When Does Surgery Become the Right Option for Pain Management?

When I was 16-years-old, I tore a ligament in my ankle. I was in a boot for months and went to a few physical therapy sessions to recover from my injury. Even though my foot felt better over time, it turns out that it didn’t actually heal properly. While I was in college a few years later, I took my first exercise class, and my foot completely gave out. I couldn’t walk; I was in so much pain. My foot was extremely swollen from inflammation. Ultimately, my old injury was coming back to haunt me. Only this time, it wouldn’t go away.

I went from doctor to doctor and MRI to MRI. Everyone told me the same thing — “your foot looks healthy, there doesn’t appear to be anything wrong.” Still, I went to physical therapy for over a year to “strengthen” my foot. One specialist told me that exploratory surgery would help determine the issue, while other specialists convinced me that surgery is a last-ditch effort in pain management. Besides, my foot was considered to be healthy. Why operate on a healthy foot?

Instead, I took monthly cortisone shots to mitigate the inflammation and saw a top specialist twice a week who believed in non-surgical foot and ankle recovery. Week after week, the doctor used Extracorporeal Pulse Activation Technology (EPAT) to improve blood flow and break down any scar tissue developed after my original injury through shock wave therapy. I oscillated between crutches and a boot because I couldn’t walk more than a few blocks without being in severe pain. Nothing worked. Finally, I underwent exploratory surgery and the surgeons found scar tissue that was hidden from an MRI. They removed the scar tissue, and after a year of intense physical therapy and recovery, I started to feel better.

I wish I’d listened to the first doctor I saw, who told me to undergo surgery. But surgery isn’t always the first option when it comes to pain management, especially when there are alternate options to heal what’s causing you pain on its own. So, when does surgery become the right option, the only option after you’ve exhausted all your other options, for pain management?

According to Dr. Gary Esses, an Interventional Pain Management Physician⁣⁣, we first have to break down the most common reasons why people experience pain. “There might be a mechanical problem due to calcification [which can be a normal part of healing an injury] or the bones of the foot aren’t working as they should, then that could cause pain.” In that case, he explains, you can temporize the foot by getting a steroid shot to reduce the inflammation, take medication like Tylenol or Advil, or wear pain-relieving Sleeves and Braces like those from Incrediwear. However, if the pain is due to a change in your ability to function, that might be an indication to get surgery.

“For instance, if you have a problem with your knee, and your joint is down, and then you can't walk anymore, in addition to the pain, that might be an indication to get surgery. It’s the same with the foot. If it's painful and you get to a point where you're like, I can't even stand on my foot and can't do your daily activities, then we start to think about a surgical procedure,” he explains. With back pain, too, considering surgery really depends on the reason for your pain. For the lower back or the spine, sometimes it’s just a mechanical problem like a slipped disc that will go back into place on its own.

Some injuries can heal themselves with the help of physical therapy and medication to speed up the healing process and prevent recurring injuries. “The reason your back or neck can hurt is because the muscles in the back are just not strong enough to support the bones in your back. If you can strengthen the muscles, you can perhaps improve the bones and the way they're moving, such that it doesn't cause any mechanical issues and hopefully it'll also get rid of your pain,” Esses explains about the reason physical therapy can help manage pain.

In most cases, you’re not treating the pain itself, but you’re treating and strengthening what’s causing the pain. However, in cases where you are treating the pain itself, because you’re not entirely sure what the problem is (Esses says that’s rare!), then a steroid shot or even an SSRI medication (which is generally taken for depression) can help. Someone experiencing nerve pain or fibromyalgia because it’s difficult to pinpoint exactly what’s causing the pain, might explore these options.

In most cases, pain is accompanied by another problem like muscle weakness or nerve problems. After surgery, pain is not guaranteed to get better or worse. Overall, pain is the symptom of a larger problem and surgery looks to resolve the problem, with the hope of also resolving the pain.

By Bonnie Azoulay

Bonnie is a freelancer writer and content marketer with 5+ years of experience in writing and marketing.