate your anger, it will still take you down into the depths of the abyss. You still have to let it go – completely.

In Forgive for Good, Dr.  Fred Luskin out of Stanford, reported on his work with the parents of children who had been brutally murdered.  Until those parents could forgive the murderer, their quality of life was done.

I had another three visits with her.  Each conversation was remarkably pleasant.  However, she never acknowledged that she might be angry.  She was just “right.”  I don’t know the final outcome of her situation, as she never followed up with me.

BF

The post “I Understand Your Anger. Get Over It.” first appeared on Back in Control.

The post “I Understand Your Anger. Get Over It.” 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.