Within the community of surgeons, chronic pain is a four-letter word, spoken about in hushed tones – if it’s spoken about at all, that is – and rarely ever discussed as something that urgently needs to be addressed.

But surgeons are susceptible to the same chronic conditions as are the patients they treat. In addition to the fatigue associated with conducting long, grueling surgical operations, surgeons can experience repetitive motion injury from using laparoscopic tools for minimally invasive procedures – injuries that can, if left untreated, lead to long-term consequences.

“There have been a few studies on this, but I think we’re just scratching the surface,” explained Dr. Adrian Park , chair of surgery at the Anne Arundel Medical Center in Annapolis, Md. Dr. Park was the lead author of a 2010 study that identified chronic pain among surgeons as a serious and underreported issue within medicine.

That study, which evaluated 317 surgeons using a 23-question survey, found that 86.9% of surgeons experience “physical symptoms or discomfort,” with the most significant indicator of such symptoms being a high case load. Subsequent studies from Europe and eastern Asia also found rates of 80% or higher among surgeons in those regions of the world.

With so pervasive a problem, however, the relative paucity of data and conversation among medical professionals is alarming. “As a surgeon leader, I can tell you surgeons complain about a lot of stuff, but one of the things they tend not to complain about is themselves and their own health and well-being,” said Dr. Park.

The reasons for that, Dr. Park explained, are plentiful. Most surgeons simply don’t find it acceptable to speak up about any pain they’re experiencing, while “some may have felt it was a sign of weakness to report these injuries, some may have felt it would affect their referral base and their work,” according to Dr. Park.

To that end, Dr. Mario Cerame is well aware of what a seemingly innocuous, relatively small chronic pain can do to a surgeon. A surgeon in North Carolina, Dr. Cerame began to experience symptoms of repetitive motion injury about 2 years ago, symptoms which he says “crept up on me.”

It began as simply numbness at the tips of his fingers, affecting the way he held laparoscopic tools during surgery and other, more menial, daily tasks. Initially suspecting it was carpel tunnel syndrome, Dr. Cerame brushed it off, until the numbness spread to three whole fingers and, eventually, his entire hand. His physician explained what was happening, instructing him that if he didn’t undergo orthopedic surgery immediately, he ran the risk of becoming quadriplegic.

“I got the diagnosis on Thursday, and had the operation on Tuesday,” said Dr. Cerame, explaining that the diagnosis was spinal stenosis. Two areas of his spinal column were pinching inward, causing the slow but steady paralysis he was experiencing. With physical therapy, Dr. Cerame could have some function back within 2 years of the operation – so far, it’s been just over 16 months. The point of the operation, however, was to prevent further damage and paralysis, not necessarily to restore Dr. Cerame’s motor function to 100%.

Dr. Cerame’s story, however, isn’t what usually happens. Because surgeons generally keep things to themselves, they have to find other ways of coping with chronic pain. Some choose noninvasive options: massages, physical therapy, and so on. Other do choose to go under the knife, but such surgeries don’t provide a permanent solution to the problem. With laparoscopic tools becoming increasingly ergonomic, and monitors allowing surgeons not to keep their heads bent at an angle for hours on end during surgery, things are improving – but more can be done.

“I’ve published an awful lot of papers, but the thing that struck me about [the 2010] paper is the response I got,” said Dr. Parks. “Surgeons, literally from around the country, would call me saying ‘I used to be able to do this operation, I no longer can do that,’ or ‘this used to be what my case list looked like, I can no longer do this, you can use me as an example.’ People came forward.”

Then there’s the darker side of coping with chronic pain: substance abuse. Tight-lipped surgeons who won’t talk about pain certainly won’t talk openly about using painkillers or narcotics to ease their muscle aches or joint stiffness, but with physicians having relatively easy access to such products, could substance abuse among surgeons be a problem?

“When livelihoods are at stake, I think folks will take opportunities to stay in the game,” admitted Dr. Parks, adding that “it’s not something that folks advertise, but in anonymous surveys [surgeons] respond amazingly to stuff like this.”

The bottom line, according to both Dr. Parks and Dr. Cerame, is for surgeons not to keep quiet about these issues if they ever do experience them. Asking for help and getting things checked right away is better, not only for a surgeon, but for his family and patients, too. While Dr. Cerame has gone back to work, he is unable to handle the case load he once had and isn’t sure if he’ll ever be able to.

“Surgeons and physicians in general have a tendency to get so consumed with other people’s health that they don’t focus on their own health issues,” said Dr. Cerame. “It took me almost 8 months from the time I had symptoms to actually get it checked out [because] I thought it would go away, [so] if you find something that’s not kosher or you feel something that isn’t normal, take care of it.”

The other side of this, Dr. Parks elaborated, is the overload of mental stress, leading to surgeon burnout. “There’s really a growing literature on surgeon burnout, and it is not a trifling issue; in studies from North American, Australasia, Europe, Great Britain, the rate of burnout among surgeons averages about 35%, and again, surgeons are very reluctant to talk about this sort of thing.”

Dr. Park and Dr. Cerame did not have any relevant financial disclosures.

dchitnis@frontlinemedcom.com

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