CHRONIC PAIN AFTER BACK SURGERY

Chronic Pain After Back Surgery

If you are still experiencing back pain after enduring back surgery, you’re not alone. While the goal with any surgery is to fix a condition that is causing pain, there is a chance that patients might still experience Chronic Pain After Back Surgery. The team at Texas Pain Care in Missouri City, Sugar Land, and Houston areas knows how frustrating this can be, which is why they are proud to offer additional treatment methods with the goal to finally get their family of patients out of a life of pain.

What is Failed Back Surgical Syndrome or Chronic Pain After Back Surgery?

Surgery, regardless of which option you’re undergoing, can be dangerous. Recovering from surgery can also be a nuisance. While it’s expected to experience cramps, swelling or bleeding since the body is still recovering and healing, there is a point when the pain becomes too much. While time, patience and medications can help the recovery process, physical recovery is also a great solution.

It takes, on average, three to six months for post-operative healing, so it’s normal for patients to experience pain during this time. Tissues are healing, inflammation is decreasing, and nerves regain normal function. After all, you just endured surgery on a major part of your body that is used for every normal function, like walking, sitting and lying down. It’s important not to rush how your body heals, and to give it the time it needs. However, if you find that you are still experiencing pain, either the same, greater or different, than before surgery, it’s time to speak with a pain management specialist because you might be experiencing Failed Back Surgical Syndrome (FBSS), or Failed Back Syndrome (FBS).

FBBS occurs when a patient experiences a persistent pain or new pain after undergoing back surgery. Coping mechanisms, previous surgeries and a patient’s medical condition at the time of surgery can all be factors for experiencing FBBS. Because this condition is complex, it’s imperative to seek professional help from an expertly-trained doctor. A pain professional will work to determine the reason for the patient’s chronic back pain and utilize other pain management options with the goal to help the patient experience a pain-free life. If you are experiencing ongoing pain after back surgery, don’t wait before seeking help.

Why Does FBSS Happen?

As you can imagine, the spinal cord is an intricate system of vertebrae, discs, muscles and more. Due to the fact that the spine has many different levels, patients can experience a successful surgery at one level of the spine, but then continue to have wear and tear above and/or below. Even if the surgery is successful at the onset, there are cases when similar symptoms can recur months or years later.

The cause of FBSS is common with traditional open back surgery as well as spinal fusions. As the complexity of spinal surgery increases, so does the chance of FBSS. At Texas Pain Care, we always exhaust all possible conservation and non-surgical options before resorting to surgery to resolve the patient’s pain.

It’s important to note that if a patient experiences back or neck pain after surgery, this doesn’t mean the surgery failed. FBSS means that you and your surgeon’s expected and intended surgery outcome for pain reduction didn’t happen.

While there are several reasons FBSS might occur, some of the most common reasons include:

FBBS is a challenging problem for patients and doctors alike, as there is not always a clear cause of the pain. One of the main reasons why it’s challenging is because surgery performed on the spine changes the biomechanical movement of the spine. So while the surgery would have addressed the main issue of pain, the implants or fusions themselves can cause stress and imbalances with the muscles, nerves and joints in and around the spine. Unfortunately, this constant stress and imbalance can lead to chronic pain, even if the surgery was performed without any complications and had a favorable result.

HOW IS FBSS DIAGNOSED?

If you are dealing with chronic pain after back surgery, and don’t feel like the recommended healing and recovery methods are providing you with any relief, it’s time to talk with your doctor. He/she will review your medical history and perform a neurologic exam to determine if you might have FBSS. The purpose of the exam is to check for any movement restrictions in the neck and back, evaluate any feelings of weakness in the arms or legs, as well as texting reflexes. 

Additional diagnostic measures might include: 

X-ray: to determine that any surgical hardware is intact, as well as to evaluate spine alignment and bone structures

MRI: helpful for diagnosing most back problems and checking to see if there are any herniated discs or pinched nerves

CT Scan: to determine if bones fused well post-operatively

Discography: a procedure to evaluate the possibility of disc pain

EMG (Electromyography): to evaluate how nerves in and around the back are functioning

Diagnostic injections: epidurals and nerve blocks can help to determine the cause of back pain. These injections are performed by a pain specialist.

Your doctor and surgical specialist will utilize all possible diagnostic options so as to recommend the best treatment or therapy to help manage and hopefully eliminate your chronic pain. 

How Do I Know If I Have FBSS?

If you’re experiencing chronic pain after back surgery, there is reason to believe that FBSS might be the issue. While pain and discomfort are common after back surgery, especially if you underwent spinal fusion (because of the required physical therapy), a feeling of intense pain that won’t seem to go away could be a sign of something worse. If you experience any of the following symptoms of FBSS, it’s important to discuss your feelings of pain with your provider. 


There are a myriad of symptoms that can be associated with FBSS, and can include: 

There are also factors that can occur before surgery (pre-operative), during surgery (intraoperative), and after surgery (post-operative).

Pre-operative factors can include presence of mental and emotional disorders, obesity, smoking, chronic pain related to other medical health issues like fibromyalgia, or having back surgery performed when there are signs it might not improve pain levels. Intraoperative factors include inadequate decompression or excessive compression, so not enough space or too much space around spinal nerves/spinal cord, respectivel.

After surgery, the factors that can lead to FBSS include spinal infection, balance-related issues, spinal nerve root irritation, epidural fibrosis (when nerves are trapped by scar tissue from surgery), adjacent segment disease (where the level above a fusion has increased stress and can degenerate), balance issues relating to the spine that can cause degeneration, and more. 

The Texas Pain Care team understands that the decision to undergo back surgery in the first place shouldn’t be taken lightly. It’s usually decided upon because the pain being felt is strong and bothersome enough to have a surgical procedure. So when the pain isn’t resolved, it can be extremely frustrating mentally, physically and financially. It can even make the patient question whether or not the surgery was worth it in the first place, or if they’ll have to deal with pain for the rest of their life. We believe that shouldn’t be the case. No one deserves to deal with debilitating pain, and our pain care specialists will work to ensure pain is resolved and relief is felt. 

What is Neuropathic Pain?

There are times when surgery is successful, and post-operative MRIs, X-rays and CT Scans don’t show that anything is out of the ordinary. But, the patient still complains of pain. In cases like these, a provider might diagnose the patient with neuropathic pain (NP). This condition occurs when nerve fibers become overactive and send abnormal or inappropriate pain signals to the spinal cord and brain. There is no narrowing or constriction that squeezes spinal nerves. 

NP is unique in that patients experience extraordinary levels and duration of pain. This pain is often different from pain that is felt immediately after an injury occurs. It can reach unbearable levels and, if left untreated, can last for years. The pain itself is often described as a dull pain in the back, or it can even be a sharp/stabbing pain in the leg. 

There is a roughly 1/10 chance that NP can develop after back surgery. While it can sometimes arise without a direct cause, it can also occur from nerve issues resulting from trauma or nerves trapped in scar tissue from post-operative healing. Patients who experienced NP prior to surgery might still experience chronic pain after back surgery, even if the surgery was successful. The next options to alleviate the pain could include nerve blocks, spinal cord stimulators, antidepressant/anticonvulsant medications, or pain pump implants.  

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WHAT ARE FBSS TREATMENT OPTIONS?

What is the best treatment for failed back surgical syndrome? Unfortunately the answer is not straightforward. It depends on several factors that have to be diagnosed and addressed by your medical professional. But, it is possible to recover. 

Realizing that your surgery did not yield a completely pain-free outcome can be very disappointing. But don’t lose hope. There are therapies and treatments that the Texas Pain Care team can expertly utilize to help provide you relief from your chronic pain. Most often, your pain team will utilize a comprehensive care approach, opting for medications, non-invasive therapy options, and possibly additional surgical approaches. So by placing your care in the Texas Pain Care team’s hands, you’re on the first step to recovery, which includes a reduction of pain, improved mobility, and proper recuperation methods to correct the condition causing you pain. 

Epidural Steroid Injections

Epidural Steroid Injections are a common treatment for both mid-back pain and one-sided leg pain. The treatment method involves injecting a steroid into the epidural space (where the tissues and veins are located) of the spinal cord, with the purpose of pinpointing and treating the irritated nerves. The steroid will also spread to other parts of the spine, where it will reduce inflammation and irritation.

The role of the injection is typically to provide sufficient pain relief to relieve the patient of chronic FBSS pain. This pain management technique has been used for decades and is considered an integral part of the non-surgical management of FBSS pain.

Spinal cord stimulation

Nerve signals are being sent to the brain constantly. When nerves become damaged, whether due to trauma or other medical conditions, they send pain signals to the brain even if an injury is not occurring. 

Spinal cord stimulation (SCS) is a relatively new technology that has been proven to help manage chronic pain when the cause cannot be removed or the injury cannot be repaired. The technique uses an implanted electrical device under the skin and over the spinal cord, which confuses the spinal cord and pain processing centers in the brain. Painful signals are replaced by tingling electrical signals. A trial is first done to determine if this device will help long term, and if so, a permanent device is implanted. 

The device consists of a stimulating wire or “electrode” or connected to a control unit or “generator.” By placing a stimulating electrode over the spinal cord, the pain signal cannot be sent up from the spine to the brain. After a patient has been evaluated and non-surgical treatments have been used, spinal cord stimulation is considered to help manage chronic FBSS pain, with a goal to help the patient improve his/her quality of life and mobility. 

Oral Medications

In an effort to control the possibility and intensity of pain post surgery, your pain management specialist will recommend taking oral medications (as prescribed). Nonsteroidal anti-inflammatory (NSAIDs) drugs are over-the-counter medications that help to provide back pain relief by decreasing the inflammation in the nerve roots and spinal joints. Muscle relaxants can also help to reduce the frequency of muscle spasms, and anticonvulsants have proven to be helpful in decreasing pain for patients who are experiencing FBSS. 

Physical Therapy

Often used in conjunction with oral medications, physical therapy is recommended after surgery to help strengthen the muscles in the back that support the spine. Physical therapy can also help improve posture, which creates more space in the spinal canal. This ultimately leads to a reduction of pressure on the spinal nerves that could be causing the feeling of pain. 

Depending on the severity and duration of pain related to FBSS, most pain management specialists will suggest various non-surgical treatments. If these options prove to be ineffective at relieving pain, surgical options might be the next step. 

What Are Risks Associated with FBSS?

Patients are more likely to experience chronic back pain if:

They are chronic smokers. Smoking decreases the body’s ability to deliver oxygen to tissue, which can lead to poor surgical results and slower healing.

They have a progressive disease. While back surgery can remedy the one, intended cause of pain, there could be another cause that creates additional back pain.

There is a great formation of scar tissue. While the formation of scar tissue is normal after any surgery, the scar tissue in the back could interfere with blood flow (and subsequent oxygen flow) needed to heal. It could also tether a nerve, which would result in pain.

There is postoperative muscle tension. A common result of back surgery, tension in the back can be treated with therapy methods, and can go away pending therapy is begun as soon as the muscle pain is felt.

Hardware was installed in the back. Patients who had surgery wherein metal hardware was placed in the back can experience pain from the hardware rubbing on nearby muscles and ligaments.

Hardware becomes loose or breaks. Repeated and strenuous movement can cause stress on the fusion spot in the back, causing hardware to loosen and create instability at the surgical site. Another surgery would have to occur in the event that the hardware fractures in the body.

The patient has undergone previous back surgeries. Not only does the success rate of multiple back surgeries decrease with each surgery, but there is also an increased chance of NP and biomechanical changes to the natural spine.

Psychological and social factors are present. Patients who suffer from anxiety, depression and stress can affect the duration and intensity of pain experienced after surgery.

Prevention and At-Home Care

While pain might not be entirely preventable since it’s related to post-surgery development, there may be some at-home methods you can do to minimize the risks of FBSS. These ways include: 

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What’s Important to Understand About Chronic Pain After Back Surgery?

The main goal of a provider is to try and get a diagnosis, regardless of whether the pain is due to surgical factors or not. It’s important to figure out what the underlying cause of the pain could be, that way the treatment can best resolve the issue. 

The primary symptom of chronic pain is persistent pain that lasts weeks, months or even years. It can feel like aching, burning, shooting, squeezing, stiffness, stinging or throbbing. It’s also possible to have several different of causes of pain that overlap, which is what makes diagnosis so important. 

The pain specialists at Texas Pain Care have access to all the tools needed to get a specific diagnosis, including special imaging studies, knowledge of specific medical and health conditions, and more. The team also has the treatment capability to take care of every patient in pain, regardless of any condition or pain level. From minimally-invasive procedures to intense, complex surgery, we can handle it all. 

But none of this can happen without working together with the patient and learning about his/her pain level, where the pain is being felt, how long and when the pain occurs, and more. The personalized approach to pain management helps to ensure positive outcomes, and it’s what we’re most proud of as pain care specialists. 

Best Texas Doctor for Treating FBSS

If you’re dealing with chronic back pain that you believe to be Failed Back Surgical Syndrome or Failed Back Syndrome, don’t try and manage the pain alone. A doctor who specializes in FBSS or FBS can help to recommend treatment options that will help you get out of pain and get back your quality of life. 

At Texas Pain Care, our team of highly-trained pain management specialists offer back pain treatment options in the Sugarland, Houston and Missouri City areas. We work with our family of patients to approach their pain in a comprehensive manner with a goal to provide not only immediate pain relief but also in the most efficient and comfortable way possible. 

We understand that each patient’s pain case is different, and there is no “one size fits all” treatment method. Each patient’s case will be carefully reviewed before the provider works with the patient to put together a recommended treatment plan that is individual to each patient’s needs and goals. 

The team is proud to provide a complete range of safe and effective pain treatment options, always selecting minimally-invasive treatments before recommending surgical options. We know how frustrating it is to still have pain after back surgery, and are committed to helping minimize the occurrence of pain now and in the future. 

If you would like to know more about how the Texas Pain Care team can help manage your pain for Failed Back Surgical Syndrome, please reach out today. We are here to help you better manage your pain systems and get back to living your best pain-free life. 



 

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