Surgery Often Won't Cure Back Pain
Social, Psychological Problems Have Negative Impact on Back Surgery, Researchers Say
Feb. 25, 2005 -- Surgery for back pain is not the cure-all that many patients believe it to be, say orthopaedic experts.
Many patients who seek surgery for chronic back pain have other health problems, and failing to take them into account limits the usefulness of back surgery, they say. And the more problems they have, the less they benefit.
Back pain patients free of such problems benefit more but still remain far from normal one year after an operation, according to a study.
Researchers performed snapshot evaluations of more than 3,400 patients before and after back surgery. They presented their results at the annual meeting of the American Academy of Orthopaedic Surgeons in Washington, D.C.
James Slover, MD, and colleagues from Dartmouth Medical College found that factors such as a low education level, depression, smoking, frequent headaches, and a workers' compensation claim had a profound impact on patients' functional abilities. These were far more powerful than the influences of medical illnesses such heart disease or rheumatoid arthritis.
Psychology Plays Huge Role
Patients and doctors should be aware that such common psychological and social factors play a "huge role" in how patients fare before and after back surgery, notes co-author William A. Abdu, MD.
"Patients, doctors, and others who take care of patients need to understand that," says Abdu, associate professor and director of the Spine Center at Dartmouth Medical College in Hanover, N.H.
For those with multiple health problems, the new research shows, the outlook is not very good. "It's like Humpty Dumpty," he says. "You just can't put them back together again."
Although patients with no other health problems did better, back surgery failed to provide even those patients with complete relief of symptoms or normal function.
Treat the Whole Person
Should spine specialists portray back surgery as a procedure that generally delivers patients from pain and disability?
"Spine patients are nowhere near normal when they walk in the door," says Abdu. Their spinal condition and other problems are so burdensome that they don't function well. After back surgery, people don't return to normal and still have the psychological and social problems they had before back surgery, he says.
"The tone of this study is quite clear," says Nortin M. Hadler, MD, professor of medicine at the University of North Carolina and author of Last Well Person: How to Stay Well Despite the Healthcare System.
"We've got a real problem," Hadler says. "If surgeons are not careful about selecting patients who are free of all these [other illnesses], they're not going to help many people. I'm not sure there is a surgical solution to back pain. I am sure there's no surgical solution for any suffering that enshrouds the pain." Hadler was not involved in the study.