A spinal surgeon shares how to relieve chronic back pain without going under the knife.
In my 32 years as an orthopedic complex spinal deformity surgeon, I discovered that, all too often, patients were seeking surgical options to help them cope with their chronic pain, which is usually not amenable to surgery. This is not to say that surgery is never appropriate to treat pain, but when a patient’s spine is structurally sound, the numbers are dismally low for how effective surgery can be.
In fact, when the data came out in 1993 that the success rate for a fusion to treat lower-back pain was less than 30 percent after a two-year follow-up, I immediately stopped performing the procedure.
There was one patient who really changed things for me. Even though her x-rays and scans revealed there was nothing of concern with her spine, she was in constant, unrelenting pain. When I looked at her intake form, she had written that her job had become more difficult, she was experiencing marital difficulties, and her 26-year old son had recently drowned. Never had it been so apparent to me how crucial it is to take a full view of a patient’s life and circumstances, instead of just looking at surgical solutions. From that moment forward, some form of structured rehabilitation became my focus with every patient, without exception.
Since I quit my practice in 2018 to educate the public and medical providers, I feel like I’ve been helping more people solve their chronic pain than ever before. Through years of experience and research, I have developed a system of practices for patients that are highly effective in helping them manage pain without surgery:
- Learn about chronic back pain. Chronic pain is a complex neurological problem heightened by elevated levels of stress chemicals. Mental and physical pain is processed in a similar manner. However, mental pain has a greater impact on your life because you can’t escape from it. Many physical symptoms are created by the sustained alterations of your body’s chemistry. Ask yourself, is your doctor operating on your pain or on your anxiety?
- Practice expressive writing. A daily practice of expressive writing is the foundation for the rest of the process. There are almost 1000 research papers that document its effectiveness.
- Meditate. Drawing attention to a physical sensation connects you with the present moment. This shifts your attention off of your pain circuits and helps calm your system.
- Sleep. This is the cornerstone of solving your pain; real changes won’t occur without adequate sleep.
- Don’t share your pain. Your brain will develop wherever you place your attention. Don’t discuss your back pain with others, especially those who are close to you. Talking about your problems reinforces these unpleasant circuits.
Through my experience, I’ve found the two biggest factors in promoting healing are expressive writing and sleep.
Expressive writing, as a practice, involves writing down your thoughts and then instantly destroying them. Begin by writing down specific thoughts. They can be positive or negative, rational or irrational. Don’t worry about making sense or even being legible. This creates a space between you and your thoughts on the paper.
As you write, focus on the physical sensations you are experiencing, as this helps create new neurological connections. Don’t analyze your thoughts. It’s counterproductive to keep these as a journal. When you rip up the pages that you’ve written, your brain then associates the space you’ve created as a physical separation from your thoughts. This allows your nervous system to calm down, and your pain symptoms to lessen. I have all my patients write for 15 to 30 minutes as a mandatory, daily practice. After two weeks, the difference most people feel is remarkable, especially because it helps many to get a good night’s sleep.
In my practice, sleep proved to be an equally important variable in helping patients heal. I originally thought that people in chronic pain could not sleep because of their pain. But a large Israeli showed that pain does not cause insomnia. Surprisingly, the opposite is true: lack of sleep induces chronic pain. I took an aggressive approach with my patients, and after providing them with basic sleep hygiene concepts that helped them calm down their nervous system and adjusting their medications, most people begin to experience a consistently restful night’s sleep within four to six weeks. If we couldn’t make that happen, I would quickly refer them to a sleep specialist. Not sleeping is not an option.
Despite overwhelming data that has revealed the answers to chronic back pain, medical culture has become more aggressive in performing interventions that are repeatedly documented as ineffective, expensive, and risky. The consequences are brutal, both at a societal and individual level. This is why I tell my patients that they need to direct their own care and get their power back.
I often get asked, “How long will this take?”
After seeing thousands of cases, the only thing I can confidently say is that everyone’s journey is different. This is a process and you can’t compare yourself to anyone else. There is no one-size-fits-all solution for healing your chronic pain.
If you are kind to yourself, patient, and invested in the process, I promise you will see an improvement. It won’t hurt to try.
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