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Col. Mustered, in the Library, with a Rope

Last weekend my college aged daughter was reminiscing playing the game of Clue as we used to do on family game nights – before teen social calendars became too busy.  Clue was one of our favorite games, where you play detective to solve a murder mystery by ruling out possible suspects and murder weapons.  During the course of the game, if you think you have solved the mystery, you can lay down your cards and make the accusation of the murderer, but if you’re wrong, you lose the game!

Solving the source of an injured worker’s back pain is much like the game of Clue.  The physical exam, diagnostics, and conservative treatment measures including medications, therapy, and injections will hopefully alleviate the pain source.  The general public has a misconception that surgery will “fix” their back.  Injured workers many times don’t like it when a second surgical opinion is recommended; it feels like the insurance carrier is cheaping out and won’t let them get their back “fixed.”  What we need them to understand is that jumping from the accusation of nerve impingement into back surgery can also “cause you to lose the game!”

As RN Case Managers, we must help the injured worker and adjuster understand when spinal surgery is and is not appropriate.  Pain is subjective, and is affected by many variables including education, sleep deprivation, frustration and anxiety.   Surgery is one tool the evaluating physician has in his bag of treatment options, but it is not the ultimate fix-all answer, nor is it the last resort.  Decisions for inappropriate surgical intervention can have lifelong detrimental effects.  Even when an appropriate surgical decision has been made, the patient is likely to have lifelong back problems.  We therefore want to help our patients find the most appropriate treatment for their pain generator, and this will result in the best outcome and quality of life for their injury.    
Dr. David Hanscom, MD is an orthopedic spine surgeon that is known for his “salvage” procedures, meaning he has patients referred to him that have had unrelenting pain following one or more surgical procedures that have failed to relieve their pain.   A great number of his patients are workers compensation injuries – a population that is known to have less successful outcomes than the general population.   He notes the injured worker tends to be angrier than other medical patients – angry with their employer, angry with insurance, frustrated at their situation and lack of control.

 It is very sad when patients go thru surgery and recovery all to have continued pain.  The real tragedy, is when that surgery was not indicated in the first place!  We RN Case Managers have got to evaluate, educate, and assure each surgical recommendation is going to benefit our patient before authorizing it to proceed, or else we have helped to create a much bigger, costlier problem of chronic back pain before utilization of the other tools in our medical bag.  

Ironically, Dr. Hanscom’s salvage procedure does not always involve surgery.  He and his office have developed a strict protocol to follow for these patients, addressing all aspects of pain. 

Email me if you are interested in obtaining a copy of Dr. Hanscom’s protocol for his back pain patients.
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