What Decades of Treating Back Pain Patients Have Taught Me

Written By Professor Volodymyr Gongalsky, Meddiagnostica Medical Center, Kyiv, Ukraine

One of the most common questions I hear from patients is surprisingly simple:

“Doctor, do I need surgery?”

Most often, the question comes long before we have completed the examination, reviewed MRI scans, or discussed treatment options. Many people arrive convinced that a herniated disc automatically means an operation is inevitable.

After decades of treating patients with spinal disorders and chronic back pain, I can say that reality is usually more complex.

MRI Results Don’t Tell the Whole Story

Modern imaging technologies have dramatically improved our ability to diagnose spinal conditions. MRI scans can reveal disc herniations, degenerative changes, spinal stenosis, and many other abnormalities.

However, one lesson stands out from years of clinical practice: MRI findings do not always explain how a patient feels.

I have seen patients with large herniated discs who continued working and leading active lives with relatively minor discomfort. At the same time, some patients with much smaller disc protrusions experienced significant pain and limitations.

That is why treatment decisions should never be based solely on imaging results. The patient’s symptoms, neurological examination, medical history, and overall health are equally important.

Pain Does Not Always Mean Damage Is Getting Worse

Many people assume that persistent pain means their condition is rapidly deteriorating.

In reality, pain is far more complicated.

Inflammation, muscle tension, nerve irritation, stress, sleep quality, and lifestyle factors can all influence how pain is perceived. Two patients with similar diagnoses may experience very different levels of discomfort.

Understanding this helps patients avoid unnecessary anxiety and focus on recovery rather than fear.

Surgery Has an Important Role — But Not for Everyone

There is no question that surgery can be life-changing for some patients.

When significant neurological deficits develop, muscle weakness progresses, or bladder and bowel function becomes affected, surgical treatment may be necessary.

However, many patients are surprised to learn that conservative treatment remains the recommended first-line approach in a large number of cases.

Over the years, I have seen countless patients improve through a combination of rehabilitation, physical therapy, lifestyle modifications, pain management strategies, and carefully selected complementary treatments.

The goal is always the same: restore function, reduce pain, and help patients return to their normal lives.

Recovery Requires Patience

Perhaps the most difficult lesson for patients to accept is that recovery often takes time.

We live in a world that expects immediate results. Unfortunately, the spine does not always follow that timeline.

Patients who understand the recovery process and actively participate in their treatment plan often achieve better long-term outcomes than those searching for a quick fix.

Consistency matters more than speed.

Every Patient Is Different

One reason back pain remains challenging to treat is that no two patients are exactly alike.

A treatment strategy that works well for one person may not be appropriate for another. Age, occupation, activity level, previous injuries, general health, and individual goals all influence the treatment plan.

This is why personalized care remains essential.

At Meddiagnostica Medical Center, every patient undergoes a comprehensive evaluation before treatment recommendations are made. The objective is not simply to address MRI findings but to understand the individual behind them.

The Most Important Lesson

If there is one thing decades of clinical practice have taught me, it is this:

A diagnosis should never be viewed as a sentence.

Many patients arrive fearful after reading MRI reports or searching the internet for answers. Yet with an accurate diagnosis, an individualized treatment plan, and realistic expectations, a significant number of people can improve without surgery and regain their quality of life.

Medicine continues to evolve, but this principle remains unchanged: successful treatment begins with understanding the patient, not just the image on the screen.

About the Author

Professor Volodymyr Gongalsky is a neurologist and specialist in the conservative treatment of spinal disorders and chronic pain. He practices at Meddiagnostica Medical Center in Kyiv, Ukraine, where he helps patients with herniated discs, spinal stenosis, headaches, and other neurological conditions.