A Nation in Pain by Foreman Judy

Author:Foreman, Judy
Language: eng
Format: epub, mobi, pdf
Publisher: Oxford University Press, USA
Published: 2014-01-19T16:00:00+00:00

SURGERY—DON’T LEAP!

Okay, then. What about surgery? There’s no question that back surgery is still more popular than it should be, in part because patients in chronic pain are so desperate but also, as one back surgeon privately confessed to me, because of the surgical mindset: “I am a surgeon. I have a hammer. Therefore you are a nail.” Not to mention, of course, that back surgery is a veritable gold mine, with surgeons getting paid boatloads of money to operate. Some estimates say the average cost of such surgery is $70,000 per patient.82 Indeed, in recent years, there have been billions of dollars spent worldwide on surgery for low back pain and thousands of research articles, as Stanford University researchers discovered when they combed through the literature.83

Every cool new surgical device or fancy gizmo seems to spur new twists on old techniques for eager back surgeons. For spinal fusion surgery in particular (in which two adjacent vertebrae are grafted together to reduce pain and increase stability), rates of surgery soared dramatically in the 1980s and even more so in the 1990s, Dartmouth Medical School researchers found when they probed the issue.84 It’s truly mind-boggling: Between 1992 and 2003, Medicare spending for lumbar surgery more than doubled, even though, as the Dartmouth team noted, the explosion of fusion surgery far outpaced any evidence that it worked.

Part of the problem is that it’s not all that easy to figure out who should and who should not be a candidate for surgery. X-rays and MRI scans are not nearly as informative as one might think: In fact, there’s surprisingly little correlation between what scans show and the back pain a person feels. “I have patients with MRIs so hideous I want to throw up, and they say they’re in no pain,” says Stephen Parazin, the chief of spine surgery at New England Baptist Hospital in Boston. “Then, 20 minutes later, I see an MRI so beautiful it would make angels weep and the person is all curled up in the fetal position because it hurts so much. You just can’t always equate images on an MRI with back pain.”85

Surgery is not even recommended for certain types of neck and back pain. In the case of my neck pain, for instance, the pain stemmed from irritated nerve roots—called radiculopathies—which means the pain originates inside the nerve itself. “We treat radiculopathies conservatively,” Parazin explained. “You basically do supportive things like acupuncture, physical therapy, chiropractic that will make you feel better and buy you time until Mother Nature takes care of it.”

Even for people with back pain not caused by radiculopathies but with pain that is appropriate for back surgery, the results are disappointing. In a clinical trial conducted between March 2000 and November 2004, a different team of Dartmouth researchers randomized 501 back pain patients from 13 spine clinics in 11 states to surgery or nonoperative care.86 All had been deemed good candidates for surgery on the basis of persistent pain and scans that showed herniated spinal discs.

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