My Dad had back surgery about six months ago. He's about 62-years old. He complained mightily about back pain that went down his leg. The surgeon removed a disk that had gone bad and was pressing on a nerve. His leg pain went away but the back pain is still there. In fact, Dad thinks his pain is worse but we think he's way better. He can do more. He sleeps better. He isn't limping. Is he just looking for sympathy or what? We can't figure it out.

Posted December 22nd, 2009 by Matt

Spine General (involves multiple spine areas)

You may be observing something doctors call response shift phenomena. It happens to many, many patients before and after surgery (or other treatment). They have less pain and better function, but they rate their progress as worse than before treatment. They seem to see themselves as more disabled even though tests show they are stronger and more active.

The patient has adapted to the new level of ability and then his or her expectations change. It's a bit like a moving goal post or using a shorter yardstick for measuring desired outcomes. Showing the benefit of treatment becomes a challenge because patients change their internal standards for how they view their pain or other symptoms. They may reassign importance of one symptom over another.

Your father's example is a good one. Someone with back and leg pain from degenerative disc disease has surgery to remove the disc. After surgery, the leg pain is gone but the back pain is still there. Even though half the pain is gone, the patient rates pain-related disability as much worse than before surgery when there was back AND leg pain.

This patient has had more than just one type of response-shift phenomena. Besides changing internal standards of pain, now he or she has reprioritized the relative value of pain severity. In the absence of leg pain, suddenly the same level of back pain is much worse and more disabling.

It may take some time before things settle out and your father recognizes the improvement in his function and quality of life. At the same time, the doctors and therapists can now address the back pain and see if additional treatment can help. It is possible that gently pointing out the changes you have observed may help your father take a step back and re-evaluate his own situation. This may or may not help create a better appreciation for the results of treatment so far. After all, pain is pain and it has a way of getting our full attention!

Carolyn E. Schwartz, ScD, and Joel A. Finkelstein, MD, FRCS(C). Understanding Inconsistencies in Patient-Reported Outcomes After Spine Treatment: Response Shift Phenomena. In The Spine Journal. December 2009. Vol. 9. No. 12. Pp. 1039-1045.

Post to Del.icio.us

Email to a Friend

Comments

ucvhost is a leading web

On February 27th, 2010 keith12 says:

ucvhost is a leading web site hosting service provider that is known to provide reliable and affordable hosting packages to customers. Cheap Hosting company believes in providing absolute and superior control to the customer as well as complete security and flexibility through its many packages. Forex Vps Moreover, the company provides technical support as well as customer service 24x7, in order to enable its customer. price. windows vps
One good linux hosting option is the package cheap vps offered by ucvhost , which not only provides the best in terms of hosting packages but also believes in truly being there for the customer, 24x7. Moreover windows hosting , they offer unlimited bandwidth as well as nearly 1GB storage along with database maintenance, email facility along with storage, availability of sub domain and many other important features for a very low . thanks ucvhost

replica watches

On June 12th, 2010 cheap watches says:

replica watches

On June 12th, 2010 cheap watches says:

. Glashutte Original creates Cheap Zodiac Watches complex Best Replica Watches mechanical timepieces of grand cheap replica handbags stature. Reclaiming its former Cheap NIKE Shox NZ position designer evening dresses of glory. this brand is dedicated to horological excellence—producingChina LED Ribbon Light watches that are beautiful both inside and out. Originally founded as Glashutte in 1845. the Swiss Replica Watches brand produced some of the finest timepieces in Germany's history. But in 1951 the company's business was Fake Gevril Watches stifled cl boots by Cheap Nike Shox Turmoil the East Replica PRADA t shirts German black devil cigarettes government. designer shoes which merged Sporting goods stores the Sporting goods stores Fake Zodiac Watches cigarette sales discount kent Saxony region's various watch brands into one company. However cheap adidas shoes Soccer Jersey wholesale. following the German reunification in 1990 Cheap Watches. Glashutte proudly Gucci Handbags reestablished itself. %AIn 1994. designer shoes Glashutte Original was formed and two years later the brand unveiled its first watches. Its MP3,MP4 player timepieces met with marked fake Zodiac Watches satisfaction from collectors around the world thanks to the Cheap NIKE Shox R4 company's excellent craftsmanship and elegant designs. %A%AIn the year 2000. replica Ceinture Discount Prada Bags The Swatch Group purchased Glashutte and vowed to continue in Christian Louboutin boots Cheap replica FENDI shoes leather the Cheap Nike Shox Turbo company's traditions. All timepieces are created in limited editions and are mechanical masterpieces that blend state-of-the-art technology with traditional horology. %AAmong Replica BURBERRY t shirts the shining stars created adidas running shoes by Glashutte are a Cheap Nike Shox Turbo MP3 MP4 player column-wheel chronograph movement and designer shoes a Michele Rplica Watches caliber fitted with a tourbillon escapement. %AIn fact. the company has 10 proprietary western wedding apparel movements. a watch line Fake Chanel Handbags comprised of five different collections. and a host of Cheap replica FENDI shoes leather master complications—all created Prada Handbags in limited editions. %AMost recently the replica soccer jersey brand unveiled two new models inspired by its very successful Replica Adidas Superstar Sneaker Shoes top Burberry corium shoes leather color=red>Replica Replica Pulsar Watches Watches. long-since sold-out PanoRetroGraph watch. The newest timepieces. Cheap D G Ceintures the PanoReserve and the PanoGraph. take their design inspirations from cheap adidas shoes the Replica Omega Watches original model. replica soccer jersey %AThe elegant Replica Handbags dials feature an off-center hour and minute display and a subsidiary seconds hand. Glashutte developed soccer jersey wholesale new. exceptionally lavish. manually wound movements Whimsical Watches for sale for these Fake Watches watches.%A%9%9%9%9%9%9%A

new jordan sneakers

On June 21st, 2010 air jordan says:

hi!
please add www.toetoeshoes.com to your directory!
there are a lot of shoes for selections
authentic jordan shoes
air jordan
jordan af1
rare jordans
jordan kicks
jordan air force one
new jordan sneakers
cheap jordan sneakers
authentic jordan
it looks perfectly fit for young people.
there must be one of your interesting.
thank you for share.

Discount Ugg Boots

On July 1st, 2010 fivefingersshoes says:

I agree you! Excellent review!Anyway, as I posted to Facebook, I ended up getting those Discount Ugg Boots , Australia Ugg Boots , Uggs Cheap , Short Ugg Boots , Classic Ugg Boots .

UGG Boots on sale

On July 8th, 2010 fang says:

uggs on sale

On July 14th, 2010 uggs on sale says:

sharepoint

On July 15th, 2010 keith123445 says:

sharepoint services
sharepoint Consulting
sharepoint

Online Marketing Services

Supra Shoes

On July 18th, 2010 bugang says:

100awf

Good post! Welcome to our Supra Shoes store. We own Supra Shoes UK, Supra Trainers. Here you can buy Supra Vaider, Supra Muska Skytop, Supra Society. The Supra Tk Society are also good. Supra Indy, Supra Strapped and Supra Suprano also win lots of customers.

Cheap Spyder Jacket

On July 18th, 2010 bugang says:

100awf
All series of Cheap Spyder Jacket is Selling Crazy on Spyder Jacket store, if you love skiing or outdoor activities, maybe Spyder Ski Jacket and Spyder Insulated will give you surprise, if you are a women, we also offer some choice for you when you are doing exercise, like Womens Spyder Ski Jacket and Womens Spyder Suit, if you have a naughty child at home, maybe Spyder Kids Jacket will help you take care of him, Spyder Leader and Spyder Down are also good, Spyder Vest is fit for any season. Just click Spyder Jacket Sale, you can owning one for yourself.

Supra Sneakers

On July 18th, 2010 bugang says:

100awf
Oh my god! They are Various Supra Sneakers on Sale at discounted price in our superstore! Supra Sneakers include Supra Strapped, Supra Cruizer, Supra Society, Supra Vaider, Supra Trinity, Supra Suprano Hi, Supra Thunder, Supra Skytop Shoes, Supra Skytop 2 and Supra Indy. Recently, Supra Shoes become more and more popular. And you could contact us to buy Cheap Supra Shoes.

Cheap Spyder Jackets

On July 18th, 2010 bugang says:

100awf
Welcome to Cheap Spyder Jackets which has Spyder Ski Jackets, Spyder Ski Pants, Women Spyder Ski Jackets, Women Spyder Ski Pants, Women Spyder Ski Suit, Kids Spyder Ski Jackets and Spyder Gloves.

Clearance sale for Supra Shoes, high quality Supra Skytop Shoes and Supra Society Shoes Men are sold 40% off, the discount of Supra Vaider Shoes and Supra Society Shoes Women is 37%-45%, but Supra Suprano Shoes are at surprise price with 50% cutting down. maybe you will love Supra Cruizer Trainers or Supra Strapped Shoes.

Moncler Outlet

On July 18th, 2010 bugang says:

100aye
Good article! Welcome to Official Moncler Outlet! We provide Moncler Jackets, Moncler Coats, including Moncler Men Hooded Jacket, Moncler Men Down Short Jacket, Moncler Women Down Short Jacket, Moncler Scarf, Moncler Bags, Moncler Men Long Down Jackets, Moncler Mens Vest, Moncler Hooded Jackets Women, Moncler Women Long Down Jacket, Moncler Women Vest, Moncler Trench Coat, Moncler Kids Jackets.?

Blow out! Cheap North Face are on sale now in our North Face Canada outlet. We have series of the products of The North Face, like the Women's North Face Denali Jacket, the Men's North Face Denali Jacket, the Women's North Face Jacket, the Kids's North Face Jacket, the Men's North Face Jacket, the Men's North Face Down Jacket, the Men's North Face Down Vest, the North Face Backpack, and the North Face Gloves. Have fun shopping!

Moncler

On July 18th, 2010 bugang says:

100aye
Good article Moncler has 50-year Milestones, Ramillon and Vincent bought a Moncler Coat factory in 1952. Moncler Jacket for the production of outdoor hiking supplies. Cheap Moncler Outlet Products include Men Moncler Vest, Women Moncler Vest, Moncler Bag, Moncler Boots, Moncler Kid Jacket, Women Moncler Long Jacket, Women Moncler Hooded Jacket, Women Moncler Down Jacket, Men Moncler Hooded Jacket, Men Moncler Down Jacket. In 2000, Moncler Jacket as the cold season, even when the skiing elegant occasions recognized the essential single product.

Good Comments! The North Face hot sell Cheap North Face Jackets in the North Face Outlet. We offer kids North Face Jacket, Womens North Face Denali hoodie, Womens North Face Denali Jacket, Mens North Face Jacket, Mens North Face Denali Jacket, Mens North Face Denali Hoodie, Mens North Face Down Jacket, Mens North Face Down Vest, and Womens North Face Jacket. In addition, North Face Backpack, North Face Sweeper Backpack, North Face Recon Backpack, North Face Gloves also hot sale in 2010.

New Ghd Rare Styler

On July 18th, 2010 bugang says:

100ajf
said Yes Ghd Hair Australia Socrates I Ghd Hair Straighteners think your Ghd Straighteners advice is Ghd Hair Styler very good Ghd Australia the past Buy Ghd Hair Australia I do Cheap Ghd Hair Australia not like GHD Green Envy borrowing money Buy GHD Green Envy because we GHD Purple Indulgence know that when GHD Red Lust I borrowed Ghd IV Dark Styler money to Ghd Precious Styler complete Buy Ghd Pink I will not Buy Ghd Pink pay people Ghd Pure White Styler but now Ghd Pure Blue in order Ghd Purple Styler to obtain Ghd Gold Styler the necessary Ghd IV Dark Styler funds to Ghd Benefit Styler Ghd Kiss Styler start working Ghd Salon together I Ghd Rare think I Ghd IV Mini Styler could do New Ghd Rare Styler was.

At 90, cellist Pablo Casals Cheap Ugg Boots would start his day by playing Bach. As Discount Ugg Boots the music flowed through his Ugg Boots fingers, his stooped shoulders would straighten and joy Ugg Australia would reappear in his eyes. Music, for Ugg Classic Cardy Casals, was an elixir that made life a never ending adventure. As author and poet Samuel Ullman once wrote, "Years wrinkle the skin, but to give up enthusiasm wrinkles the soul."

Louis Vuitton Epi Leather

On July 18th, 2010 bugang says:

The terrific responsibility about Louis Vuitton Handbags is the symbol of Discount Louis Vuitton Handbags versatility to the Louis Vuitton Beach line-with a LV purse Louis Vuitton Cruis credit every design, material, color, Louis Vuitton Damier Canvas and a bag for every trigger. Louis Vuitton Epi Leather is by abysmal the Louis Vuitton Mahina finest close purse brand Louis Vuitton Monogram Canvas of our time, Louis Vuitton Monogram Denim and one of the Louis Vuitton Monogram Miroir incomparably perceptible brands Louis Vuitton Monogram Perfo ascendancy the system.

ugg boots on sale

On July 19th, 2010 shely77 says:

It's a interesting news,i like it.Additionally,wellcome to my website oboots.There are so many cheap ugg boots such as:

ugg UK|uggs on sale|cheap ugg boots|ugg classic boots|