We have all experienced back pain to some degree. Maybe you strained a muscle lifting something heavy or perhaps you’re just sore from a tough workout. In cases like this, back pain may be unpleasant, but it is also short-lived. For some people, however, back pain is chronic and debilitating.
According to the American Chiropractic Association, as many as 31 million Americans suffer lower back pain at any given time, and it is the single leading cause of disability around the world. Additionally, back pain is one of the most commonly cited reasons for missed work and the second most common reason for doctor’s visits.
Back pain is difficult to treat because the back is a complicated structure of bones, joints, muscles, and ligaments with many potential causes. If you’ve been experiencing back pain for a significant period of time and nothing else has worked, you might be considering surgery. Before you agree to go under the knife, however, you should make sure you fully understand the choice you are making – ask yourself these questions to make sure surgery is the best option.
What Causes Chronic Back Pain?
Because the back is such a complex structure composed of myriad muscles and ligaments, bones and joints, there are many things that go wrong. Back pain can be caused by something as simple as a strained muscle or ligament, maybe even a muscle spasm. These things can be triggered by lifting something that is too heavy, lifting with improper form, or moving in an awkward or abrupt way. Fortunately, these causes for back pain often resolve on their own with time and with rest.
More serious causes for back pain are often related to structural problems affecting the spine itself. Ruptured or bulging disks, for example, can put excess pressure on nerves in the pine, causing back pain that can be moderate and chronic or sharp and shooting. Sciatica is caused by a bulging or herniated disk in the spine pressing on a nerve, and it causes a sharp, shooting pain that travels down the spine through the buttock and down the leg.
Some of the more long-term causes for back pain include various forms of arthritis and other spinal issues like scoliosis. Scoliosis is an abnormal curvature of the spine and, depending on the degree of curvature, it can cause mild to moderate or even intense pain on a daily basis. Arthritis is another chronic condition that can contribute to back pain and it is often also present in the hips, knees, and hands. In some cases, it can even lead to spinal stenosis, a condition in which the space around the spinal cord narrows.
Aside from medical conditions, there are also some risk factors which may make you more likely to develop lower back pain. Some of these risk factors include the following:
- A sedentary lifestyle
- A stressful job
- Advanced age
- Overweight or obesity
- Strenuous exercise
- Strenuous physical work
Because there are so many potential causes for back pain, diagnosis is often a complex process. It starts with a physical exam and a review of symptoms but may also include additional tests such as x-rays, MRI or CT scans, bone scans, and even electromyography. In some cases, further examination by a chiropractor may be warranted or at least consulted when it comes to determining the best course of treatment for the problem.
Questions to Ask Before Back Surgery
Treatments vary for the different causes of back pain. In many cases, pain can be managed with over-the-counter painkillers or prescription medications, but these treatments may not address the underlying issue. In more chronic cases, physical therapy may help to correct problems with the spine, muscles, or ligaments and cognitive behavioral therapy can help you learn coping mechanisms for dealing with chronic pain and mitigating its impact on your quality of life.
In rare cases, surgery may be the best option to correct the underlying problem causing your back pain. It is important to understand that back pain is only an option in certain cases – problems that might be resolved with surgery include the following:
- Herniated disk
- Spinal fracture
- Infection in the spine
- Tumor in the spine
- Spinal instability
- Loss of feeling in the legs
- Spinal stenosis
- Loss of bladder or bowel control
In cases where back surgery is warranted, there are several different options which include discectomy, percutaneous discectomy, laminectomy (for spinal stenosis), kyphoplasty and vertebroplasty, and spinal fusion. Like all surgery, these procedures come with serious risks, so you need to make sure you fully understand the procedure, the risks, and the recovery before you go under the knife. To ensure that you are fully cognizant of what you are agreeing to, ask your surgeon the following questions:
- Have you correctly identified the cause of my pain? Before you agree to go under the knife, you had better be sure that your doctor has correctly identified the problem – nothing is worse than an unnecessary surgery. Make sure your doctor has performed the necessary tests to diagnose your problem and then move to the next question.
- Is the cause of my pain treatable with surgery? Once you’ve identified the cause of your pain, you need to ask whether it is treatable with surgery. If your issue is a problem with the ligaments or muscles, surgery will not help – surgery is most helpful for infections, spinal instability, and structural or nerve issues.
- What are the chances of success with this type of surgery? There are no guarantees when it comes to back surgery, even if you are otherwise healthy and your surgeon is supremely qualified. Make sure you understand the risks completely and decide whether you are really willing to take them or not.
- How many of these surgeries have you performed? All surgeons go through a lengthy education but, like anything in life, practice makes perfect. If you aren’t absolutely sure that your surgeon is qualified to perform the procedure, ask for another surgeon.
- What are the prognosis and recovery like for this type of surgery? Surgery is incredibly invasive, and your body is going to need time to recover. During that recovery period, you should expect to experience some pain and there is a risk for post-surgical infection. Ask your surgeon about the recovery for this type of procedure to make sure you can handle it and that you will be able to take the necessary steps to ensure a healthy recovery.
- Are there any nonsurgical options available? This question may be the most important of them all because you do not want to put your body through the stress of surgery unless absolutely necessary. Ask your doctor about alternative therapies and consider doing some research of your own about natural remedies. You’ll have to decide for yourself if it is worth dealing with a little bit of daily pain to avoid the risks of surgery.
In addition to asking these questions, you should also ask your surgeon about getting a second opinion. Every medical professional has his or her own way of approaching problems, and some surgeons are more aggressive than others. Even if your second opinion makes the same recommendation, you will have peace of mind in knowing that you made the right choice.