I always find attending the York Spinal Support Group meetings a moving experience. At the 3rd December meeting a patient had come all the way from Chichester and left quite encouraged having met so many patients who had done well after treatment. A 77 year old sports journalist from York said surgery had allowed him to continue working and a 72 year old car enthusiast said it had allowed him to continue his hobby and not sell his large home.

These meetings are useful for patients because they get very different messages in primary care: that they just have to put up with their back pain; that its age related and they just have to take pain killers; that there is no surgery available to help them or that it is dangerous and can leave them paralysed. We have had no death or paralysis from surgery in 15 years , but patients keep getting told this- and it scares them unnecessarily. Major advances in spinal surgery have made the impossible , possible- but it will take time for this message to get down to the grassroots.

Researchers in Cambridge, writing in the journal Science, have identified a gene HCN2 that is responsible for chronic pain. By removing it from nerve endings in a mice study, they were able to stop the chronic pain response.

This may lead to the development of drugs that block the HCN2 gene, thus providing hope to the 1 in 7 Britons who suffer from chronic pain. Currently, drugs are poor at controlling chronic neuropathic pain, and this discovery is a major step forwards in developing new drugs for this debilitating condition.

An increasing number of elderly patients are coming forward for treatment and they have the same questions: Am I too old to have surgery? Are the risks of having a problem higher because of my age?

Age on its own does not increase the risk of having a problem with surgery. Associated illnesses like heart disease, diabetes and high blood pressure can however increase the risk slightly. We routinely do hip replacement on patients over 80. My oldest patient was 90, and he wanted surgery to able to continue riding his bicycle! In fact I operated on a 76-year-old lady recently, and she bounced out of bed the next day- faster than patients much younger than her on the same ward. She has done very well. Recovery in older patients can however take longer, but patients get there in the end. Anaesthesia has become much safer over the years. We are now able to operate on elderly patients with no significant additional risk.

We are also able to help many patients with spinal injections and not all the patients need to have surgery.

I think that pain in the elderly is often neglected and many hold the view that it is normal to have pain, as one gets older and patients should manage with painkillers. While this is true in many cases long term painkillers have their own side effects including drowsiness, constipation and can cause abdominal pain, heart disease and high blood pressure.

It is especially important to look carefully at this group of patients, as many more options for treatment now exist. They must enjoy their last years in good health and without distress.

At the spinal support group meeting today a 5-year-old girl along with her brothers aged 3 and 2, came up to me and gave me the most beautiful hugs, and said thank you for making their mummy better.

After spinal surgery 6 weeks ago, their mum had managed to join the family at breakfast, for the first time in 3 years. The pain had affected the whole family, and all 5 of them had turned out at the meeting. It was a pleasure to see them beaming with smiles all round.

We had about 60 patients attend the York Spinal Support Group meeting, held at the York Nuffield hospital. The hospital very generously hosts the meeting, which is free to everyone to attend, and their staff are at hand to provide refreshments and support. One couple had travelled from Dumfries in Scotland, and stayed overnight to attend.

They said they were very pleased they came, because they were able to get the support of several other patients who had recovered and done well from spinal surgery. A chef who was unable to work due to his back pain was going back to work after surgery, and said the pain he had had for 24 years had gone.

A new £435 test from a Spanish company called Life Length may predict how long a person may live. It measures the length of a telomere, a gene sequence at the end of a human chromosome which protects it from deterioration. Shorter telomeres predict premature ageing and increased risk of cardio-vascular disease and cancer.

The test will predict whether the ‘biological age’ as measured by the telomere is less or more than the chronological age. The Nobel prize for medicine in 2009 was won by Elizabeth Blackburn and her 2 colleagues, for discovering the protective effect of the telomere and the enzyme telomerase.

This could have a huge impact on society. Do we really want to know how long we will live? What will insurance companies do with that information? Will scientists develop drugs or gene therapy to increase telomere length and the human lifespan ?

This is no longer the stuff of science fiction, but could become a reality in the next 20 years.

We already know that meditation results in a lengthening of the telomere and an increase in the telomerase enzyme level. A study by Dr Clifford Saron published in October 2010, compared 30 patients who mediated
6 hours daily with a another group who did not. The meditation group had a 1/3 increase in telomerase levels in the
white blood cells. Other studies have shown that chronic stress can lead to a shortening of the telomere lengths. This provides tantalizing evidence of the link between the mind and the body, and will fundamentally change our perception of what ‘health’ is – a healthy mind being as important as a healthy body. The motto of my old school ‘
Mens Sana in Corpore Sanum’- a healthy mind in a healthy body, may be closer to the truth than was once thought.

The next meeting of the York Spinal Support Group will take place on Saturday 10th September 2011 at the Nuffield Health York Hospital, Haxby Road, York between 10am and 12pm. This free, informal meeting is aimed at anyone suffering from back or neck pain, and gives you the chance to meet fellow back pain sufferers to share stories and experiences. Friends, family and carers are also welcome! We look forward to seeing you there!!

A patient came to see me recently with a 20 year history of back pain. He was severely disabled and depressed by her symptoms. For the first decade he was under the care of a rheumatology team, and latterly under
the care of a pain clinic. He was on high doses of pain killers, which were affecting his ability to think clearly.

He thought there was no hope. He had never seen a spinal surgeon before. He came to see me through a
recommendation by a friend. His MRI scans showed a straight forward problem that could be easily
fixed by surgery. When I told him this, he broke down in tears, unable to comprehend why he had suffered for so long, and never been told about the possibility of surgery to fix his problem. Could he have asked for a second
opinion earlier? Would that have made a difference? Why do we accept , without question , the opinion of
professionals ?

What are the rights of patients when it comes to a second opinion? Why are they important? Medical knowledge is expanding all the time, and its impossible for all doctors to keep up to date with all the recent advances. In this case the Rheumatologist or the Pain Clinic Specialists probably did not know that surgery was an option to help this patient. Even within a particular speciality opinions differ, and meeting another consultant can offer a different perspective and other treatment options. Most medical problems have many different treatment options, and a consultant is likely to recommend the one they are most familiar with . Most specialists will practise according to the way they have been trained.

If you are dissatisfied with the diagnosis or treatment options being proposed, or the outcome of treatment , you can request your GP or Consultant to refer you for a further opinion. Though you have no legal right to one, doctors rarely refuse. Patients are often worried that they will offend the treating doctor or Consultant by requesting this. There is no need to feel this way. Your health is far more important than a few bruised doctors’ egos. I have often referred challenging cases to colleagues for a second opinion, even when not
requested by the patient. It gives the patient confidence that everything is being done to help solve their particular problem.

You can also request a second opinion from a different GP within the practise.

In 1948 the WHO defined health as a state of ‘complete physical, mental and social well being’ . Experts are challenging this because its not achievable for most of us, as it implies we expect to always be happy. Happiness is a personal state of mind, and related to many factors other than one’s health.

It puts a huge responsibility on health care systems and absolves the individual from assuming personal responsibility for their health because they feel that the ‘health care system’ they are part of will sort them out. People need to take more responsibility for reducing the 4 major contributors to ill health – alcohol, tobacco, physical inactivity and a poor diet. GP colleagues say that patients seek help for common ailments which they could manage themselves- like a headache or tiredness, a fear of dogs, or a cold.

An alternative definition being proposed is ‘ the ability to adapt and self manage in the face of physical, social and emotional challenges’. This puts the responsibility for health back on the individual. 70% of the NHS budget is spent on chronic diseases like arthritis, mental health problems, diabetes and high blood pressure . Empowering individuals to live a fulfilled life, and adapt to and self manage their chronic illness is important. Responding to life’s many challenges positively, whether health, work or relationship related is the key to health and happiness, and the rising level of mental health related problems in our society reflects that we could do it better.

Pain is now being seen as not just a sensation but an experience. 10 people given the same pain stimulus will respond to it and experience it differently, as my work with back pain patients shows. Experts say that the pain experience now includes not just the recognition of the pain sensation, but also the emotional response to it and the motivation to get better.

For example we recommend regular exercises to treat back pain, and its only the few motivated individuals who take the advice seriously do something about it. Some patients are anxious and have a much stronger emotional response to pain than others.

This new approach has influenced the way we treat patients. In addition to the traditional approach of pain killers and surgery to address the problem we have designed treatments to address the patients’ emotional distress as well with treatments like cognitive behavioural therapy, support group meetings, online discussion forums, anti-depressant medication and counselling. I also know that the most motivated patients are the ones who respond best to surgical intervention.

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