I had the back surgery, but I am still in pain, now what?
If you or a loved one had spine surgery hoping to alleviate or completely relieve your pain, but unfortunately immediately after or a few months after the surgery, the pain came back – a phenomenon known as failed back surgery syndrome (FBSS) – this can be a very frustrating experience for both patients and surgeons alike.
FBSS Risk Factors
Having failed back surgery doesn’t suggest that you or your surgeon have failed. Many factors that lead to FBSS are out of your control. There are multiple reasons and risk factors for that, to mention some:
- Creating too much space, or not enough space, around nerves
- Recurrent original diagnosis (e.g. recurrent disc herniation at the same site or at a nearby level)
- Adjacent segment disease(after spinal fusion where the level above and/or below the fusion level has increased stress and therefore can degenerate in an accelerated fashion)
- Epidural fibrosis (when nerve roots are trapped by scar tissue)
- Spinal infection
- Pseudoarthrosis (lack of fusion which results in loosening of the screws)
Some surgeries have a higher rate of failure, like fusion surgery for multi-level lumbar degenerative disc disease, with estimated failure rates ranging from 30% to 46%.
Learning your spine surgery did not produce the outcomes you expected can be extremely disappointing, but there are therapies that may help reduce your pain and restore your ability to function in everyday life. Establishing a relationship with a Pain Doctor is your first step to reaching that goal.
Multidisciplinary Approach to Address Pain
Your doctor may use a multidisciplinary approach to address your pain and limitation in function, this means that instead of relying on one treatment (e.g. medications or surgery), he or she may recommend a mix of therapies that comprehensively address different aspects of your pain. Your doctor may use one or more of the following therapies:
- refer you to a physical therapy and rehabilitation program.
- refer you to a behavioral health professional to address mental and emotional health.
- Your doctor may prescribe medications to help you manage your pain, this may include non-steroidal anti-inflammatory drugs, oral steroids, antidepressants, nerve-pain medications, and muscle relaxants.
- There are multiple interventional options that could be helpful, like Epidural Steroid Injection (ESI), Sacroiliac Joint (SI) injection or Radiofrequency Ablation (RFA).
- Luckily with the advancement in science, research, and technology; Neuromodulation is a very promising therapy to help treat failed back surgery syndrome. Your doctor may recommend Spinal Cord Stimulator (SCS) as a very effective therapy and long-term solution to your pain.