Surgery is failing to remedy back pain and is increasingly being used to treat other causes including depression and social isolation, medical researchers have warned.
A disproportionately high number of spinal fusions are being performed in private hospitals in response to the unrealistic expectations of patients with lower back pain.
Writing in the Medical Journal of Australia to be published on Tuesday, Associate Professors Leigh Atkinson, from Wesley Pain and Spine Centre in Brisbane, and Andrew Zacest, from Royal Adelaide Hospital, warn patients often wrongly expect a surgical solution to their back pain.
Professor Atkinson said busy surgeons were often willing to perform an operation, despite growing evidence showing it often fails to cure back pain.
The researchers reported a disproportionately high increase in number of back operations performed in private hospitals compared to public ones.
The researchers say pain from a back injury can be compounded by work dissatisfaction, family stress and depression. A sedentary lifestyle can also contribute to low back pain, which is the most common symptom seen in GP surgeries.
"Armed with mobile phones, consumed with social media, and with rapid access to online information, our patients present with high expectations of modern technology, including surgery," the researchers said.
"With outstanding results from hip and knee arthroplasties, they expect similar results from spinal surgery. Not uncommonly, the patient attends the surgical consultation with an expectation that the problems can be fixed."
But more often than not, the surgery fails to fix the problem.
Patrick Scala, from Shoalhaven Heads, has had two back operations including one in September last year and both failed to relieve his pain. He injured his lower back on three occasions between 2005 and 2008 when he was working at night packing supermarket shelves. He has not worked since 2007 and has been fighting a legal battle to top up the lump sum payment he received from WorkCover in 2009.
Associate Professor Atkinson told Fairfax Media that state-based workers compensation schemes rank the seriousness of impairment due to back injury more highly after surgery is performed. He said surgeons were often too busy to "flesh out" the real cause of a patient's back pain.
He said many injured workers needed to be re-assessed and offered pain management instead of surgery. He said back pain can often get worse in people with untreated depression, workplace or social problems.
"There are psycho-social issues that complicate and distort back pain. So surgeons operate for the wrong reasons," he said. "You can't cure depression or workplace unhappiness with a back operation."
The medical journal paper says the workers compensation system and third party insurance can prolong rehabilitation and extend recovery times. A study of patients receiving workers' compensation in NSW found surgery outcomes were so poor that the benefits were marginal.
Four in ten people continued to experience pain after a back operation and the success rate was 50 per cent "at best".
Professor Atkinson said spinal fusion surgery for non-specific low back pain is controversial, particularly its origin is not known "and imaging of the spine is unhelpful".
"I see so many failed back operations," he said. "We really need to have a look at the psychological and social issues."
