Be Fully Informed Before You Decide To Have Elective Surgery for Pain
Surgery can be offered as a solution to stop your pain. Pinning all of your hopes on having an operation is something many of us do, but because it's not a small thing to do, it's important that we arm ourselves with as much information as possible. The best way to get information is to ask questions and ensure you get answers.
In this article I will cover three important questions to ask your surgeon to help you make an informed decision of when and whether to have an operation with the purpose of curing or stopping the pain that you have had for months or even years.
Why do you need the operation - make sure you understand the reasons the operation is being done.
Will the planned operation stop you being in pain - what is the likelyhood that you will be painfree after the physical recovery from the actual surgery.
Will I be back to my normal activities and lifestyle that I had before your pain developed or will you have to change how you live.
As far as chronic pain is concerned many operations are called elective surgery. This is interesting terminology, implying that you choose to have surgery, when often if you have chronic pain it may seem to be the only option. What I hope to do in this article is to give you cause for thought and to help you to be fully informed as to whether to have surgery, or not have surgery and continue to look for other options to stop your pain.
My first thought was to look at the definition: -
According to Collins dictionary "surgery is medical treatment in which someone's body is cut open so that a doctor can repair, remove or replace a diseased or damaged part."
The first question to ask may seem obvious, however I suspect it's something that many of us don't ask, or feel we are not able to ask the pain specialist or surgeon who has told us that we need surgery.
Question One
Why Do I Need This Operation?
I always explain to each client who joins me that chronic pain (pain that lasts longer than three months) is complicated. If you would like to have an operation because you think it will "cure your pain" with the result being you will be pain free, be sure to ask questions, lots of questions.
As an example let’s consider knee pain, but these ideas are relevant to any musculoskeletal chronic pain.
A painful knee that stops you: -
o Walking easily, especially any distance.
o Makes it difficult for you to get up from the chair.
o Causes you to limp.
o Stops you from doing your favourite activities or restricts you from doing almost any activity.
o Puts an end to lifelong exercise - exercise that is part of who you are.
During your diagnosis and assessment of your pain most of the focus is on your knee, perhaps extending to the muscles in that one leg. You're kind of put under a microscope, or at least your knee is, with the rest of your body just brought along because it's connected to your knee!
But as I said above chronic pain is complex and I fully believe successful treatment must include all of your body. What us natural therapists label "holistic" treatment. Bear in mind when I say body that includes your head, which contains your brain to which we must add your emotions, your reactions and thoughts. It is particularly these latter three that much of my focus belongs because that's where many of the answers to chronic pain, reside and belong.
Now let me return to the first question to ask, why do I need an operation? I want you to think about the following, two stories that might give you cause for thought.
Information Depends On Who You Ask
I found the best way to explain something is to tell a story. The story I have for you is about getting different opinions and clear information comes from when I was a high school teacher.
Story One
I used to be a mathematics teacher. At the senior level of high school there comes a time; in the UK it's when you do A-levels, in New Zealand it may be sixth form, Australian (I'm not sure), but pupils have to make subject choices. Decisions have to be made to specialise in subjects that are best for their career or the next step in their education.
When pupils have to make this decision there is lot of what we could call 'gaming' going on amongst their teachers. If I have someone who is a talented mathematician then of course I'm going to suggest to him or her that they continue to do mathematics.
But little did I realise that this pupil, who I assumed would perhaps study mathematics and science to take them to university, was also being encouraged to take English or history, they may be exceptional at physical education or be a talented artist. It can turn out that there's a whole group of teachers vying for a pupil's attention and for their enrolment in our own particular subject area.
With this story, it's obviously, each teacher is promoting their own subject as they view things through their own lens. This 'lens view' of the person giving you information can certainly influence what happens in your pain treatment.
Different Information Given to Chronic Pain Patients
Let's look at the lens through the specialty of various clinicians you are visiting about your pain.
- Surgeons who do operations will of course see an operation as a solution to your pain.
- Chiropractors will manipulate your spine to affect your nervous system and hence a solution to your pain.
- Naturopaths will expect lifestyle changes and prescribe supplements as a stopgap to making those lifestyle changes.
- Psychologists will advocate for talk therapy, as will counsellors.
- Physiotherapist will give exercises and perhaps a massage.
- Doctors will prescribe medicines, injections or other interventions.
And all of these specialties will have their reasons which they give you Their explanations about their expertise. Some clinicians reading this will say yes Jean, but there are such things as multi-disciplinary pain clinics where you do see different people. That's true but one of the things I've discovered is there is a hierarchy of influence, and at the top of there seems to be the medical pain specialists and, more relevant to this article, the surgeons and the respect given to their position.
Do I Really Need Surgery For My Pain?
To the question of - why do I need this operation is worth asking many times, and of many different clinicians. And then you need some way of integrating that knowledge perhaps adding in some of the many and varied self-help techniques you can get from spending time on this website.
Time For Another Story - Getting A Second Opinion
Story Two
A man in his 50s came into my pain clinic in Canning Vale in Perth, Western Australia. He was a traddie, perhaps he worked in the mines. He wanted to discuss his knee pain, just an enquiry, as he needed to talk to someone different. His surgeon was telling him that he needed a knee replacement because of his chronic knee pain that was getting worse and interfering with his ability to do his work.
He really didn't like the idea of an operation, and it's not my first go to solution either. What I did suggest is that he got a second opinion from another knee replacement surgeon. A couple of weeks later he called in again and brought me up to date about his knee pain.
The second surgeon really didn't want to do an operation as he thought; the man being in his 50s was too young for such a drastic solution. This second opinion suggested he look at other options to strengthen his knee and the muscles of his legs and hips. And this is what he was very keen to do.
So I guess the final answer to question one is to ask many questions yourself of your surgeon, of your doctor, your physiotherapists or your naturopath (that would be me). And like the gentleman above get a second or even a third opinion before you take a walk through the one-way door-that's surgery!
Question Two
Will The Operation Stop My Pain?
Almost without exception when I first meet a new client and ask "what can I do for you?" the answer hardly varies.
The versions are:
o I want you to stop my pain.
o I want to be pain-free.
o Take my pain away, please.
o I want life to be like it used to be before I got this pain.
Gees - I wish I could do this!
If you've had chronic pain for years many people are looking for answers, they hope that the next doctor or pain specialist they see will be able to take their pain away.
I remember giving a talk to the fibromyalgia support group in Perth, quite early in my career of treating chronic pain. This turned out to be an interesting experience. The group listened attentively to my beliefs about the importance of emotions and my ideas around chronic pain.
But after my talk, I was quickly outdone by one of the members gathering a group around her as she talked about a new therapy that she had just started. Her hopes were high for this latest alternative treatment with a price tag of nearly $2000.
During my university study of pain management we talked about the idea of "Hope" that the next treatment would be the one to take away your pain. Much of our discussion was centred around when do pain specialists decide to stop trying:
o New tests.
o Looking and perhaps finding a new diagnosis (perhaps some of you reading this have collected a few different diagnoses over the years of pain).
o Another treatment, an injection, nerve block or other.
o Various nerve stimulation or one more medication.
When Have You Had Enough Tests?
I think it's important for chronic pain patients to know that a lot of medical research and development is going into finding ways of "fixing" chronic pain. Pain specialist can be just as frustrated as you. But some doctors are starting to look for the time to say enough, enough tests and treatments that keep failing. Recommending a move towards pain management strategies that are more reliant on self-help rather than being fixed by someone else.
Personally I find the idea of pain management doesn't sit well with me because who really wants to manage pain. I'm beginning to find there are people like myself who believe that for quite a number of pain sufferers there can be resolution, as Professor Lorimer Moseley said," let's try living without pain". Granted this doesn't work for everyone but it's been my experience that most of the people I have worked with have been able to live with little or no pain.
"Surgery is a one-way door".
"At the same time surgery is often that final "hope" offered for debilitating chronic pain."
People Can Be Determined That Surgery Is The Answer.
You have the right to be told what are the risks for your elective surgery, any side effects and what is the true possibility that you will still have pain after surgery. Which brings us to question three.
Question Three
Will I Return To Normal Lifestyle - Be The Same As Before Pain?
I thought it would be useful to find some statistics about how successful knee and hip replacements were and also their overall benefit.
The statistics I chose are based around two forms.
1. Oxford Knee Score (OKS)
2. Oxford Hip Score (OHS)
These questionnaires are used to give you the chance to assess your pain, disability and how these impact on your life. The forms are your opinion, or self-assessment.
Many of the reports and statistics I found were complicated, written to inform surgeons and other health professionals working with chronic pain. However I did find some figures put out by the National Health Service of the UK. These figures are based around the forms I mentioned above. Patients provided feedback, as self-assessment, before and after their knee or hip replacement surgery.
There are separate tables (under resources section) provided for knee and hip replacement surgery, where I choose some of the reported statistics to share with you.
The overall results were good; the knee score of 91% of people had improved with the hip score 95% improvement.
Okay, before you all start signing up for the surgery - here's a question I want to ask you.
"Is your operation just about pain?"
If the answer is yes, results are still promising.
o Hip replacement over 85% improvement in pain.
o Knee replacement again 85% improvement in pain.
But.
o Knee replacement and its effect on night pain was only 70% better (that means 30% of people remain the same or worse).
Interesting question here for the pain specialists?
What Results Do You Want From Joint Replacement Surgery?
But, if you wanted surgery for a better quality of life afterwards, regaining the lifestyle and mobility you had before your pain started, the news is not so good.
The results remind me of a conversation I had with my lecturer during my postgraduate study on pain management. The lecturer was very experienced and had been teaching pain management for over 20 years and I was surprised to hear some people never regained their full mobility and lifestyle that they had before developing chronic pain.
Here's where the news about surgery for chronic pain is a bit more concerning. Feedback from post surgery patients raise concerns that need answers from your specialist.
Mobility After Knee Replacement Surgery.
The worst result, shown on the research above from NHS, was kneeling, 55% of people ended up the same or worse following replacement surgery. Another conundrum for your chronic pain specialist to answer?
Lifestyle is about being able to do everything, easily without thinking. Such as: -
o Easily walking up and down stairs.
o Going for a walk, walking around the shopping mall, the golf course, or the beach.
o Getting washed showered and dressed, again easily and able to rush about in the morning to get out to work.
The results for the 'same or worse' for these lifestyle things we do on a daily basis range was from 30 to 50%, for either hip or knee surgery.
Going Up And Down Stairs No Better After Surgery?
Story time again - this time it's about my knees. Perhaps it'll get you thinking about your own 'knee history' before you choose a knee operation.
Christchurch, where I live is a very flat city and before that I lived in Perth for 15 years, also flat city. Not too strenuous for my knees. Also, my 'knee paradise' was living in single-storey houses for most of those 15 years.
Imagine, the shock to my over 60's knees when I came to Christchurch for a holiday (checking it out for changing countries) where we stayed in a house with the bedrooms upstairs. Lots of walking, coming and going throughout the day, so lots of up and down stairs, two flights each time. Hubby and I couldn't figure out what was wrong with our knees - they hurt and ached most of the first two days. After that they seemed to get used to the stairs and felt much better.
"Check out your knee history."
"Do your knees need stair walking education?"
Conclusion And Final Thoughts
I want you to remember it's your decision. Beware of who is giving you information and what's their "skin in the game". Always get a second opinion or even third opinion as the man in my story above with knee pain. The ideas and suggestions in the article can also be applied to hips, back, shoulders etc.
Finally before you decide to lie back and have a surgeon take away your pain, Why not try self-help techniques?
Most pain clinicians will have many self-help ideas for you to try, you just have to ask. My stories and articles have many ideas throughout this website. Daily, my clients and myself are creating more. Chronic pain may be difficult and complex but even small changes can make an impact and start to reduce your pain.
A full and open discussion is necessary to learn about any risks of your surgery and the possibility of revision surgery - that is a second surgery on the same part of your body.
Remember many doctors and surgeons work in a world of very technical language, but they will be able to use more everyday language, if you remind them. Keep asking for explanations and get clarity for yourself.
Finally returning to your decision, what do you want to get from surgery?
o How do you want to feel?
o What do you want to be able to do?
o What will my life look like after surgery?
o How long will recovery take?
o What help and advice do I get, to have the best recovery possible and live, as I want to live?
And any more questions you need answered.
Choosing surgery cannot be undone and doesn't work for everyone.
This article represents the thoughts and ideas of the author provided for information only and is not medical advice. Any pain you experience should be checked by a doctor.
If you'd like to connect with me to discuss your pain, check out my Pain-Less Journey
References
Professor Lorimer Moseley talks on Facebook
Tables used for pre ad post-surgery can be found in the resources section of this article.
The information above is copyright © 2012 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.
Jean Jordan
Want to find simple effective ways to reduce your chronic pain (change for each blog/topic) without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics pain I started Natural Pain Solutions online business to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.
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