One patient of mind sought me out from Florida for a second opinion on his neck. He was about 50 years old and had been disabled since 2001 with chronic pain over most of his body. He had at least 10 different symptoms of burning, aching, stabbing, and tingling that would migrate all over his body. He also was experiencing bladder urgency, balance problems, and dizziness. In 2003, a neurosurgeon performed a laminectomy of his neck. That is an operation where the lamina or the bone over the back of the spinal cord is removed to relieve pressure. His symptoms seemed to improve for a little while. In 2005, the symptoms worsened, and in 2009, a surgeon in Florida performed a fusion through the front of his neck between his 5th and 6th vertebrae. Again there was a slight improvement but two years later he was in my office with crippling pain throughout his whole body.
As I talked to him, I could see how desperate he was for relief. He also was not sleeping and his anxiety and frustration were a 10/10 on my spine intake questionnaire. I could not find any neurological problems on my physical exam. When I looked at an MRI scan of his neck, I could see where the two prior surgeries had been performed, but there were no pinched nerves. The alignment and stability of the vertebrae were also fine. He also had undergone several workups of his brain and the rest of his nervous system. Everything was normal.
When I explained to him that I did not see a structural problem that was amenable to surgery he became understandably very upset. He was stuck on the idea that the prior surgeries had helped and that I was missing something. It did not matter what I said or how I explained it him.
What I did not tell him was that I had also looked at his scans he had prior to undergoing each surgery. Telling a patient that they did not really need a prior surgery is a very unproductive, unpleasant interaction; I didn’t see why this patient’s prior surgeries were performed. On the first MRI of his neck, there were no bone spurs and the spinal cord was completely free. There was not a structural problem that could have been corrected by surgery. On the scan before the second operation, there also was not a hint of anything that could be causing any symptoms of any type.
What is difficult for patients (and physicians) to realize is that the placebo rate for any medical or surgical treatment is between 25-30%. This is not an imaginary improvement. The body really does feel less pain. The pain-killing effects of a placebo are reversed with Narcan. Narcan is the drug used to reverse the effect of narcotics. There is a part of the frontal lobe of your brain that actually shuts off pain pathways for short periods of time. Another example is the placebo effect of cardiac medications causes the heart rhythms to actually change. Just because a prior surgery or procedure might have been temporarily effective has nothing to do with you making current decisions about your spine. I tell my patients “If I can see it, I can fix it” and “If I cannot see it, I cannot surgically correct anything.”
I suggested that he take a look at the DOCC website and I would be happy to explain the whole program to him in as much detail as needed. I did not think I would hear from him again.
Over the next couple of months, I received a couple of emails and had a telephone conversation that seemed to go pretty well. He was willing to engage in the DOCC protocol and began some of the writing exercises. I had a second phone conversation with him a couple of weeks later that seemed to go even better and he was able to recognize that his thought of me “missing something that needed to be fixed” was an obsessive thinking pattern. I was encouraged and thought that maybe I had somehow been able to break through his “story.”
Time went by and our third and final conversation was dismal. He could not let go of the thought that “something was being missed” and that his C7 was “out of alignment.” I assured him it was OK. As a surgeon, I am also quite obsessive about not missing problems that I can fix. At this point, it did not matter. He had found a surgeon who was going to fuse his neck.
Physicians use the term “injury conviction” to describe this phenomenon. It is the relentless pursuit of a cause for your symptoms that is well beyond reason. My concept has changed in that I feel this pattern of thinking becomes its own irrational neurological circuit. Rational arguments have absolutely no effect. I just re-wrote the chapter in my book “Anxiety and Anger, The Highway to Hell.” Unfortunately if you are in this pattern, you are in Hell, and the only way out is through you. If you don’t realize you are there, you will remain there. I never give up, but I have learned to let go when I cannot penetrate that firewall of obsessive thinking. For those of you that have let yourself out this hole, I am open to suggestions as to what gave you the insight to move forward. I realize the first step is to recognize that you are in there.
I don’t know how many tests and surgeries he will undergo over the next 30 years. The personal cost to him and society will be enormous.
What is puzzling is that if any of the surgeons who chose to operate on this man’s essentially normal anatomy were examined by a board examiner about their indications for surgery, they would be failed immediately for giving a “dangerous answer.”