Stage 5 Posts – Decision-making

Objectives: Although there is no question about the dedication of physicians to providing excellent care, the rigors of training, the demands of practice, and the business of medicine have made it increasingly difficult to treat you – a person. A major factor is doctors are not allowed the time it … Read More

When I began my surgical practice in 1986, I was convinced that spine surgery was a definitive solution for pain, and I aggressively offered many patients surgery. I eventually learned much better ways to solve pain; usually without surgery. I never dreamed that even surgical patients could have their pain … Read More

George was a 78 year-old businessman who acted and looked about half his age. He was pleasant and talked freely about his LBP and pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe with standing and walking, … Read More

Objectives Chronic mental and physical pain are complex. Isolated interventions cannot and don’t work. Surgery is often considered a “definitive solution.” For chronic symptoms, it is not. It is simply one tool. Only two factors must be considered to make a decision regarding undergoing surgery – the anatomy and the … Read More

A person’s stress level has a marked effect on both your central and peripheral nervous systems. The central nervous system (CNS) consists of your brain and spinal cord. The peripheral nervous system (PNS) includes all other nervous system tissue—the nerves exiting your spinal cord, all sensory receptors, and sensory and … Read More

One middle-aged patient sought me out in Seattle from the East Coast for a second opinion regarding his neck. He had been disabled since 2001 with chronic pain over most of his body. He had at least 10 additional symptoms of burning, aching, stabbing, and tingling that would migrate throughout … Read More

Do You Really Need Spine Surgery? Take Control with Advice from a Surgeon considers all factors affecting your perception of pain and organizes them into a treatment grid that allows you to make a good decision regarding having spine surgery. Spine surgery is out of control. I am not against … Read More

About three years ago, my staff noticed that our surgical patients who participated in The DOC Journey principles were doing much better. The outcomes were more consistent, and we were seeing fewer failures. The postoperative pain was more easily controlled. Patients were moving forward quickly with rehab while re-entering a … Read More

I started my practice in Seattle in 1986.  I was feeling pretty beat up from my spine training. I felt well-trained and began to perform fusions for LBP with a zeal. It was what I was trained to do.  It quickly became clear that chronic low back pain was much … Read More

Objectives 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 … Read More

Jean was a 48 year-old woman who came to me from a neighboring state for a second opinion. She filled out an extensive spine pain questionnaire, which included many questions about her quality of life, in addition to a history and diagram of the pain. She was a healthy physically active … Read More

Any skill in life, mental or physical is first learned and then embedded in our brains with repetition. This is true for physical sensory input as well as mental. In both chronic mental and physical pain, the impulses are memorised in about 6-12 months. The circuits are embedded and permanent. … Read More

There is deep basic science and clinical research that documents effective treatments for chronic mental and physical disease. Most of it has not entered into clinical care and our burden of chronic disease continues to grow. In fact, much of what is being done is not only risky, based on … Read More

Preston Phillips, the spine surgeon shot this week in Tulsa, was a colleague of mine in Seattle. I did not know him well but interacted with him in conferences and some patient care. He was as well-intentioned a surgeon and nice person as I have worked with. It is easy … Read More

Please do not let this happen to you, your family, or friends. The downside of failed spine surgery can be catastrophic, and it is impossible for you, as a patient, to comprehend how bad it can be. Complications happen with every surgeon, including me. That is not the issue. The … Read More

I quit my surgical spine practice in 2019 because I was seeing so much surgery performed on normally aging spines. They were causing severe damage to people’s spines and destroying their lives. Frequently, the impact was catastrophic. At the same time, I was witnessing hundreds of patients having their pain … Read More

This letter was sent to me by a woman that I have corresponded with a few times but I have never met or worked with. One of most powerful aspects of the DOC process is that is simply a structure that presents well-established documented treatments. Once a person understands the … Read More

When the DOC project began to evolve in 1999 it was my feeling that if there was a structural problem that it first needed to be dealt with surgically and then we could move ahead with the rest of the protocols. I define a structural problem as one that can be identified … Read More

Mainstream medicine is frequently not offering you effective care. Many procedures performed for spinal problems have been documented to be ineffective. Much of the problem stems from the corporatization of medicine where the interventions that have been proven to be effective, such as ACT (acceptance commitment therapy) (1), mindfulness-based stress … Read More

I received this email from a physical therapist on the East Coast, who I’ve never met. He’d heard about my work on a podcast. Before you read this letter, I’d like to emphasize that research has documented for decades that arthritis, bone spurs, disc degeneration, disc bulges and herniations are … Read More

“Prehab” is refers to a patient engaging in a rehabilitation process before surgery. There are well-documented factors that affect pain and surgical outcomes. It’s important to implement treatments to address all of them prior to undergoing a procedure with significant risks. Chronic pain infiltrates every aspect of life. You have … Read More

Deciding whether to undergo spine surgery is one of the most important choices you will ever make. Currently, failed spine surgery is so common there is even a separate diagnosis for it – “Failed Back Surgery Syndrome.” You do not want to become one of these people, as it usually … Read More

A seventy-three-year-old woman—let’s call her Dorothy for the sake of this story—was understandably apprehensive. She had just been told that she needed an eight-level spine fusion from her tenth thoracic vertebra to her pelvis, so she came to me for a second opinion. Dorothy was a retired National Guard armed … Read More

Ernie presented to me a few years ago with severe back and leg pain. He had undergone two spine fusions for LBP about 10 years earlier that had not been helpful. His three lowest vertebra had been fused from L4 to the sacrum. Additionally, he now had severe leg pain … Read More

Mike is a local physical therapist who is a friend of mine. He has been interested in the DOC project and, like me, has struggled with severe chronic pain. I have been helping him work through different strategies to pull out of it and he is slowly coming out of … Read More

Patients and physicians are frequently making illogical decisions regarding spine surgery. I have watched this phenomenon steadily worsen for over 30 years. One of the core problems is that there is little accountability. You would expect your surgeon to do everything he or she could do to optimize your chances … Read More

When I published the first edition of my book, Back in Control: A Spine Surgeon’s Surgeon’s Roadmap Out of Chronic Pain in 2012, I was still of the mind set that if the correct pathology could be identified as the source of the pain, surgery was the best option and the sooner the better. Then … Read More

My surgical decision-making dramatically changed over the last five years of my practice. In spite of watching so many successes of people healing from chronic pain without surgery, I still had a surgical mindset and was always looking for a surgical lesion that I could “fix”. In the first edition … Read More

A friend of mine asked me for an opinion a couple of years ago about his back. I was giving him advice as a friend, not as a surgeon. He was having some pain and numbness down the side of his leg. It was down the distribution of his 5th … Read More

Roy Carey, a well respected spinal surgeon in Melbourne created this video highlighting the decision-making about undergoing spine surgery. It helped reduce the frequency of spinal surgery in Victoria, New Zealand.  

I discuss the cultural belief system about spine surgery and it’s impact on the treatment for chronic pain. It took me years to understand that performing fusions for LBP is based on unsubstantiated belief rather than hard data. I thought that surgery could always alleviate pain and felt I had an … Read More

I discuss the lack of awareness to the alternative approaches in the spine surgeon world and the treatment of chronic pain. We are both not being trained in the correct and effective approach, but also ignoring well-established data. (1)   Young AK, et al. “Assessment of presurgical psychological screening in … Read More

What percentage of success would you want from your potential surgery on your lower back before you decided to proceed with a major surgical intervention such as a back fusion or artificial disc? Most of my patients feel that they would like a greater than 75% chance of significantly decreasing … Read More

In order for a surgery to go right the first time, you need an idea of when spine surgery is appropriate and at what level of complexity.  There is not an operation that is effective for non-specific low back pain. For the most part then, spine surgery for lower back pain … Read More

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 … Read More