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 I become aware of the data that showed that operating in the presence of pre-existing chronic pain in any part of the body was more than a bad idea, it was a terrible idea unless it was an emergency. New or increased pain can occur as a complication of any surgery 5-10% of the time if the factors that address chronic pain are not addressed before surgery. (1) For those of you already suffering from chronic pain, this is a terrible statistic, because it will follow you the rest of your life. If I had a neurological complication rate of 5-10%, I not only would not have stayed in business as a surgeon, I would have quit. New or worsening pain after surgery is seldom discussed as a complication. It is also unpredictable when it might happen.
After attempting many different approaches that failed, our team finally dug in our heels and wouldn’t consider elective surgery unless a patient would take responsibility for learning about pain and taking charge of his or her own care using a DOC-type structured approach. We wanted them to be engaged for at least eight weeks and preferably longer. My goal was to optimize the outcomes and avoid creating chronic pain. My surgical outcomes were better and my practice became more enjoyable and rewarding. What I didn’t expect was that dozens of patients with surgical problems began to cancel their scheduled operation because the pain had disappeared, even in the presence of bone spurs pinching nerves and causing severe sciatica. Here is one of those stories. This occurred about seven years ago. He still intermittently emails me and he never required surgery.
A pinched 5th lumbar nerve?
One afternoon, I received an anxious phone call from Jack, a 65 y/o retired businessman, asking me if I could see him urgently. His leg pain, which began two months earlier, was quite severe. As his pain pattern was so classic for a pattern for the 5th lumbar nerve root (L5), and he was traveling, I put him on the surgical schedule. His MRI scan showed several bone spurs next to the L5 nerve, but none that were new. Although surgery was an option, I was a little uncomfortable, and wanted to give him a little time to calm down his nervous system. Much to my surprise, his pain quickly disappeared and I cancelled his surgery.
He experienced a second major flare-up about four months later. We both agreed that this time we would just get the problem definitively solved with surgery, and I put him back on the surgical schedule. By the time he saw me a week later for his pre-operative appointment, his pain again disappeared. This time we both felt that flared up pain circuits were were the cause. He wrote up his story, and we wanted to share it with you.
Jack’s story
When severe sciatic pain left me almost disabled 9 months ago, I knew it was time for back surgery…but the surgeon suggested I investigate an alternative to surgery; that my pain could be caused by a stressed nervous system. I was skeptical, but my research/practice of techniques eliminated my chronic pain…I am pain-free now. Details follow.
POSTPONE YOUR BACK SURGERY!
Yes, that’s correct…I’m humbly suggesting that you delay or postpone your back surgery until you’ve tried this alternative. I am grateful every day that I postponed my surgery…”dodged a bullet” as I think of it! Of course, I’m NOT a medical expert and I can’t adequately explain what happened to me; and your results may vary. But read my story, and see if you can benefit from this alternative to surgery.
Spontaneous onset
Here’s the background: I’m a 65+ male, and have enjoyed excellent health my entire life; have jogged 3x per week since 1966 when Cooper first wrote Aerobics. About 18 months ago, I began noticing some mild sciatic pain…so I tried stretching…didn’t help. The pain level slowly increased, so my next “solution” was deep-tissue massage…maybe helped a little, but soon I was taking Tramadol, a mid-level pain reliever. Helped, but didn’t “fix” the problem. You know what comes next; right, I began Oxycodone. So in about 6 months, I had gone from healthy to being almost completely incapacitated with sciatic pain in my right leg. I could no longer jog. I realized it was time to consider back surgery!
Wait a minute
My primary care physician ccv referred me to Dr. David Hanscom, I now realized that the sciatic pain was caused by something seriously wrong with my lower back (a pinched or impinged nerve was my guess), and it seemed like surgery was necessary. By the time of the appointment, walking even with “help” from Oxycodone was painful. Dr. Hanscom and his team reviewed the imaging they had ordered (MRI and myelogram) and informed me that, yes, I had a “complicated” back! (Scoliosis, stenosis, pars defects, thin disks between the lower vertebrae, bone spurs, severe age degeneration). The surgery to correct this would be an L5-S1 fusion. But Dr. Hanscom also explained that none of these defects looked quite severe enough to be the convincing cause of my pain. So, while he would do the surgery if I insisted, he suggested I first look into other sources of my chronic pain. He gave me a copy of a book he wrote, Back in Control, and the link to his website, www.backincontrol.com.
I began reading the book when I returned to the hotel, and finished it that same evening! What a revelation! Chronic pain can be caused by mental stresses? Of course I was skeptical…I KNEW my pain couldn’t be caused by stress; I was retired, so what did I have to stress about? As the book explained, excessive stress and the chronic pain that results, are often not caused by external forces, but by internally generated issues. Could my sciatic pain be explained this way? It appears that this was the case.
Pain free
Over the following weeks, and now months (8 months since my initial appointment with Dr. Hanscom), I’ve read and tried to follow the therapies prescribed by several additional books that have helped understand the cause of my pain…and the pain has been in total remission for about two months now. I’m even jogging again! Of course, there have been ebbs and flows of increased and decreased pain, but the trend is definitely decreasing. (I’m keeping a “pain journal” where I record a daily pain level, and activities that might impact the pain.)
Resources
Here are the other books I’ve found valuable:
1) Unlearn Your Pain, by Howard Schubiner, MD
2) Forgive For Good, by Fred Luskin, PhD
3) The Hoffman Process, by Tim Laurence
4) Healing Back Pain, by John Sarno, MD
5) The Mindfulness Solution to Pain by Dr. Jackie Gardner-Nix
My hope is that this short history of my struggles with chronic pain will motivate potential back surgery patients to at least consider a self-directed structured approach as an alternative to surgery.
Jack
P.S. Why am I opposed to back/spine surgery? As I understand it (a “civilian”, NOT a medical professional!) the complexity of the spinal area, the bone, muscle, and nerves, makes the outcome of spine surgery “iffy”. For many patients, the first surgery is “1 of __”. In my case, I thought that simply decompressing the spur impinging the L5 nerve was the easy answer. But Dr. Hanscom explained that such a “simple” surgery could cause instability in other portions of the spine.
My initial position was,” I’m in pain, YOU fix it!”—a passive approach. The effective concept is that I CAN FIX THIS MYSELF!
Modern neuroscience
We now know that although “stress” is linked to pain, the more accurate description would be that any mental or physical threat simulates the body to secrete hormones that increase your chances of survival and your whole body goes into a hyper-vigilant state. It is a necessary survival response. When these levels of stress chemical sustained, they wreak havoc with your body. There are many illnesses, symptoms and diseases that result, including early death. One of the effects is markedly increasing the speed of nerve conduction, so you will feel more pain. (2) As you learn the techniques to regulate your body’s chemistry, many symptoms resolve, including pain – even in the presence of “surgical” lesions.
Making your final decision about spine surgery will be outlined in my book, Do Really Need Spine Surgery? Take Control with Advice from a Surgeon. All the factors affecting your choice are organized around a “Treatment Grid” to help you heal, with or without surgery. Make the correct choice.
- Perkins, FM and H Kehlet. Chronic pain as an outcome of surgery. Anesthesiology (2000); 93: 1123-1133.
- Chen X, et al. Stress enhances muscle nociceptor activity in the rat. Neuroscience (2011); 185: 166-173.