I am part of a documentary titled “Who is Luigi Mangione?” It will air this coming Monday evening, February 17th, at 8 pm ET on HBO Max.
Many of you have heard about the shooting of Brian Thompson, the CEO of United Healthcare. The shooter was Luigi Mangione, a 26-year-old with a promising future. Brian Thompson lost his life in his prime. Both situations are unspeakable tragedies.
My role was to explain spondylolisthesis and a spine fusion’s purpose. I do not delve into detail about his medical care, as I did not see him as a patient before the surgery. Surgery is sometimes indicated, but it must be part of an overall care plan for consistently successful outcome.
Compare his situation to that of a patient of mine, who was 27 years old when I first met him. He had been suffering from lower back pain (LBP) for over three years. Three surgeons at major medical centers recommended a one-level fusion to alleviate his pain. He had a stable spondylolisthesis at the same level, L5-S1, and only experienced back pain; surgery should never have been an option in his case. After three to six months of working through the healing concepts, his pain resolved, and he has had no limitations many years later. Here is a video of his story.
Prehab
Sometimes, a surgical fusion is necessary for severe instability or significant leg pain. However, for any elective spine surgery, the literature clearly outlines the treatments that should take place to optimize outcomes. Here is an example of the protocol I have used over the past 10 years in my practice. A considerable number of patients completely avoided surgery because their pain resolved. Those who did undergo surgery reported less postoperative pain, easier rehabilitation, and more consistent outcomes. The data also indicate that fewer than 10% of surgeons follow the recommended treatments before surgery.1 His surgeon may have worked diligently on his prehab, but only so much can be achieved, and surgery is not always successful.
He also read my book, Back in Control. Reading a book alone won’t solve chronic mental or physical pain. It requires learning skills to calm and reroute your nervous system, which happens over months with repetition. Perhaps he did that as well.
An aspect of prehab is not simply checking off boxes. My criteria included achieving restful sleep, addressing anxiety and anger to some extent, and resolving back pain. Medications need to be stabilized. Perhaps he also had these measures in place.
Don’t undergo surgery without addressing the chronic pain component
Even with optimized rehab, some people can’t escape pain. However, operating with ongoing chronic pain can exacerbate it 20-60% of the time.2 Either way, the pain cycle must be broken, or elective surgery is usually a poor choice. I can’t begin to tell you how most of my patients view surgery as a final solution. It is not. My message today is that surgery is rarely a definitive solution for chronic pain. It can be part of an overall treatment plan, but it is not consistently effective when done in isolation.
Watching people’s lives devastated by unnecessary surgery or suboptimal conditions ultimately led me to leave my practice and advocate for healing principles in the public sphere.
The data on what to do to optimize your outcome, with or without surgery, is right in front of us. Let’s implement what we know. Too many people are suffering – badly.
References
- Young AK, et al. “Assessment of presurgical psychological screening in patients undergoing spine surgery.” Journal Spinal Disorders Tech (2014); 27: 76-79.
- Perkins FM and Henrik Kehlet. Chronic Pain as an Outcome of Surgery. Anesthesiology (2000); 93: 1123-1133