Back Surgery often fails
In my reading of online health news, I came across this article from the Washington AP. The first line of the article was "Why did they cut you?"
Dr. Hauser often asks this question of our patients when they come to see him having already received back surgery, albeit unsuccessfully. Obviously, the reason the patient is coming to Caring Medical is because he/she continues to have pain.
 Dr. Hauser discusses a case with Havil, Medical Assistant.
In this article, a spine surgeon was asked this question by a patient who was still in severe pain after an earlier back operation. This patient was confused and didn't know what to believe because two additional surgeons had suggested even more surgery. Unfortunately, as we discuss in our back study published in the Journal of Prolotherapy these types of surgery are ever-increasing. Each year, 65,000 patients are permanently disabled by conditions associated with back pain and 80% of the U.S. population is estimated to suffer from back pain at some point in their lives.
This AP article states that by one recent estimate, Americans are spending $86 billion per year in care for back pain - and this includes things like MRIs, pain pills, nerve blocks, and acupuncture. Interestingly enough, that research found little evidence that they improved even as these costs have been soaring over the last 10 years. We find, and this article concurs, that time often is the best cure. Most people will experience back pain at some point in their lives, but up to 90% will heal on their own within weeks.
The article goes on to say that for run-of-the-mill cases, doctors aren't even supposed to do an x-ray or MRI unless the pain lingers for a month to six weeks.
We find the exact same thing to be true in our patient population. Unfortunately, medicine has gotten so that we do not physically touch our patients, let alone talk to them, but are very quick to whip out the prescription pad to write for an x-ray or MRI. Most of these tests do not reveal the problem, as we have written about in many of our other articles. Click here to listen to Dr. Hauser discuss why he is not a fan of MRIs and x-rays.
Yet this study states that a study last year found nearly 33% of Medicare patients who complain of back pain get some kind of back scan within that first month.
We have been writing about over ordering of tests for years in our newsletters. Why is this a problem? This article states, "Those scans can be misleading. By middle age, most people who don't even have pain nonetheless have degeneration of their disks, those doughnut-looking shock absorbers between vertebrae. So in someone who does have pain, pinpointing that a particular black spot or bulge on a scan is the true cause is tricky."
AMEN to that! MRIs do not tell you the cause of your back pain - YOU do!
There is some consensus in the medical community on how to treat acute low back pain, but treatment of chronic pain presents many challenges and little agreement on standard of care. Nonsteroidal anti-inflammatory drugs and antidepressants provide some short-term benefit, but no published data warrant their long-term use. Manipulative therapy, physiotherapy, and massage therapy studies have also shown only temporary benefit. Long-term results on more invasive therapies, such as intradiscal electrothermal therapy (IDET) or surgery have been poor. This stems from the fact that too much emphasis has been placed on pain arising from the intervertebral discs and not enough on chronic low back pain originating from the sacroiliac joint and ligaments. Because of the limited response to traditional therapies, many people have looked to other approaches for pain control.
Prolotherapy, also known as regenerative injection therapy, is a nonsurgical injection therapy used to treat unresolved musculoskeletal pain and has shown some promise in relieving lower back pain. The procedure involves injecting soft connective tissue with one or more proliferants designed to provoke local inflammation, stimulating the body’s production of collagen at the injection site. The resulting growth of new ligament and tendon tissue is believed to alleviate pain.Prolotherapy has a long standing history of use with tendinopathies and ligament sprains in peripheral joints. Treatment of degenerative joint and spinal disease, including chronic low back pain arising from the sacroiliac joints, has also been reported with Prolotherapy.
The AP article then goes on to discuss the benefits of exercise on back pain. "Exercise is medicine, but it has to be the right exercise," said Dave Carpenter, president of Physicians Neck & Back Clinics in Minneapolis, where this back pain patient finally turned. The clinic's rehabilitation program focuses on strengthening muscles that support the spine, and published a study showing that only three of 38 patients prescribed surgery still needed it in the 13 months after completing tailored rehab.
The patient in this article was able to get back to doing all of his normal activities once he started the proper exercise program. He wishes he never had surgery to begin with because it did not address the problem. We find that when exercise or physical therapy fails, then this is the time for Prolotherapy because the issue in undoubtedly a ligament/tendon problem. Exercise can strengthen muscles, but not ligaments. The only treatment we know that can do that is Prolotherapy.
This article was really pretty good in some respects, however, they are missing the boat on available cures such as Prolotherapy.
Here is their summary and our comments in italics:
"-Don't expect an X-ray, MRI or CT until a month to six weeks has passed, unless the doctor suspects a more serious problem. Following that guideline is becoming a quality-of-care measure in many organizations." We concur. Get an MRI if you want surgery.
-Get back to normal activity as quickly as possible; the days of prescribed bed rest are over. We definitely concur - and use heat.
-Patients with sciatica, pain radiating down the leg, have the best outcomes from those nerve-easing decompression surgeries, Deyo stressed. California's Rosen said three criteria determine chances of success: a scan that correlates with the pain site; the patient has some weakness; and specific pain occurs when the doctor raises and straightens the legs. We use Prolotherapy in these situations, not surgery.
Herniated disks heal on their own over about two years, but surgery for a faster fix is reasonable in good candidates, he said. we also use Prolotherapy in these situations, very successfully.
-Fusions are appropriate for far fewer patients, those with fractures, unstable or slipping spines, curvature of the spine and rare other reasons, Rosen said. Agreed.
-Deyo recently studied surgeries for stenosis, that painful narrowing, and found decompression surgery as effective and less risky than fusions, which are more complicated and costly.
-A formal exercise program is especially effective if coupled with cognitive behavioral therapy that teaches patients to manage and function with pain, Deyo said.
-What if surgery fails? Usually, it was the wrong operation or the wrong candidate, said Rosen, who sees one or two patients a week classified as having "failed back syndrome" because of multiple failed surgeries. Agreed - but most likely the patient needs Prolotherapy.
Always get a second opinion. Rosen, who founded the Association for Medical Ethics, also recommends asking about a doctor's ties to companies that make spine-surgery products. That way you'll feel assured that a recommendation to cut doesn't come from a too-cozy relationship. AMEN
-Not a good candidate? A primary care physician can be a neutral adviser in helping navigate next steps. Patients with more challenging back problems may fare better at a multidisciplinary spine center with numerous specialists - in rehab and pain management - under one roof." Seek out an experienced Prolotherapy physician.
To read the full AP article, click here. If you would like to talk to us about your back pain or any painful condition, please email Dr. Hauser at drhauser@caringmedical.com or comment on this blog. We'd love to hear from you. To read our back pain study published in the Journal of Prolotherapy, click here.
Leave a Comment
Recent Blog Articles:
Complete Blog List
|
