Chronic pain among surgeons needs to be addressed

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What a pain!
Dr. Frank J. Veith

Dr. Park and Dr. Cerame deserve credit for bringing to light an issue that has rarely been discussed, but is of great importance to all surgeons and particularly to vascular surgeons: occupational health hazards. In addition to the general problems pointed out by Dr. Park, vascular surgeons face special hazards.

Aside from the long hours, little sleep, and the stresses of taking care of sick patients who may not do well despite our best efforts, vascular surgeons should be aware of special risks they face. These risks are associated both with open vascular and endovascular procedures. It is crucial that even young vascular surgeons maintain an awareness of these risks so they can be prevented or at least minimized – and treated promptly if symptoms develop.

Dr. Frank J. Veith

The open operations that vascular surgeons are called upon to perform, particularly for advanced disease, are often time consuming and intense. They may require bending or working with the head or back flexed for long periods. A difficult redo leg bypass is one such example. Spinal disk problems are common in both the cervical and lumbosacral areas in vascular surgeons who perform these lengthy arterial operations.

Vascular surgeons with busy endovascular practices face even greater occupational risks.

Endovascular surgeons are exposed daily to radiation, none of which is totally safe. Increased risks of cancer and cataracts are the most prominent risks, and there are marked differences in individual susceptibility to these dangers. Accordingly every effort must be made throughout a vascular surgeon’s career to minimize this exposure, both by emphasizing radiation safety, taking every possible protective measure, and being constantly aware of the hazards.

One of the protective measures is the wearing of lead gowns. Heavier lead aprons are more protective and should be used. It is not surprising, however, that all interventionalists who use lead protective gear for long hours also face an increased risk of cervical and lumbosacral disk problems, which can require treatment or even end their careers. Devices that limit the weight of these aprons and place the operator further from the radiation source are being developed and should be explored by all those who use radiation imaging in their daily practice.

All vascular surgeons should take the study by these researchers seriously and heed its warnings.

Dr. Frank J. Veith is professor of surgery at New York University Medical Center and Case Western Reserve University, and the William J. von Liebig Chair in Vascular Surgery at the Cleveland Clinic Foundation. He is also an associate medical editor of Vascular Specialist.



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.”

Dr. Mario Cerame

Dr. Mario Cerame

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?

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