A Knife in the Back

Is surgery the best approach to chronic back pain?. Surgeons have often touted procedures that ultimately proved to be disappointing. In the nineteen-fifties, many patients with angina and coronary artery disease had an operation that involved tying off an artery that runs under the sternum. The idea was that it would increase the flow of blood to a heart that was being starved of its normal supply. Then, at the end of the decade, a clinical trial demonstrated that patients who underwent a sham operation did just as well as those who had the real one; the placebo effect apparently accounted for the fact that so many patients felt better afterward. Alternative to Radical Mastectomy The radical mastectomy pioneered a century ago, used to be routinely performed, too. Physicians believed that breast cancer spread in a contiguous, stepwise fashion from the primary tumor, and that the only way to eradicate the disease was to remove the entire breast and the underlying muscles. By the nineteen-eighties, it had become clear that tumor cells could spread throughout the body early in the disease, through lymph channels and blood vessels. A lumpectomy, followed by local radiation, proved as effective as a radical mastectomy in treating the cancer, and was far less traumatic to the patient. Sciatica, Herniated Disc, Discectomy? Last year, approximately a hundred and fifty thousand lower lumbar spinal fusions were performed in the United States. The operation, which involves removing lumbar disks and mechanically bracing the vertebrae is of tremendous benefit to patients with fractured spines or spinal cancers. More frequently, however, it is performed to alleviate chronic lower back pain. But how effective is it? That's a question that many of the doctors who perform the fusions, and the insurers who pay for them, appear reluctant to ask Roughly two thirds of all Americans will experience significant lower back pain at least once during their lives; some will also have sciatica, a. pain that follows the nerve running from the lower back down the leg In the United States, current estimates of the cost of medical care for those who have been disabled by severe back pain range from thirty to seventy billion dollars annually. Back pain is most likely to occur between the ages of forty-five and sixty-four, and, over all, nearly one in four Americans claims to suffer chronically from the problem. Many of these people are being told that fusion surgery is the solution. If you had rather have information on alternative approaches to relief from lower back pain, more information is available .