Back Pain After Surgery
Although back disorders and back pain can be caused by a single traumatic injury most are the result of months or years of:
• Poor posture
• Bad ergonomics in the workplace
• Improper body mechanics
• Stressful living
• Insufficient nutrition
• Poor physical fitness
• Lack of flexibility
Sometimes the incident we blame the back injury on was just the final “straw that broke the camels back”.
Hearing your doctor utter the words, “We’re going to have to operate,” can send a shiver down your spine. Immediately, questions about the seriousness of your condition, the procedure itself, and the likelihood that it will cure what ails you flood the mind. Then, there is the prospect of post-surgery pain. How badly is this going to hurt?
The bad news is that some pain is an inevitable companion to most types of surgery.
What is the incidence of individuals who have spine surgery and have partial relief, total relief, no change, or worsening of their pain?
Among spinal surgery patients, one out of every four patients is dissatisfied with their surgery two years post-op. (Surg Neuol 1998 Mar; 49(3): 263-7)
Dr. Belanger, a skilled surgeon, recognizes that even “successful” surgeries might require follow-up surgery in the future.
A major textbook in medicine states that physicians should wait at least 2 months before recommending surgery; moreover, 90% of back pain patients will be better by that time. (1)
Before considering spinal surgery for lumbar disc herniation or spinal stenosis, think about the following studies from Harvard University on the clinical outcomes of surgical versus non-surgical care: not much difference.
• 400 patients with sciatica resulting from a lumbar disc herniation were treated surgically or non-surgically. They were followed over a 10 year period and their clinical outcomes were compared. At 10 years post-surgery,
o 25% of surgical patients had undergone at least one additional lumbar spine operation.
o 25% of non-surgical patients had at least one lumbar spine surgery.
o 69% of surgically treated patients and 61% of non-surgically treated patients reported improvement in their predominant symptom of back or leg pain. (2)
Stenosis Surgical Vs. Non-Surgical Care Statistics: Again No Difference
• 97 patients with low back and leg pain due to spinal stenosis were treated surgically or non-surgically. At 8 to 10 years post-surgery,
o 53% of surgically treated and 50% of non-surgically treated patients reported that their predominant symptom of low back pain was improved.
o Both groups were satisfied with their current status:
55% of surgically
49% of non-surgically treated patients. (3)
Worker’s Compensation outcomes of single or multiple spine surgeries is not encouraging. Note:
• 600 single-operated workers compensation low back patients showed
o 71% did not return to work 4 years later
• 400 multiple-operated backs showed
o 95% did not return to work 4 years later (4)
Chiropractic treatment of lumbar disc herniation is recommended before back surgery. It is far less expensive compared to surgery, physical therapy, medications, outpatient services:
• Cost of chiropractic care for the treatment of lumbar intervertebral disc herniation patients is 2% of total spent.
• A trial of conservative non-operative/non-surgical care is advised before surgery in patients with lumbar disc herniation.
• 30,709 patients with lumbar disc herniation cost a total of $105,799,925.
• During the 90 days before spine surgery, there was an average of $3,445 per patient spent.
• Average charge for discectomy procedure was $7,841.
o injection procedures totaled $16,211,246 or 32% of total charges
o diagnostic imaging $15,648,769 (31%)
o outpatient visits $6,552,135 (13%)
o physical therapy visits $5,723,644 (11%)
o chiropractic manipulation $1,177,406 (2%)
o preoperative studies $426,976 (0.8%)
o medications $263,039 (0.5%)
o miscellaneous charges $1,177,371 (2%) (5)
From 2002-2007 the rate of complex fusion procedures increased 15-fold:
• from 1.3 to 19.9 per 100, 000 beneficiaries.
Life-threatening complications increased with increasing surgical invasiveness:
• from 2.3% among patients having decompression alone to 5.6% among those having complex fusions.
Adjusted mean hospital charges were high:
• for complex fusion procedures $80,888 compared with $23,724 for decompression alone. (6)
What Causes back pain after surgery?
Back surgery is an invasive procedure that could in fact CAUSE you MORE pain than you had to begin with. In fact, the risk of back surgery causing more pain is so high that it has been labeled “failed back surgery syndrome” and is defined as “chronic pain in the back or extremities following open spine surgery.” (PMRehab 09). Dr. Scott Fishman admits to having cases where people feel worse after the surgery. Interviews with patients months and years after their surgery have revealed that upwards of 90% still feel pain and that more than 70% cannot do normal activities.
Since scarring is a natural part of the healing process after surgery, scar tissue may be the cause of a lot of post-surgery back pain.
How to Relieve back pain after surgery Naturally
– The first one is ice or cold therapy that uses cold packs to reduce inflammation on and around the scar tissues.
– Spinal adjustments
– Massage therapy and trigger point therapy
– Stretching tight muscles, joints, tendons and ligaments
– Ginger: Ginger is possesses anti-inflammatory properties and is also a well-known remedy for the treatment of nausea and vomiting. Some people develop severe nausea and vomiting after surgery due to a reaction to the anesthesia or other pain-killing drugs administered.
– Chiropractic Care
what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!
Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability.
NOT utilise chiropractic post-surgically seems almost as foolish as not utilising it pre-surgically!
The chiropractic approach to treating the back pain after surgery is to find the source of the nerve irritation and relieve the pressure causing the pain. By correcting the source of the problem, the body can heal naturally without nerve interference. Back pain after surgery, like other health conditions that can be traced to the spine, often responds dramatically to the restoration of normal spinal function through chiropractic care.
Chiropractic is one of the most cost effective and safest form of care for back pain after surgery pain. Clinical evidence suggests that chiropractic is more effective in dealing with back pain after surgery than other more common medical treatments.
Chiropractic adjustments free the nervous system to communicate effectively so that the body can self-heal and self-regulate.
1. White AA, Panjabi MM: Clinical Biomechanics of the Spine. p 326
2. Bigos SJ et al: Acute Low Back Problems in Adults. Clinical Practice Guideline No 14, Agency for Health Care Policy and Research Publication No. 95-0642, Public Health Service, U.S. Dept of Health and Human Services, December, 1994
3. Atlas S, Keller RB, Wu YA, Deyo RA, Singer DE: Long Term Outcomes Of Surgical And Non Surgical Management Of Sciatica Secondary To Lumbar Disc Herniation: 10 Year Results From The Maine Lumbar Spine Study. Spine 30(8) April 15, 2005
4. Atlas SJ, Keller RB, Su YA, Deyo RA, Singer DE. Long Term Outcomes Of Surgical And Nonsurgical Management Of Lumbar Spinal Stenosis: 8 To 10 Year Results From The Maine Lumbar Spine Study. Spine 30(8). April 15, 2005
5. Daffner, SD; Hymanson, HJ; Wang, JC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine Journal 10 (6). JUN 2010. p.463-468
6. Richard A. Deyo, MD, MPH; Sohail K. Mirza, MD, MPH: Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults. JAMA. 2010;303(13):1259-1265.