AANS Neurosurgeon | Volume 29, Number 1, 2020


We Feel the Pain

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This week, a 28-year-old presented to my office with symptoms secondary to a recurrent herniated lumbar disc. Seeing his name as the last patient of my day produced a cacophony of thoughts and emotions. His story demonstrates poignantly how neurosurgeons are in an incredibly unique position to understand and impact what many are calling a national emergency, the opioid crisis. 

Just nine months earlier, this dashing young man related his progressive and refractory pain, weakness and numbness from a massive herniated disc and opted to move forward with surgery. Then, he surprised me by acknowledging an opioid addiction for which he had recently completed rehabilitation. The surgery went well and at his request, the small number of pain pills prescribed were placed in the possession of his girlfriend. Unfortunately, like too many others, his addiction kicked in, and he convinced an on-call doctor to provide him more narcotics. The result was catastrophic. I was shocked on Monday morning when I learned he had overdosed and lay comatose in a remote ICU.

For the next six months, he raged a battle against his addiction, frequently calling my office to try and get his fix. His personal life crumbled, he lost his good paying job and was spiraling downward. Somehow, the safety net held, and he is now clean three months. Unfortunately, he may require more surgery, and this time he will have to manage any postoperative pain without any narcotics – by mutual agreement. 

Why did AANS Neurosurgeon choose to devote an entire issue to pain? What unique and important perspectives do we have? What crucial information can we share that others need to know? 

Every neurosurgeon knows:

  • Someone close who has died or suffered the ravages of opioid addiction and acknowledges that prescriptions account for many of the pills being abused;
  • Many neurosurgical conditions (degenerative spine, brain and spine tumors, infections, peripheral nerve injuries) can cause acute and chronic pain;
  • The need for postoperative narcotics to help patients achieve the desired quality outcomes after surgery;
  • Alternative neurosurgical interventions derived through research and innovation have proven efficacy in treating many pain conditions; and
  • The importance of advocacy and appropriate policy to address the real and complex issues of pain, narcotics and addiction.

I sincerely hope that the phenomenal contributions in this issue will serve as a rational forum – a springboard toward progress – to finding real solutions to this complex problem.



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