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Surgery Often Won't Cure Back Pain

Social, Psychological Problems Have Negative Impact on Back Surgery, Researchers Say

Treat the Whole Person continued...

Other observers agree.

"Back pain is not a thing you can surgically cut out or pharmacologically kill. It's flavored by cognitive and social factors," notes Stanley A. Herring, MD, clinical professor and medical director of the Spine Center at the University of Washington in Seattle.

"You don't want medicine to be like the butcher chart, where you're just talking about one particular cut of meat. Medicine is about the whole person," says Michael Von Korff, ScD, a researcher with Group Health Cooperative in Seattle.

In a survey published in the February issue of the journal Pain, Von Korff and colleagues found that nearly nine out of 10 people with chronic back pain reported at least one chronic pain condition, chronic physical ailment, mental disorder, or substance abuse problem.

"There's the risk of focusing too much on the one particular anatomical problem when what influences quality of life is what's going on with the whole person," he explains.

One goal of this research is to give patients information so that they can make treatment decisions that fit their own values and preferences. Without this knowledge, "Patients may have inappropriate expectations of their treatment choices," say Abdu and colleagues. Co-researcher James N. Weinstein, DO, addressed this issue in a recent commentary in the journal Spine.

Unfortunately, most spine surgeons are either unaware of the importance of these psychological and social risk factors or for a variety of reasons don't employ methods to detect them in their patients, says Herring. "Some of this is due to a lack of understanding. Some of it is lack of a plan and resources to interpret the information. And some of it is time, which they don't have much of," he explains.

Fewer Problems, Better Results

The study's participants were selected from among 34,000 surgical patients treated at 26 centers in the National Spine Network, a U.S. research consortium of spine care providers. Each patient filled out several questionnaires before back surgery and then again one year later. Some of the questions helped to create a profile of emotional, psychological, and social characteristics. Others painted a picture of the patient's physical abilities and limitations.

The results raise another question. If the benefits of back surgery are so modest in so many, are there some candidates -- or many -- who simply should not undergo back surgery?

"I think the conclusion is that expectations need to be reasonable," says Dartmouth's Abdu. "We can't make these people normal -- that is, healthy with full function -- and we shouldn't think we can."

For the person with long-suffering chronic pain, he says surgery is a poor bet. "We're not going to cure back pain by operating on 40-year-old people with 20 years of back pain," he explained. "We can't cure them by operating on them."

If a spine surgeon doesn't ask you about your family, your work, and other aspects of your life, "seek a second opinion," advises Herring.

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