David Hanscom

[LindaRacine]

One of the surgeons with whom I worked brought this guy to my attention because he knows of my concern that too many spine patients are undergoing surgery. I've been reading Dr. Hanscom's blog for awhile, and continue to be impressed by his techniques. If you ever read anything by John Sarno (who died last year), you'll recognize a lot of similarities.

One of the pieces I read today was of particular interest: http://www.backincontrol.com/are-you-kidding-me/

[burdle]

this makes excellent reading. What i would like to see is if the effort is now transferred from surgical impetus to the pain management side of things. Patients who go down the road of pain management are often just abandonned and not supported.

I have wondered though if there have been studies where a surgical procedure that 'was not needed' actually resolved a patient's pain - such is the power of the mind !

[titaniumed]

Linda, There is a lot of excellent information on his blog... Much of his writings and ideas I can apply to my trials and errors through the years....before and after my surgeries.

Its nice to write or post in general. It's something I like to do but many of us around here with severe scoliosis do have multiple structural issues. I don't need to justify my surgical decision after all these years but its of high interest and much of what he says applies to different periods in my life battling scoliosis.

In this particular post, the surgical patients that he mentions in Argentina might have had serious structural problems, and avoiding surgery is possible. I know, I did it for many years. The last 6 years of varying intense sciatica, with multiple trips to Hawaii to de-fuse mentally, did work....I did have success and the (4) herniation's did retract if that's what they did. Of course, this was temporary and basically the last 6 years of my battles avoiding surgery were extremely painful, a waste of time and cost a fortune. You cant lump severe adult scoliosis patients in with everyone else. The woman had a 2 level 100K procedure, my surgeries were $2 million dollars, 10 years ago. I have posted in the past that I should have done surgery at age 40 for my case. Maybe I waited too long? But then waiting for the right hand of cards to fall was worth it. Each of us has to decide and define pain and quality of life.

Now, I am repeating this cycle with my neck. Funny how these things work...

"If patients and surgeons are not making logical decisions, then they are misinformed". I agree with this, but its hard to lump the best scoliosis surgeons we have in with the rest of the spine community. For those that had their lives saved and for those surgeons that did it, deserve much more credit. Some fires cant be calmed down.

"If your going to be a classical pianist and play the classics, be the best." -Tori Amos-

Thanks for posting...
,
Ed

[burdle]

You cant lump severe adult scoliosis patients in with everyone else.
"If your going to be a classical pianist and play the classics, be the best." -Tori Amos-

Thanks for posting...
,
Ed

Very well put. It would be nice to think that the specialists in Scoliosis will not succumb entirely to the 'pain management viewpoint' However If some of the needless spinal operations in general ceased it might mean more time and effort is put into assessing scoliosis. Currently we are lumped in with everyone else with back pain- especially if we have degenerative AIS. I would argue that those of us who have degenerative AIS in pain should be higher up in the 'queue' than those with degenerative de Novo scoliosis and certainly those with back pain without scoliosis. Of course this is too much of a simplification but I make the point because the degenerative AIS patients are likely to have exhausted all the pain management programs as they age and are ultimately defeated by pain and loss of mobility. If you look for studies on patients with scoliosis beyond their 50s (in age) there are none because we are 'lumped in' with everyone else by this point.

You cannot ignore the bio-mechanical entirely!

[Pooka1]

I mentioned a while back about hearing a surgeon on Doctor Radio say he completely gave up doing these one to two level fusions for pain because it wasn't helping the pain. Instead he changed fields and now does pain research. Now I am not sure how an orthopedic surgeon can switch like that without years of training in that specialty and ever compare to a board-certified pain management doctor but he is trying. His claim is that pain perception is in the brain and that he was interested in studying how to address it there.

It is known that these one or two level fusions which make up the vast majority of fusions are ineffective most of the time yet they are still done. It is amazing. It is claimed to be the most over-used surgery last I heard. While I think these surgeons should probably stop doing many of these procedures, that doesn't mean they can all switch to physiatry and make any progress. The best hope is with board certified physiatrists and PhD pain researchers to ever crack that nut.

I don't think either Hancom or this guy I heard were talking about long fusion scoliosis surgeries done to stabilize spines. For example, I don't think there is much disagreement over fusing or tethering or stapling a large curve in a growing child. The agreement wanes when discussing large curves in adults who have pain, though. At present, these people face tough choices and there may be no answer at the moment to help them. Some are helped by surgery and some are not. It's like a crapshoot. I wish someone could find out which patients are likely to be helped by surgery. This would probably require orthopedic surgeons working together with physiatrists and PhD pain researchers in clinical trials.

[LindaRacine]

I mentioned a while back about hearing a surgeon on Doctor Radio say he completely gave up doing these one to two level fusions for pain because it wasn't helping the pain. Instead he changed fields and now does pain research. Now I am not sure how an orthopedic surgeon can switch like that without years of training in that specialty and ever compare to a board-certified pain management doctor but he is trying. His claim is that pain perception is in the brain and that he was interested in studying how to address it there.

It is known that these one or two level fusions which make up the vast majority of fusions are ineffective most of the time yet they are still done. It is amazing. It is claimed to be the most over-used surgery last I heard. While I think these surgeons should probably stop doing many of these procedures, that doesn't mean they can all switch to physiatry and make any progress. The best hope is with board certified physiatrists and PhD pain researchers to ever crack that nut.

I don't think either Hancom or this guy I heard were talking about long fusion scoliosis surgeries done to stabilize spines. For example, I don't think there is much disagreement over fusing or tethering or stapling a large curve in a growing child. The agreement wanes when discussing large curves in adults who have pain, though. At present, these people face tough choices and there may be no answer at the moment to help them. Some are helped by surgery and some are not. It's like a crapshoot. I wish someone could find out which patients are likely to be helped by surgery. This would probably require orthopedic surgeons working together with physiatrists and PhD pain researchers in clinical trials.

Hanscom is talking about pain, which is rarely the reason kids have scoliosis surgery. He is talking about adults, and I don't think that having a structural problem is a reason to dismiss his ideas. If you read his work, you'll find that he doesn't rule out surgery completely. He rightly states that there are valid ways of avoiding surgery for many people. In my mind, having scoliosis doesn't give me a pass on doing what I can to TRY to avoid surgery.

[LindaRacine]

its hard to lump the best scoliosis surgeons we have in with the rest of the spine community. For those that had their lives saved and for those surgeons that did it, deserve much more credit. Some fires cant be calmed down.

Maybe some can't be calmed down, but that doesn't mean we shouldn't try. The vast, vast majority of adult scoliosis surgeries are not medically necessary. (That is, they're not life threatening.) Most of us adults choose surgery because we're feeling overwhelmed by the pain and disability. The majority of spine surgeons (as well as other types of surgeons), are not conservative, and will perform surgery if the patient wants it and it can be justified by their insurance company. In fact, we frequently hear of surgeons telling their patients they'll "end up in a wheelchair" or "bedridden" if they don't have surgery.

[burdle]

dont understand - lots of surgery is done that is not for life threatening conditions . some is done for mental health only. why should pain relief not be a goal for spine surgery ' unless you are saying that spine surgeons are less competent than other surgeons ? surely the goal is is quality of life .

[LindaRacine]

dont understand - lots of surgery is done that is not for life threatening conditions . some is done for mental health only. why should pain relief not be a goal for spine surgery ' unless you are saying that spine surgeons are less competent than other surgeons ? surely the goal is is quality of life .

Since you always seems to find something wrong with my words, it doesn't surprise me that you don't understand.

No one said that surgery shouldn't be done for pain relief. I had surgery for pain relief. Hanscom is suggesting that there are other ways of getting pain relief, and perhaps that would be a worthwhile effort before signing up for a surgery with such a high complication rate.

[Pooka1]

Hanscom is talking about pain, which is rarely the reason kids have scoliosis surgery. He is talking about adults, and I don't think that have a structural problem is a reason to dismiss his ideas. If you read his work, you'll find that he doesn't rule out surgery completely. He rightly states that there are valid ways of avoiding surgery for many people. In my mind, having scoliosis doesn't give me a pass on doing what I can to TRY to avoid surgery.

Right I was saying this other guy I heard seems to agree with Hanscom. This idea of going after the pain directly should be pursued since it may be the only hope for some people who are not helped by surgery.

[burdle]

Since you always seems to find something wrong with my words, it doesn't surprise me that you don't understand.

No one said that surgery shouldn't be done for pain relief. I had surgery for pain relief. Hanscom is suggesting that there are other ways of getting pain relief, and perhaps that would be a worthwhile effort before signing up for a surgery with such a high complication rate.

If I find something wrong with your 'words' then it is always worth debating. I don't remember being insulting though!

If I took what was said out of context of your intention it is only because I am passionate about the health care for Scoliosis. I did say that the Hanscom article made excellent reading. I am a student of pain science. I have had to be since this is the only resource I can use for myself. I believe that whilst discussion takes place about the need for surgery and maybe pain therapy being offered as an alternative or even replacement that the necessary impetus is needed from the pain management and pain science lot. I believe I said that in an earlier response.

I understand about the pathways to the brain; there are no such thing as pain messages- only messages interpreted as pain by the brain. Nevertheless when you go into a pain management program the doctors working in that field are not all up to speed. It is a complex subject but it needs to be out in the public arena as a worthwhile solution for the ordinary patient. A lot of pain management practitioners are still 'old fashioned'. And a lot of patients still come away from doctors upset that they have been told their pain in 'in their head'. They clearly have not understood but it is the job of the medics to explain more carefully if they want patients to get on board. If they don't then the clamour for a surgical solution will not decrease. What Hanscom says is very welcome but he has to make sure he says it clearly to his peers!

In western civilisation health care is designed mainly to keep people well enough to pay their taxes to support what is needed by society. That and to not be an undue strain on resources. A person in chronic pain is unlikely to fulfil this role very well hence medical/surgical intervention.
I was challenging the statement that ‘most scoliosis operations’ are not medically necessary in so far as that argument could be made about any operation. Surgeons perform fusion as the standard on young people. They do not say ‘live with it’ because it is only probably going to cause your pain later on so not medically necessary now. In fact VBT surgeons Betz, Lonner and Antonacci etc openly acknowledge that scoliosis can cause pain even as a juvenile. However the condition at 10 and 11 years old is not life threatening. Equally my surgeon tells me that he can do fusion on me when I am 80 years old if needed. Yes I am sure that there may be medical contra-indications when I am that age but the surgery itself not that much more complicated.
All surgery has it contra-indications- however we do hip/knee replacements as routine now and none of these are actually medically necessary by the same argument. They are however necessary to keep us in a position to walk without pain etc. and function in society. So I don’t think we why we should apply that argument to scoliosis surgery. Just as these replacement surgeries are now routine so maybe scoliosis surgery can be.

The management of chronic pain – especially widespread chronic pain is very difficult. I think that achievement is much more likely to be made in stopping acute pain becoming chronic. In other words educating those who catastrophize too early that their sudden acute pain will never go away and who seek intervention too early etc. We are ‘forever’ away from a real pain management solution for widespread structural pain from scoliosis where endless nociceptors are firing all the time from all over the body, which the brain interprets as pain.

I have always thought that those who train to be a surgeon are vocational and believe in what they do. I expect though that there are some who are not motivated thus whether consciously or sub-consciously and ego of course can play a big part. We have to believe in the majority though. We have to believe that if they offer us a surgical solution that that is the best option for us. It is surgeons peers who need to play the role of monitoring this and not so much the patient in my opinion.

I did try to make the point though that if the ‘decks are somewhat cleared’ from some unnecessary surgery then more effort can be put into surgery ( e.g. scoliosis surgery) that may well be needed to make further advances and reduce complication. However ironically the more surgeons can learn from failed surgeries the better the outcome for future surgeries. If we are ever likely to be a society that can replace entire defective spines then we will need our surgeons!

Debates such as this are always worthwhile. I assumed this forum was the place for them. However the number of people posting now is minimal. Facebook is not a place for debate- it is polarised into trolling or sycophantic emotion- which is a shame. The UK Scoliosis forum is no more. NSF is by its name more than the sum of a few individuals and its members are more than likely to be compromised by pain and disability. It would be more than a pity if people are put off because argument cannot be made.

[Pooka1]

I wish I knew what about Linda's case allowed her to get pain relief for surgery and what about Burdle's pain is thought to not get relief from surgery. Are there indications of likely success and likely failure for surgery to address pain such that Linda was likely to benefit and Burdle is not?

The situation with adults seems very disconnected to that of kids. It is almost like another subject.

Burdle I assume your remarks about FB are about the tethering group. What is going on in that group lately?

[burdle]

I wish I knew what about Linda's case allowed her to get pain relief for surgery and what about Burdle's pain is thought to not get relief from surgery. Are there indications of likely success and likely failure for surgery to address pain such that Linda was likely to benefit and Burdle is not?

The situation with adults seems very disconnected to that of kids. It is almost like another subject.

Burdle I assume your remarks about FB are about the tethering group. What is going on in that group lately?

Hi,

the remarks about FB are not just about VBT group . It is just difficult in general to get a discussion going because the remit of the groups is often JUST support and if someone questions something a lot of people say they are offended. Some FB groups are better than others though and there are a few set up for Scoliosis! A lot of people on FB see a discussion as somehow wrong. I think the cross section of people on a forum like this is more likely to have those who are keen to engage in a healthy debate.

As to my pain. I think my stance is that I don't want surgery because of what I know from pain science, And of course I can question a surgeons motives... ( cost effective etc.)
Some days I think I would just opt for it and admit defeat - hedge my bets- could the result be any worse sort of things. But I try to keep some of my points objective. Just because I am not opting for surgery etc... doesn't stop me from arguing from a surgery standpoint. We can't let ourselves be overlooked.

[Pooka1]

As to my pain. I think my stance is that I don't want surgery because of what I know from pain science, And of course I can question a surgeons motives... ( cost effective etc.)
Some days I think I would just opt for it and admit defeat - hedge my bets- could the result be any worse sort of things. But I try to keep some of my points objective. Just because I am not opting for surgery etc... doesn't stop me from arguing from a surgery standpoint. We can't let ourselves be overlooked.

Since you have studied this, why do you think some people like Linda and Ed get pain relief from surgery and what about your case makes you think you won't?

This field of pain is very interesting and I think for every dollar spent there is a huge bang for the buck given how much pain there can be with scoliosis and other conditions. I wish Doctor Radio would have more shows about it. They only have one by a rehab doctor who only occasionally talks about pain as far as I can tell.

[burdle]

Since you have studied this, why do you think some people like Linda and Ed get pain relief from surgery and what about your case makes you think you won't?

This field of pain is very interesting and I think for every dollar spent there is a huge bang for the buck given how much pain there can be with scoliosis and other conditions. I wish Doctor Radio would have more shows about it. They only have one by are hab doctor who only occasionally talks about pain as far as I can tell.

Yes pain science is a really interesting topic. Patrick Wall has a good book- will find out the name again and post.

In my case I have 3 curves but all are balanced. Every bit of me is affected - head, hands legs, feet , back , stomach. But from a purist point of view surgeons look to address balance.

of course it eventually will be difficult for me to stand upright due to lack of lordosis. My surgeon told me that we would like to see me crawl in on my hands and knees before he attempted surgery , because He says surgery is not for pain. And I believe him because I think that my pathways are pretty well established and I understand that the nociceptors are still likely to be firing even if they have straightened me up. Also I am likely to have more pain from the surgery that might become chronic as well.

Miserable future to look forward to. I did allude to surgery being done in US possibly a bit more often than UK on adults and he was not entirely complimentary towards his US colleagues citing the number of revision surgeries needed and the revenue they brought in. I try to distance myself from those sort of comments but they do leave a lingering doubt. How we are supposed to stay sane is beyond me!