Explore the relationship between back surgery and pain management as it relates to failed back surgery syndrome. Read about tips for home-based post-surgical pain management for back pain after surgery.
There are many different reasons a doctor might recommend surgery for a patient with back pain, but it’s rare for the back pain itself to be one of the main reasons. While it sounds paradoxical, it’s important for patients to know that post-surgical pain is normal, especially in recovery and that a surgery is not always going to help reduce or moderate back pain on its own.
Should You Be Concerned About Post-Surgical Pain?
Pain after surgery is normal – especially in the first few weeks. Back surgery can be invasive, and while advancements in medicine have greatly reduced the trauma of a laminectomy or a spinal fusion procedure, it still takes time for the swelling to go down, and for the wounds to heal. It takes an average of six weeks for the body to recover from back surgery, but that number depends on your procedure, your age and fitness, and the quality of your recovery.
Once the initial recovery is over, post-operative pain can still be an issue. Not all back surgeries are meant to address pain but can be a necessary step towards preserving spinal health and function. For example, if your surgery was necessitated by worsening spinal stenosis, then removing the encroaching tissue around the nerve roots may prevent worse pain, as well as disability – but it may not have fully addressed every factor surrounding a patient’s pain.
Pain is complicated, and pain management requires a multifaceted approach to reflect that complexity. Surgery, when necessary, plays an important role in a patient’s spinal health, but it’s just as important to continue to explore pain management in the weeks and months after the operation.
Can Back Surgery Fail?
Failed back surgery syndrome is the name for when a patient did not experience pain relief after surgery. But that does not necessarily mean the surgery failed to achieve its intended outcome.
A laminectomy removes the portion of bone that is restricting a nerve during spinal stenosis. Spinal fusion sets out to stabilize the spine and prevent spinal deformation, or worse pain. These procedures do not always result in complete painlessness – a doctor, sadly, cannot cut out a patient’s pain.
But these procedures can still fail. A laminectomy can address a nerve impingement but may damage the nerve. A spinal fusion may heal improperly, or fail to set.
It’s important to continue to schedule follow-up appointments with your doctor for at least a few months after your procedure to ensure that everything is healing as it should.
Pain itself, however, is not necessarily a sign that things went wrong on the operating table. If you continue to feel pain after post-surgical recovery, talk to your doctor about other pain management methods, including ones you’ve already tried before the surgery.
Home-Based Pain Management for Back Pain After Surgery
Depending on the outcome of your treatment, your doctor may recommend or refer you to a number of pain specialists for post-surgical pain management.
If your doctor is concerned about your diet or weight, they may recommend the services of a dietician or rheumatologist specializing in diet, pain management, and rheumatic medication, especially for conditions such as arthritis, gout, lupus, and other auto-immune conditions.
Physical therapy is another common element of post-surgical recovery, helping the body rebuild vital musculature and reduce the potential for recurring pain.
Neurologists and psychiatrists can also play a role in the management of physical pain signals through nerve blocks or pain pumps or utilizing talk therapy to address post-surgical depression.
But aside from professional help, there may be several things you can do to help manage your post-surgical pain at home, speed up recovery, and help reduce the chance of recurring pain after surgery.
Over-the-counter medication: it doesn’t have the kick of a morphine drip, but it often does not need to. NSAIDs and paracetamol (acetaminophen) can help reduce your pain in the days and weeks after surgery. Be sure to follow your doctor’s dosage recommendations, or the advice of a pharmacist – overuse of these medications rarely leads to toxic effects but can have a long-term impact on the heart and liver.
Ice for swelling, heat for comfort: current evidence suggests that cold therapy can slow the healing process, but when your pain is significant, a little ice can go a long way, especially on an incision site. Be sure not to keep your skin in direct contact with the cold, whether it’s through an ice pack or a bag of peas – always wrap it in clean cloth, first, to minimize the risk of tissue damage. If you are experiencing muscle pain or aching after your surgery, then a hot compress can offer some comfort as well.
Light movement: once you feel ready to get back on your feet, try to stay on your feet a little longer each day. Bed rest is important, but there is a point of diminishing returns. Physical movement, especially walking, is not just important for rebuilding your strength but for reducing your pain perception.
The Role of the Mind in Pain
Adjusting your expectations can also help alter pain. We know that simply expecting pain in the recovery process can help positively reshape our perception of pain after a surgery.
Patients who don’t expect pain or expect to have their pain resolved immediately after a back surgery may feel nervous when they don’t feel much better, or when the discomfort returns to some degree. On the other hand, expecting too much pain can actually increase the odds of a patient experiencing more lingering pain.
Depression and a low mood are conducive to stronger, worse pain. It’s not like being sad makes the injury worse – but it does affect your perception of it, bringing pain into the foreground and amplifying it. The inverse is true, too. A better mood leads to lower pain. Try to manage your stress levels – take a longer break from work, if you need to – and invest time in doing things that make you happy.
Healthy, realistic expectations are important. There will be some discomfort while recovering from surgery, and many procedures cannot guarantee an elimination of pain symptoms. But spine surgeries are often a necessary step towards addressing a critical spinal issue, or improving a long-term prognosis.
The Truth About Back Pain After Surgery
Surgery might not always help to reduce or eliminate your back pain, but it can be vital for avoiding or addressing spinal fractures, stenosis, and a host of other conditions. In many cases, when surgery becomes medically necessary or advisable, it can help alleviate the causes of some back pain. If the causes of your pain are progressive, surgery can slow the disease but not reverse it.
But in other cases, the back pain may come back due to unresolved factors, a recurring injury, lack of vocational or behavioral modification, and even factors outside of our control, such as an unforeseen condition or genetic trait.
Back surgery cannot promise to leave you pain-free, but as a compromise, a doctor wouldn’t recommend surgery if conservative options were still on the table, and the better choice. After surgery, the road to recovery is individually specific, and the outcomes are never guaranteed.
But that doesn’t mean you’re doomed to feel pain. Post-surgical pain management, whether at home, through referred experts, or as a result of a second or third opinion, can take on countless different shapes and forms. What’s important is finding the approach that works best for you.
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