Anger Altering Surgical Decision

Imagine your life before the pain. Stop and visualize a day or period in life when you were just plain angry. What kind of a day was it? Now add the pain back in and see what you get–a catastrophe.

One of the byproducts of anger is obsessing over negatives. With chronic pain, it is deadly. As the brain focuses on the pain, the signal becomes stronger. As the pain worsens, you become even angrier. An endless cycle emerges, and you spiral downward.

I know you have pain, but what exactly are you looking for? When I ask that question in the clinic, the most common answer I hear is “ I just want to get rid of the pain.” I’m sure you want this too, but even if the pain disappears, will the rest of your life just come together and be great? Being pain free is just one of the things you need to live a stress fee, happy, and healthy life. It turns out that if you work on some of these other things, like learning to deal with stress, the intensity of your pain becomes reduced.

Around 1990, I had a patient in her mid thirties who had suffered a lifting injury at work. She was seeking another surgical opinion. She had a moderate curvature of her lower back that she had been born with. The term for the disorder is congenital scoliosis. Although there is a slightly higher chance of low back pain with lumbar scoliosis, I felt strongly that she should not have surgery. I reminded her that patients with straight spines have the same type of pain after a lifting injury. She was also under a lot of personal stress and extremely angry. She had not fully participated in a conditioning program. I talked to her for over an hour about why she should not have an operation. She wanted to have seven levels of her spine fused. This included her whole lower back and her thoracic spine. She was determined to go ahead with the surgery. I was unwilling to do it, so she proceeded to have another surgeon fuse her whole lower back.

She returned to me two years later in a wheelchair because of ongoing severe low back pain. Although the fusion had not completely healed, it was stable. She had a recommendation to have the weak spot in her fusion surgically repaired.

The success rate of repairing the fusion is high. We are able to remove the hardware, re-graft the area, replace the hardware, and obtain a solid fusion most of the time. The chances of relieving her pain, however, were almost zero. Unless the weak area of the fusion is unstable, my feeling is that surgery is not necessary. Her pre-operative mental state had markedly deteriorated after two more years of pain. There was nothing that could be done to surgically relieve her suffering.

This situation occurred before I knew much about comprehensive rehabilitation and the importance of calming down the nervous system. Her main reason for returning to see me was to undergo yet another operation. She could not let go of the idea that surgery was the definitive solution.

This scenario is common in my experience. A patient has ongoing chronic pain. They are justifiably angry about the whole situation. A surgeon offers them an option, which seems likes a way out a dark situation.  The option is hard not to pursue–surgery seems to be a “definitive solution.” With their anger in full gear, they are not thinking clearly and will often pursue options that have a low chance of success. The downside of failed surgery is not fully comprehended. Then when a given surgery fails they pursue surgery again and again.

Don’t let anger alter your decisions about surgery. An inauspicious surgery is just that, no matter how angry you are.

BF