For any person who is considering [url:165,type=|term|,content=|back surgery|] to alleviate [url:137,type=|term|,content=|chronic pain|], the question of “What if the surgery does not work” is likely to cross the mind at one point or another, possibly adding more stress to what is often already a difficult decision.

The term “[url:1216,type=|term|,content=|failed back surgery syndrome|]” (also known as FBSS or failed back syndrome) is sometimes used to describe [url:976,type=|term|,content=|back surgeries|] that are not successful. Patients should be aware that this term is a misnomer rather than an actual syndrome acquired following surgery, and basically refers to situations in which patients continue to experience [url:1470,type=|node|,content=|pain after surgery|].

A back surgery may not achieve its desired results for various reasons that are out of the patient’s hands; with that said, there are some things that patients can do to minimize the chance of an unsuccessful surgery in which postoperative [url:145,type=|term|,content=|back pain|] is present.

1. Be Confident in Your Diagnosis

   
   
   

   The number one reason that back surgeries are not effective is because of misdiagnosis of the probable cause of back pain, leading to operation on the wrong anatomical lesion. Prefacing this point, it’s important to know that [url:1583,type=|node|,content=|spine surgery|] is only indicated when there is an identifiable anatomical lesion causing spinal instability or nerve pinching.

   
   

   With this stated, assess your spine surgeon’s confidence in his or her diagnosis of the source of your back pain. Ask them about the specific anatomic lesion that would be addressed by the surgery, the alternatives to surgery, and what would happen if the condition is left untreated, and also question the surgeon on why he or she is recommending the specific surgery.

   
   

   If the surgeon is unsure about the diagnosis, if you are not confident in the answers provided or if you would just be more comfortable, consider getting a second opinion. Visiting a different spine surgeon can allow the patient to get another perspective on radiographic findings and see what that surgeon would suggest for the situation.

   
   

   Remember that if you are going to have surgery, you owe it to yourself to know that you’re doing it for the right reason. Understand how to get an [url:673,type=|node|,content=|accurate back pain diagnosis|].

   
   

2. Trust Your Spine Surgeon

   
   
   

   It goes without saying that your spine surgeon will play a major part in the success of your surgery. Regardless of whatever surgery is suggested, ask the surgeon about his or her experience performing the procedure. For example:

   
   
   • How many of the recommended surgeries does this surgeon perform each year?
   • How have other patients fared in the past following a similar surgery by this surgeon?
   • Does the surgeon have any patients who have had the same surgery and would be willing to talk to you about their experiences?
   • Who would be assisting with the surgery?

   As you will be entrusting this person with your health during surgery, it’s important to be confident and comfortable with your spine surgeon. Consider these specific [url:1549,type=|node|,content=|questions to ask your spine surgeon|].




3. Know the Percentages

   
   

   Patients should know that even with the best surgeon and indications, spine surgery is not 100% guaranteed to produce a successful result. In other words, a spine surgery can be performed for the right anatomical reason and done according to textbook, yet some pain may still exist following surgery.

   
   

   To cover some of your bases in regards to this above point, know the success rates of the recommended surgery. For example:

   
   
   • Certain surgeries like a discectomy or microdiscectomy for a lumbar herniated disc that is causing [url:887,type=|node|,content=|leg pain|], and a spine fusion for spinal instability from spondylolisthesis are more predictable operations.
   • On the other hand, surgeries like a discectomy for a herniated lumbar disc causing [url:896,type=|node|,content=|lower back pain|] or a spinal fusion for multi-level lumbar degenerative disc disease are far less likely to be successful.

   Knowing the success/failure rates of specific back surgeries can provide patients with a better feel for the surgery, yet patients should not put full stock in these success rates as applied to their situations. For example, just because a surgery is successful 90% to 95% of the time doesn’t mean that it will automatically be so for you.

   
   

   Learn more about what you can expect from [url:1615,type=|node|,content=|spine surgery for lower back pain|].




4. Be Ready to Rehabilitate

   
   
   

   Back surgery is more than just the surgery, with rehabilitation playing an important role in making the surgery as beneficial as it can be. Probably the second most common reason that back surgeries do not succeed is because of inadequate or improper rehabilitation following the procedure.

   
   

   With this in mind:

   
   
   • Understand what your rehabilitation program will entail following surgery (how many hours per day/times per week, etc.)
   • Speak to a physical therapist to learn more about your rehabilitation program and to get a projected schedule of what will be expected of you
   • Honestly ask yourself if you will be dedicated and self-motivated to rehabbing to the best of your abilities after surgery.

   Learn more about the importance of [url:1239,type=|node|,content=|rehabilitation and exercise following spine surgery|].




5. Set Realistic Expectations and Avoid Stress as Best as Possible

   
   

   Easier said than done when it comes to having surgery, this point hits on the overall theme of doing your homework prior to surgery.

   
   

   Ideally, the more prepared you are for surgery, the more prepared you’ll be for it afterward. Extensive research has demonstrated how the patient’s overall experience and ultimate outcome from back surgery can be improved with psychological preparation.

   
   

   From having confidence in your decision to have surgery to making accommodations in your work and daily life for rehabilitation prior to surgery to even having your [url:6591,type=|node|,content=|post-operation must-haves|] all in order before the operation, there are many ways in which you can minimize certain stressors and focus on what matters the most: achieving effective pain relief after surgery.

   
   

   Learn [url:1453,type=|node|,content=|how to prepare psychologically for back surgery|].

More on this Topic:

• [url:1969,type=|node|,content=|Specialists Who Treat Back Pain|]
• [url:1583,type=|node|,content=|Lumbar Spine Surgery|]
• [url:1472,type=|node|,content=|Lumbar Decompression Surgery|]
• [url:1582,type=|node|,content=|Lumbar Spinal Fusion Surgery|]
• [url:1545,type=|node|,content=|Scar Tissue and Pain after Back Surgery|]

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NATIONAL PANEL SOUNDS ALARM ABOUT LACK OF PHYSICIAN TRAINING TO TREAT CHRONIC PAIN; MAJOR HEALTH GROUPS ENDORSE NEW REPORT WHICH CALLS FOR URGENT MEDICAL SCHOOL AND HEALTH SYSTEM REFORM

"Epidemic" of under-treatment affects more than 70 million Americans suffering from persistent back pain, headaches, joint pain; disproportionately affects minorities and low income 

WASHINGTON, DC (November 4, 2009)-- Warning that patients shouldn't assume their doctor has enough knowledge to treat their pain, a national panel of experts today called on medical schools to train doctors and nurses on the basics of pain care, reform the nation's reimbursement system, and address pain as a public health crisis. The group insists that without health reforms and better training to diagnose and treat pain properly, people with untreated pain may face a lifetime of pain as a chronic illness – which could lead to job loss, depression and in some cases, even suicide. 

"Doctors, who don't lack for compassion or medical skills, often offer only limited treatments to patients disabled by chronic pain," said Lonnie Zeltzer, M.D., co-chair of the panel, and the director of the Pediatric Pain Program at the University of California, Los Angeles. "With little or no specific training in pain management, and working in systems that make it much easier to treat common conditions like high blood pressure than a complex problem like pain, doctors may intend to help but leave most patients under-assessed and under-treated. Minorities, children and women often faced the highest risk of under-treatment." 

The panel, convened by the New York City-based Mayday Fund, included anesthesiologists, neurologists, primary care doctors, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates (the full Committee is included below). After a conference in Washington D.C. and deliberations that lasted over several months, the panel's report, A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform, says pain is a huge public health problem. They developed several recommendations for government agencies, Congress and the medical community to address. 

The report and recommendations have been endorsed by more than 30 organizations, including the American Academy of Family Physicians, American Academy of Pediatrics, The Joint Commission, American Nurses Association, American College of Emergency Physicians, and the American Academy of Neurology (the list of current signatories is below). 

"As we get closer to the possibility of health care reform, the frontlines of medicine - adult and pediatric primary care - could face enormous strains from millions of new patients seeking care for pain," says Russell K. Portenoy, M.D., panel co-chair and the chairman of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York. "Primary care is the first stop for people in pain, and both the training received by clinicians and the system of care should facilitate best practices in pain care, but this is not the way it is." 

The Mayday Fund Special Committee on Pain and the Practice of Medicine writes that chronic pain should be reframed as a chronic illness since "the burden of chronic pain is greater than that of diabetes, heart disease and cancer combined." People in chronic pain have longer hospital stays, and many duplicative tests and unproven treatments—all of which drive up the nation's health care spending, the panel said. 

Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report says. "This is a wasteful system," Portenoy adds. "Major reforms in the health care system are needed if we want to improve the quality and cost effectiveness of care for chronic illnesses, and pain is as much a chronic illness as diabetes and heart disease." Although the impact of pain on patients and on society is among the most serious of public health concerns, chronic pain has been largely left out of the current national debate on health reform, the panel writes. 

According to the report, about "one-third of people in pain report that their pain is disabling and has a high impact on their ability to function in daily life. Research suggests that the high cost of under-treated pain includes lost productivity. Pain is the second-leading cause of medically-related work absenteeism, resulting in more than 50 million lost workdays." 

The authors pay particular attention to the numerous studies that suggest low-income populations, minorities, women and children are more likely to be under-treated for pain or not receive pain care at all. If doctors do not recognize chronic pain as a serious illness, or as serious as others, or they perceive that pain complaints cannot, or should not, be treated, persistent pain results. In some cases, such as pain in young children and adults with dementia, patients may not report their pain, and under-assessment drives under-treatment. 

"The tragedy of this system is that it leaves many people suffering from unrelenting pain," says Zeltzer. "Pain that goes untreated may permanently change the body's nervous system and may lead to pain that can be managed but never goes away." 

Federal policymakers have recognized the impact pain has on individuals and the health care system and have included provisions of the National Pain Care Policy Act 2009 (NPCPA) in health reform proposals. That bill calls for an Institute of Medicine Conference on Pain; increased funding for the National Institutes of Health to collaborate across institutes to find more effective treatments for pain and to better understand the biology of pain; a grant program to improve health professionals' understanding of and ability to assess and treat pain; and better public education so that consumers understand the danger of letting pain go untreated. 

"Remarkably, less than one percent of the NIH budget was devoted to pain in 2008," Zeltzer said. "This amount is not commensurate with a public health problem of this magnitude." 

In addition to medical school reforms and expanded funding for pain management training programs, the panel cited specific measures that would ease this public health crisis. Among them: 

• Health care providers, insurers and government agencies should eliminate disparities in access to pain care related to race, gender, age and socioeconomic status. All Americans in pain, including low-income Americans, should be offered timely and effective treatment for their pain.

• Government, health care payors and providers should develop coordinated health information technology (IT) systems to track pain disorders and treatments. Computerized IT systems can boost physicians' knowledge about the best treatment for pain by providing them with best practice information quickly.

• The Department of Health and Human Services should reform payment to eliminate the current incentives that drive pain care toward procedures or unproven treatments. Primary care doctors should be reimbursed for the time it takes to provide comprehensive pain care to patients who are disabled by chronic pain—a system that can cost a little more up front, but often reduces the cost of treating pain over the long haul.

• The Surgeon General should mount a public education campaign to inform the public about the risks associated with under-treated pain. Consumers should understand that if they wait too long to treat acute pain they run the risk of developing a chronic syndrome, one that's costly to treat and potentially disabling.

Remove Aspergers as a Diagnosis?

H1N1, Vaccines, and Mercury

Like other states, Colorado is trying to figure out how to deal with the United States Department of Justice's announcement last week that users and providers of medical marijuana will not be prosecuted when they are in compliance with state law. Here in Colorado, local officials say that a big concern is a surge in new users of the drug, which Colorado's top health official, James B. Martin, called "an abuse of the system."

In recent months, he said, thousands of young men in their early 20's have applied to doctors and, by complaining of severe or chronic pain, received cards to put in their wallets that allow them to legally buy high-quality marijuana. Marijuana is an itemized category of treatment for those symptoms under an amendment to the Colorado Constitution passed by voters in 2000.

"It is exceedingly unlikely that there's an epidemic of chronic pain among young male adults," said Mr. Martin, the executive director the Colorado Department of Health and the Environment, which administers the state's system for medical marijuana.

Figures from the department also show that issuing medical marijuana cards has become something of a medical specialty. Based on figures through mid-August, nearly three-fourths of the 10,003 marijuana permits issued in the state had come from just 15 doctors. One doctor alone was responsible for about one-quarter of the total.

More ...

Help For Headaches is a non-profit organization, and a registered Canadian charity that is committed to educational services for those suffering from and treating headaches. Our charity focuses mainly on Ontario. We firmly believe that being an 'informed patient' will:

• Make it easier for you to prepare for your physician's appointment  
• Give you additional options that may be able  to help you – as you search for an effective treatment with your physician

Our focus is to educate the community on the severity and symptoms of headaches and migraines and rare headaches.

Understanding your headache-type will always be your first step.

Our vision is to assist headache sufferers in their quest for relief. We believe that since headaches are diagnosed - and ultimately treated according to a particular classification - understanding and communicating these symptoms to your doctor or headache specialist  can have dramatic results.

Our belief is that through education, resources become apparent, silent suffering can be eliminated and awareness can foster treatment directions.

November 2: World Pneumonia Day

COPD Awareness Month: November

The thought of post-Halloween back pain may conjure images of taking the costumes back up to the attic or lugging heavy bags of candy. But let's not forget the extra weight you may be carrying from having eaten those Halloween treats! With the holidays approaching, be forewarned that back pain a very common problem for overweight people. Carrying extra pounds can increase your risk for developing several back disorders.

Don't Get Post-Halloween Back Pain! originally appeared on About.com Back & Neck Pain on Sunday, November 1st, 2009 at 23:39:46.

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"They took out my ovaries," the 46-year-old woman told the doctor. "And my appendix, and most of my colon. I had several exploratory surgeries where the doctors were just trying to find out what was wrong." Dr. Thomas Chelimsky listened attentively. "I've had, like, 13 surgeries," the woman reported, her voice edged with sadness. "It's really been a nightmare." For the past 23 years, this slender, middle-aged woman was tormented by these intermittent attacks of abdominal pain and fever that lasted sometimes for weeks. None of her doctors had been able to figure out what was causing the strange episodes of devastating illness that prompted all these surgeries and dozens of hospitalizations.

But that was not why her doctor sent her to Chelimsky. She'd been losing feeling in her hands and feet for the past couple of years. It started off as a tingling sensation that came and went. Now her hands and feet were always numb. She could barely hold a pen, and she often stumbled because she couldn't really feel the ground under her feet.

Chelimsky was a neurologist at University Hospitals Case Medical Center in Cleveland. The patient was there to have her hands and feet examined by EMG — electromyography — a test that looks for damaged nerves by sending tiny shocks through the muscle to the delicate strands that connect it to the spinal cord and brain. A change in the speed at which the electricity moves up the nerve indicates whether there is damage and, if so, where. As Chelimsky gently inserted the slender needle into the patient's muscle, he continued to ask questions about these unexplained attacks.

The first came when she was 23, she told him. She had this pain in the left side of her stomach. It felt like a knife stuck deep into her gut. Her temperature soared to 102 degrees. Her blood pressure rose to a level that frightened her doctors. She was delirious. She vomited uncontrollably. Her legs were so weak she couldn't walk.

The doctors in the hospital suspected it was her appendix, but when they took it out, the organ looked normal. After the surgery, the pain intensified. She stayed in the hospital for more than a week, and the pain slowly subsided but her doctors never figured out where the pain came from.

She had had other mysterious medical problems as well. At times her heart would beat so rapidly she would become lightheaded. Her cardiologist suspected that her heart had difficulty pacing itself, but repeated interventions failed to fix her heart's natural pacemaker. She had chronic constipation and what seemed to be frequent urinary-tract infections that were so severe she wasn't able to urinate at all. Other times, her joints and bones would hurt so awfully that she could barely get out of bed. There was never any redness or swelling of the joint, just this dull ache.

She had been given countless diagnoses — one doctor thought it was lupus; another told her it was multiple sclerosis. Repeated testing for these diseases was negative. Still another thought it was ovarian cysts — but the pain persisted even after first one ovary, then the other was removed. Some of the doctors she saw told her it was all in her head and suggested stress-reduction techniques.

Four years earlier, she found an internist whom she trusted, and together they tried to figure out the cause of each of the many problems she had. But she felt as if they were no closer to finding answers than they were when they started. Her internist was a kind man, she told Chelimsky, but it just seemed as if every time he'd come up with some theory about what was going on and treat that, another symptom would pop up. It was like the arcade game her children played, whack-a-mole — you get rid of one problem, but then it would pop back up, along with another and another.

As Chelimsky ran his tests on her hands and feet, it was clear that there was significant nerve damage. The most common cause of this kind of damage was diabetes, but this patient didn't have that. A pinched nerve in the neck could also cause this kind of injury; so could a deficiency in vitamin B-12. But what caught Chelimsky's attention was the possibility that the disease had affected not just the nerves he was testing — those that carry information back and forth between the brain and the voluntary muscles of the body — but also the type of nerves he couldn't test by EMG, autonomic nerves, which innervate the organs like the heart, the stomach, the urinary tract. Many of her other symptoms — the rapid heart rate, being unable to urinate, abdominal pain with no visible cause, even her constipation, which had been so severe that six months before much of her colon was removed — could be caused by damage to the autonomic nervous system. All that added up to just one likely diagnosis.

"Has anyone ever mentioned the word porphyria to you?" he asked. She'd never heard of it. He wasn't certain that's what she had; he hadn't examined her or reviewed her medical records, but the involvement of both types of nerves suggested this rare disease, and he thought she should discuss the possibility with her doctors.

When the patient got home that afternoon, she told her husband that Chelimsky said that she might have something called porphyria. Together the patient and her husband, a pediatrician, went to his library of medical books and began reading up on this rare disease. They read that porphyria was the name of a group of diseases caused by a genetic defect in the way that one part of the red blood cell is made. The oxygen-carrying portion of blood, known as heme, is a complicated molecule made in the liver and the bone marrow. Porphyria is caused when one of the pieces of the anatomical machinery that makes heme is missing. This is the disease that may have given birth to the American Revolution. It's thought that King George III was suffering from porphyria as he fiddled while the colonies were ablaze with the drive for independence.

As the patient read about the most common symptoms of the disease — episodes of abdominal pain, nausea, vomiting or constipation, weakness, confusion, rapid heart rate, the inability to urinate — it was as if she were reading her own medical history: her entire life seemed to be there on the page of these old medical textbooks. All the strange and terrible symptoms she suffered through, had surgery for, been considered crazy for, were there on the pages she read. Tears flowed down her face. Her husband cried, too. They had, she felt certain, finally found the answer.

It took more than three months for the patient to get a definitive diagnosis. If figuring out this disease was difficult, testing for it was equally so. But eventually, porphyria was confirmed.

Porphyria is a disease of the nervous system. Thus, everything in the body is affected. The patient's hardworking doctors had been chopping down the trees one by one, treating each ailment in isolation. Dr. Chelimsky, a neurologist, was finally able to step back and see the entire forest.

The children of a person with porphyria have a 50 percent chance of inheriting the disease. Recently the patient's brother was given a diagnosis of porphyria. And she now realizes that her father, who died six years ago, probably had it as well. It's painful for her to think of his suffering for all those years without the diagnosis that could have saved his life.

There is no cure for porphyria, but it can be treated. Episodes of pain can be shortened by providing the body with the heme it needs. The patient learned that she could prevent many of the attacks by avoiding the disease triggers — certain drugs and hormones, stress, illness, skipping meals. She told me recently that she has worked hard to make these lifestyle changes. And, she added proudly, she hasn't had an attack in more than a year.

November Is Diabetes Month