When it’s Time to Stop Ignoring Pain and to Consider Surgery

We all experience pain at multiple times in our lives, but not every pain needs a doctor’s attention. Actually, not all pain needs to be given too much thought; sometimes getting busy with other things makes you forget that you had pain somewhere in your body until it dissipates.

This is, of course, only true of pain that is not limiting your common daily activities. Nagging pain that keeps reminding us of its presence will eventually need more focused attention.

It is important to remember that, as Pain Science aptly puts it, “pain is weird.” Sometimes, the pain may be worse than the cause of the pain signal. Alternatively, small pain can be an indication of something serious. With this in mind, the severity of pain should not necessarily be the determining factor for a surgical decision.

We can generally ignore simple pain but when it doesn’t go away, a closer look at what could be the underlying cause is necessary. Let’s take a specific type of pain and see how to recognize when it’s time to get surgery for back pain, for example.

Back Pain

Some back pain can follow exercises that keep you fit. This may be after strenuous exercises that leave your back muscles sore but not strained. A certain amount of residual soreness is to be expected in this case and your muscles will repair themselves to be stronger, but any pain felt should dissipate within days. Such pain can resolve on its own or with the help of a few home remedies such as massage ointments, hot/cold presses, and stretches.

To understand the nature of the pain and make an informed decision about it needs a good assessment. Taking the example of back pain, the following information from the patient is helpful in helping the doctor to make a decision.

  • Where is the pain located exactly?
  • Is it gnawing, sharp, cutting…?
  • How long has the pain persisted?
  • How did the pain start? Suddenly or gradually?
  • Is the pain present throughout or are there times of remission?
  • Are there any alleviating factors?
  • Does it radiate to the buttock(s) or the legs?
  • Does it interfere with walking?
  • Does it interfere with everyday activities?
  • Does it interfere with bowel or micturition habits?
  • Does it affect you emotionally?

With this information, the doctor will be in a position to move on to the next stage of pain assessment. This involves a pain scale that describes the nature of pain from the lowest point of no pain (score 0) to the worst possible pain (scale 10). The Merck Manual is often used, and this outlines other ways of assessing pain for doctors.

Physical Examination

A thorough physical examination helps to draw closer to what could be the cause of the pain and the best way to handle it – whether non-surgical or surgical management. Physical examination and radiological imaging tests can reveal the exact cause of the problem. This is where it might become clear that the cause of the pain and the nature of the pain are not corresponding.

For example, it might be realized that despite the severe back pain that some patients may describe as excruciating and unbearable, it’s only a case of strained muscles or back muscle spasms. On the other hand what bearable pain can turn out to be a case of cauda equina syndrome, for example, that requires emergency surgical intervention.

Other Considerations to Make

  • Are there progressive neurological deficiencies? With back pain, this may be a sign of a growing pathology that may eventually need surgery. This is not a pain to wish away.
  • Chronic pain. This can be pain that persists for more than three months. This should not be ignored.

The decision to treat back pain by surgical means rests upon the medical specialist. However, when patients are educated to assess the pain they are suffering from, it is much easier to accept such a surgical decision when it is made. This is because by then the patient will be aware of the type of back pain that cannot be managed by any other means but surgery.

References

Atlas, S. J., & Deyo, R. A. (2001). Evaluating and Managing Acute Low Back Pain in the Primary Care Setting. Journal of General Internal Medicine, 16(2), 120–131. http://doi.org/10.1111/j.1525-1497.2001.91141.x

Pain Science. https://www.painscience.com/articles/pain-is-weird.php#ref31

Merck Manual. http://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/pain/evaluation-of-pain

Medscape. http://emedicine.medscape.com/article/1148690-overview

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