Day 4 - the surgeon's advice

Just this past August I was referred to an orthopedic surgeon for an evaluation of my CT scan and MRI. The purpose of the visit was to obtain a second opinion as to the cause of my ongoing back and leg pain.
After a brief series of questions regarding the nature of my symptoms, the doctor pulled up my MRI. After a quick glance, he confidently asserted that the culprit for my pain was almost certainly disc herniation and degeneration at L4-L5. I found this hard to believe in light of the following:

• No pain elicited from bending at the waist, twisting or lifting
  
  
• No relief obtained from receiving a cortisone shot directly into the supposedly affected nerve bundle
  
  
• No pain in my lower back - instead the pain is focused in my right knee/foot and my upper back/shoulder
  

I asked him repeatedly how he could confidently make such a diagnosis in light of this information. He expertly sidestepped all of my questions, then circled back around to assure me once again that my pain was due to the worn out disc. When I asked him how sure he was of this, he replied “70%-80%”. I asked him what treatment options were available and he suggested that surgery to replace the disc would likely be my only choice. And if that weren’t bad enough, he told me that an artificial disc would only be likely to last roughly 10 years.

Perhaps the most sickening part of the entire ordeal was the casual, breezy manner with which he informed me of all this. Even though his diagnosis made no sense, I felt after awhile that he must be right. He seemed so confident, and is a doctor after all. I left the consultation feeling more hopeless than I’ve ever been in my entire life. I would never have a life without pain. I moved through the remainder of the day in a haze of shock, despair, panic and terrible physical pain.

Even in light of the progress I’ve made, I still keep that experience in the back of my mind. In my darkest moments, I still wonder if he might have been right. Whenever this happens, I attempt to remind myself that fear is often irrational and that there is no reason to put much stock in his diagnosis. After all, what surgeon WOULDN'T recommend surgery?

 

Sometimes it's just not a good idea to trust advice from a financially self-interested authority figure in a white coat. That's how nocebos are inflicted on gullible patients, especially when they're in pain and desperately seeking relief. Your orthopedic surgeon's convenient out, of course, is that the discomfort you're experiencing in other areas is due to the referred pain phenomenon where the structural abnormalities your MRI detected in L4-L5 are "referred" (by some as yet unexplained mysterious process) to your knee/foot and upper shoulder. I'm not an M.D. and am not offering medical advice, but your skepticism, it seems to me, is healthy and highly warranted. You know about the multiple scientific double-blind tests that have been conducted about the relationship between spinal abnormalities and sciatic and lower back pain? You take a hundred people off the street with no back pain and give them MRIs or CT scans, and about 70% will have spinal abnormalities. Likewise, if you take a hundred patients with sciatica and back pain and give them MRI or CT scans, you'll find that about 70% of them have spinal abnormalities. Then, there are patients with excruciating back pain and sciatica who have absolutely clean MRIs and CT scans. The only conclusion you can reach from this data is that back pain is not caused by spinal abnormalities, or that those spinal abnormalities are only incidental to the diagnosis.

You should be aware before you make any decision for surgery about the dismal patient prognosis for spinal surgery. Don't believe me, ask around. Some spinal surgeons have even given up performing such procedures. If they don't work out, there's always the convenient excuse that it's now scar tissue created by the surgery that's impinging on your nerves. My advice as a non-medical professional? Try doing the SEP available on the TMS Wiki first and then think long and hard before authorizing any surgical intervention.

 

Oh I've already firmly made up my mind that surgery isn't for me. Even if my pain were caused by some mysterious structural phenomenon (very unlikely), I still would not consider surgery as a realistic option. Too many horror stories!

I'm already working through the SEP, as well as Alan Gordon's more general recovery program. So far I find both to be extremely helpful. I also just ordered Unlearn Your Pain by Howard Schubiner. I can't wait to read that one! I love the way he breaks down the neurological processes behind chronic pain - very reassuring somehow.

 

Yes, Wall, Howard Schubiner's videos explaining TMS as mind-body based are quite compelling (even if his argument in favor of programmed pain pathways is not completely in line with Sarno's classical repressed emotions TMS theory). Every new perspective you get on TMS I think helps you reach your own conclusions about the phenomenon, which is were it all begins and ends anyway. Given the structural assumptions behind the traditional diagnosis of back, shoulder and knee pain, how could have your smug orthopedic surgeon come up with any other explanation than the one he gave you?

 

I was told by the doctor at the pain clinic that spinal nerves don't service parts of the body that are above them. They flow downward. Anatomically impossible for pain in the upper back and shoulders to be caused by disc abnormalities in the lumbar spine.

 

I think that it's good to know medical reasons for where pain goes in our body
but more important to discover the psychological causes of pain. The TMS repressed emotions.

Herbie tells about this in his new video which is "back to TMS basics":


http://tmswiki.org/forum/threads/what-to-know-to-heal-from-pain-pt-1.5482/

 

Don't you just love how doctors get right down to basics?

 

HAHA