You are in pain! Your back, neck, shoulder or knee are killing you. You’ve been to see a physician and surgery is recommended. Yay! You are going to feel better. Not so fast…
If you are in enough pain, you will agree to anything to make it stop. We know that. We also know that in 90% of neck and back pain cases, you will get better with time and maybe a few non-invasive treatments. The hard part is getting through the bad times without making a spur-of-the-moment decision.
After any back or neck injury, a thorough medical assessment needs to be done. The big reason for this is to make sure emergency surgery is not required. Any signs of spinal cord injury, cauda equina syndrome, foot drop etc. need to be treated right away. This would include any type of paralysis,incontinence or “balance” problems.
Once you are cleared of any emergent problems, time and movement become your greatest allies. The old thought of lying in bed waiting to get better (even if that is what you want to do) are outdated. We now know that sensible movement and exercise will speed up healing and also help you avoid the side effects of lying in bed for days. Walking and stretching are two necessities to any regimen. A Physical Therapist or Chiropractic Physician should put you on the right track.
Medications may be ordered for you by your own physician or in the ER. No one should be in severe pain or spasm but caution should be used with narcotics or muscle relaxers. Anti-inflammatories, if you can tolerate them, will often work well to alleviate pain and steroid packs, if used properly, can be very effective. For severe or long term pain, steroid injections are often recommended. Sometimes one does the trick; sometimes a group of three are required. If you do not get significant improvement with injections, it is not necessary to repeat them. The side effects and expense outweigh anything less than a 50% improvement in discomfort.
If any of these treatments do not improve your symptoms in 6 -8 weeks, it is then time to consider a surgical consult. From previous blogs, you know how to pick a spine surgeon. PICK TWO! Do not pick two who work in the same place or the same practice and make sure they both have access to all the same films, reports and notes. Make sure they do a physical (neurological) exam and explain what surgery is being done, why, and what you can expect theresults to be. If you have opposing opinions, get a third. Remember, you have one spine. A decision made in pain may not be the best one in the long run. Be informed, be careful, and be well.
- Vialle E. Second opinion in spine surgery: a Brazilian perspective. Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S3-6. PubMed PMID: 25947932