When I first started my own pain journey, I was surprised at how often I was steered toward surgery. Many believe that if an MRI or X-ray shows an abnormality, the only solution is to have it “cut out.” But chronic pain is far more complex than just a piece of damaged tissue or a misaligned joint. In this post, I want to share why surgery is not always the best option, explore other approaches that can help, and encourage you to consider all layers of your pain before making decisions about your treatment.
Overuse of Surgery and Its Limits
We frequently hear about back pain and the rush to get imaging tests done. However, pain is not exclusive to the back. Many of us face issues with hip impingement, torn rotator cuffs, and degenerative knee problems. The truth is that structural changes revealed on imaging do not always explain why you hurt. For instance, many people show labral tears in the hip or signs of arthritis on an X-ray yet live their lives without pain. This tells us that imaging only captures one piece of the puzzle.
Studies have found that a significant number of surgeries on the spine, knees, hips, and shoulders may not only be unnecessary but can sometimes even worsen the pain. Patients are often told that surgery is the most direct fix. However, these studies reveal that many surgical interventions do not provide long-term relief, prompting a closer look at non-surgical options. When you read research from experts like Brinjikji et al. (2015) and Deyo et al. (2010), it becomes clear that abnormal findings on scans don’t necessarily equal the root cause of your pain.
Surgery Doesn’t Always Solve the Problem
I’ve met many patients who, after undergoing what was supposed to be a “fix,” found that the pain still persisted. Consider spinal fusions, arthroscopic knee surgeries, or even rotator cuff repairs. While these procedures might repair a visible issue, they often do little to address the chronic pain that lingers long after the incision has healed.
Take the example of spinal fusion surgery. Although the procedure can stabilize the spine, many patients continue to experience pain. In some cases, they even develop a condition known as Failed Back Surgery Syndrome (FBSS), where the pain remains just as severe, if not worse, than before. Similar challenges arise with knee surgeries. Studies comparing arthroscopic surgery with physical therapy have shown that, over the long term, non-surgical treatments can be just as effective—if not more so—in relieving pain and improving function.
Even in the case of rotator cuff repairs, a significant number of individuals experience no long-term benefits. Often, the shoulder issues seen on an MRI are found in individuals who do not suffer from pain, suggesting that the problem might lie elsewhere. It becomes evident that the structural “fix” surgery offers is not a one-size-fits-all solution.
Understanding the Multifactorial Nature of Pain
One of the most profound lessons I’ve learned in my journey with chronic pain is that pain cannot simply be “cut out” with a scalpel. Chronic pain is a multifactorial experience. It involves more than just physical tissue damage. Our nervous system, particularly the brain, plays a significant role in how we perceive pain. Processes such as central sensitization can cause the brain to overreact to pain signals—even after the tissue has healed.
Central sensitization means that your nervous system can become stuck in a heightened state of sensitivity. This state often continues to produce pain signals long after an injury has resolved. The work of Woolf (2011) shows that the brain’s role in chronic pain is substantial and that removing the damaged tissue does little to calm these hyperactive neural pathways.
In addition to biological factors, emotional, psychological, and social influences also contribute to your pain experience. Stress, anxiety, depression, and even your environment can amplify how you feel pain. When imaging shows signs of arthritis or a rotator cuff tear, it doesn’t capture these critical dimensions of your well-being. The research by Gatchel et al. (2007) highlights the importance of adopting a biopsychosocial approach in understanding and treating chronic pain. It’s a reminder that while biological findings are real, they do not tell the whole story.
Weighing the Risks and Costs of Surgery
Surgery, like any medical intervention, comes with its own set of risks. Beyond the commonly known complications such as infection, blood clots, or adverse reactions to anesthesia, there are additional hidden costs. Recovery after surgery can be long and challenging. The physical limitations during recovery, the need for extensive rehabilitation, and the potential for additional complications add up quickly.
For many patients, the financial cost of surgery is also a major concern. Beyond the initial expense, the costs of rehabilitation and time off work can put a significant burden on both individuals and their families. Moreover, some patients find themselves caught in a cycle of relying on pain medications post-surgery. The risk of opioid dependency is a serious concern and can lead to further health complications down the road.
Research, including that by Martin et al. (2011), underscores that the post-surgical period is not always a time of relief. Instead, it can be fraught with its own challenges—making it crucial to weigh whether the potential benefits of surgery truly outweigh these risks.
Exploring Evidence-Based Alternatives
There is significant hope and promise in non-surgical treatments for chronic pain. Many patients experience remarkable improvement through alternatives that focus on holistic healing rather than just addressing the structural problem.
Physical Therapy and Movement
Physical therapy is often a key component of non-surgical treatment. It focuses on retraining your body, improving mobility, and reducing pain through carefully tailored exercise programs. By strengthening muscles and increasing flexibility, physical therapy helps protect the joints and reduces the load on damaged tissues. It’s not just about moving more—it’s about moving better.
Pain Neuroscience Education
Understanding pain is a powerful tool in managing it. Pain neuroscience education helps shift your perspective from seeing pain as solely a sign of tissue damage to understanding it as a complex, multi-layered experience. This education can empower you to take control of your pain by recognizing that the brain’s processing plays a huge role in the pain you feel. Research by Louw et al. (2011) shows that when patients learn about pain neuroscience, they often experience a decrease in pain intensity and an increase in overall function.
Multidisciplinary Pain Management
A comprehensive approach that includes cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and lifestyle modifications is another powerful way to manage chronic pain. These therapies help address the emotional and psychological components of pain. They offer strategies to cope with stress, improve sleep, and manage anxiety—all of which can have a profound effect on how pain is experienced. The guidelines from NICE (2021) support this multidisciplinary approach as a way to achieve lasting relief.
Lifestyle Changes and Self-Care
Simple lifestyle changes can also make a big difference. Regular exercise, a healthy diet, quality sleep, and stress management techniques such as meditation or mindfulness can improve overall well-being. These changes don’t just address the physical aspects of pain—they help create a foundation for better mental and emotional health, which in turn can reduce the perception of pain.
When Surgery Might Still Be Necessary
I want to be clear: surgery can be a life-changing option for some conditions. For instance, if you suffer from severe fractures, rapidly worsening neurological symptoms, or major structural instability, surgery might be the best—and sometimes only—option. In these instances, the benefits of surgery clearly outweigh the risks.
However, even when surgery is indicated, it is wise to explore conservative care first. Often, a trial period of 6 to 12 weeks of non-surgical treatment can offer valuable insights into whether a less invasive approach might provide similar benefits. It also allows you to weigh your options and make a decision with your healthcare provider that is fully informed and tailored to your specific needs.
Real-Life Stories and Reflections
I’ve seen patients who have gone through multiple surgeries only to find that their pain remained stubbornly unchanged. One patient, for example, had been told that her knee arthritis was so severe that a joint replacement was inevitable. However, after dedicating several months to physical therapy and pain coaching, she not only experienced significant pain relief but also improved her mobility without the need for surgery.
Another patient, a long-time sufferer of chronic back pain, underwent spinal fusion surgery with high hopes of relief. Instead, he found himself dealing with FBSS—a situation where the expected benefits never materialized, leaving him facing a new set of challenges, and an endless amount of frustration.
These stories are not meant to dissuade anyone from surgery when it’s absolutely necessary; rather, they highlight the importance of considering all options and understanding that pain is rarely as simple as it appears on an imaging scan.
Reflecting on Your Next Steps
As you navigate your own chronic pain journey, it’s crucial to consider every facet of your pain experience. Surgery might promise a quick fix, but the reality is that healing is a long-term, multifaceted process. Before making any decisions, ask yourself some important questions:
Cost vs. Benefit: What are the financial, physical, and emotional costs of another surgery? How do these costs compare with the potential benefits?
Time Investment: How will the recovery time and rehabilitation process affect your daily life? Is it possible that non-surgical options might offer similar relief with less downtime?
Hope and Healing: Beyond the promise of a structural fix, what steps are you ready to take to address the many layers of your pain—stress, sleep, emotional well-being, and lifestyle factors?
Mind-Body Connection: How might physical therapy, pain neuroscience education, or psychological support help you manage pain in a more sustainable way?
Long-Term Outlook: Have you explored all non-surgical treatments that could offer lasting relief? What is your plan for managing pain if surgery does not fully resolve your symptoms?
Taking the time to answer these questions can help you make an informed decision about your next steps. It’s not just about choosing a treatment—it’s about embracing a comprehensive approach that addresses your overall well-being.
In Conclusion
Chronic pain is a complex experience that goes far beyond what we see on imaging tests. While surgery can be necessary in some cases, it is not a guaranteed fix and often comes with significant risks and costs. By understanding the multifactorial nature of pain, considering evidence-based non-surgical alternatives, and asking the hard questions about the true cost of surgery, you can take control of your chronic pain journey.
Healing is about more than just repairing a body part—it’s about nurturing your entire self. Consider all aspects of your pain, explore every treatment option, and choose the path that best supports your long-term health and happiness.
References
- Brinjikji, W., et al. (2015). Systematic review on imaging findings in asymptomatic individuals. American Journal of Neuroradiology
- Deyo, R. A., et al. (2010). Trends in lumbar fusion surgery and associated complications. JAMA
- Monk, B., et al. (2017). Knee arthroscopy for degenerative knee disease lacks efficacy. The BMJ
- Mirza, S. K., & Deyo, R. A. (2007). Systematic review of spinal fusion efficacy. The BMJ
- Thomson, S. (2013). Failed back surgery syndrome: a review. British Journal of Pain
- Woolf, C. J. (2011). Central sensitization and its role in chronic pain. Pain
- Gatchel, R. J., et al. (2007). Biopsychosocial approach in chronic pain. Psychological Bulletin
- Martin, B. C., et al. (2011). Post-surgical opioid dependence. JAMA
- Louw, A., et al. (2011). The efficacy of pain neuroscience education. Manual Therapy
- NICE Guidelines for musculoskeletal pain management (2021)
- Moseley, G. L., & Butler, D. S. (2015). Explain Pain.
By carefully weighing your options and considering the many dimensions of pain, you empower yourself to make the best decision for your health and future.
