What I Wish More People Understood About Back Pain
I am an orthopedic spine surgeon who has been performing complex spine surgery since 1986. But from my very first year in practice, it was clear to me that many spine surgeries were being performed for vague reasons.
Spine surgery is only helpful if you can identify a specific anatomical problem that is creating symptoms. After all, back pain can arise from many different structures — including muscles, tendons, ligaments and discs. And yet there isn’t a test that can reliably identify the source in over 80% of cases.
Unfortunately, when surgery is performed without a clear focus, the results are poor. In fact, the success of a spine fusion for low back pain (LBP) is just about 25%.
From 1986 to 1994, I was one of those surgeons who performed these fusions — a procedure that creates a bridge of bone across the disc spaces and eliminates movement between the vertebrae. The idea is that by immobilizing the disc, you’ll get rid of the pain.
And yet not only is the success rate low, but there’s also a significant chance the spine will break down around the fusion.
In 1994, I officially quit performing fusions for LBP after a study of participants in Washington State’s workers’ compensation system found that the chances of returning to work after surgery was just 15% at the one-year follow up.
In plain terms: back surgery for unclear indications usually doesn’t work.
And not only is the cost of failed spine surgery expensive, but it also often creates horrific, needless suffering for those who undergo it.
Medicine is not only not solving chronic pain and disability — we are actively creating it.
Overall, I felt that too much spine surgery was being done without adequate non-operative care, and I began to collaborate with a physiatrist colleague.
As a rehabilitation doctor, his job is to maximize function regardless of the severity of a physical problem, and I quickly learned that there were many options to solve pain instead of surgery. He and I committed early on in our careers to do whatever we could to halt unnecessary procedures.
And yet, despite our best efforts over almost 30 years of demonstrating that there are viable alternatives to surgery, today there is not only more surgery being done with the same poor outcomes — the procedures have also become much bigger.
I used to perform one- and two-level fusions for LBP. Now, it’s common to have patients undergo six- and eight- level fusions that can carry a complication rate of over 80%.
What makes the situation more difficult to watch is that the effective solutions for chronic LBP are so simple.
First, it’s critical to understand that chronic pain is a complex neurological problem that’s permanently imbedded in your nervous system. Once you’re aware of what’s present, you can create new pathways around the old pathways and experience a dramatic decrease in symptoms.
I am now witnessing hundreds of patients become pain-free with strategies that consistently work, cost almost nothing and carry no risk.
Let me give you an example. Each summer, I hold a five-day workshop on chronic pain that’s based on structure, hope, forgiveness and play. The faculty includes Dr. Fred Luskin, a Stanford professor and author of “Forgive for Good,” and my wife, Babs Yohai, a movement expert.
Esty was a participant in our first workshop. She had been experiencing severe neck pain for four years. In spite of the pain, she was working at a high-level job but was deeply struggling. She had seen 10 physicians, had undergone six neck injections, and was on increasing doses of narcotics.
She was not in a good mood and was more than a little cynical about the workshop. But between the writing, simple relaxation tools, forgiveness and play, her pain disappeared by the third day. Almost two year later, she is continuing to thrive. It has been exciting to watch, and we all feel privileged to be a part of her healing.
However, medicine has become a huge industry. It’s focused on generating revenue from dispensing medications and performing procedures, and relatively speaking, physicians are not paid or encouraged to talk to patients. Instead, we are profiled by our contribution to the profit margin.
Ironically, the procedures we are encouraged to perform have little, if any, data to back them up. The end result is that you, as a patient, are in a precarious spot. Your physician doesn’t fully understand your circumstances, and you’re being offered ineffective procedures.
Currently, medicine is not only not solving chronic pain and disability — we are actively creating it. There is much more data supporting a focused, multi-pronged approach to solving pain than for performing procedures. The demand for change is going to have to come from you, and it needs to happen soon.