Failed back surgery: New hope for patients living in pain
Severe lower back pain is one of the most common ailments reported by adults in the U.S. According to a survey by the Centers for Disease Control and Prevention, more than 25 percent of respondents reported experiencing back pain in the prior three months.
Many patients suffering from chronic back pain turn to surgery for relief. Unfortunately, surgical options are often not effective at eliminating back pain. In fact, some medical professionals use the term “failed back surgery syndrome” to describe patients who still suffer from severe pain after back surgery.
A study done in Ohio tracked 1,450 patients who had to quit work because of severe lower back pain. Half sought relief through surgery. The researchers found, after two years, only 26 percent of the surgery patients returned to work, while 67 percent of those who did not have surgery were working again. The study also showed a 41 percent increase in the use of painkillers among the surgery group.
Describing these back surgeries as failed is not completely accurate. Often, the surgeon is successful in restoring structural stability, alignment or nerve decompression through procedures like spinal fusion, laminectomy or discectomy. The problem arises, however, when the level of pain after surgery exceeds the patient’s expectations and continues to limit the patient’s lifestyle or ability to work.
Because of the complex structure of the spine and its accompanying nerves, muscles and blood vessels, there are many reasons surgery could fail to provide relief from chronic back pain. They include issues like scar tissue development, surgical hardware failure and the wrong surgical site. There might even be pre-existing nerve damage that cannot be reversed, even when surgery produces successful structural repairs of the damaged area of the back.
Instead of attempting to treat chronic back pain through surgery, a better approach might be to handle chronic back pain similar to illnesses like diabetes or high blood pressure, where treatment focuses on managing symptoms, so patients can lead productive lives.
Here are examples of some pain management treatments available to help patients suffering from chronic back pain — either after or instead of surgery.
A variety of drugs can be used to treat back pain. These include NSAIDs (like ibuprofen and naproxen), muscle relaxers, neuropathic pain medications and opioid pain medications.
Corticosteroid injections into the epidural space can rapidly diminish pain around painful nerve roots and discs.
The sacroiliac joint often mimics back pain. A sacroiliac injection bathes the painful joint and nerves with a mixture of anti-inflammatory and anesthetic medications. This reduces inflammation in the joint and around nerve tissue. When the pain cycle is broken, your body’s healing mechanisms can become more effective.
Facet injection (medial branch block)
When pain originates in the moveable facet joints, a corticosteroid mixed with anesthetic is injected around the median branch nerve, which numbs the often painful capsule surrounding the facet joint. Reduction or elimination of pain is often rapid.
Using a fluoroscope (X-ray), a doctor inserts a special needle alongside the nerves transmitting pain. A small electric current is sent through the needle to help recreate the usual pain and cause a muscle twitch in the neck or back, helping the physician know if it is the correct spot. When the right location is pinpointed, radiofrequency waves create heat at the tip of the needle, and the resulting heat lesion disrupts the nerve’s ability to send pain signals.
Spinal cord stimulator
As a last resort treatment, an electrical generator with tiny electrode leads can be implanted into the epidural space over the affected area. This spinal cord stimulator tricks your nervous system into feeling a pleasant vibration sensation instead of pain.
For patients who have undergone back surgery and are still experiencing lower back pain, there is hope. An experienced pain management specialist can help create a treatment program that permits a return to a more normal lifestyle.
Dr. Alex Bigham is the owner and CEO of Novocur Pain Management Clinics and has over 18 years of healthcare experience in private practice and Ambulatory Surgical Center settings. Novocur offers advanced treatment options in a concierge type practice without the concierge price tag. Dr. Bigham appears frequently on local TV and radio programs to discuss the latest in Pain Management or related health topics.