Arm the Worker

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Fixing the problems with the worker’s comp system is critical.  However, the system is unwieldy and we are not going to change it anytime soon.  We know extremely well what needs to happen to enable a worker to move smoothly through the system.  One of my physiatrist colleagues felt so … Read More

It Really is Upside Down

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I have a patient who is a muscular 43 y/o welder. He injured his back on the job about four years ago.  After undergoing a laminectomy for low back pain, his pain actually increased.  When I first saw him a couple of years ago, his complaint was unrelenting low back … Read More

“I Want to Believe”

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Florence, Italy My wife lived in Florence, Italy from 1983 to 1990.  She is fluent in Italian and some of her best friends live in Italy.  We go back every year to spend time with our friends and enjoy the Italian culture.  In 2009, I took three weeks off to … Read More

The Catastrophe Index

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The danger of falling into the “abyss” is that it makes chronic pain patients more vulnerable to the suggestion of surgery, which is often unnecessary.  Along with the possibility of surgery comes the risk of catastrophe. Here are a few examples. The cases of these patients are not unusual. A … Read More

Your Doctor Might Not be Listening

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Doctors are trained to “fix” Chronic pain patients often feel a lack of compassion from the health care community. Physicians, as a group, tend not to take time to listen to patients. Our training emphasizes taking action – in the form of prescribing treatments – instead of listening. Medical school … Read More

Surgical Results Overly Optimistic

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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

Indications for Surgery

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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

Worsening Prognosis with Time Off of Work

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It is well documented in several studies that the chance of ever returning to work dramatically decreases the longer a person is off from work.  Dr. Gordon Waddell showed in the 1980’s that if a worker is off from work for a year, the chance of ever returning to work is … Read More

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