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Identify the locus of the pain

The hardest part of the job

One of the hardest aspects of my job – harder than performing surgery on patients – is identifying the cause of a patient’s pain. When patients come to me, they will have certain symptoms, and I will try to identify the locus of the pain by asking the right questions and carrying out a neurological examination. However, even MRI scans don’t always show which nerve, in which location, is causing the pain. Take, for instance, a double hernia. If a patient suffers from a double hernia, the image will show two instances of disc herniation on the same side of the spine, but which hernia is the one causing the pain in the patient’s legs? Team work will be required to answer this question. My ally in all cases requiring detective work is an anaesthetist specialising in pain management named Dr Poell. Like a modern-day Sherlock Holmes and Dr Watson, Dr Poell and I go on the hunt for the hernia which is causing all the trouble. One of them is bound to be more painful than the other. You see, generally disc herniation doesn’t cause any pain, so I can’t just operate on any old hernia.

Our method is simple. Dr Poell administers a numbing injection to the part of the back we suspect is the culprit. If the pain then subsides, I’ll know that this is the spot I’m going to have to operate on, because clearly, that was the spot causing all the trouble. If we are lucky, Dr Poell will identify the location on his first attempt, but every once in a while, several injections will be required to temporarily relax the affected sciatic nerve. The numbing agent will not last for long – half an hour to a day at most. Long enough to give the patient some respite, and for me to decide on which part of the back I should operate.

The same identification method works very well in other situations, too. Muscles or the cavities of joints can also be subjected to test numbing. If, once a patient has been given a numbing injection, his or her pain subsides, we know that we have identified the cause of his or her pain. I use this identification method several times a week, so as you can imagine, it’s a good thing that Dr Poell works in the same building and that we get on well!

Last but not least, you’ll wonder how badly the injection will hurt and whether there are any risks associated with it. I find it interesting that many patients are happy to request surgery but refuse to receive any injections, most likely due to a fear of needles which developed at some point during their childhood. It seems that many grown-ups can remember their childhood jabs all too well and do not particularly cherish the memories. So I’m pleased to say that Dr Poell works with very thin needles and is a kind and patient man, as well as a very competent and experienced doctor. The great majority of patients hardly experience any pain when injected. And even if the sensation should be somewhat unpleasant, remember that you are suffering for a good cause. Once Sherlock Holmes and Dr Watson have pointed out the culprit, a solution can be found. It is then up to you whether or not you wish to undergo surgery. Just remember: the relief you will feel after your surgery will last a great deal longer than just a few hours.

It should be noted that there are certain types of pain which cannot be surgically remedied. In many of these cases, Dr Poell will have some other therapies up his sleeve with which we will be able to reduce your pain.

Surgery manual

Dr. Schröder is happy to inform you about the surgical treatment of your neck or back condition. He also discusses the possible complications of the procedure with you.

After you've carefully weighed up the pros and cons of the surgery, you can decide for yourself whether you consider your condition serious enough to operate.

View the surgery manual

  • Instructions for after you have left the clinic

    Once you leave the clinic:

    • Make sure that someone comes and picks you up in a car, and refrain from driving yourself
    • Make sure that you recline your car seat
    • Make sure that you are not home alone for the first few days following the operation
    • Allow the wound to heal for the first 2 to 3 weeks
    • You are allowed to shower, as the nurses will give you a waterproof plaster to cover your wound before you leave the clinic
    • You must not drive for 3 weeks, but you will be allowed to sit in the passenger seat while someone else drives you around
    • You are allowed to do whatever you feel up to, as long as you keep listening to your body and stop doing whatever it is you are doing whenever your body tells you to stop

    Your doctor, nurse and/or physiotherapist will provide you with more information on how to look after yourself following the operation.

  • How long will I have to stay at the clinic?

    Depends on the nature of the operation

    The duration of your stay with us will depend on your situation and on the type of surgery you are undergoing. If everything goes according to plan, and if you are undergoing a minor back or neck operation, you will only have to stay with us for one night. If you are undergoing major surgery, such as a spinal instability operation, you will generally have to spend a few nights at our clinics.

  • Swelling after surgery

    Swelling reduced after 2 to 3 months

    After the operation, your wound will swell, which may be painless but may also be a little uncomfortable due to your skin being pulled so taut. Generally speaking, the swelling will subside of its own accord within 2 to 3 months of the operation, and the skin will grow less thick.

  • Medication after surgery

    Following the operation, you will be given painkillers for as long as you need them. You will receive these painkillers in accordance with a set schedule. It is vital that you take your medication at the scheduled times, even when you are not experiencing any pain. In this way, your body will build up a steady level of analgesia.

    Most people will be able to stop taking painkillers a few days after undergoing back or neck surgery. If your painkillers somehow fail to provide you with a sufficient level of relief, we recommend that you notify a nurse as soon as possible. If you were on morphine-like medication prior to your operation, we advise that you gradually cut down on your medication after the operation, if your level of pain allows you to do so, in consultation with your GP. Acute withdrawal may result in adverse events.

  • Post-operative pain

    If you are experiencing an excessive amount of pain, you will receive additional painkillers

    The level of post-operative pain differs from person to person, and from operation to operation. Generally speaking, major lengthy operations will prove more painful than brief minor operations. At our clinics, all patients receive proper painkillers following surgery, as a result of which very few of our patients ever experience a great deal of pain. In consultation with yourself, we will determine your pain score, both at the ward and once you are home (we will call you to discuss this with you). If your pain score is too high, you will be given additional painkillers.

100% insurance covery

Nearly all treatments performed by Dr Schröder are covered by health insurance. This is true for the following conditions: neck hernia, spinal hernia, lumbar spinal stenosis and cervical spinal stenosis.

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Dr Schröder's blog

Dr Schröder regularly publishes new articles on his blog. Read all about spinal hernia, neck hernia, spinal stenosis, neurosurgery and other related subjects.

View all blog posts

  • 13. On coincidence, bad luck and science

  • 12. Dozing off

  • 11. The Big Spinal Quiz for the articulate patient

  • 10. Sherlock Holmes and Dr Watson

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