By Joseph Cheng
“Fear is only as deep as the mind allows.” Japanese Proverb. No other word seems to be linked to spinal surgery as much as “fear”. Patients are afraid of what they do not know or understand; fear giving up control of what happens to their body; fear of bad outcomes such as paralysis and death. This is a basic human emotion, with many risking possible long term consequences to avoid the terrifying sensation of fear. I remember trying to coax my young son to allow me to pull his loose baby tooth as it was causing his adult teeth to grow in crooked. Nothing doing and now we have spent hundreds of dollars in dental visits with an irritating retainer [brace] that he has to use every night; all which could have been easily avoided.
This is no different than many of those who are so fearful of spinal procedures and surgery that they may not seek even the most basic help for their disabling spinal problems. And this fear is only fuelled by the media, such as the almost daily reports of the problems with meningitis related to contaminated steroids used in epidural spinal injections. While this was a tragic situation, injections remain safe in the millions performed each year, but this has not stopped hundreds of our patients in the middle Tennessee region to be incapacitated by their severe pain and disability rather than have a spinal procedure due to their fear of meningitis.
Our recent North American Spine Society (NASS) member survey found that 37.2% of spinal care experts noted that patients frequently wait too long to go see a spinal specialist. This delay in their care appears to stem from a fear of potential treatments available for their spinal problems, with 66.2% fearful of treatments such as spinal injections, surgery, or even “non-invasive” options such as physical therapy. And while the Harvard School of Public Health report from July 2010 noted that more than two billion people worldwide do not have access to adequate surgical treatment, it is ironic that many of those in the USA who do have access do not take advantage of it. Perhaps through a better understanding of spinal surgery and treatments in the modern age, this often misunderstood part of their medical care can be made less traumatic and fearful for our patients.
The first step is to understand the myths and misperceptions that need to be corrected, and the “9 for Spine” survey was developed by NASS to do this. Based on our results, a startling 66.5% of spinal specialists noted that fear of prospective treatments, including surgery, kept their patients from seeking help for their back pain. Many patients believe the myth that once you have spinal surgery, you are destined to have multiple spine surgeries and that there is a high risk of paralysis in spinal surgery. Based on the survey, the top nine myths of back pain were:
- Exercise causes back pain.
- Surgery will cure back pain completely.
- “If I have spine surgery, I’ll have to keep having spine surgery the rest of my life”
- Spinal surgery has too many risks, including paralysis
- Bed rest is the best cure for back pain.
- “If I see a spinal specialist, I’ll end up getting surgery”
- “If I have back pain, I probably need surgery”
- “Back pain is a normal part of ageing”
- “If I take pain medicine, I will become addicted
As fear is really only in the mind, education and knowledge are our tools to conquer this. As healthcare providers and advocates, we need to ensure that our patients realise that the vast majority (90%) of people with back and neck pain will get better without medical treatment or by using conservative treatments such as anti-inflammatory medication, exercise, coping skills and physical therapy.
Spinal surgery and procedures are only recommended in only about 1% of cases, with very specific diagnoses and when it has good potential benefits for our patients. It is heartbreaking to see that myths and an unnecessary fear of surgery are holding people back from getting even the most conservative help for their back pain, and many will be surprised to find that spinal surgeons spend most of their time telling new patients that they do not need spinal surgery. I believe that once patients in need understand their spinal disease and treatment options better, that they will pursue beneficial and appropriate spinal surgery and care, and allow us to help them get back to being healthy and productive.
Joseph Cheng is associate professor of Neurological Surgery and director, Neurosurgery Spine Program at Vanderbilt University Medical Center, Nashville, USA.
With additional reporting from Nicolle Heller, who is the public affairs manager for the North American Spine Society.