Most people experience back pain at some point in their lives, and many experiences debilitating chronic back pain throughout the year. Pinpointing the origin of that pain can be difficult, especially after surgical intervention. When a patient’s pain symptoms haven’t improved after a surgical intervention, doctors may diagnose them with “failed back surgery syndrome,” or FBSS. Sometimes, the treatment didn’t take – and in other cases, back pain surgeries can address one issue but lay bare another. However, don’t let that name fool you. There’s still hope for your condition, and depending on your circumstances, you may have multiple treatment options.
What Is Failed Back Surgery Syndrome (FBSS)?
FBSS refers to any back pain symptoms that linger after surgery and is a syndrome, not a condition, because it isn’t necessarily something a patient is diagnosed with. This does not always mean the surgery failed or that the back failed to recover from the surgery. Instead, it describes a collection of pain symptoms that can occur after surgery for various reasons.
Semantically speaking, FBSS only refers to a surgical intervention that set out to resolve the pain and was unable to do so. This means your symptoms may have another cause, a different cause, or multiple causes. The original ailment may have been addressed in some cases but can be recurring, such as a slipped disc or spine fracture. Remember, other surgeries can “fail,” as well. Only FBSS receives its official nomenclature.
It’s essential to recognize that while the ultimate goal of treating back pain is to address and eliminate a patient’s pain, most spine surgeries do not set out to do so. Doctors use nerve blocks, local anesthetic injections, and pain pumps to interfere directly with how the body sends pain signals back to the brain. Spine surgeries, on the other hand, usually set out to either:
- Clear the area around a compressed nerve by removing bone tissue, lesions/tumors, and inflamed disc tissue.
- Stabilize a vertebra in critical condition, such as an unstable fractured joint, usually through spinal fusion.
Most spine surgeries do not directly address the pain issue but attempt to relieve it by addressing the core issue. If your back pain is mainly neurological, a laminectomy, discectomy, or spinal fusion might not help reduce your pain in the long term.
Recognizing FBSS
You may be experiencing FBSS if your pain hasn’t resolved in the weeks after recovering from spine surgery. Depending on the nature of your surgery, it could be normal to feel pain for some time during the recovery process. But if your pain worsens, hasn’t changed, or reappears differently after your surgery, you will want to contact your doctor. It can be challenging to diagnose FSBB without the specifics of your condition.
It’s usually a good idea to call and ask your doctor what red flags to keep an eye out for. They will be able to help you pinpoint symptoms that indicate poor recovery or ongoing pain and separate them from symptoms that are normal during the recovery process. Keep a list of symptoms at hand that warrant an emergency call. Surgeries can suffer from complications and post-surgical pain from scarring or bleeding.
Surgery and Recovery
Depending on your surgery and recovery process, recovery can last anywhere from three to six months. In general, you will want to look out for:
- Pain that is worsening rapidly.
- Recurring pain after reducing in severity.
- Suddenly reduced mobility, especially more than a month or two after surgery.
- New symptoms that weren’t previously associated with your condition.
Some surgical interventions are more statistically successful than others. Your doctor and surgeon can inform you expressly about your chances of re-experiencing or continued pain after surgery based on similar cases. For example, surgical intervention will usually result in long-term pain reduction if you are experiencing leg pain and numbness due to a lumbar disc herniation – a swollen disc pressing on the nerve that runs through your hips and leg. But if your main complaint is lower back pain, surgery will less likely eliminate your pain.
Spinal fusion may resolve instability in one spinal joint, but just one surgery may not fix disc degeneration along multiple joints in your lower back. Most doctors recommend surgery only as a last resort or in situations where success is statistically likely. In cases where surgery usually ends up “failing” to address pain, your doctor is more likely to recommend a treatment plan that involves patient- and condition-specific pain management, from psychotherapy to pain pumps, physical rehab, recurring nerve blocks, and more.
FBSS Treatment Options
If you received surgical back treatment and did not resolve your pain, you may still have multiple treatment options on the table. Your doctor may refer you to a pain clinic specializing in back pain patients. Pain clinics employ physicians and medical professionals from multiple backgrounds to form a team with an exhaustive list of pain management experiences. Their specialties include neurology, osteology, oncology, physiotherapy, and anesthesiology. In addition to long-term pain management, your doctor will continue to observe and assess your condition based on multiple factors, such as:
- Symptoms are new or recurring.
- You have had mostly leg or back pain.
- Problems are systematic or localized.
- Other signs of neurological pain or inflammation.
- Comparing post-operative complaints to pre-operative complaints.
- Applying physical and imaging tests to further narrow down potential causes of continuing pain.
Your treatment plan will depend on individual needs and recommendations but may include:
- Personalized physical therapy and rehab.
- At-home exercises and posture-related recommendations.
- Vocational training.
- Medication (for pain, autoimmune conditions, and other related problems).
- Pain pump.
- Nerve blocks.
- Spinal cord stimulation.
- Psychotherapy (talk therapy for pain).
- And more.
Finding out that your back surgery has potentially failed is frustrating. Surgical interventions cost a lot of time, money, and energy, and we always hope for the best outcome. However, just because your pain has returned or changed doesn’t mean all hope is lost. There are always other methods and treatments to try. Talk to your doctor or a pain specialist to determine your next steps in treating your back pain.
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