This is where back and neck pain is the most important thing on my mind.
There’s an old joke about a patient who says, “Hey doc, it hurts when I do this.” Without even bothering to look up, the doctor replies, “Then don’t do that.” Of course, this cynical view of the doctor-patient relationship is hardly the reality. MOST doctors look. But here’s the problem – for quite a few doctors – they spend so little time with their patients – and in my opinion, far too little.
When physicians skip to what they believe is the central cause of a problem, they may miss essential facts that can lead to other complications down the line. For instance, “failed back surgery syndrome” or FBSS. I find it mindboggling that so many patients are wandering around with a diagnosis like this. All because a surgeon couldn’t spend another 15 or 20 minutes longer than the prescribed 10 minutes allotted for patient discussion.
As a board-certified neurosurgeon specialist practicing medicine for 25 years with a private practice in Beverly Hills, CA – I’m very interested in learning every aspect of my patient’s pain. I’ll take whatever amount of time I need to listen to the full description of the pain, where it is located, and how it increases or decreases with movement. I want to know everything I can learn about the patient. And my reasons are pretty straightforward.
There are two aspects of time that I believe is the most critical factor in healing. The first one is what I call “impact time” – how much time do I need to spend on one case to discover what is wrong with my patient. The second is “process time” – the time it takes my patient to run the course of a particular treatment before they require more help from me.
The scalability of Impact time
The patient and I determine how much time is needed for me to learn what kind of movement makes the pain worse or lessens it. I want to record any other sensations such as numbness and tingling in extremities that may be far from the actual injury. I’ll learn a great deal about the nature of the pain with a detailed description of other pain that may or may not seem to be associated with the actual problem. In my experience, the smallest detail may be a clue to a hidden problem or a consequence of other treatments.
I’m also interested in the condition of the body. What I mean to do here is evaluate whether the patient is athletic or sedentary or somewhere in between. The shape of the body may contribute to how the patient was injured in the first place. The injuries could be the result of weak muscle from lack of physical activity. Keeping in mind that when we talk about back or neck pain, it’s important to think of the spine as a system of movement. The system includes the bones of the spine (the vertebrae), the facet joints held together with cartilage, ligaments, and muscle. With a system this complex, anything can go wrong.
I also need to understand what kind of movement causes you to have pain. This may seem obvious, but as is the case with so many of my patients, too much movement of one kind or another may lead to injury or degeneration of one or more components in the spine.
For instance, a golfer practices a precise full swing and follow-through. They’ll repeat that same movement, over and over. Professional golfers will do this day, after day, after day. Stresses on the vertebral structure can wear out discs and trigger bone spurs that can put pressure on nerves.
However, an even greater threat to our spine health is our habitual use of phones and other electronic devices. We tilt our head down and to the side; we hold a “reading position” for hours and hours a day. Eventually, something breaks down and wears out.
Complications of Process Time
Ever hear the old saying, “A stitch in time saves nine”? It’s true. And it is another source of frustration that I hold for those in the medical community who believe it is okay to tell their patients to wait until the back or neck pain is so severe that they can’t bear it. In their mind, spinal fusion is the ultimate destination regardless of the patient’s body, their diagnosis, or any of the other potential solutions that may be available.
The patient may wait for five years or more, managing their pain with OTC medications at first, progressing to prescription pain-killers when stronger measures are needed. Meanwhile, additional damage to the spine progresses. Instead of a partial herniation of the disc, now we have a full collapse that contributes to extensive damage to the facet joints. The cost to the body may become so severe that fusion is our only solution.
The fact remains that much can be done for patients to not only relieve the current cause of pain but also to PREVENT the need for fusion. And in many cases – when patients see me early enough – I can prevent fusion from ever being necessary.
This is the most crucial factor in my treatment process. This is one of the reasons that I spend so much time to talk with patients. This is why I believe that, in the Transition Zone, TIME is on our side.