Editor’s note: Wellness Word is an informational column which is not meant to replace a health care professional’s diagnosis, treatment or medication.
Spinal Surgery Explosion
By Ron Feise, DC
Over the last few decades, spinal surgery rates for patients with degenerative disc disease have risen by more than 625%. Yet, degenerative disc disease is not a condition that necessarily requires treatment.
The US has the highest rate of spine surgery in the world, roughly twice that in New Zealand, Australia, Canada, Norway and Finland, and more than three times the UK rate. Yet, there are no known biological differences from country to country, and studies suggest that rates of neck and back pain are similar among geographic areas.
Degenerative changes and disc herniation of the spine are biological realities, but pain and disability do not necessarily accompany these conditions.
A major problem with MRI imaging is that it can reveal things that are alarming, but irrelevant. International research teams, including The American College of Physicians and the American Pain Society have found no evidence that disc degeneration is a risk factor for neck pain or back conditions.
About 30% of 20 year-olds and over 80% of 80 year-olds have disc degeneration or bulge without any symptoms. Contrary to popular belief, changes like disc degeneration, disc bulge, and disc protrusion are part of the normal aging process, rather than conditions requiring treatment.
Recent scientific research has found that herniated discs can be resolved after conservative treatment or even after no treatment. The probability of low back herniated disc regression without surgery, but with conservative treatments like spinal manipulation, exercise, physical therapy or NSAIDS, is 70% for disc extrusion and 41% for disc protrusion.
Serious adverse events caused by spinal surgery are remarkably common. Two studies published in British Medical Journal and The Spine Journal found the re-operation rate (failure rate) for spinal surgery to be greater than 22%. Serious post-operative pain and disability was experienced by more than 29% of patients following lumbar disc replacement.
In patients with neck arthritis, 37% suffered from at least one adverse event. Blindness following spinal surgery is estimated at more than 1 per 1,000 operations, and death rates are about 5 per 1,000 operations.
Randomized, double-blind, placebo-controlled trials are the gold standard for evaluating interventions and assessing medical therapies, but spinal surgeons have been reluctant to use imitation surgery to assess the placebo effect of spinal surgery. It is well-known that surgery has a larger placebo effect than non-surgical treatment. So the question remains, could the purported benefit to patients from spinal surgery just be placebo?
This question about the placebo effect of spinal surgery is the focus of a new book, “Surgery, The Ultimate Placebo”, by Dr. Ian Harris, a well-respected practicing orthopedic surgeon, research scientist and professor of orthopedics.
He critically examines his own profession and thoroughly documents the failure of spinal surgeons to demonstrate that spinal fusion is better than pretend surgery. Harris clearly and compellingly explains the power of placebo as it relates to surgery and the importance of this alarming information for patients considering spinal fusion.
Dr. Ron Feise is President of the Institute of Evidence-Based Chiropractic.
Should Opioids For Spinal Pain Be Banned?
Hari Dass Khalsa, DC
Several national guidelines, including one by the U. S. Department of Health and Human Services, have made recommendations regarding the appropriate use of opioids (e.g., oxycodone, fentanyl, morphine) for the management of acute low back pain. These recommendations suggest that opioid analgesics could be an option for symptom control, but only for a short course due to their side-effects.
Recent research supports this limitation. A scientific study published in Spine, the leading international orthopedic journal, found a negative association between patient results and the early use of opioids for acute low back pain. In other words, the more opioids a patient used, the worse their results.
The research team investigated the relationship between early opioid use for acute low back pain and results in a 2 year period following low back pain onset with 8,443 participants. Their analysis took into account such items as low back injury severity, age, gender and job tenure.
The findings are important. Patients with an early use of high morphine equivalent amounts were, on average, disabled 69 days longer, the risk for surgery was 3 times greater, the risk of receiving late opioids was 6 times greater, and medical expenses were more than $15,000 greater than those who received no early opioids.
Researchers concluded that the use of opioids for the management of acute low back pain is counterproductive to recovery and other research teams affirm these findings.
They’ve also found a relationship between opioid prescribing and an increase in overall healthcare costs and an association between opioid use and disability duration. Opioid side effects are not limited to drowsiness, debilitation, impaired judgment, and reaction time, but also include opioid-related death, which is not infrequent .
It is interesting to note that before the 1980s, treatment with oral opioid analgesics was limited to terminal cancer patients experiencing chronic pain. During the late 1980s, pharmaceutical companies conducted a large-scale media campaign aimed at increasing the use of opioids for acute pain management. The marketing succeeded in increasing opioid prescribing.
In 2002, opioid analgesics were the most frequently prescribed controlled substance.
Dr. Hari Dass Khalsa is a chiropractor specializing in the non-surgical treatment of spinal conditions. His offices are in the Hawthorne District. 503.238.1032 for more.