Anyone who has experienced chronic low back pain knows how frustrating it can be to find a doctor to help. From a surgeon's perspective, I often see patients who have seen multiple other doctors and physical therapists and have not had relief of their pain. (After all, if non-surgical treatment was working they wouldn't be coming to me to get a surgical opinion in the first place.)
If you've had your back pain for a long time, you already know that finding the cause of the pain and an effective treatment is quite complicated. Treating chronic low back pain is almost like detective work, and the better the communication is between the patient and the physician, the better the expected outcome. Apart from basic courtesies such as arriving to your appointment on time with all your paperwork ready, there are several important things that you can do to assist in your own care.
Treating chronic low back pain is almost like detective work, and the better the communication is between the patient and the physician, the better the expected outcome.
Document the treatments you've already tried
Knowing ahead of time what you have tried and whether it worked (even if it worked for only a short time) is helpful. The more information you can give pertaining to your prior care, the less time will need to be spent re-exploring these treatments. Being specific about the treatments is also very important.
Just saying you have tried physical therapy is meaningless. What the physician will want to know is what was tried in physical therapy and for how long. Are you still continuing with an excercise program? Did the therapy just consist of ultrasound and hotpacks with no active excercise? Were you instructed in core stabilization exercises?
Similarly, if you have tried pain medications, the physician will want to know the specifics on which medications have been tried, at what dosage and for how long. Did they help with the pain or help increase daily functioning? The same is true for any injection. What kind of injection was it? Did it help and if so how much and for how long.
Having all of this written out prior to the appointment will help the physician be able to quickly understand and assess your situation, and it'll make sure you don't forget anything.
Bring any prior imaging studies
Besides the history and physical exam, the next most important piece of information to a surgeon is the imaging studies. The actual imaging studies are what will be needed. Reports on imaging studies (vs. the image itself) are pretty much meaningless as there is no standardized terminology for reporting on imaging study findings. Old studies can also be useful to see if there are any progressive changes.
Ask the physician in person for any paperwork
At the end of an interview, you should not be afraid to request any needs you have such as medication refills or return-to-work paperwork. It is far easier to close out all these practical problems of chronic low back pain while you have face to face time with a physician rather than ask their staff for these items on their way out of the office or calling back later.
Keep the peace
Lastly, while dealing with chronic low back pain is frustrating, and we all know that dealing with the healthcare system can also be frustrating, it never helps to get angry with your surgeon on the first visit. This may sound obvious, but it happens. Some patients lose perspective and take their anger and frustration out on the surgeon, which will not help the patient and may cause the surgeon to ask them to leave.
Remember, especially if this is the first time you are meeting with a surgeon, he or she is not to blame for your pain and may actually be able to provide your best chance for some pain relief.
Have clear expectations of what a spine surgeon can do for you
When you consult with a spine surgeon, what he or she will be mainly looking for is an anatomic lesion (problem) that is both the probable cause of your pain and is amenable to surgery. Basically, spine surgery can only decompress a nerve or stabilize a painful motion segment, and these two conditions comprise a surprisingly small percentage of all the causes of chronic low back pain.
In about 80-90% of cases no anatomic lesion can be found as a cause of the patient's pain. This does not mean the patient has no reason for the pain he or she is experiencing; it just means that an anatomic cause of pain is not identifiable and this is not uncommon with back pain. Understandably, this disappoints many patients, as they may feel their pain has not been validated and surgery cannot provide a clear course of action for pain relief.
After the initial consultation, a spine surgeon should be able to tell a patient whether he or she may be a surgical candidate. Most patients conditions will fall into one of three categories.
- They may definitely have a surgical lesion
- They may have a lesion that is potentially surgical but requires further work up
- They may have no identifiable anatomic lesion as a cause of their pain.
For those patients that have not gotten pain relief from non-surgical treatment, and have an anatomic lesion as a cause of their pain (e.g. disc herniation, degenerative disc disease, spondylolisthesis, spinal stenosis) they will need to know what kind of surgery is being considered, what is the recovery time, and what is the surgeon's personal success rate with this type of surgery. They will also need to know risks and possible complications, and what would be the natural history of their condition if they were to not have surgery. Surgery for low back pain is almost always elective, and it is the patient's choice as to whether or not they wish to undergo an invasive procedure.
The patient is the only one who has the pain, and the only one who knows how it is impacting his or her life. The surgeon should be able to articulate what can technically be done and what kind of postoperative course and outcome a patient can reasonably expect. Armed with the knowledge from the surgeon a patient should be able to make an informed decision. The patient information on this site can help a patient with their decision making process.For those patients who have an anatomic lesion that potentially may be treatable by a surgical procedure, they will want to know the same above information before further workup. If they do not have enough pain to undergo surgery, further workup is not warranted. For instance, if the proposed surgery is a fusion for degenerative disc disease, and a discogram is necessary as a preoperative study to confirm if surgery would help, a patient may choose not to undergo the discogram if they do not wish to consider fusion surgery.
If a surgeon cannot articulate what a patient has and what type of treatment will be potentially advantageous, the patient may want seek yet another opinion. After all, deciding on surgery can be very difficult and if the surgeon cannot help in this process, it is doubtful he or she will be effective in helping one deal with postoperative rehabilitation or treating potential postoperative complications.