A back surgery placebo is a fascinating phenomenon in which an operation provides usually temporary relief due to psychological suggestion, rather than actual efficacy. Being that some procedures act as placebos, and nothing more, this occurrence can explain why failed back surgery syndrome results in so many patients after the placebo effect wears off.
Spinal surgery, like any other type of treatment, can enact a placebo effect, providing partial or temporary relief for a variety of back pain diagnoses, even though the procedure does absolutely nothing to resolve the true source of pain.
Surgical placebo has been studied for many health conditions and continues to fascinate doctors and psychologists who understand and appreciate the depths of the human mind, as well as how the mind and body interact constantly to create overall health.
The topic of surgical placebo is explored in depth in this focused and extremely interesting discussion.
A placebo treatment is one which creates a positive result, even though the therapy demonstrates no actual curative potential based on anatomical criteria. A great number of spinal surgeries are unnecessary and inappropriately used, since the conditions they are attempting to cure are not the real sources of symptoms. This has recently been validated by diagnostic criteria changes which caution physicians not to implicate structural spinal issues located on imaging studies as the sources of pain without definitive proof.
Furthermore, the same medical organizations which issued the above warning state that in the vast majority of cases and conditions, no links exist between common spinal irregularities, such as herniated discs, and the incidence of pain.
Therefore, even if the surgery is successful based on structural goals, the pain will not go away, as it does not come from the mistakenly diagnosed source. However, some patients do enjoy partial or temporary relief, even though the actual source of pain remains.
In some of these cases, the actual underlying symptomatic causation may be ischemia driven by a psychoemotional back pain process. In others, there may be a disease process at work or a yet undiscovered structural condition elsewhere in the spine.
Regardless, it is unfortunate that the placebo created is almost certain to be short lived. To put it simply, a surgical placebo makes the person think the pain is gone by eliminating the suspected causative issue, but the real issue enacting the symptom remains and will usually flare-up again, creating what is known as failed back surgery.
Back surgery is generally the least enlightened and most contraindicated of all treatment options for chronic back pain, except in the rarest of cases. Sometimes, surgery is indicated, although these occurrences represent only a small minority of operated patients. The rest are being subjected to barbaric torture for conditions which do not need surgery.
It is no surprise to me that I continually receive countless letters each week from postoperative patients who feel worse after surgery. This is to be expected, considering the epidemic incidence of misdiagnosis. However, I also get many letters stating how a surgical procedure partially or completely ameliorated symptoms for several weeks, months or years.
In some patients, the pain may have been a caused by a misdiagnosed structural source. For them, the surgical event was so powerful, that some benefit was still imparted physically, even though no actual positive change was made to the anatomy. In others, the source of pain is a mindbody condition. For these patients, the pain eventually returned in identical form or in a new expression, commonly far worse than before.
This is easily explained by the idea of surgical placebo. The psychoemotional imperative actually causing the pain could only be fooled by the placebo effect for so long, necessitating a recurrence of pain and bringing the patient back to square one in their quest for relief.
Surgical placebo is not science fiction. It is a very real and proven occurrence which explains why many patients see any relief at all from their surgical interventions. Without the surgical placebo phenomenon, some patients would see no benefit from surgery or would simply be instantly worse off after enduring the very real damage enacted by the spinal procedure. Ironically, most spine surgeons do not actively acknowledge this occurrence, even though it is directly responsible for much of their success.
Remember that the mind and body are interconnected in all they do. Although this basic human fact was still denied by some doctors only a few short years ago, now there is virtually universal acceptance for the tenets of mindbody medicine. You will see the proof of the effectiveness of mindbody interventions in cancer care, addiction rehabilitation and chronic pain clinics the world over. You might also see the evidence of the placebo effect in dorsopathy patients undergoing operations for seemingly very structural pain syndromes. Hopefully, with time, more patients will learn about the back surgery placebo effect in order to save themselves from the often unnecessary trauma of spinal operations.