Patients suffering from chronic back pain understandably want to find a solution—and many hope for a "silver bullet" that relieves most if not all of their pain. Surgery can often seem to be the best answer to relieve pain quickly. There are alternatives, however.
While back surgery has proven successful in addressing a wide range of painful back conditions, several recent studies show that an interdisciplinary chronic pain management program can offer a different and sometimes better choice for certain types of patients.
When physicians fully inform patients about the potential risks of spine surgery and benefits of programs to manage chronic pain management, many patients prefer a rehabilitation model over surgery.
What Is Chronic Pain Management?
The interdisciplinary chronic pain management approach is fundamentally different from the traditional model in which the doctor is relied on to correct a medical problem. Instead, interdisciplinary chronic pain management teaches patients to manage pain themselves and cope by participating in:
- Physical conditioning
- Thorough education about risks and alternatives
- Occupational counseling to aid in returning to work
- Problem-solving and support with other patients suffering from similar conditions
Interdisciplinary chronic pain management takes a team approach. Team members vary depending on patient needs, but may include physical therapists, pharmacists, nurses, psychologists, and nutritionists/dietitians, in addition to physicians.
This article reviews current research on chronic pain management so patients can have an informed discussion with their physician if they are contemplating surgery.
Results: Comparing Chronic Pain Management with Surgery
One research study comparing lumbar fusion with nonsurgical approaches for lumbar disc degeneration found both methods had similar results. In the study, patients were randomly assigned to surgical or nonsurgical treatment. Those assigned to nonsurgical treatment followed a program including exercises directed by specialists in physical medicine and physiotherapists.
The patients also took part in peer counseling to encourage confidence that ordinary physical activities would not damage their discs.
Patients who had spine surgery and those who went through a chronic pain management program both obtained major improvement in pain and in their activity levels. There was no significant difference in improvement between the two groups of patients. Within four years after the study began, nearly a quarter of the patients first assigned to the nonsurgical regimen had chosen to have surgery. Almost a quarter of the people who had an initial fusion surgery underwent a repeat surgery. Of those who underwent surgery, 58% took pain medication every day or every week, compared with 35% of those who did not have surgery.1
Another study looked at surgical and nonsurgical treatments for lumbar spinal stenosis. Some patients underwent surgical decompression, also called a laminectomy or foraminotomy, while others participated in a six-week program of physical therapy. The physical therapy program included targeted exercises, general conditioning, and patient education. The researchers found similar results for both the surgery and nonsurgery patients.2
When Chronic Pain Management May Be Better
Based on these and other study results, chronic pain management is an effective alternative to back surgery for chronic pain patients, especially for those patients who have one or a combination of the following characteristics:
- A high level of fear, anxiety, or other psychological or social risk. Back surgery does not address these issues, whereas one of the goals of an interdisciplinary chronic pain management program is to help build a patient’s coping skills.
- Uncertainty about whether back surgery is the best strategy.
- Expectation of poor outcomes from back surgery, either because of fear or a previously problematic procedure or failed back surgery.3
- Addiction to or dependence on painkillers. Since substance abuse or overuse is associated with worse spine surgery outcomes,4 patients with such problems may be better served by participation in a chronic pain management program than having back surgery.
- Unrealistically high expectations of the degree of pain relief achievable through back surgery. The medical literature includes several studies showing that positive expectations of pain relief before surgery are sometimes linked to more patient dissatisfaction with a procedure.5,6 (Conversely, higher expectations of improved functioning after surgery were associated with greater improvement in functioning and greater satisfaction.)
If a potential surgical patient has any or a combination of the above noted situations or psychological characteristics, a chronic pain management program should be considered as an alternative to back surgery to avoid further patient disappointment, additional cost, and the possibility of continued pain even after surgery.