Operating with pain: Surgeon workplace injury underrecognized



Dr. Mario Cerame is well aware of what a seemingly innocuous, relatively small chronic pain can do to a surgeon. A general surgeon practicing 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.”

Dr. Mario Cerame

Dr. Mario Cerame

It began as 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 carpal 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 orthopaedic surgery immediately, he ran the risk of paralysis.

“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 returning function within 2 years of the operation.

“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. Park. “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.”

Risks of ignoring, self-medicating

Then there is the dark side of coping with chronic pain: risk of substance abuse. A study published in the Journal of Addiction Medicine (2013;7;349-353) on misuse of prescription medication among physicians found that surgeons were among the specialists at highest risk for substance abuse. According to this study, the beginning of addiction for many doctors is a prescription or self-medication for chronic pain. For surgeons, chronic pain from occupational injuries could lead to dependence on pain medication.

“When livelihoods are at stake, I think folks will take opportunities to stay in the game,” admitted Dr. Park.

The bottom line, according to both Dr. Park 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 family and patients, too. While Dr. Cerame has gone back to work, he is unable to handle the caseload 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 you feel isn’t normal, take care of it.”

Dr. Voss, Dr. Park, and Dr. Cerame had no relevant financial disclosures.

Neil Osterweil contributed to this article.

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