What Is Failed Back Surgery Syndrome and What Are My Treatment Options?
If you have been suffering from back pain and have tried more conservative treatments without relief, then you may have decided to opt for a back surgery like a spinal fusion, laminectomy, or discectomy. Many patients find their pain much improved following such a procedure, but many other patients do not obtain symptom relief.
For those patients who continue to suffer from back pain following surgery, their condition is labeled as failed back surgery syndrome. One study found that almost 50 percent of people who undergo a spinal procedure will continue to experience back pain; the success rate falls to 30 percent, then 15 percent and finally 5 percent for each subsequent back surgery.
Why Do Back Surgeries Fail So Often?
It is estimated that as many as 80,000 people in the U.S. annually undergo a back procedure but find no pain relief. There are many reasons why this is such a common outcome with most related to the complexity and sensitivity of this part of our bodies.
Among the most common reasons for failed back surgery syndrome include complications related to the procedure. In many cases, the spinal fusion procedure proceeded just as intended which resulted in pain relief—for a period of time. However, losing a joint in your spine puts additional strain on other areas that will begin to start hurting.
In addition to this kind of complication are those that are related to any kind of invasive surgery. These include infection, nerve damage or scar tissue formation. If any of these complications were to arise in sensitive areas like the spinal cord, it could develop into a serious pain condition.
Another thing to consider is that you should understand what to expect following the procedure. For example, if you go in for a spinal fusion, then you should know that there is a high risk of adjacent segment disease which is accelerated degradation of other spinal bones and tissue due to the altered shape of the spine.
You should have an honest discussion with your surgeon beforehand so that your expectations align with reality. If your physician warns you that there is a higher risk of poor outcome, then you should be prepared for disappointment. You should only opt for surgery when the goals are clearly understood and there is a high likelihood of success.
A quite common reason for failed back surgery syndrome is that the problem may be misdiagnosed. The spine is an intricate and very compacted structure so that it can be difficult to identify the exact cause of a back pain issue. Needless to say, if the wrong issue is targeted or the wrong surgery applied, then the likelihood of a successful outcome is negligible.
Some back surgeries fail because the scope of the health issue is too great. For example, if too many of the bones of the spine have suffered compression fractures, then a single surgical procedure may not be sufficient to correct the problem.
Finally, it is important to consider the skill of the surgeon. Perhaps, the surgeon was incapable of successfully performing the procedure due to error or inexperience. If that is the case, then finding another surgeon to perform the surgery may produce a better outcome.
Treatment Options after Failed Back Surgery
Unfortunately, the number of lumbar spinal surgeries being performed is only going to increase in the United States as the population ages. This also means that there will be a growing number of failed back surgery syndrome sufferers seeking remedies for their pain condition. One study published in the Journal of Orthopaedic Surgery and Research found that one in five people who undergo a spinal surgery will experience ongoing back pain within two years.
Although new treatments are being researched all the time, it is unlikely that a “miracle” cure for back pain will be available anytime soon. Therapies like stem cells have been touted as potentially revolutionary therapies, but most of these are less promising than originally thought or are still very early in development.
For most failed back surgery syndrome sufferers, an interventional pain management approach that utilizes a broad range of therapies from multiple medical disciplines is most likely to produce an improvement in pain symptoms. These therapies include
- OTC medications—over-the-counter medications like aspirin or Tylenol can bring down the swelling of inflamed tissue and provide powerful pain relief if used appropriately. Ask your doctor if OTC drugs are okay for you and how best to use them.
- Prescription pain relievers—opioid pain killers or muscle relaxants may be appropriate for some failed back surgery syndrome sufferers, but it is very important to use them as directed to avoid health issues like dependency, coma, or death.
- Physical therapy—various exercises can help strengthen your back and core which can reduce the strain on your back. A physical therapist may also provide some ways to keep your spine properly aligned and increase flexibility.
- Hot and cold applications—if you apply heat and ice, you can soothe the pain symptoms while relaxing stiff muscles and promoting blood flow to injured areas. You should only apply ice packs or heat for 20 minutes at a time to avoid tissue damage.
- Neurostimulation– spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are techniques that requires electrical leads be placed beneath the skin. The leads are powered a small pulse generator that produces mild electrical currents. These mild currents interfere with pain signals, diminishing pain symptoms by up to 80 percent.
- Cognitive behavioral therapy—while it may initially sound absurd to treat back pain with psychotherapy, studies show that CBT has very good efficacy in managing pain symptoms. This kind of therapy helps you reduce stress and depression which can often worsen pain intensity.
- Nerve blocks—if your pain is related to inflammation of tissue pressing on a nerve, your doctor may inject the anti-inflammatory compound corticosteroid near the spine. This should ease the pressure on the nerve and reduce pain symptoms for a short period of time.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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