Many medical interventions, including surgery have unknown effectiveness. Does this statement shock you? It certainly did me when I read the British Medical Journal’s findings about interventions to treat disease which found that 56% of interventions have unknown effectiveness or unlikely to be beneficial or even harmful according to the research evidence1. This is the experience of orthopaedic surgeon Dr David Hanscom who has been working in the USA performing complex spine surgery since 1986. I heard him lecture at a conference in 2016 and he commented that, “most spine surgeries should not be performed”. After 30 years doing just that, I guess he knows what he’s talking about and certainly concurs with the lack of evidence for using surgery and other medical health interventions in many instances. He argues that the central nervous system is a key determinant of the generation and continuation of chronic pain. A person’s psychological wellbeing and history needs to be taken into account. Questions should be asked: Have you suffered any emotional trauma? Are you stressed? Have you lost your job? Has a loved one died? Our personalities and upbringing will determine how we react to such life events. How resilient we are to life’s punches and so whether these events might be held in the body as physical pain. The medical literature point towards these events causing chronic pain and this pain persisting, despite any surgery or other medical intervention you might have. This is because the surgery (or drugs) isn’t actually addressing the real problem which is psychological and locked into your nervous system, like a reflex response.
Another problem is that states such as stress, anxiety and depression depress the immune system. Infections post-operatively are a major cause of complications and death. Depression is strongly associated with post-operative pain and is a risk factor for long and incomplete recovery from surgery2. Despite all this medical evidence few doctors are assessing their patients psychological wellbeing before surgery. In Dr Hanscom’s field he said less than 10% of surgeons are addressing the stress levels of their patients before deciding on surgery. By calming the nervous system before elective surgery Dr Hanscom has noted outcomes have been more predictable and many patients, even with surgical lesions have avoided surgery.
Acupuncture has a useful role prior to surgery to calm the nervous system and boost the body’s own natural painkillers which lessens the need for opioids such as morphine after surgery (morphine can have many negative side-effects). Initial research is suggesting it might have a use for reducing preoperative anxiety, postoperative nausea and vomiting and postoperative pain experiences3. Acupuncture also helps boost the immune system in preparation for the “attack” on the body by the surgeon’s knives. We know acupuncture triggers a number of neuropeptide cascades and indeed lots of other physiological changes in the body (lots we don’t understand). While counselling and self-help techniques (journaling/affirmations/meditation etc) will help people longer term to address psychological, emotional blockages, acupuncture is likely to offer a quicker route to prepare the mind and body for surgery by initiating a beneficial, natural biochemical response and so enhance recovery afterwards.
Dr Hanscom lectured at the SIRPA conference in 2016 Chronic Pain, Royal Society of Medicine http://www.sirpauk.com