To Your Good Health: Surgery is a last resort for chronic back pain | Columnists

I consider referring patients to a back surgeon when their pain is bad enough to…

To Your Good Health: Surgery is a last resort for chronic back pain | Columnists

I consider referring patients to a back surgeon when their pain is bad enough to affect daily activities and when they are unable to get relief or require large doses of opiates. The surgeon evaluates the anatomy and provides a opinion, but the ultimate choice is the patient’s.

Back surgery is usually effective, but sometimes fails to relive pain. In a few cases, it makes things much worse. Back surgery should never be entered into lightly. However, it does sound in your case that a consultation was appropriate. I would suggest you consider getting a second surgical opinion, as it seems you are also a little reluctant. If the second surgeon also recommends a fusion procedure, that would be stronger evidence that surgery may be beneficial. It is likely that the arthritis process may cause problems to recur years from now.

DEAR DR. ROACH: I give myself allergy shots with minimal reactions. My generic EpiPen expired in October 2019. When should I replace it? I wanted to buy a 1 milliliter ampule of epinephrine to draw up and inject in the event of need. Why did my pharmacy refuse to cooperate? — T.R.

ANSWER: Drug manufacturers are required to put an expiration date on their drugs, but more than 90% of drugs sold are still effective 15 years after their expiration dates. Epinephrine in particular is a very stable compound and will almost certainly be good. However, in the case of an allergic reaction, epinephrine is literally life-saving, and you’d like to be as sure as possible it’s going to work. In general, I recommend replacing drugs within a year of expiration.