For some time I have been wanting to take a look at some of the contributors to the book which I co-edited, Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment. In this blog I’ll focus on the chapter on back pain. David Hanscom MD is an orthopaedic spine surgeon based in the US, and is one of the professionals who shares his expertise.
He himself suffered from symptoms of Psychophysiologic Disorders (PPD) for 15 years before he finally managed to resolve them. He didn’t understand how until he heard a lecture by Dr Howard Schubiner, which informed his own approach to patients with PPD. He has since launched his own website and written two books: Back in Control: A Surgeon’s Roadmap out of Chronic Pain, and Do You Really Need Spine Surgery? Take Control with Advice from a Surgeon.
Over the last five years Dr Hanscom and I have developed a supportive relationship. I’ve been impressed by his enthusiasm and determination to consider the welfare of the patient from every angle when assessing spine pain. He has no qualms about the use of surgery when necessary, but through his experience he recognises that a ‘hyper vigilant’ nervous system may be playing a significant part in the patient’s pain.
In his chapter, Making the Right Choice About Spine Surgery, Dr Hanscom explains why spine surgery is not always the best solution for back pain, and argues that in many cases in the US it is overprescribed and can even be harmful. In his former practice he used to act as ‘salvage surgeon’, treating patients following a failed operation. But, he says, he could rarely return those patients to the condition they had before the failed surgery.
Dr Hanscom divides patients with spine pain into two groups: those with a structural abnormality which shows up on an x-ray, CAT scan or MRI, and those without. In the cases of a structural abnormality which corresponds to the pain, he advises that surgery is an option after the nervous system has calmed down. Without evidence of a matching abnormality, so the pain is non-structural, he does not consider surgery an option.
He explains that because many people with spine pain also have significant stress and/or other psychophysiologic issues, surgery or treatment of just the spine does not solve the problem. He says: “Rather than assessing for psychosocial stress, many patients and health care providers consider surgery as the definitive solution. Operating in the presence of a hyper vigilant nervous system often makes the pain worse, in spite of a well-done procedure. Just because rest, physical therapy or injections have not worked doesn’t mean a patient should head for the operating room.”
Dr Hanscom advocates for the patient to be more involved in the recovery and decision-making process, and for medical professionals not to assume that surgery is the definitive solution when there is no structural abnormality. Surgery should only be done for a structural problem with a calm nervous system.
Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment is available here, and you can find out more about David Hanscom and his work at his website here.