The Story of Failed Low Back Surgery - A Case Study
A Pathway to Persistent Pain
In this post, I’ll describe a common pathway into persistent pain when the focus on a physical cause of the pain ends up creating more problems than it set out to solve.
It's a story repeated many times and in many physical areas of pain. The more you understand from this case study, the more you’ll recognise your own and others’ beliefs about their pain.
A 32-year-old man had an 18-month history of low back pain and left leg pain.
He described this as starting with an initial sensation of discomfort after he lifted heavy weights doing deadlifts at the gym.
He described feeling a ‘pop’ in his lower back, and although it was uncomfortable, he continued exercising.
He described this as ‘stupid’ because he realised it would have been better if he had stopped. Later that day, the symptoms in his back became much worse, and by the next morning, he couldn’t get out of bed.
He called his doctor and was given painkillers and anti-inflammatories. Several weeks passed and there was no improvement and his GP sent him for an MRI scan. This showed that he had a lumbar disc prolapse.
The Medical Wild Goose Chase
He was referred to a consultant who reviewed the findings and recommended that he undergo spinal surgery, which he did six months after the initial onset of the pain.
When he came out of surgery, he was told that the operation hadn’t gone quite as well as expected.
He was told that they ‘couldn’t quite get all the disc out’, and that they thought ‘he may have some nerve damage’. The symptoms after the surgery were no better.
Within four weeks of having the surgery, he developed left leg pain known commonly as sciatica. He was taking oromorph, which is a really strong opiate, and other tablets totalling up to 32 different pills per day.
The Effects on his Life
The pain was so bad he was not able to return to work, go to the gym, play with his children, or even manage simple tasks around the house.
He had several episodes of calling the ambulance due to falling as the left leg gave way.
This resulted in acute hospital admissions where his pain was controlled and then he was discharged. On one occasion, he was reassessed by another consultant who told him, ‘I would have gotten all the disc out’.
Following a repeat MRI scan, it was seen that the surgery had been successful and that there was nothing on the scan which justified further surgery.
He was advised to continue with the painkillers, and it was explained that the ongoing symptoms sometimes occur and result from inflammation or nerve damage.
The only other option available to him was to go on the waiting list for the insertion of a spinal stimulator, which is a small device inserted under the skin, aimed at relieving the pain.
Common as Muck
This is a common description of a situation described as failed spinal surgery.
The decision to do surgery was based on what the MRI showed and the patient’s clinical presentation.
But when the procedure is complete and the patient doesn’t respond as expected — in this case, he felt even worse — often what is found on MRI was there before someone complained of pain.
Many changes on X-rays and MRIs are found in people who have no pain at all.
So, if the pain was due to this physical abnormality and the surgery has corrected it, why has the pain not changed and even get worse?
If there was nerve damage, then why did that start only four weeks after he was told about it?
There are clues in his presentation that point to fearful thoughts and concerns arising from what he was told.
They come from the nurse and doctors saying, ‘The operation didn’t go as well as expected’, ‘We think you’ve got nerve damage’, and ‘We couldn’t get all the disc out’, and another surgeon offering an opinion that he would have gotten the disc out.
All of these statements create a potential fearful thought and cue that becomes associated with his pain.
“Are you looking in the right place,
to find the cause of your pain?”
Looking in the Wrong Place?
When you focus only on the physical aspects, you miss the opportunity to discover much more about what may be contributing to the person’s pain.
Remember — pain is only about protection; it is not an indicator of damage or how much damage has been sustained.
It is magnified by the emotions we are feeling.
If there is something in that person’s life pushing them or creating an emotional charge of such intensity or for so long, and they are ignoring how they feel, the brain can trigger physical pain from that overload.
If we misinterpret that message, we potentially put that patient through wasted and ineffective medical intervention. We also risk, as happened in this case, leading the patient down the path of a life of persistent pain.
If Not Damage, What Else Could it Have Been?
Look at what happened to him before he complained of any pain.
Estranged from his partner and not getting access to his daughter.
Working seven days a week in a salaried position and trying to build up a self-employed business.
His stress relief came from pushing himself really hard in the gym; he had been used to this for years as he reached a high level as an athlete in his youth.
He exhibited traits consistent with people who push really hard.
The entry point into the event is the key, as he was already in a high level of stress. His down buttons from that were his exercise and then pain stopped him from continuing that activity, as well as affecting many other aspects of his life.
This subsequently caused him more stress.
The pain was stressful, the failure of the medical intervention was stressful, the perception of any movements of his back was stressful, any other potential threat to it simply exacerbated the situation to complete the chronic pain cycle.
Seeing the Link
Fortunately, once this was explained to him, he was reassured that the findings on the MRI were normal, and that the pain or ‘pop’ was simply the straw that broke the camel’s back.
The overload he felt in his life and the situations he was facing, enduring, and carrying on with were the link.
In resolving those situations or changing the way he felt about them, led to a level of discomfort within him, so he used his hard physical training to block out as a method of stress relief.
Once he realised he was no longer as damaged as he originally believed, and he started to attend to himself in a gentle and consistent way, his pain reduced.
He started to use some simple techniques consistently, listened to his body, paced himself, and made a complete recovery.
No further surgery, no spinal stimulator and no further pills.
It was possible for him, it's possible for all of us, and it’s possible for you.
What’s next?
Take A Step Towards Recovery.
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