Wednesday, February 4, 2009


Everybody gets back pain. More precisely, about 80% of the world will get a significant episode of back pain at least once in their lives. Mostly, back pain is self limiting, such that whichever modality of treatment is used (from nothing through physiotherapy, chiropractic, osteopathy right through to surgical fusion) it usually gets better. Most successful predictors for chronicity (that is long lasting) of back pain are employment status, social class, psychological profile and presence or otherwise of a legal case. Put simply, back pain will never be eradicated until everybody has a job that they like, plenty of money and somebody to love.

Every clinic I do I see patients who have chronic back pain, and who hope that I will be able to fix it. Surgery can rarely, if ever, fix back pain. The same is true, even more so, for neck pain. There are of course rare exceptions where significant pathology is present, but generally speaking surgery has little role to play in the treatment of spinal pain.

I often see patients whose expectation of treatment differs from mine. They come to clinic wanting me to fix them, and take my inability to do so as either an unwillingness to treat them or as a lack of interest in their problem. Neither scenario is true. As a surgeon, I've been trained to recognise problems that can be alleviated by an operation, and have learned when to operate and more importantly when not to operate. I can understand that patients with backache are looking for a solution. Unfortunately, a solution is often not available.

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