Qué hacer antes de decir sí a la cirugía ortopédica

El hecho de que la cirugía ortopédica sea una opción no significa que sea la única. Try these other strategies before you decide to go under the knife.

“You need surgery” aren’t words anyone likes to hear. Yet if you’re looking for relief from knee, hip, shoulder, or back pain, your doctors might suggest that surgery could help. What’s important to remember is surgery isn’t always your only option.

“Just because you can identify something that surgery could address doesn’t mean that same condition couldn’t be effectively managed without surgery,” says Mary O’Connor, M.D., a surgeon herself, as well as cofounder and chief medical officer of Vori Health, a health provider that incorporates health coaching in an integrated approach to musculoskeletal care.

She points out that doctors who are surgeons want what's best for patients, of course. But they also tend to approach conditions "through the lens of being a surgeon," she says. In some cases, though, there may be other, nonsurgical steps you can take that can help address your pain.

Before you schedule an operation, consider the following strategies — and talk them through with all the health care providers you’re working with.

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1. Ask if Delaying Surgery Would Cause Problems

First, you want to find out whether taking time to explore other options carries the risk of making your condition worse. If the answer is no, a delay won't cause you an additional harm, you'll feel freer to say "Okay, I'm going to work on this without surgery and see if I can get better," Dr. O'Connor says.

2. Get a Second Opinion

"It's never wrong to get a second opinion. Most surgeons welcome it," Dr. O'Connor says.

When looking for a second opinion, you can go to another doctor in the same field or try a different specialty. For conditions like chronic joint pain, for instance, you may benefit from seeing a sports medicine physician.

A physiatrist might also be able to help. Physiatrists emphasize rehabilitation and management of conditions, and they focus on the patient as a whole person - not just a case of knee pain or back pain. They also typically work within a team of other specialists.

Getting a second opinion takes extra time and legwork, but it can be worth it. Even if you end up sticking with the first opinion you received, you've become a more informed patient, says David Woznica, M.D., M.S., director of clinical medicine at Vori Health. And that's always a positive step for your health.

3. Try Physical Therapy

If your doctors don't think you will be doing damage by delaying surgery, physical therapy - often called PT - may prove helpful. This is especially true for back, knee, hip, and shoulder problems. A physical therapist can analyze your movements to figure out the source of your pain and recommend exercises to help strengthen weak areas or get joints back into alignment.

Physical therapy is a time commitment, to be sure. Each session can take an hour or longer, and you'll usually need to have regular sessions for anywhere from several weeks to several months.

Make the decision to give PT a chance to help you: Make sure to do the full course prescribed by your doctor and don’t skip any home exercises the physical therapist assigns you, Dr. O’Connor advises.

And remember, it's not effort down the drain if you try PT and still have pain. Getting stronger before surgery can help you recover faster afterward.

Recommended reading: 7 Surprising Reasons to See a Physical Therapist

4. Prioritize Your Overall Well-Being

How is your health other than your joint issues? Are you under a lot of stress? Are you dealing with insomnia?

Factors like these can contribute to musculoskeletal conditions and pain, according to Dr. O'Connor. Lifestyle changes may help you improve without surgery, she says.

Your healthcare team might suggest steps like:

• Losing weight
• Eating a more nutritious diet
• Getting restful sleep
• Lowering your stress
• Quitting smoking

Take nutrition, for example. "If you have a skeletal injury, you need to make sure that you are giving your body the nutritional components that it needs to help heal that injury," Dr. O'Connor says.

Working on changing your behavior or lifestyle for the better can be difficult, which is why Dr. O'Connor often suggests seeking out a health coach. Health coaches work with patients to help set personal health goals and coach them through the steps it takes to achieve those goals.

Health coaches are not licensed healthcare providers, so look for one that is certified by a reputable organization, such as the National Board for Health & Wellness Coaching.

5. Ask About Less Invasive Medical Options

You could be a candidate for other medical therapies that don’t involve surgery, Dr. Woznica says.

One is called radiofrequency appellation, or rhizotomy. It's a minimally invasive procedure that destroys the nerve fibers that are sending pain signals to the brain. The relief from pain is immediate and can last as long as a few years. Rhizotomy generally only takes a few minutes to perform, and you'll most likely be able to go home that same day.

Another approach is a peripheral nerve stimulator (PNS). With PNS, a small electrical device is implanted next to the nerve that's causing your pain. It delivers electrical pulses that block the nerve from sending pain signals to the brain and can be controlled through a remote control or even your smartphone.

Acupuncture might be another treatment to try. A practitioner will insert tiny needles into your skin, which has been shown to promote healing.

Dr. O'Connor also suggests pain education. It might sound surprising, but learning to rethink the way you view your pain and the strategies you use to cope with pain might actually lead to reducing it, she says. Some of the strategies include meditation, breathing exercises, progressive relaxation, and guided imagery.

One study reported in the Scandinavian Journal of Pain showed that patients with chronic pain who received pain education reported lower levels of pain intensity and a greater outlook, compared to those who didn’t receive the lessons.

6. If You Do Decide to Have Surgery, Do Prehab

What's important about all of these strategies is that they don't take away surgery as an option. You can try any or all of these steps and still end up choosing surgery. In fact, by giving these options a go first, you'll be a better educated and healthier patient when your surgery date arrives.

For the best results from surgery, work with your doctor to come up with a prehabilitation, or prehab, plan. The same way rehab can help you heal faster after a surgery, prehab can set you up for success before your surgery even happens.

Prehab usually involves exercise, diet adjustments, stress management, and putting a support system in place, says Dr. O'Connor. That way, you can focus on healing - and getting back to your life - as soon as possible.

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