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Discuss: Is pain alone reason enough for surgery?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
I would like to start a civil discussion on whether back pain alone is reason enough to have surgery.

Do you think that surgery should only be considered in situations where there is risk of damage to tissues (nerves, etc), risk of permanent numbness, or spinal instability?

Or do you think that intractable pain, that doesn't respond to conservative therapies, warrants surgery?

I'm not looking for yes or no answers, but a discussion of your opinions and explanations if possible on why you feel the way you do.

Please let's keep the discussions civil, respect the opinions of others.


  • Well for me, I did everything I could do to avoid surgery. Because of a short 4 month delay in getting my severe herniation off my nerves, I now have permanent nerve damage. I reherniated, had a floating extruded disc that led to a 2nd surgery. That surgery messed me up physically and my 3rd surgery fixed the 2nd surgery and finally stabilized my back.

    Do you think there are people who have serious back surgery who really may have another option? I have encountered people who try everything NOT to have surgery, rather than rushing to surgery.

    Interesting subject. My vote would be - don't be stubborn. If your doc says your nerves are impinged, get it fixed before it's too late. I would give anything not to have laterally numb hips, thighs, calves, feet and 4th and 5th toes, to be able to do more than sit in a recliner 23 hours a day. My spinal cord stimulator (which blocks the pain signals) is a week old and doing great, but I have to lay low for 4 to 6 weeks while the leads scar down. I won't be able to say "hey, I have a new life thanks to SCS" until I have full range of activity again. But so far, it's wonderful.

    I've only ever had nerve pain. Some back pain, but nothing compared to the nerve pain. Hard for me to separate the 2, I guess. I never just had back pain to consider fixing.

  • Hi Cathy.

    In my case, I had back spasms, tingling 24/7 in my right arm and was losing the use of my left arm. These symptom would be included in the "risk of permanent damage" catagory and of course warrants surgery. I know people who had cervical issues who waited and woke up one day with their left arm completely limp and unusable. Because they had put off surgery and conservative treatments didn't work, they risked permanent loss of a limb.

    But I also believe that surgery is a viable option to relieve pain when conservative measures don't provide any. Of course, it is a personal decision between patient and surgeon whether to risk surgery based on the percentage of success. I think it would be an abomination if someone was in chronic, life-altering pain and was not allowed a chance at surgery if that surgery has a 75% chance of success and the patient chooses to take those odds.

    Pain is an unseen, silent, and personal condition that is as valid as a broken leg, tennis elbow or any other condition and deserves proper treatment, whether it's conservative or invasive. It ultimately needs to be the pain-sufferer's choice.

    There. That's my $.02 worth.
  • In my situation, I had back pain since I was a teenager. I went to multiple doctors who would either give me the shots or perscribe ibuprofen for the pain. I would go months feeling no pain then it would hit like a bag of bricks. Once I turned 40 and found a doctor who actually looked for why I was feeling the pain, I found that I had Spondylolithesis all these years and by the time that they found it damage was already done to my muscles and nerves.

    I personnally believe that it depends on the type of injury that you have. I could have just continued pain meds and went to physical therapy instead of having the surgery but then where would I be at in another 10 years from now? I would still be taking the pain meds, still have the problem that I had and it would have just gotten worse and worse. I didn't want to live like that.

    I chose the surgery so that in years to come I can play with the grandkids, go on picnic, walk through parks, all without worrying about if my back is going to get in the way of having fun. Also without having to take pain meds just to get up in the morning.
  • at all, and so struggled with back pain, on and on until I could barely walk. Pain is still my biggest issue.

    Slowly my life became erroded as I learnt the triggers and my back became more "reactive" to movement.
    I got to the point that, when I met my surgeon for the first time and he offered me my second injection, I cried from releif, just puttng that date in my diary.
    Boy, did he look at me funny.

    However, he still made me jump thro all the conservative measures hoops first although I suspect he knew exactly what was going on and where we would end up.
    I am in my 30's.

    My aim was to buy myself another 10 years as my children grow up, then if I end up in a wheelchair then, it wasn't as bad.

    Further surgery for me was always likely, alongside the risks. But I got to the point I "had nothing to loose" - and that my friends is not a good place to be, at all.

    I take pain meds now 4-6 hourly. Do not regret my surgery but do wish I had sought help sooner.
    I blame myself and the medical profession. I was never really taken seriously until it was too late.

    So pain alone, if severe enough should warrant careful examination and management.
    That is just my opinion.

    Thanks for an interesting thread. =D>
  • Hi Cathy,

    1. I think surgery is warranted if there is progressive neurological deficits and instability causing severe pain and lowered quality of life. If someone develops cauda equina syndrome, they must have emergency surgery for bladder and/or bowels incontinence.

    2. In cases of intractable pain after failing all conservative measures, I think it's elective surgery. You can choose to go to pain mgt. and have a series of injections and use pharmaceutical means to control the pain if you can tolerate it. You can supplement this with massage, accupuncture, and other alternative means that are reasonable.
    Of course, if conservative measures fail and you have an intolerable amount of pain, you should have the option to have surgery.
    If you have intractable pain with neurological deficits, surgery should be considered to take pressure off the nerve being compressed.

    It's hard to say if someone should have back surgery for pain alone. Usually there are other problems that go alongside with pain that complicate matters.
  • I will start with my moms:
    She was leaning over and getting something out of a lower drawer in her kitchen. She couldn't move and have severe pain. My step dad litterally had to carry her to the bathroom and at times she couldn't even do that! She went to the ER. How she was ever able to do that is beyond me. She ened up seeing a well known doc in Seattle. She had a herniated disk and one doc said that she should have surgery on it. This doc in Seattle said NO WAY! here are some meds and see me in a month. Well low and behold she was lucky in the fact that the herniation swelling went down and she is as good as new!
    I am now 32 yrs old. When I was 18, I threw a football while playing tackle football with my brothers and some friends. After I threw the football I couldn't move. I was literally in bed for 3-5 days. My friends boyfriend actually had to carry me to the bathroom, then my friend had to come in and help me with my pants and stuff. Anyway it went away. Then when I was about 21 I would have a pain in my low back. I chalked it up to an irritation in the area. This happened about 2x's a year. At 24, I became pregnant, had my daughter and all was well. After the pregnancy the pinching pain started returning more and more often. When I was 27, in 2003 I went to an Ortho who wanted to just burn or coterize the disk. I decided to go to an NS that had removed a tumor out of my hubbys back, for a second opinion. He did a diskogram and said that if I would have had the procedure the Ortho suggested I would have been worse off. So the NS decided the do an L5-S1 fusion through my belly. I was still in pain after the surgery although it was a lot less. HOWEVER, over teh past 2 years the pain has slowly come back. Over the past 8-12 months it has been unbareable!!! I am going to try a radio frequency or ablasion on my facet joint from L5 to L3. I have had numerous injections and am over the whole process. The new Ortho that I have said that if these dont work he will go ahead and put in some plates and screws for stablization in through the back. So FOR ME and ME only in my position I WOULD do the surgery TOMORROW if I was able!!! Doc said come April he will do the surgery in April IF I would want him to! IF it relieves 10% of my pain I am for it. So MY OPINION in MY SITUATION is======>>> YES I would do surgery and I feel I should have that choice RIGHT NOW instead of April! So I think that being in pain and other options have been exhausted and pain is still over ruling your life then having pain and an identifying reason for the pain you should be able to have surgery! Hope all of this makes sense. I have been typing this and chasing my son around at the same time. So I hope I didn't repeat myself or jump around. LOL
  • Here is my situation. I have lumbar DDD, no nerve impingement or herniation on the MRI (though who knows - I have heard that MRI's don't always show everything). I have been trying to avoid surgery, and for two years have tried all conservative measures, with little to no pain relief. I am finally getting some relief from medication, though pain is still always there. And now I am considering surgery (fusion or fusion/ADR combo).

    My DDD is not going to get better, and without surgery is guaranteed to continue to cause me pain for at least another 20 years (I am 46), until the aging process causes total disc degeneration and autofusion. I had someone ask me why the surgeon was recommending surgery when I did not have nerve impingement or instability. I guess there are surgeons who have said to patients that they are only doing surgery because the patient has some of these problems. And I have seen comments on this board saying that pain alone is not a reason for surgery.

    My pain negatively affects my quality of life and my work. I do not like having to take strong narcotic medications all the time. And I cannot imagine having to spend the rest of my life like this. I have no life to speak of, I go to work (though my functions have changed because of my inability to do everything I was hired to do) and I come home to recuperate. I can't stop at a store on the way home, unless it is a very short trip with nothing heavy to buy. I cannot go to movies with my boyfriend. I really don't do much at all socially.

    That said, I do realize that surgery may not be the answer, and may leave me with more pain than I currently have. I have no illusions that surgery is absolutely guaranteed to make me pain free for the rest of my life. However, without surgery I will at the very least continue to have the same level of pain, or possibly more pain. For me, I feel that the possibility that I may be able to get some (hopefully most) of my functionality back is worth the risk of surgery.
  • has a good chance of relieving the pain, then yes absolutely.
    I was told surgery would most likely relieve 60-65% of my pain. This was after I had the disogram that confirmed my pain was from the disc which was herniated & had an annular tear.
    I am 3 1/2 weeks post op, and so far my pre surgery pain is gone. God willing, I will be able to have a full active life when I fully recover, and no longer let my "back" decide when I will have a good time! :)
  • meydey321 said:
    Hi Cathy,

    1. I think surgery is warranted if there is progressive neurological deficits and instability causing severe pain and lowered quality of life. If someone develops cauda equina syndrome, they must have emergency surgery for bladder and/or bowels incontinence.
    I agree with this completely.
    meydey321 said:

    2. In cases of intractable pain after failing all conservative measures, I think it's elective surgery. You can choose to go to pain mgt. and have a series of injections and use pharmaceutical means to control the pain if you can tolerate it. You can supplement this with massage, accupuncture, and other alternative means that are reasonable.
    Of course, if conservative measures fail and you have an intolerable amount of pain, you should have the option to have surgery.
    This is my situation. I tried PT, injections, and acupuncture over the course of two years. The injections gave me limited relief, but it only lasted about a week. I have only recently found medication that helps my pain, though it is still always present. And yes, I would consider it elective surgery, it is not life threatening. But my PM doc says that there is nothing more she can do for me, except to continue giving me meds. But see my full explanation - I do not have nerve impingement or herniation (at least not visible on an MRI).
  • I would say you are taking a pretty big risk by having elective surgery. However, it seems that it works out for most people (75 percent). Before my surgery, I had LBP but not much leg pain. Well, now, I have LBP and nerve pain. My MRI did not show impingement, but the doc said he had to decompress the nerve and move it to a more healthy location--my L5/S1 disc was totally gone--as in bone on bone. When he got in there the nerve was stuck in between the bone. I have had complications, but I don't think they have affected the recovery all that much. I have a feeling that those with the most leg/nerve/back pain pre-surgery end up being the happiest with their surgery. The day of my surgery, my back pain wasn't too bad--I should have walked away. What's the Coldplay song? "every step that you take...could be your biggest mistake..." That's how I feel today--it doesn't mean I have a negative attitude--I'm fighting like crazy--but you asked for an opinion--we'll see. Ask me in 6 months.

  • Well, I do have nerve pain, even though there is no impingement (and I'm not quite sure how that happens - maybe there are nerves within the disc). And maybe if I have surgery before I get to the point you were at before your surgery, I will have a better outcome, I don't know.

    I am wondering if having surgery before it gets really bad may help with recovery and outcome. I read a study that said the only difference the researchers could find between those that had good outcomes and those that had bad outcomes was whether or not the patients were working before surgery. So that tells me that it may be worse if you wait too long, until you are so bad that you can't work any longer. Of course it's just a theory.
  • I think your doctor should order a ct/myelogram. It is more sensitive than an MRI but picks up a lot more details. My surgeon wasn't completely sure that my nerve was impinged judging from my first MRI. He sent me to have a ct/myelogram and there it was, compressed for the whole world to see. Then I went on to have a microdiscectomy/laminectomy. Unfortunately that it wasn't the end of my problems.
  • I had MRI, CT, Mykegram,All the shots, radio freqency lesioning, you name it I had PT and aqua therapy. Nothing worked. They coulodnt find my problem. Finally went to like my 5th Spine Dr and he said not al tears in discs show up on MRI's. Had a discogram and they found 3 torn discs. Surgeon wanted to do 3 level fusion.Scared went to another Dr. He also said fusion, but only 1 level. He wass unsure aobut discogram, cause they didnt record pressures. Long story short, another discogram and I had 2 level fusion. But I felt comfortable before surgery that I had done all the tests and conservitive measures I could do first. I also after the second discogram felt better that I needed a two level fusion. Three levels are rare and more risky. I hope the other disc doesnt go bad and have another down the road. But I would rather have a sucessful 2 level and possibly repeat it in a few years for the other, than take the risks of failure on a three level. Thats just my own opinion, for those that have had three. My point is, makes sure all the test are done and you have all your options done before you have surgery. I am 4 weeks post op and have had alot of surgerys, and this has been the hardest. If I could have solved it another way I would have, but with torn discs, my only future was staying on strong narcotics and that didnt seem good for my body long term. Good Luck with your decision. It is hard one to make. Hope this rambling made sense and helped in some way.
  • Nearly everyone I know who had back surgery for pain had a bad experience, and are feeling worse now than they were before. Honestly. Sure, it might work for some people, but even the doctors I have seen refuse to do surgery based on pain alone. There has to be some physical effect on the body for them to go through a surgery as big as fusion. I think if someone has weakness and numbness, they should be considering surgery asap. As for pain,... Unless it's debilitating, it's not really warranting surgery. In my opinion, it's asking a bit too much. Even after surgery, people still have pain... So why would you bother going through all that trauma when you will still hurt afterwards? If you can walk, and get around, and can work, etc... There is no real reason for surgical intervention. If someone's pain is debilitating, almost ALWAYS there is something beyond pain that is going.

    Just my opinion. People who chose to have surgery for pain need not defend themselves. It won't change my opinion, and there is no need to try to justify your own decisions in your own life to me, it doesn't matter what I think, nor does it matter to me what you think. Lol. Juuuuust a disclaimer. Like always; keep the red pens out of my thoughts.
  • Just to clarify, I also had a discogram which verified that two levels were causing my pain.

    And I wasn't really asking for this topic to be all about me, but just in general.

    It is nice when someone explains their situation, so we know where they are coming from though.
  • I will ask my doctor it he thinks a CT/myelogram would give him any additional, and most importantly, relevant information.
  • I haven't had surgery as I was told by 1st Ortho that I just needed pain management Dr. I go for 2nd opinion next week and I'm unsure of what he'll say. With my LTD I have the choice of staying on disability for another year before I lose my job. I'm hoping the disc will heal on it's own. I would want to try IDET or nerve burning but it hasn't been offered. My 2nd PM works part time and don't know if he would do that or Ortho? So I'm not able to work or socialize but I'd rather do everything before surgery. The pain is dragging me down though. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Just to clarify; my response wasn't based on the original poster's situation. It's a generalized opinion.
  • To the O.P.~Mild degeneration doesn't generally warrant a fusion. Ideally, a discectomy should solve the nerve pain issues. DDD doesn't cause nerve pain, nerve impingement does. DDD generally cause instability, and CAN cause pain... But unless a disc is pretty useless, there is no reason to remove it. I think most adults would have mild degeneration if we were all given MRIs. You really don't want to start the domino effect early if you don't have to. I would wait, personally. I had severe nerve compression and a totally shot disc, which is the only reason why I had a fusion so young. Otherwise, I would have waited. I'm more likely than not going to have more back surgeries in my lifetime... But I didn't have the option of leaving my back the way it was & not risking serious permanent damage. I think you should really try the least invasive route possible... I would never get a 2 level fusion over mild degeneration until it was clear that my discs were shot and if my nerves were being so compressed that had numbness & weakness. There is enough time from the onset of that type of compression to the point where you're risking permanent damage. Fusion should NEVER be a preventative measure, but a corrective measure. It's not a very good precaution, because it can cause more damage than not having surgery at all. It may come down to waiting a few years, and having one surgery... Or having one now, and another in 5 years, and another 5 years after that, etc...

    I'm giving you my opinion because you requested the thoughts of others. You don't have to defend whatever choices you've made or are going to make... That part isn't my business, and it doesn't matter if I or anyone else disagrees with whatever you choose to do. However, my opinion stands for anyone in the same situation, not just you, so each person's personal argument against my opinion isn't going to change it. It's just how I feel. Everyone is entitled to that.

    Good luck with whatever you choose to do in your situation!
  • I had a pinched nerve in my cervical spine (twice) and the pain was unbearable, tortureous and I wouldn't have been able to stand the amount of pain meds required to end it-so I would find a surgeon who would operate-even if it had to be exploratory, to find out what was going on. Luckily the MRI showed the herniation and bone spurs.

    So yes, to your question. Unless the pain is faked-pain to me is a good enough reason, even if permanent tissue damage is not a current concern. But usually it becomes one after a few years.
  • In my case, I was having major nerve damage issues and a great possibility of them becoming permanent. I was told by my NS that my surgery most likely would cause no pain relief, just nerve relief, which ended up being correct. My surgery did not fix any pain problems. However, I know that some people do have surgery that relieves pain depending on what the underlying cause of that pain it...I personally would not have had the surgery if I was not having nerve damage.
  • Hello Lo,

    Thank you so VERY much for sharing your thoughts and words of wisdom.

    Food for thought for everyone.


  • My back pain started two years ago when I fell on ice FIVE times after the Denver blizzard of 2006. I went to the ER and was told that I only had a bruise _ I thought I had a broken tailbone. THe apin persisted and got worse,my GP told me I had pulled a muscle and all I wanted was vicodin. She sent me to PT> Meanwhile, a friend of mine who is an RN referred me to a spine care clinic and the doctors at first tried all conservative treatments injections, massage and so on. After a CAT scan and a discogram, it was revea;ed that I had a fracture and two ruptured disks. I had 2 level PLIF in February 2008 and while I still have pain, it is better than it was beofer the surgery.
  • Interestingly enough, when I had my L5-S1 taken care of, when I came out of surgery, woke up, they put me in a room with another person. Young kid, maybe 17 years old. Couldn't feel his legs half the time, pain so bad he was crying, couldn't walk, etc.

    His doctor was my doctor. His mother came over and asked me how I liked the doc and all. She explained everything to us (my wife and I) and said he MRIs are perfect. All the other tests they ran were normal. The kid wanted surgery done, the doc said he won't do it because there is nothing visibly wrong and he doesn't know where to begin or end and referred him to a specialist down in the city.
  • Hi Treefrog, I think chronic progressive back pain is reason enough to have fusion surgery if it is affecting your quality of life. I know the risks and the alternatives.
    MRI's do not always show annular tears, which are very painful. I did not have any obvious nerve impingement, no numbness or tingling. I did have 20 years of back pain off and on that culminated in hip pain, that caused me to limp. I cannot take narcotics at work, epidurals were no longer giving any relief. I had marginal instability from spondy, but my surgery was not done for instability (which turned out to be severe when he got in there). My surgery was done for pain, back and hip. I am very glad I had it done. I still have back pain, but my hip pain and limp are gone. I definitely would not have rushed to it over a few months. It was over 2 1/2 years of progressive hip pain and limping that was no longer responding to epidurals. So, that is my opinion. It is always very individual, as it should be. >:D< Cali-Sue
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