How (And Why) To Train Your Pre-Frontal Cortex
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Dr. Chapman’s Keys For Mental Focus
This is Dr. Sandra Chapman; she’s a cognitive neuroscientist, on a mission to, in her words, further our understanding of:
- what makes the brain stronger, faster and last longer
- what enhances human cognitive capacity, and
- what enhances the underlying brain systems across the lifespan.
To this end, she’s also the founder and Chief Director of the Center For Brain Health, where she has worked on her mission for the past 25 years (clocking up hundreds of peer-reviewed publications to her name), as well as being a professor of Behavioral and Brain Sciences at UT Dallas.
What does she want us to know?
Get your brain into gear
When it comes to your brainpower, it is “use it or lose it”, but it is also perfectly possible to use it and lose it.
Why?
Very often, what we are using our brains for is high-strain, low-yield stuff, such as multitasking, overthinking, or overthinking while multitasking. And to make it worse, we often do it without sufficient rest.
This is the equivalent of owning a Ferrari but trying to drive it in second and third gear at once by switching between the two as rapidly as possible. And doing that for 18 hours each day.
Suffice it to say, you’ll be going nowhere quickly.
An alternative “use” of brainpower is low-strain, low-yield stuff, such as having to pay close attention to a boring conversation. It’s enough to stop your mind from doing anything else, but not enough to actually stimulate you.
This is the equivalent of owning a Ferrari but keeping it idling. The wear and tear is minimal this time, but you’re not actually going anywhere either.
Better, of course, are the other two quadrants:
- low-strain, high-yield: consistently using our brain in relatively non-taxing ways that encourage its development
- high-strain, high-yield: here the Ferrari metaphor definitely fails, because unlike cars, our bodies (including our brains) are machines that benefit from judicious regular progressive overloading (but just by a bit, and with adequate recovery time between overloads).
See also: 12 Weeks To Measurably Boost Your Brain
How to do the “low-strain, low-yield” part
When it comes to “what’s the most important part of the brain to help in the face of cognitive decline?” the usual answer is either to focus on memory (hippocampi) or language (various parts, but for example Wernicke’s area and Broca’s area), since people most fear losing memory, and language is very important both socially and practically.
Those are indeed critical, and we at 10almonds stand by them, but Dr. Chapman (herself having originally trained as speech and language pathologist!) makes a strong case for adding a third brain part to the list.
Specifically, she advocates for strengthening the pre-frontal cortex, which is responsible for inhibition, task-switching, working memory, and cognitive flexibility. If that seems like a lot, do remember it’s a whole cortex and not one of the assorted important-but-small brain bits we mentioned above.
How? She has developed training programs for this, based on what she calls Strategic Memory Advanced Reasoning Tactics (SMART), to support support attention, planning, judgment and emotional management.
You can read more about those programs here:
Center For Brain Health | Our Programs
Participation in those is mostly not free, however, if you join their…
Center For Brain Health | BrainHealth Project
…then they will periodically invite you to join pilot programs, research programs, and the like, which will either be free or they-pay-you affairs—because this is how science is done, and you can read about yourself (anonymized, of course) later in peer-reviewed papers of the kind we often cite here.
If you’re not interested in any of that though, we will say that according to Dr. Chapman, the keys are:
Inhibition: be conscious of this function of your brain, and develop it. This is the function of your brain that stops you from making mistakes—or put differently: stops you from saying/doing something stupid.
Switching: do this consciously; per “I am now doing this task, now I am switching to this other task”, rather than doing the gear-grinding thing we discussed earlier
Working memory: this is effectively your brain’s RAM. Unlike the RAM of a computer (can be enhanced by adding another chip or replacing with a bigger chip), our brain’s RAM can be increased by frequent use, and especially by judicious use of progressive overloading (with rests between!) which we’ll discuss in the high-strain, high-yield section.
Flexibility: this is about creative problem-solving, openness to new ideas, and curiosity
See also: Curiosity Kills The Neurodegeneration
How to do the “high-strain, high-yield” part
Delighting this chess-playing writer, Dr. Chapman recommends chess. Although, similar games such as go (a Chinese game that looks simpler than chess but actually requires more calculation) work equally well too.
Why?
Games like chess and go cause structural changes that are particularly helpful, in terms of engaging in such foundational tasks as learning, abstract reasoning, problem-solving and self-control:
Chess Practice as a Protective Factor in Dementia
Basically, it checks (so to speak) a lot of boxes, especially for the pre-frontal cortex. Some notes:
- Focusing on the game is required for brain improvement; simply pushing wood casually will not do it. Ideally, calculating several moves ahead will allow for strong working memory use (because to calculate several moves ahead, one will have to hold increasingly many possible positions in the mind while doing so).
- The speed of play must be sufficiently slow as to allow not only for thinking, but also for what in chess is called “blunder-checking”, in other words, having decided on one’s move, pausing to consider whether it is a mistake, and actively trying to find evidence that it is. This is the crucial “inhibition habit”, and when one does it reflexively, one will make fewer mistakes. Tying this to dementia, see for example how one of the common symptoms of dementia is falling for scams that one wouldn’t have previously. How did cognitive decline make someone naïve? It didn’t, per se; it just took away their ability to, having decided what to do, pause to consider whether it was a mistake, and actively trying to find evidence that it is.
- That “conscious switching” that we talked about, rather than multitasking? In chess, there is a difference between strategy and tactics. Don’t worry about what that difference is for now (learn it if you want to take up chess), but know that strong players will only strategize while it is their opponent’s turn, and only calculate (tactics) while it is their own turn. It’s very tempting to flit constantly between one and the other, but chess requires players to have the mental discipline be able to focus on one task or the other and stick with that task until it’s the appointed time to switch.
If you feel like taking up chess, this site (and related app, if you want it) is free (it’s been funded by voluntary donations for a long time now) and good and even comes with free tuition and training tools: LiChess.org
Here’s another site that this writer (hi, it’s me) personally uses—it has great features too, but many are paywalled (I’m mostly there just because I’ve been there nearly since its inception, so I’m baked into the community now): Chess.com
Want to know more?
You might like this book by Dr. Chapman, which we haven’t reviewed yet but it did inform large parts of today’s article:
Make Your Brain Smarter: Increase Your Brain’s Creativity, Energy, and Focus – by Dr. Sandra Chapman
Enjoy!
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How to Do the Work – by Dr. Nicole LaPera
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We have reviewed some self-therapy books before, and they chiefly have focused on CBT and mindfulness, which are great. This one’s different.
Dr. Nicole LaPera has a bolder vision for what we can do for ourselves. Rather than giving us some worksheets for unraveling cognitive distortions or clearing up automatic negative thoughts, she bids us treat the cause, rather than the symptom.
For most of us, this will be the life we have led. Now, we cannot change the parenting style(s) we received (or didn’t), get a redo on childhood, avoid mistakes we made in our adolescence, or face adult life with the benefit of experience we gained right after we needed it most. But we can still work on those things if we just know how.
The subtitle of this book promsies that the reader can/will “recognise your patterns, heal from your past, and create your self”.
That’s accurate, for the content of the book and the advice it gives.
Dr. LaPera’s focus is on being our own best healer, and reparenting our own inner child. Giving each of us the confidence in ourself; the love and care and/but also firm-if-necessary direction that a (good) parent gives a child, and the trust that a secure child will have in the parent looking after them. Doing this for ourselves, Dr. LaPera holds, allows us to heal from traumas we went through when we perhaps didn’t quite have that, and show up for ourselves in a way that we might not have thought about before.
If the book has a weak point, it’s that many of the examples given are from Dr. LaPera’s own life and experience, so how relatable the specific examples will be to any given reader may vary. But, the principles and advices stand the same regardless.
Bottom line: if you’d like to try self-therapy on a deeper level than CBT worksheets, this book is an excellent primer.
Click here to check out How To Do The Work, and empower yourself to indeed do the work!
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Ovarian cancer is hard to detect. Focusing on these 4 symptoms can help with diagnosis
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Ovarian cancers are often found when they are already advanced and hard to treat.
Researchers have long believed this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be hard to identify as they’re vague and similar to other conditions.
But a new study shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist.
As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages.
So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly?
Ground Picture/Shutterstock Why is ovarian cancer hard to detect early?
Ovarian cancer cannot be detected via cervical cancer screening (which used to be called a pap smear) and pelvic exams aren’t useful as a screening test.
Current Australian guidelines recommend women get tested for ovarian cancer if they have symptoms for more than a month. But many of the symptoms – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses.
This makes early detection a challenge. But it is crucial – a woman’s chances of surviving ovarian cancer are associated with how advanced the cancer is when she is diagnosed.
If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has already metastatised, meaning it has spread to other parts of the body.
If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%.
There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women failed to reduce deaths.
That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly.
What did the new study look at?
Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK.
They were asked to monitor for these four symptoms:
- persistent abdominal distension (women often refer to this as bloating)
- feeling full shortly after starting to eat and/or loss of appetite
- pelvic or abdominal pain (which can feel like indigestion)
- needing to urinate urgently or more often.
Women who reported at least one of four symptoms persistently or frequently were put on a fast-track pathway. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines.
Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound.
What did they find?
The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer.
A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths.
Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body.
There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%).
It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body.
What does this mean for detection?
The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates.
It also points to the importance of public awareness about symptoms.
Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue.
But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought.
This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient.
Many women remain unaware of the symptoms of ovarian cancer. This study shows recognising them may help early detection and treatment.
Jenny Doust, Clinical Professorial Research Fellow, Australian Women and Girls’ Health Research Centre, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Do We Need Supplements, And Do They Work?
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Does our diet need a little help?
We asked you for your take on supplements, and got the above-illustrated, below-described set of results.
- The largest minority of respondents (a little over a third) voted for “I just take something very specific”
- The next most respondents voted for “I take so many supplements; every little helps!”
- Almost as many voted for “I just take a vitamin or two / a multivitamin”
- Fewest, about 8%, voted for “I get everything I need from my diet”
But what does the science say?
Food is less nutritious now than it used to be: True or False?
True or False depending on how you measure it.
An apple today and an apple from a hundred years ago are likely to contain the same amounts of micronutrients per apple, but a lower percentage of micronutrients per 100g of apple.
The reason for this is that apples (and many other food products; apples are just an arbitrary example) have been selectively bred (and in some cases, modified) for size, and because the soil mineral density has remained the same, the micronutrients per apple have not increased commensurate to the increase in carbohydrate weight and/or water weight. Thus, the resultant percentage will be lower, despite the quantity remaining the same.
We’re going to share some science on this, and/but would like to forewarn readers that the language of this paper is a bit biased, as it looks to “debunk” claims of nutritional values dropping while skimming over “yes, they really have dropped percentage-wise” in favor of “but look, the discrete mass values are still the same, so that’s just a mathematical illusion”.
The reality is, it’s no more a mathematical illusion than is the converse standpoint of saying the nutritional value is the same, despite the per-100g values dropping. After all, sometimes we eat an apple as-is; sometimes we buy a bag of frozen chopped fruit. That 500g bag of chopped fruit is going to contain less copper (for example) than one from decades past.
Here’s the paper, and you’ll see what we mean:
Supplements aren’t absorbed properly and thus are a waste of money: True or False?
True or False depending on the supplement (and your body, and the rest of your diet)
Many people are suffering from dietary deficiencies of vitamins and minerals, that could be easily correctable by supplementation:
However, as this study by Dr. Fang Fang Zhang shows, a lot of vitamin and mineral supplementation does not appear to have much of an effect on actual health outcomes, vis-à-vis specific diseases. She looks at:
- Cardiovascular disease
- Cancer
- Type 2 diabetes
- Osteoporosis
Her key take-aways from this study were:
- Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases
- People using supplements tend to be older, female, and have higher education, income, and healthier lifestyles than people who do not use them
- Use of supplements appreciably reduces the prevalence of inadequate intake for most nutrients but also increases the prevalence of excess intake for some nutrients
- Further research is needed to assess the long term effects of supplements on the health of the general population and in individuals with specific nutritional needs, including those from low and middle income countries
Read her damning report: Health effects of vitamin and mineral supplements
On the other hand…
This is almost entirely about blanket vitamin-and-mineral supplementation. With regard to fish oil supplementation, many commercial fish oil supplements break down in the stomach rather than the intestines, and don’t get absorbed well. Additionally, many people take them in forms that aren’t pleasant, and thus result in low adherence (i.e., they nominally take them, but in fact they just sit on the kitchen counter for a year).
One thing we can conclude from this is that it’s good to check the science for any given supplement before taking it, and know what it will and won’t help for. Our “Monday Research Review” editions of 10almonds do this a lot, although we tend to focus on herbal supplements rather than vitamins and minerals.
We can get everything we need from our diet: True or False?
Contingently True (but here be caveats)
In principle, if we eat the recommended guideline amounts of various macro- and micro-nutrients, we will indeed get all that we are generally considered to need. Obviously.
However, this may come with:
- Make sure to get enough protein… Without too much meat, and also without too much carbohydrate, such as from most plant sources of protein
- Make sure to get enough carbohydrates… But only the right kinds, and not too much, nor at the wrong time, and without eating things in the wrong order
- Make sure to get enough healthy fats… Without too much of the unhealthy fats that often exist in the same foods
- Make sure to get the right amount of vitamins and minerals… We hope you have your calculators out to get the delicate balance of calcium, magnesium, potassium, phosphorus, and vitamin D right.
That last one’s a real pain, by the way. Too much or too little of one or another and the whole set start causing problems, and several of them interact with several others, and/or compete for resources, and/or are needed for the others to do their job.
And, that’s hard enough to balance when you’re taking supplements with the mg/µg amount written on them, never mind when you’re juggling cabbages and sardines.
On the topic of those sardines, don’t forget to carefully balance your omega-3, -6, and -9, and even within omega-3, balancing ALA, EPA, and DHA, and we hope you’re juggling those HDL and LDL levels too.
So, when it comes to getting everything we need from our diet, for most of us (who aren’t living in food deserts and/or experiencing food poverty, or having a medical condition that restricts our diet), the biggest task is not “getting enough”, it’s “getting enough of the right things without simultaneously overdoing it on the others”.
With supplements, it’s a lot easier to control what we’re putting in our bodies.
And of course, unless our diet includes things that usually can’t be bought in supermarkets, we’re not going to get the benefits of taking, as a supplement, such things as:
Etc.
So, there definitely are supplements with strong science-backed benefits, that probably can’t be found on your plate!
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The Worst Cookware Lurking In Your Kitchen (Toxicologist Explains)
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Dr. Yvonne Burkart gives us a rundown of the worst offenders, and what to use instead:
Hot mess
The very worst offender is non-stick cookware, the kind with materials such as Teflon. These are the most toxic, due to PFAS chemicals.
Non-stick pans release toxic gases, leach chemicals into food, and release microplastic particles, which can accumulate in the body.
One that a lot of people don’t think about, in that category, is the humble air-fryer, which often as not has a non-stick cooking “basket”. These she describes as highly toxic, as they combine plastic, non-stick coatings, and high heat, which can release fumes and other potentially dangerous chemicals into the air and food.
You may be wondering: how bad is it? And the answer is, quite bad. PFAS chemicals are linked to infertility, hypertension in pregnancy, developmental issues in children, cancer, weakened immune systems, hormonal disruption, obesity, and intestinal inflammation.
Dr. Burkart’s top picks for doing better:
- Pure ceramic cookware: top choice for safety, particularly brands like Xtrema, which are tested for heavy metal leaching.
- Carbon steel & cast iron: durable and safe; can leach iron in acidic foods (for most people, this is a plus, but some may need to be aware of it)
- Stainless steel: lightweight and affordable but can leach nickel and chromium in acidic foods at high temperatures. Use only if nothing better is available.
And specifically as alternatives to air-fryers: glass convection ovens or stainless steel ovens are safer than conventional air fryers. The old “combination oven” can often be a good choice here.
For more on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- PFAS Exposure & Cancer: The Numbers Are High
- It’s Not Fantastic To Be Plastic ← for the closely related topic of microplastics and nanoplastics
Take care!
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The Five Pillars Of Longevity
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The Five Pillars Of Longevity
This is Dr. Mark Hyman. He’s a medical doctor, and he’s the board president of clinical affairs of the Institute for Functional Medicine. He’s also the founder and medical director of the UltraWellness Center!
What he’d like you to know about is what he calls the “Five Pillars of Longevity”.
Now, here at 10almonds, we often talk about certain things that science finds to be good for almost any health condition, and have made a habit of referencing what we call “The Usual Five Things™” (not really a trademark, by the way—just a figure of speech), which are:
- Have a good diet
- Get good exercise
- Get good sleep
- Reduce (or eliminate) alcohol consumption
- Don’t smoke
…and when we’re talking about a specific health consideration, we usually provide sources as to why each of them are particularly relevant, and pointers as to the what/how associated with them (ie what diet is good, how to get good sleep, etc).
Dr. Hyman’s “Five Pillars of Longevity” are based on observations from the world’s “Blue Zones”, the popular name for areas with an unusually high concentration of supercentenarians—Sardinia and Okinawa being famous examples, with a particular village in each being especially exemplary.
These Five Pillars of Longevity partially overlap with ours for three out of five, and they are:
- Good nutrition
- Optimized workouts
- Reduce stress
- Get quality sleep
- Find (and live) your purpose
We won’t argue against those! But what does he have to say, for each of them?
Good nutrition
Dr. Hyman advocates for a diet he calls “pegan”, which he considers to combine the paleo and vegan diets. Here at 10almonds, we generally advocate for the Mediterranean Diet because of the mountains of evidence for it, but his approach may be similar in some ways, since it looks to consume a majority plant diet, with some unprocessed meats/fish, limited dairy, and no grains.
By the science, honestly, we stand by the Mediterranean (which includes whole grains), but if for example your body may have issues of some kind with grains, his approach may be a worthy consideration.
Optimized workouts
For Dr. Hyman, this means getting in three kinds of exercise regularly:
- Aerobic/cardio, to look after your heart health
- Resistance training (e.g. weights or bodyweight strength-training) to look after your skeletal and muscular health
- Yoga or similar suppleness training, to look after your joint health
Can’t argue with that, and it can be all too easy to fall into the trap of thinking “I’m healthy because I do x” while forgetting y and/or z! Thus, a three-pronged approach definitely has its merits.
Reduce stress
Acute stress (say, a cold shower) is can confer some health benefits, but chronic stress is ruinous to our health and it ages us. So, reducing this is critical. Dr. Hyman advocates for the practice of mindfulness and meditation, as well as journaling.
Get quality sleep
Quality here, not just quantity. As well as the usual “sleep hygiene” advices, he has some more unorthodox methods, such as the use of binaural beats to increase theta-wave activity in the brain (and thus induce more restful sleep), and the practice of turning off Wi-Fi, on the grounds that Wi-Fi signals interfere with our sleep.
We were curious about these recommendations, so we checked out what the science had to say! Here’s what we found:
- Minimal Effects of Binaural Auditory Beats for Subclinical Insomnia: A Randomized Double-Blind Controlled Study
- Spending the night next to a router – Results from the first human experimental study investigating the impact of Wi-Fi exposure on sleep
In short: probably not too much to worry about in those regards. On the other hand, worrying less, unlike those two things, is a well-established way improve sleep!
(Surprised we disagreed with our featured expert on a piece of advice? Please know: you can always rely on us to stand by what the science says; we pride ourselves on being as reliable as possible!)
Find (and live!) your purpose
This one’s an ikigai thing, to borrow a word from Japanese, or finding one’s raison d’être, as we say in English using French, because English is like that. It’s about having purpose.
Dr. Hyman’s advice here is consistent with what many write on the subject, and it’d be an interesting to have more science on, but meanwhile, it definitely seems consistent with commonalities in the Blue Zone longevity hotspots, where people foster community, have a sense of belonging, know what they are doing for others and keep doing it because they want to, and trying to make the world—or even just their little part of it—better for those who will follow.
Being bitter, resentful, and self-absorbed is not, it seems a path to longevity. But a life of purpose, or even just random acts of kindness, may well be.
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Elon Musk says ‘disc replacement’ worked for him. But evidence this surgery helps chronic pain is lacking
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Last week in a post on X, owner of the platform Elon Musk recommended people look into disc replacement if they’re experiencing severe neck or back pain.
According to a biography of the billionaire, he’s had chronic back and neck pain since he tried to “judo throw” a 350-pound sumo wrestler in 2013 at a Japanese-themed party for his 42nd birthday, and blew out a disc at the base of his neck.
In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.
Musk’s original post has so far had more than 50 million views and generated controversy. So what is disc replacement surgery and what does the evidence tells us about its benefits and harms?
What’s involved in a disc replacement?
Disc replacement is a type of surgery in which one or more spinal discs (a cushion between the spine bones, also known as vertebrae) are removed and replaced with an artificial disc to retain movement between the vertebrae. Artificial discs are made of metal or a combination of metal and plastic.
Disc replacement may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.
Disc replacement is major surgery. It requires general anaesthesia and the operation usually takes 2–4 hours. Most people stay in hospital for 2–7 days. After surgery patients can walk but need to avoid things like strenuous exercise and driving for 3–6 weeks. People may be required to wear a neck collar (following neck surgery) or a back brace (following back surgery) for about 6 weeks.
Costs vary depending on whether you have surgery in the public or private health system, if you have private health insurance, and your level of coverage if you do. In Australia, even if you have health insurance, a disc replacement surgery may leave you more than A$12,000 out of pocket.
Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion) but its use is increasing.
In New South Wales for example, rates of privately-funded disc replacement increased six-fold from 6.2 per million people in 2010–11 to 38.4 per million in 2019–20.
What are the benefits and harms?
People considering surgery will typically weigh that option against not having surgery. But there has been very little research comparing disc replacement surgery with non-surgical treatments.
Clinical trials are the best way to determine if a treatment is effective. You first want to show that a new treatment is better than doing nothing before you start comparisons with other treatments. For surgical procedures, the next step might be to compare the procedure to non-surgical alternatives.
Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain. As a result, there’s a great deal of uncertainty about the treatment.
There are no clinical trials we know of investigating whether disc replacement is effective for neck pain compared to nothing or compared to non-surgical treatments.
For low back pain, the only clinical trial that has been conducted to our knowledge comparing disc replacement to a non-surgical alternative found disc replacement surgery was slightly more effective than an intensive rehabilitation program after two years and eight years.
Many people experience chronic pain. Yan Krukau/Pexels Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.
In the clinical trial mentioned above, 26 of the 77 surgical patients had a complication within two years of follow up, including one person who underwent revision surgery that damaged an artery leading to a leg needing to be amputated. Revision surgery means a re-do to the primary surgery if something needs fixing.
Are there effective alternatives?
The first thing to consider is whether you need surgery. Seeking a second opinion may help you feel more informed about your options.
Many surgeons see disc replacement as an alternative to spinal fusion, and this choice is often presented to patients. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement to spinal fusion. These studies show people with neck pain may recover and return to work faster after disc replacement compared to spinal fusion and that people with back pain may get slightly better pain relief with disc replacement than with spinal fusion.
However, spinal fusion is similarly not well supported by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm.
Fortunately for patients, there are new, non-surgical treatments for neck and back pain that evidence is showing are effective – and are far cheaper than surgery. These include treatments that address both physical and psychological factors that contribute to a person’s pain, such as cognitive functional therapy.
While Musk reported a good immediate outcome with disc replacement surgery, given the evidence – or lack thereof – we advise caution when considering this surgery. And if you’re presented with the choice between disc replacement and spinal fusion, you might want to consider a third alternative: not having surgery at all.
Giovanni E Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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