I’m sharing a story submitted through my website about an unsuccessful spine surgery, which is, sadly, all too common. This issue even has a name: “failed back surgery syndrome” (FBSS). Most of these surgeries start with operating on normally aging spines that don’t actually cause pain. The data shows this clearly, yet the trend toward more aggressive spine surgeries continues to grow.
His story
I had two major falls when I was in my 30s. I was always active and exercised regularly. One of my falls happened when I was on a high deck and was thrown off it, hitting the ground. Another fall happened after I interviewed for a job at Eli Lilly. I was wearing new shoes, and my dad had just had a heart attack. I was taking my 5-year-old son to my former mother-in-law’s house so I could go to the hospital after spending most of the day at Lilly for interviews. I met with five different people that day, and it had to be before Christmas. I slipped on her porch and was in so much pain. I HAD to get to the hospital, and I did. My dad died the day after Christmas.
In two weeks, I found out I got the job at Lilly. That was the best news ever. I worked there for 28 years. While I was there, I received on-site physical therapy. Sometimes it helped a little, but there was never a time when I felt much better! In 2018, I had a “simple” surgery—a lumbar laminectomy. I was so sure it would change everything, but it didn’t. I got three different opinions—each one different! One doctor said he would not recommend the surgery. But the ortho surgeon I saw (not a neurosurgeon) said it usually has a 90% success rate. It was not successful for me. I was in so much pain. I do not handle meds well. Many times, I feel worse taking the meds.
After the surgery, they gave me Gabapentin. My mouth drooped to the right, and I had to lift it back up. I knew from working at Lilly that Cymbalta wasn’t really a good option. That was the doctor’s first choice for me, but I told him I wouldn’t take it.
People say, “Well, you look ok.” I just want to smack them. There is no one who understands the pain I am in most days. I don’t go out very often because I hurt so much. None of my friends really understand. I wouldn’t wish this on anyone. I try to stay positive, but it’s hard. I make handmade greeting cards. I have a son who is 46. He is my only child. He’s a blessing.
My perspective
It is essential to calm the nervous system before any procedure, even simple ones. Performing procedures with untreated chronic pain anywhere in the body increases the risk of worsening pain by 40-60%, which can last up to a year. About 10% of the time, this pain becomes permanent.1 If I had a neurological complication rate this high, I would have lost my surgical privileges. One could argue that living with chronic pain for a lifetime is an even worse complication.
This data is well documented but not widely known. I was never taught about this issue during my practice, and I was puzzled when a carefully performed operation for a straightforward problem did not relieve pain and often made it worse. Well before I knew anything about the neurochemical nature of chronic pain, I would not electively operate on anyone who was under a lot of situational stress. I did not have a particular treatment protocol, but I waited at least three months before performing surgery. My first hint that there was more to chronic pain than I was taught, was that a number of patients experienced resolution of their pain, and cancelled surgery. Close family stresses are particularly impactful, and his father died shortly after his fall. His surgery was done much later, but the pain and trauma were closely connected.2 It is well-known in the neuroscience world that “neurons that fire together, wire together.”
The second point is that chronic pain, whether mental or physical, is a neurochemical state. Over six to twelve months, your nervous system memorizes the pain, regardless of the original cause. The surgery was done in the back, but the pain is remembered in the brain. It is like operating on phantom limb pain, except in that scenario, there is no limb to operate on.3
Thirdly, when you feel trapped, your whole body goes on high alert, increasing your discomfort. More stress; more pain. More pain; more stress. It is a terrible cycle. Your body goes into fight or flight mode, which increases nerve conduction speed, inflames the brain (microglial cells), and amplifies the pain.
Fourth, I don’t know why he underwent the laminectomy. If it was for low back pain, it doesn’t work. A laminectomy relieves pressure on nerves that cause leg pain, but it won’t relieve back pain. A back fusion, which he did not have, causes bigger problems. Not only is it ineffective in relieving back pain, but it also creates abnormal spine mechanics, and the levels above and below the fusion break down. Then as more fusions are done, the stresses increase, there is a cascade of events, and the fusions become longer. It was common in my practice to see patients undergo over ten failed surgeries. I had two patients with 29 spine surgeries over 20 years. Neither of them needed the first surgery.
Fifth, repeatedly dashing hope causes depression, and the medical profession is rife with offering procedures that have been proven to be ineffective. The success rate for a fusion for chronic LBP is less than 30%.3 What has been shown is that lack of sleep INDUCES chronic low back pain.4 Additionally, it is more challenging to help people who have undergone failed procedures. They are legitimately angry, which is an inflammatory state. You cannot just think your way out of it. It is necessary to learn skills to calm and reroute the nervous system. The tipping point is ALWAYS centered around processing anger. The anger at the surgeon who promised them relief is intense. They are correct, but they are the ones who will continue to suffer.
Finally, he referred to people saying, “You look fine.” The medical term for this scenario is “MUS” (medically unexplained symptoms). What the doctor is really saying is that “I know you hurt, but I don’t understand why. We’ll do the best we can.” It is a disastrous term because the patient is also hearing that there is no endpoint to their suffering. Hope is taken away, and the already bottomless abyss feels permanent. This term is categorically wrong. If you understand the effects of sustained fight-or-flight chemistry on your body, all the symptoms are clearly explained. A better term is MES (medically explained symptoms).
His pain is still solvable
I don’t know this gentleman, and I hope he reaches out. It doesn’t matter why the original pain occurred or how long he has had it. His pain can improve or resolve with a self-directed, multi-pronged approach. I was an end-of-line surgeon, and although I occasionally had to perform further surgery, the healing I regularly witnessed occurred by the body healing itself when bathed in safety physiology. Most of my patients had multiple symptoms, and often all of them resolved as they learned skills to regulate their physiology. I personally had 17 physical and mental symptoms that have been gone for over 20 years. You can reprogram your brain around almost any pain, and I have seen it happen hundreds of times.
My course, The DOC Journey, has evolved as I have gained a better understanding of the physiology of chronic illness. The healing process requires only 10-20 minutes a day, and no more. It involves repetition to learn and internalize new ways of processing stress and calming down. The focus is on skill development, not pain. Usually, changes occur over three to six months.
I have also learned that mental pain comes from similar mechanisms as physical pain, but it is less tolerable. Ruminating thoughts reflect your fight-or-flight response, and they subside as you create safety physiology. Some additional steps are outlined in my new book, Calm Your Body, Heal Your Mind: Transcend Pain, Anxiety, Anger, and Repetitive Unwanted Thoughts. It presents a new approach for managing bothersome thoughts, and I am eager to see people heal as I continue to learn how to help more effectively.
I quit my surgical practice to better learn how to help others help themselves. I don’t like unnecessary suffering, especially when it is inflicted by the medical profession.
References
- Perkins FM and Henrik Kehlet. “Chronic Pain as an Outcome of Surgery.” Anesthesiology (2000); 93: 1123-1133.
- Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014); 32:129-139.
- Hashmi, JA, et al. “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.” Brain (2013); 136: 2751–2768
- Franklin GM, et al. Outcome of lumbar fusion in Washington State Workers’ Compensation. Spine (1994); 19:1897–903.
- Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.