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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...

    "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.

    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.

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