“I had seriously considered back surgery about 16 months ago for intense pain. I made a decision to at least delay my surgery, follow through with my therapy, and go to my gym on a consistent basis. Then Hinge Health came along. Now I’m not even considering surgery!”
Nancy, a past Hinge Health participant, tells a story that countless others can relate to.
It’s true that some injuries and conditions are best addressed with surgery. But shortly after starting the Hinge Health program, Nancy learned what thousands before her have: that surgery should never be your first option for reducing persistent pain. In order to understand why, let’s talk through a few things.
Surgery Is Not as Effective as We Once Thought
We know a lot more about pain now than we used to. And the most recent research shows that surgery doesn’t always address the root cause of persistent pain.
According to associate professor at Harvard Medical School, Dr. Steven Atlas, only half of patients who have spinal fusion surgery will experience significant pain relief. He argues that very few people actually need the surgery. 
Research supports Dr. Atlas’ stance. A systematic review published in the journal Spine reported no meaningful differences between surgery and nonsurgical treatments.  And in another study, 87% of participants who had back surgery were still in pain two years later. 
While these studies may or may not reflect your personal experience, they do show that a dramatic treatment like surgery doesn’t guarantee a dramatic change in pain.
Scans Don’t Show Pain
Imaging has an important place in medicine. But it’s proven to be quite unreliable when dealing with persistent pain because scans don’t tell your whole pain story.
If you’ve ever had an MRI or a scan, you may be familiar with the uneasy feeling of waiting for your doctor to give you bad news. Maybe your thoughts and emotions about your pain were influenced by an ‘abnormality’ your doctor saw on that scan.
Your back is no different than the rest of your body in the sense that changes are normal as you age. When you’re young, the discs between your vertebrae are flexible. As you age, those discs naturally lose some of their height and integrity. But surgery usually isn’t needed to fix these changes. They’re natural, just as it’s natural to develop wrinkles on your skin and gray hair on your head.
Systematic reviews show that 80% of individuals older than 50 years of age with no pain show signs of disc degeneration on an MRI. That number steadily rises as you age, with 93% of pain-free individuals over the age of 80 showing signs of disc degeneration on an MRI. 
You see, persistent pain is incredibly complex. An MRI may reveal an ‘abnormality,’ but that doesn’t actually tell us why you have pain.
Control What You Can Control
In the previous playlist, you learned about the many different factors that can contribute to your pain. Some treatment options, like exercise, address multiple factors in your backpack.* Other treatments only address the physical contributors to pain. Surgery is a perfect example of this.
We now know that the best way to manage persistent pain is to focus on the pain contributors you can change.
You can’t control your genetics or previous injuries. But you can make changes to your exercise and movement routine. You can set goals to work toward better stress management and sleep. You can make an effort to learn more about persistent pain. And when you focus on changing those factors in your backpack, it’s possible to avoid surgery altogether.*
Regardless of whether you’ve already had surgery, believe it’s inevitable for you, are determined to avoid it, or are unsure of what to think, we want you to feel confident in having an empowered conversation with your doctor about what’s best for you.
What you see on a scan should not dictate whether or not you have surgery to treat your pain. And it’s almost always worth it to address pain with movement and exercise therapy before having surgery. You too could end your story like countless other Hinge Health participants.
“Before starting this program I just assumed surgery would be in my future (with increasing discomfort and my age). I figured it was just the cost of aging. I'm really excited at the prospect of avoiding surgery.”
* We added a video and additional content to the article “Rethink Your Pain,” which you read in a previous playlist. In case you missed it, be sure to take a look at “Rethink Your Pain” in the Library of your Hinge Health app for important background information and context.
Surgery should never be your first choice for reducing persistent back pain.
Pain is personal and multifaceted.
By focusing on what you can control, you may be able to avoid surgery altogether.
Harvard Health Publishing (June, 2014). When is back surgery the right choice? Retrieved June 12, 2019, from Harvard Health website: https://www.health.harvard.edu/pain/when-is-back-surgery-the-right-choice
Mirza, S. K., & Deyo, R. A. (2007). Systematic Review of Randomized Trials Comparing Lumbar Fusion Surgery to Nonoperative Care for Treatment of Chronic Back Pain. Spine, 32(7), 816. https://doi.org/10.1097/01.brs.0000259225.37454.38
Back pain is a massive problem which is badly treated. (2020, January 18). The Economist.
Brinjikji, W., Luetmer, P., Comstock, B., Bresnahan, B., Chen, L., Deyo, R., … Jarvik, J. (2014). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.a4173