Page 20 - The New Age Chronicles Newspaper No 1 Vol 1

20 Optimizing Spinal Surgery

Optimizing Spinal patients. of risk is made.
• Less than 10% of surgeons assess stress As I walked out the door to get some
Surgery before making the decision to perform surgery. educational materials about the proposed

Therefore, there is little shared decision- procedure, she said, “My daughter just died.” I
making. turned around and sat down. “My 32 year old
o Frequently, major life-altering decisions daughter died a couple of months ago from
are made on the first visit with inadequate data cancer.”
and patient education. I told her that even before I knew much
• Surgeons feel they can assess mental about chronic pain, I’d never perform surgery
stress in the clinic. Yet it’s documented that they when someone was experiencing a severe
can do so less than 45% of the time. personal stress or loss. I said that I wasn’t
• Sleep is rarely addressed by anyone. willing to make a decision on this visit and to
• In spite of the overwhelming evidence call me in a week.
that the outcomes of surgery for degenerative In the meantime, I asked her to begin
disc are poor and unpredictable, there are working on the tools on my website,
Dr. David Hanscom, M.D. hundreds of thousands of them performed www.backincontrol.com. She wasn’t that happy

annually in the United States. with me, but she did call me back in a week and
We live in an era of unprecedented knowledge • Narcotic usage is seldom defined and stated that she had decided to proceed with
and resources that were unimaginable just 50 stabilized before surgery. surgery. I told her I would sign her up and see
years ago. It was only a little over 100 years ago • Although physical therapy is often her in a week for a pre-op appointment. She had
that we even had anesthesia available to allow prescribed, there is often no long term begun the expressive writing exercises that are
surgeons the time to perform their complex and conditioning plan implemented. the foundation of the prehab process.
often lengthy procedures. However, while • A multi-faceted approach to resolving She came in with her husband on the
technology has advanced, medicine has lost its chronic pain is often not available. Most next visit and asked me if she could delay the
focus on the most important aspect of healing – physicians are not well trained to deal with surgery for couple of weeks, because she was
listening to the patient. chronic pain and dislike dealing with it. feeling a little better. When I saw her a month
It’s impossible to solve a problem in any • Surgery is simplistically viewed as the later for the final pre-operative visit, her pain
arena without knowing the full extent of it. This definitive solution. It is just one tool and is was gone and never returned. She was now able
is particularly true in the presence of an illness, actually dangerous. Chronic pain is seldom to verbalize her loss to others and was more
in that the patient’s environment may be mentioned as a complication of surgery. concerned about the effect of the loss on her
stressful, which changes the body’s chemical About three years ago, I, along with my husband.
makeup. This creates an adverse environment team, decided to become more systematic with Variations of this story occur in my clinic
that affects every organ in the body and results our pre-surgical process. We coined the term, weekly. I have gone from dreading chronic pain,
in multiple physical symptoms. “prehab.” We will not perform elective spine to being energized by people without hope
These environmental variables are well- surgery unless the patient is willing to work regaining their lives – with or without surgery.
documented in the medical literature and have through his or her part of the protocol for at Chronic pain is a solvable problem. The
been shown to negatively affect the outcomes of least six weeks. I also no longer perform surgery first step is understanding it.
spinal surgery. Currently, the medical for back pain.
profession/culture is ignoring them, frequently • Surgical decisions are not made on the About the Author:
resulting in catastrophic results: first visit. Dr. David Hanscom is a leading
• It is reported in over one thousand peer- *Specific educational material is available for a orthopedic spine surgeon at the Swedish
reviewed research articles that anxiety, shared decision-making process on follow up Neuroscience Institute in Seattle, WA. Though
depression, catastrophizing, and fear avoidance, visits. he believes that surgery and medication have a
adversely affect the results of surgery. • Psychosocial variables are obtained and role, he knows that these standard courses of
o They are better predictors of outcome acknowledged on the first visit. treatment aren’t what’s needed to treat chronic
than the actual pathology. o Anxiety/ anger/ depression assessed and pain. Instead, he provides the framework so the
• Shared decision-making regarding treated. patient can find his or her solution, allowing
procedures with permanent sequelae is critical. o Must have some degree of improvement them to live free of pain, forever. His method,
o A fusion for LBP (Lower Back Pain) is prior to proceeding with surgery. which transforms all kinds of pain, including
successful only about 25% of the time at two- • Sleep: back, neck, arthritis, fibromyalgia, and
year follow up. o Should be sleeping at least six hours per migraines, is explained in BACK IN
• Surgeons cannot accurately assess night, for more than six weeks. CONTROL: A Surgeon’s Roadmap Out of
patient stress in the office setting. • Medications defined and stabilized: Chronic Pain. []
• Sleep is a well-documented factor that o Pain consultation if daily opiate intake >
affects the perception of pain. 100 mg of Morphine equivalent.
• Degenerative disc disease is a part of the I have observed that patients’ post- Native American Quote:
normal aging process and has been shown to operative pain is less, rehab is easier, the
have little, if any, correlation with back pain. outcomes are more consistently excellent, and “When you are in doubt, be still, and
• Any surgery performed in any part of there is a quicker return to full function. What wait;
the body can create chronic pain as an outcome has been surprising is that I have now seen
of the procedure. It occurs 10-40% of the time dozens of patients who have had their pain When doubt no longer exists for you
and it can be permanent around 5-10% of time. resolve without surgery, in spite of having then go forward with courage.
• High dose narcotics not only create a significant anatomical problems that I had
tolerance, but also increase the actual level of planned on solving with surgery. So long as mists envelop you, be still;
pain. One woman presented to me with left
• Physical conditioning and activity are leg pain, which she had been experiencing for Be still until the sunlight pours through
important in decreasing pain. over a year. Her MRI scan showed a pinched and dispels the mists
• Focused structured care can markedly nerve that matched the pattern of pain. She
improve both surgical and non-surgical seemed very straightforward, and the situation -As it surely will.
outcomes. seemed so clear-cut that I decided to offer her an
operation on her first visit. That’s not my usual Then act with courage.”
Here is what is currently being done: practice. I generally feel it’s important for me to
• Surgeons are monitored on productivity get to know my patients over several months Ponca Chief White Eagle
and discouraged from spending time with before a decision involving a significant amount