Navigating the risks of orthopaedic surgery in chronic pain cases

Orthopaedic surgery is a crucial medical intervention that aims to alleviate pain, improve function, and enhance the overall quality of life for individuals with musculoskeletal issues. 

While it has proven successful in treating various conditions, including fractures, joint injuries, and degenerative diseases, the risks associated with orthopaedic surgery become more pronounced in cases involving chronic pain conditions. Chronic pain, often persistent and debilitating, poses unique challenges that necessitate careful consideration before opting for surgical interventions.

In many personal injury cases, a claimant may be faced with a medico-legal expert or a treating physician recommending surgery, and another warning against it due to the risk of worsening an already present chronic pain condition.

Understanding chronic pain

The NHS describes chronic pain as being persistent pain discomfort that extends beyond the expected healing time, often for 12 weeks or more. Conditions such as osteoarthritis, rheumatoid arthritis, and complex regional pain syndrome may lead patients to consider orthopaedic surgery as a potential solution. 

However, the nature of chronic pain introduces complexities that demand a thorough evaluation of the risks and benefits associated with surgical interventions.

What are the risks associated with orthopaedic surgery?

1. Limited success rates:

   Chronic pain conditions often involve complex, multifaceted issues that may not be fully addressed through surgery alone. Success rates for orthopaedic procedures in chronic pain cases may vary, and patients may experience only partial relief or, in some instances, no improvement at all.

2. Postoperative pain and discomfort:

   Surgical procedures inherently involve a certain degree of postoperative pain and discomfort. In chronic pain cases, patients may find that the surgery adds an additional layer of pain, complicating the overall pain management process. This can be particularly challenging for individuals with heightened sensitivity to pain.

3. Potential for complications:

   Orthopaedic surgeries carry inherent risks of complications such as infection, blood clots, and nerve damage. Individuals with chronic pain conditions may be more susceptible to these complications due to their compromised health status, potentially leading to prolonged recovery periods and increased discomfort.

4. Psychological impact:

   Chronic pain often has a significant psychological component, and undergoing surgery can contribute to increased stress and anxiety. Managing the psychological impact of surgery becomes crucial, as untreated mental health issues can hinder the overall recovery process.

5. Rehabilitation challenges:

   Successful recovery from orthopaedic surgery requires diligent rehabilitation efforts. Chronic pain conditions may impede a patient's ability to engage fully in postoperative rehabilitation, potentially affecting the long-term outcomes of the procedure.

Mitigating risks and considering alternatives:

1. Comprehensive evaluation:

   Thorough pre-operative assessment, including a comprehensive evaluation of the patient's medical history, pain profile, and psychological well-being, is essential. This helps in identifying potential risk factors and tailoring the treatment plan accordingly.

2. Multi-disciplinary approach:

   In cases of chronic pain, a multi-disciplinary approach involving pain management specialists, physical therapists, and mental health professionals is crucial. This collaborative effort can enhance the overall success of the treatment plan and minimize potential risks associated with surgery.

3. Exploring non-surgical alternatives:

   Before opting for surgery, exploring non-surgical alternatives such as physical therapy, pain medications, and lifestyle modifications is advisable. These approaches may provide relief without exposing the patient to the inherent risks associated with surgery.

Conclusion

Orthopaedic surgery for chronic pain conditions requires careful consideration of the potential risks and benefits. While surgery can be a valuable tool in certain cases, a thorough evaluation of the individual's overall health, pain profile, and psychological well-being is essential. A balanced approach, incorporating a multi-disciplinary team and exploring non-surgical alternatives, can help mitigate risks and enhance the likelihood of a successful outcome for individuals grappling with chronic pain. Ultimately, informed decision-making and a collaborative healthcare approach are pivotal in navigating the complexities of orthopaedic surgery in chronic pain cases.

To a claimant who is suffering with pain following an injury, it can be difficult to understand or indeed accept that the pain is not coming from an organic cause such as a fracture, especially if such a cause was initially present. If there is any doubt as to whether surgery may be appropriate, a second opinion should always be sought from either a different orthopaedic doctor, or a consultant in pain medicine.

Discover more about Irwin Mitchell's expertise in supporting people and families affected by serious injuries at our dedicated section on the website.  Alternatively, to speak to an expert contact us or call 0808 291 1803.

To a Claimant who is suffering with pain following an injury, it can be difficult to understand or indeed accept that the pain is not coming from an organic cause...if there is any doubt...a second opinion should always be sought...”