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 .