[[You will realize there are very few chronic pain conditions a Neurosurgeon with 40 years experience at Mass General didn’t encounter. ]]
I call BS- Respectfully-
[[Research investigating a popular form of surgery aimed at easing chronic shoulder pain doesn’t fix the problem, a careful, placebo-controlled study suggests.]]
[[Surgery is rarely used in chronic pain cases. If it is used, it’s generally the last resort. However, if you have serious neurological complications (such as bowel or bladder dysfunction), along with chronic pain, you may need immediate surgery.]]
https://www.spineuniverse.com/conditions/chronic-pain/surgery-chronic-pain
[[The biggest risk of sacroiliac joint fusion is the possibility that surgery won’t alleviate pain, and/or that fusion of the joint will be unsuccessful.]]
[[Despite careful diagnosis and a successful operation, some patients may still experience pain after their back surgery. This persistent pain or continuation of symptoms is known as failed back syndrome (sometimes called failed back surgery syndrome),
However, epidural fibrosis, the formation of scar tissue near the nerve root, can put pressure on the nerve roots and thereby cause pain.]]
Yup- just keep gettign surgeries- nothign to it-
http://www.back.com/back-pain/conditions/back-pain-after-surgery/index.htm
As well, there are many cases for which there are numerous pains for which surgery can not correct- fibromylagia being one of them ore common- who have intractable pain for which htere is no surgey-
Degenerative spinal disease post-surgery 32%
Degenerative spinal disease non-operable 22%
Fibromyalgia 15%
Migraine-vascular headache 8%
Neuropathies 6%
Congenital skeletal disease 5%
Headache-post trauma 3%
Reflex sympathetic dystrophy 3%
Osteoporosis 2%
Systemic lupus erythematosus 2%
Abdominal adhesions 1%
Interstitial cystitis 1%
[[Who Is the IP Patient?
The authors define IP as “pain that is excruciating, constant, incurable, and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation and may produce a desire to commit suicide for the sole purpose of stopping the pain.”]]
https://www.practicalpainmanagement.com/resources/intractable-pain
As you knowe0- there are many inoperable back pains- Many people can not get back operations for one or several reasons- both medically and financially- There have been too many surgeries, too much scar tissue- too much damage that has become irreparable- etc- There are things such as inoperable hernias that put people at too great a risk to have surgery- inoperable brain tumors- spinal tumors- on and on it goes- Your $400 book doesn’t address any of these situations- or conditions with multiple causes and locations of pain- surgery is not an options for these folks- so no- it’;s not true that he hasn’t ‘found many that he couldn’t operate on’ if He’s working at one of the largest hospitals in the world- If he made that claim, then he’s hiding the truth- and just because “there are very few chronic pain conditions a Neurosurgeon with 40 years experience at Mass General didn’t encounter.” doesn’t mean he operated on all of them and cured all or even most of these people of pain- it just means he’s encountered a great many people with various pain problems- IF He’s claiming he fixed most of them, then he’s leaving out the inoperable cases he didn’t take on-
I’m not spending all day on this- you and I disagree- greatly- many chronic pains can not be operated on- and many that can- do not result in complete cure, or sustained relief- and it’s not an option to just keep going back and getting risky, expensive surgeries for many- especially when there’s no promise of cure- Surgery is not something to be taken lightly- and not all conditions even qualify for surgery when there are other methods available- opioids included- because of the risks of surgery- and complication that can and often do arise-
[[[[Surgery is rarely used in chronic pain cases. If it is used, it’s generally the last resort. However, if you have serious neurological complications (such as bowel or bladder dysfunction), along with chronic pain, you may need immediate surgery.]]]]
And again, the reason it’s used as a last resort in many cases, is NOT because ‘doctors just don’t want to help the patient’ but because of the risks of surgery, and because surgery is not to be taken lightly- it’s a last resort- not a first resort- and that is the way it should be- You not only have the risk of the surgery itself, but hte risk of anesthesia- risk of infection- in hospital, risk of infections after you get home, complications etc- This is why surgery is last resort- almost 20,000 people are year in the US die from staff infections- more from other drug resistant infections-
Very good post. IP consumes you. It builds upon itself. It leads to physical and mental disease. It crushes the mind body and soul. There is no way out of it. The nanny state would rather you eat a bullet than a pain pill.
Thanks Bob!
Now that opiates are taboo we know what’s going to happen next.
More complications from unnecessary surgery. We’re also going to have more bleeding ulcers, kidney damage/failure, allergic reactions from NSAIDS.
And right now we’re already seein the suicides from forced opioid tapers, and increased deaths from street drugs.
In as you have indicated, lower back surgery has historically been the most common cause of iatrogenic chronic pain. Surgeons operating on chronic pain pains that were poor candidates because of medical and psych co-morbidities, long term pain, disc degeration without nerve compression, patients with diabetic neuropathy interpreted as sciatica (one of my favorites), 2nd 3rd and 4th re-operations with fusions beginning at L5-S1 and working up the spine.
Think about this, we had one case (sure, n=1) I recall that really opened my eyes to what is possible. I honestly can’t remember what the diagnosis was or the guy’s daily dose of Morphine but it was substantial. He had a problem with chronic pain on one nerve root. We put a small catheter in that nerve root sleeve and hooked it up to a pump that infused 1 mg of Morphine a day. Right into the nerve root sleeve. It was 100% effective. The guy got off systemic opiates completely. Think about it. If you can do that with one nerve root why not several. The point I am trying to make is we aren’t even trying. We are buying into this “it’s opiates or nothing”. That is a false choice.