Ask a Doctor: Surgery doesn't have to be a normal part of aging

Matt McClanahan, D.O.

Q: My surgeon told me, "It's only a matter of time until you'll need that surgery. You'll know when to call me." I'm not sure why he would say that, and I don't want to have surgery if I can help it - it's risky and doesn't seem to work for everyone. Is there anything I can do, or am I just doomed to fall apart and have pain as I age?

A: I find it interesting how medical professionals, by the words we use, can sometimes do more harm than good and perpetuate beliefs that are not supported by research. Degenerative changes and aging do not necessitate pain or disability.

For example, in two separate studies on people with no pain, the majority of people had MRI findings that frequently are blamed for pain and used to justify surgery - e.g. at age 50, 80% of people (with no pain) have degenerative disc disease and 60% have disc bulges (Journal of Neuroradiology, 2015). As well, in two studies in the New England Journal of Medicine comparing knee arthroscopy for osteoarthritis ("wear and tear") and degenerative meniscal tears (in 2002 and 2013, respectively), there was no difference in pain between the group that got the surgery and those that got an unnecessary surgery. That's right, even surgery can be a placebo.

In contrast, other research has demonstrated that when people understand pain, and when medical professionals talk about it in ways that minimize fear and emphasize adaptability and function, people recover from knee replacement more quickly, need less medication and have less pain.

So knowledge can actually be a treatment! Why? Because pain is a danger signal that activates in response to perceived threats, such as the messages, "You just have a 'bad' back" (as if backs can be "good" or "bad") or the belief that "Everyone in my family eventually breaks down" (which is more of a self-fulfilling prophecy than science) or "It's only a matter of time " (which is one person's fear-inducing opinion and not fact).

However, when people are more hopeful and confident in their body's capacity to recover and adapt, feel empowered to understand and engage their pain and they're given active strategies to get moving and calm the unpleasant sensations rather than passively avoid or suppress them, their brains feel much safer and thus the danger alarm subsides and does not become overactive.

X-Rays and MRIs are an important part of our medical system and have saved many lives from pain, or worse, but degenerative spine or joint findings are also a normal part of aging - and doctors do a great disservice by sowing seeds of fear and reducing human beings to a set of inevitable problems. We need many things to be healthy, but faith (in the resilience of our body and mind), hope (that we will be supported and recover), and love (to chase after a meaningful, active life rather than being paralyzed by the fear of pain or disability) are critical, and doctors can and ought to be the first to encourage these things in the treatment of their living, human patients.

- Matt McClanahan, D.O., Center for Insight Medicine; member, Chattanooga-Hamilton County Medical Society