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Pain Management
Pain Management
A surgeon's perspective on pain management — why chronic spinal pain is a specialty in its own right, led by pain-medicine and multidisciplinary teams, and how Mr Madi works alongside them.
Not all spinal pain is a surgical problem, and one of the most important things I do as a surgeon is recognise when the answer is not an operation but a considered pain-management approach. Pain management is a medical specialty in its own right, led by pain-medicine consultants and multidisciplinary teams — I am a spinal surgeon, not a pain specialist, and the detailed management of chronic pain belongs to them. My role is to identify who has a surgically treatable problem and who is better served by referral to pain services, and then to work alongside those colleagues. This page explains, from a surgeon's viewpoint, what pain management is and where it fits.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
Why chronic pain is different
Acute pain is usually a signal of a specific problem, and treating that problem resolves it. Chronic pain — pain that persists beyond the expected time of healing — behaves differently: it becomes influenced by the nervous system, by mood, sleep, beliefs and circumstances, and it often cannot be "fixed" by addressing a single structure. This is why chronic spinal pain is managed rather than simply cured, and why it needs a broad, multidisciplinary approach rather than a purely surgical one. Understanding this distinction is central to giving people honest advice and avoiding operations that will not help.
What pain management involves
Multidisciplinary pain management typically combines several elements delivered by different professionals: medical management by pain specialists (including medication review and, where appropriate, targeted injections); physiotherapy and graded activity; and psychological approaches that address the impact of pain on mood, sleep and daily life. The aim is usually to reduce the burden of pain and, above all, to restore function and quality of life, rather than to eliminate pain entirely — which, for many chronic conditions, is not realistic. This is the province of pain-medicine and multidisciplinary teams, not of the surgeon.
How I work with pain services
When I assess someone whose pain is not from a surgically treatable problem — or who has ongoing pain after appropriate treatment — the most helpful thing I can do is say so honestly and refer them to pain services rather than offer surgery that is unlikely to help. I then work alongside those colleagues, contributing the surgical and structural picture. Being clear about the limits of surgery, and directing people to the right kind of help, is as much a part of good surgical practice as operating well.
What the evidence shows
The evidence supports a multidisciplinary, biopsychosocial approach to chronic spinal pain. Cochrane reviews of multidisciplinary biopsychosocial rehabilitation for chronic low back pain find that it reduces pain and disability and improves the likelihood of being at work, more so than usual care or physical treatment alone. Reviews of interdisciplinary pain management set out the rationale and structure of these programmes. This evidence is why, for chronic pain that is not surgical, I regard referral to multidisciplinary pain management — not more surgery — as the right course.
What to expect
Pain management is usually an ongoing, active process led by pain specialists and a multidisciplinary team, focused on improving function and quality of life. It often combines medical, physical and psychological strands, tailored to the individual. As a surgeon, I contribute the assessment of whether any surgically treatable problem exists and coordinate with the pain team; the management itself is theirs to lead.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; chronic pain management is delivered by pain-medicine specialists and multidisciplinary teams. Every patient is different, and treatment options, expected outcomes and recovery depend upon an individual's diagnosis, symptoms, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon, pain specialist or healthcare professional.
Evidence & further reading
- —Kamper SJ, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane review and meta-analysis. BMJ 2015. (PMID 25693594)
- —Kamper SJ, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014. (PMID 25180773)
- —Marin TJ, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev 2017. (PMID 28656659)
- —Gatchel RJ, et al. Interdisciplinary chronic pain management: past, present, and future. Am Psychol 2014. (PMID 24547798)
- —Foster NE, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018. (PMID 29573872)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.