Chronic Pain

Decisions about surgery for chronic pain

Surgery has little to offer for most people with chronic pain. In patients with pain from arthritis, joint replacement can offer excellent pain relief. Hip and knee replacements are now well established form of treatment. Shoulder and elbow replacements are not yet as reliable. Joint replacements have a limited lifespan and people are usually recommended to try other treatments first.

For some patients with pain caused by cancer, surgery can offer relief if all other treatments have failed. However, for people that don't have cancer, surgery is rarely recommended and is unlikely to give permanent relief and could make the pain worse.

Nowadays there are very few reasons for spinal surgery to be performed and most usually relate to preventing damage to nerves of the spinal cord. An example would be a prolapsed disc in the spine, where the damaged disc or part of the disc that has broken away and is pressing on nerves resulting in nerve injury that could lead to incontinence or permanent disability. However, even if surgery is successful in preventing further damage, people may still be left with chronic pain.

A few of the people that we talked to underwent essential surgery because of compression of the nerves in the spinal cord. For example, one woman had surgery because of a rare malformation which could have led to brain damage if untreated.

Another woman had surgery on a disc which was compressing nerves causing bladder dysfunction and a burning pain in her leg. She was pleased that the burning pain in her leg had reduced although she still had low back pain. 

Several people had back surgery when it was more popular as a treatment for pain relief. Some experienced periods of pain relief varying from months to years. One woman said she had been lucky in having almost ten years of pain relief, although she later discovered that this was not expected to be permanent. 

Others had experienced no relief and were very frustrated, particularly when they had paid for surgery privately. Some of those whose first operation failed went on to have further corrective surgery which was also not successful. One woman said that you only have 'one good chance' with surgery and, after that, the chances of it helping are very small. 

Surgery was sometimes viewed as the cure or 'magic wand' that would get rid of pain, even by some who knew this was an unrealistic hope.

Some people had been told that their condition was inoperable or that they were unsuitable for surgery. A woman who had been pinning her hopes on surgery was initially horrified when she found it was not possible. A man who was told he wasn't suitable for surgery was relieved.

Several people considered, but decided against, surgery as an option for the relief of back or leg pain. Their decision was sometimes influenced by a consultant telling them that the chances of successful pain relief were low or that there was a risk of worsening pain or even damage to the spinal cord, which can lead to a loss of sensation, paralysis, weakness and bladder and bowel problems.

Others were aware that surgery could result in scar tissue which can contribute to the pain.

Some said they would never consider surgery because they'd heard of friends and family where surgery had failed or gone wrong. A woman had read that pain relief was short-term and didn't feel it was worth the risks.

One man considered himself one of the lucky ones because he had been on a pain management programme which had helped him to live with pain instead of undergoing surgery. Others whose surgery had not been successful said they wished that they had known about pain management before or had persevered with other less invasive treatments.

A few people that we talked to had undergone surgery which involved operating on nerves. This type of surgery is controversial as it may destroy other sensations as well, cause weakness or become the source of new pain. A couple of women had surgery for pelvic pain, but had been advised that pain relief may not be permanent and there is a risk of worsening pain.

Many said that they had been naïve about surgery and had not looked up any information, sometimes because they were desperate for pain relief and assumed surgery was the answer.

The advice of people who regretted not looking into it more was that others get as much information as possible before deciding about surgery. A woman who had undergone several unsuccessful back operations urged people to educate themselves and ask as many questions as possible. She and others advised checking out the success rates of the procedure and the surgeon's experience.

Some were happy with what the surgeon told them, but several said that information was not made easily available and were frustrated that the decision about surgery was really left up to them.

It was not always easy to get sufficient information especially about the recovery period. A woman who had taken a long time to decide whether to have a neck operation had looked up information about the technical side but had not discovered how she would feel afterwards.

Information needs to be up to date as surgical practice and rehabilitation has changed dramatically. For example a couple of people commented that when they first had an operation there was no physiotherapy whereas now physiotherapists encourage people to get moving as quickly as possible after surgery.

Last reviewed August 2018.

Last updated November 2012.


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