The story usually goes something like this: “I felt a little twinge in my back yesterday while I was lifting something. I didn’t think much of it at the time…but when I woke up this morning, I couldn’t even move!” That story illustrates one of the great misunderstandings of low back pain…and it actually means good news for you.
Although it may be hard to believe when you’re laid out in excruciating pain… it’s important to realize that the severity of low back pain does not correlate with the seriousness of the problem. Even a minor injury (like a little pinch or tear in an intervertebral disc, ligament, tendon, or joint membrane) can kick off a severe back pain episode. And when imaging like x-rays or MRIs are done on a patient in pain, they often reveal abnormalities like disc bulges or degeneration, which are then immediately assumed to be the source of the pain. But similar to the way that severity does not reflect seriousness, the findings on those imaging studies do not correlate well with the patient’s experience. In other words, people with terrible pain can have MRIs that look fine, and people who feel fine can have MRIs that look terrible.
And that’s what leads to the tragedy of unnecessary spine surgery. Take it from the story of a spine surgeon in this eye-opening article by my UpWellness team. I hope it helps you.
-Dr. Josh
Over 500,000 Americans have spinal fusions yearly, and the number one reason is chronic pain. According to the Agency for Healthcare Research and Quality (AHRQ), we spend more than $11 billion each year on operations to relieve back pain. The million-dollar question is, “How’s that working out so far?”
The horrible, never-ending pain that interferes with quality of life and drives so many to desperate measures to be free of it. However, the truth is, there is no way to know whether or not a back surgery is going to work for you. Your chances of success are about as good as a flip of the coin. This alone should make anyone think twice before going under the knife.
What you might not know about back surgery
Despite what you might have been told, there is no guarantee that back surgery will leave you mobile and pain-free. In fact, there is a chance that it will worsen your condition. Studies that have followed back surgery patients for some time are not overly encouraging, to say the least. Sadly, the rates of back surgery continue to rise. But why?
Dr. David Hanscom is a Board Certified orthopedic spine surgeon who has been practicing for over thirty years. He mainly performs very complex reconstructive spine operations at Swedish Hospital in Seattle. He has expertise in both adult and children’s spinal deformities, including scoliosis and kyphosis.
What sets Dr. Hanscom apart from the many surgeons is that he does not want to operate unless it is absolutely necessary. He does not perform surgery on anyone for back pain but chooses to work only with patients who have spinal deformities.
There was a time when Dr. Hanson did operate for back pain
At one point in his career, Dr. Hanscom did operate for back pain and didn’t feel too good about it because his patients never seemed to do very well afterward. He claims to have done many, many back fusions because he thought this was what he was supposed to do.
Dr. Hanscom gained a new perspective on fusion for back pain when in 1993 when Dr. Gary Franklin in Washington published a paper showing the staggering results of return-to-work rate after fusion. It was bad. This data convinced Hanson to stop doing fusions for back pain. At about this same time a lot of his fusion patients began breaking down above and below their fusions, which required further surgery
What is a lumbar fusion?
According to Dr. Hanscom, the theory, when he was doing fusion for back pain, was that the disc itself, the space between the vertebrae, was the source of the pain. Basically, a fusion takes vertebrae and turns it into a solid piece of bone. Screws and plates are used to hold everything together until the fusion is healed. If the fusion doesn’t heal, the hardware used will loosen or break. A fusion is dependent on creating a solid bridge of bone between two vertebrae. The thought is – eliminate the motion, get rid of the disc movement, and the pain “should” be gone. Not so, says Hanscom, fusions are very hard on the body and often don’t address the root of the pain. Here’s what he has to say,
“Once you’ve done a fusion, you’ve actually surgically assaulted the spine and the spine is stiff. It has scar tissue. The spine will often breakdown above and below the fusion and I’ve had people, we had one lady we operated on last week, that started out with a normal spine about seven years ago. She has had 10 operations. She is now fused from her neck to her pelvis. And she started breaking down, breaking down and we just spent 15 hours last week trying to get her spine straight again. She lost 15 units of blood. Society has probably spent over $3 million on her care. And she’s a train wreck. She’s not going to do well no matter what we do.”
Dr. Hanscom sees one in three patients in his office daily that have essentially healthy spines for their age, and have had either significant fusions done or recommended for back pain. There is no pathology there to operate on.
The truth about back pain
The reality is that there is often no clear indication of what causes back pain. In fact, it has been documented in the literature that disc degeneration is not at the root of back pain. If you took a sample of 100 people off the street with normal spines, many would have back pain. If you took a sample of people who have degenerated discs, arthritis, and bone spurs, some have back pain that is not any worse than the general population, and many don’t have any back pain. So, you see, it is quite a mystery, and the disc is not at the heart of the matter most of the time.
Long-term follow-up studies show that people with disc degeneration are at no greater risk of developing pain than those without degeneration. Therefore – it seems that we can safely say that disc degeneration does not cause pain. However, according to Hanscom, the medical and surgical community does not seem to support this evidence-backed truth and continue to perform hundreds of thousands of fusions for back pain.
Physicians are ignoring clinical guidelines related to chronic pain
A published paper shows that doctors are ignoring clinical guidelines relative to chronic pain. There is also data showing that some alternative therapies are more effective in dealing with back pain than traditional medicine. Common alternative therapies for back pain include acupuncture, chiropractic care, diet, movement, posture correcting, stress management, physical therapy, CBD oil, and proper footwear.
Why are so many fusions being done if the data does not support their success?
Dr. Hanscom reports that, of course, it is about money and production, but it is also happening for several other reasons that might not be so obvious. Patients can actually demand surgery – especially those who have been in pain for some time. Even patients that Dr. Hanscom sees still demand treatment after he carefully explains that the success rate will be about 25%, and there is nothing to operate on.
The combination of patients demanding surgery, doctors performing it because they get paid well, and the hospital system demanding production, which means more procedures means it can get messy for sure. A lot of highly unnecessary procedures are performed on patients who might have responded better to other non-surgical alternatives. Interestingly enough, many patients want something done to them rather than taking responsibility to do something about their pain like physical therapy etc. Part of this is our culture – we have been trained to think that when something is done to us, it will result in a good ending – clearly this is not the case with back fusions done for chronic pain.
Another important fact to note here is that most conventional doctors receive little to no training on how to handle chronic pain while in school. They are trained in one way and one way only, and when they graduate, this is how they conduct themselves. More training on chronic pain and alternatives in school would cause a significant amount of change in how chronic pain, in general, is approached in conventional medicine.
Emotional pain vs. physical pain
Pain has two drivers, a sensory and an emotional driver. A group of volunteers who had back pain for less than three months were scanned, and a part of the brain that corresponds for back pain lit up. Another group of patients who had back pain for more than ten years were also scanned using a functional MRI test. With these patients, the emotional center in the brain lit up.
Both the emotional center and the pain center are hooked to the same pain generator – without a scan, it is impossible to know which one is lit up. If surgery is performed for back pain, but the emotional part of the brain is turned on – the surgery is no way going to work. Interestingly enough, half of the acute pain patients turned into chronic pain patients. When these patients were scanned every three months, the pain center had switched completely over to the emotional center by month 12
What we know to be true
Degenerated discs do not always cause back pain – the proof is in the millions of people who have evidence of disc degeneration on MRI but have absolutely no pain. Anxiety and depression are predictors of negative outcomes. Thousands of research papers document that if you are anxious or depressed or both, the chance of surgical success is severely compromised.
Additionally, research shows similarly that for hip and knee arthritis – the severity of the arthritis is not relative to the pain. Many people with bone-on-bone arthritis have little pain, while people with very little arthritis have severe pain. This is actually relative to the degree of stress the patient is under.
Dr. Hanscom’s approach to back pain
In his clinic, pain patients are put through a six to 12- week course. They work on sleep, which helps calm the nerves, and they also do some simple writing exercises to diminish stress and anxiety and improve emotional health. The success rate has been good, with anxiety being decreased by at least 50 percent. According to Dr. Hanscom, calming the nervous system raises the pain threshold even with major structural problems, which do respond well to surgery – pain seems to go away, and there is no need for surgery.
To learn more about Dr. Hanscom’s approach to pain and emotional healing, visit his website here. If you are on the fence about whether or not to have spine surgery, take some time to review your options, gather all the resources, understand the magnitude of surgery, understand your options and always, always, make informed decisions about your health.
Ask yourself this one, very important question…Is there another way?
-The UpWellness Team
