Treatment for Failed Back Surgery Syndrome: When the Pain Doesn’t Go Away
By Dr. Asim Aijaz
If you’re one of the many post-op back surgery patients who continue to feel persistent pain and still experience limitation, then know this:
You are not alone, and your symptoms are not uncommon.
Many patients like yourself, suffer from “Failed Back Surgery Syndrome” (FBSS).
FBSS is a condition characterized by chronic pain following back or neck surgery. Common symptoms include:
- Diffuse, dull, aching pain involving your back, lower legs, neck, or arms.
- Sharp, stinging pain as well as pins and needles sensations.
- Painful numbness or increased sensitivity.
Several factors can cause this persistent pain, including residual or recurrent disc herniation, persistent pressure on a spinal nerve, altered joint mobility or instability, scar tissue, and even muscle deconditioning.
Failed back surgery syndrome doesn’t necessarily mean that there was a technical problem with the surgery, nor that the surgery was a failure.
If you’re suffering from FBSS, we know that you may feel as though you’re out of options. But let us assure you that there are therapies available to help you find relief from FBSS, and we’re here to help you find the one that suits your unique needs.
Physical Therapy with Minimal Injection Therapy
For FBSS, it’s always best practice to consider the most conservative treatment first. At Pain Clinic, we often recommend physical therapy (PT) to work on strengthening and conditioning the muscles that support the spine. Exercise gives the spine greater support and flexibility to help pain and prevent further injury.
The medical community mostly believes physical therapy and exercise are a strong component of any failed back surgery syndrome treatment plan. More research is needed to understand how effective PT is in treating back and neck pain after spine surgery.
Related: The Benefits of Physical Therapy
However, if you are unable to make significant progress with physical therapy secondary to the pain (either associated with PT or pain worsening with PT), then you have the choice to add minimally invasive injection therapies to help alleviate your pain while continuing your physical therapy program. Overall, patients that utilize both treatments together tend to do better than ones that don’t.
Epidurals, Nerve Blocks, and Ablations
Minimally invasive injection therapy utilizes epidural steroid injections or facet joint injections. Also, you can receive trigger point injections for tight muscle spasms around your spine.
All injections are done with X-ray guidance to insert tiny needles that inject steroids around target structures that commonly become inflamed and cause chronic pain after spinal surgery. The steroid medications help to reduce inflammation in the spinal column and nerve roots which typically results from:
- Stenosis or narrowing of the spinal column and canals
- Disc herniation or bulging
- Scar tissue around the spinal column or nerve roots
Joint injections and nerve blocks typically target the facet joints (the small joints along the back of the spine), and the sacroiliac joints (the joints at the bottom on the spine on either side of the sacrum) since these are the most common sites of inflammation and pain following spine surgery.
If you experience relief with injections, but it’s not long-lasting, then you may be a good candidate for a nerve ablation. During an ablation procedure, a needle is advanced to a sensory nerve, and the tip of the needle is heated to disrupt the nerve as it enters the joint. It is a very safe procedure which may be completed in 10-15 minutes.
The treatment typically offers lasting relief from six months to two years. However, nerves do grow back, and when they grow back, the pain may come back. In those cases, you repeat the ablation procedure.
Over the years, research shows that injection and ablation treatments are both effective therapies for patients with FBSS, especially if combined with a physical therapy program to strengthen the spine.
Spinal Cord Stimulation
If injections and ablations do not provide enough relief, the next step in treatment would be spinal cord stimulation (SCS). Spinal stimulators are small devices with wires that are implanted in the painful parts of the spine. A small pacemaker-like battery delivers tiny electrical signals to the spinal nerves, which disrupts pain signals, helps control your pain, and normalize sensations.
The technology has been around for decades but has tremendously improved over the years. More and more patients are finding permanent and long-lasting relief from these fantastic devices. They are improving their activity and exercise levels, reducing or eliminating their need for medication, and getting better sleep.
One of the best things about spinal cord stimulation is you get to test drive the technology before deciding if you want to proceed with the implant. It’s also completely an outpatient procedure.
During the first trial phase, a doctor inserts two small wires into your epidural space with needles, not an incision! You are sent home with the leads to see if you notice any pain relief and functional improvement with the device.
If you find that the trial was helpful, then you move forward with the implant, which involves implanting the wires with a small electrical pulse generator in your lower back. You’re given a small handheld wireless device with several specific pre-programmed cycles specific to what you feel works best for you.
Again, both phases are outpatient procedures!
Currently, there is a lot of evidence and numerous research studies that support SCS as a viable treatment option for FBSS. In fact, it’s generally preferred compared to repeat spine surgery or chronic medication management.
With more than ten years of practice, I’ve been very encouraged with the progress I’ve seen patients make after receiving an SCS implant and continue to recommend them to patients if they are good candidates. Even our practice’s founder, Dr. Malone, has one for treating his FBSS, and he is very physically active thanks to the device.
Intrathecal Drug Delivery System
If none of the above treatment options are successful, then you could consider an intrathecal drug delivery system, also called a pain pump.
Similar to the SCS, the treatment has two phases with a trial and implant. In the trial phase, a doctor injects medication into your intrathecal space (the space where your spinal cord floats) to see if it offers you pain relief. If you pass the trial, then your doctors will authorize the implant of the intrathecal drug delivery system.
The system has a small catheter that goes into your intrathecal space to deliver low doses of pain medication directly into the fluid that surrounds your spinal cord and brain. The system has a small catheter that goes into your intrathecal space to deliver low doses of pain medication directly into the fluid that surrounds your spinal cord and brain. The system offers relief with fewer side effects compared to taking oral pain medications.
This treatment has been around for years, with significant evidence that supports its effectiveness. In addition, the technology is always improving, and the literature available is expanding. There are different medications that you can utilize for this treatment.
Spinal surgery is intense, invasive, and expensive.
So we understand how frustrating it is to find the risk was not worth the investment when your pain persists or becomes even worse after your procedure.
We also understand that undergoing more treatment for a failed surgery—one that was supposed to improve your quality of life—most likely makes you overwhelmed and disheartened.
That’s why we emphasize that a failed surgery does not mean it’s the end. There are accessible and very minimally invasive therapies available to you that are proven to work.
Our mission is to help you realize that yes, sometimes the pain is inevitable.
But your suffering is optional.
There are solutions for your FBSS, and since the technology is rapidly expanding and improving, you can find the success you couldn’t achieve with surgery.
Plus, at Advanced Pain Care, you have our entire team of pain management specialists in your corner, dedicated to finding a personalized plan of care to beat your FBSS for good.
We mean it when we say we are your biggest advocates. We’re serious about finding you relief.
You deserve to live a life of freedom, health, and happiness—unlimited by the restraints of chronic pain.
If you have questions, our live chat is available 24/7. We’re available any time to answer your questions or help you book an appointment with a pain management specialist.