Do you or a loved one experience chronic pain, limited mobility, and decreased quality of life even after undergoing back surgery? If so, there may be a condition called Failed Back Surgery Syndrome (FBSS) at play. FBSS is a common complication for people who have undergone various types of spine surgery for various spinal disorders.
While this difficult-to-treat syndrome typically occurs after lumbar spine surgery, it can also occur in the cervical and thoracic regions as well. Read on as we analyze the causes, symptoms, diagnosis, and treatment approaches available for patients affected by FBSS to help clarify this frustrating condition.
Failed Back Surgery Syndrome
fWhat is Failed Back Surgery Syndrome?
Failed back surgery syndrome occurs when patients experience persistent pain after undergoing spinal surgery. This pain can range from mild to severe and can be located in the same area where the pre-existing pain was before the surgery or even in an entirely new area. It is estimated that between 7% and 27% of all spinal surgeries result in failed back surgery syndrome.
Symptoms of Failed Back Surgery Syndrome
The symptoms of FBSS can vary widely, depending on the severity and location of the pain. Commonly reported symptoms include:
- Persistent back or leg pain
- Limited mobility or difficulty walking
- Numbness in the feet or legs
- Problems with bladder or bowel control
What Causes FBSS?
Failed back surgery syndrome can occur due to a variety of reasons, including scar tissue formation around the surgical site, nerve damage caused by the surgery itself, or undiagnosed underlying conditions that were not addressed during the original operation. Whatever the cause may be, it is essential to know that there are treatment options available to help manage your symptoms and reduce your pain.
Diagnosing Failed Back Surgery Syndrome
To diagnose FBSS, your doctor will ask about the history of your back pain and take a physical examination to assess any spinal instability. They may also use imaging studies such as an x-ray, CAT scan, or MRI to get an idea of what is going on in the spine. Other tests, such as an electromyogram (EMG) or nerve conduction study, may be done to measure how well your nerves are working.
Treatment Options for Failed Back Surgery Syndrome
There are several treatment options available for those suffering from FBSS, including:
- Physical Therapy – Physical therapy is often recommended as one of the first steps in treating FBSS. It focuses on strengthening weak muscles, increasing flexibility, improving posture, and teaching proper body mechanics to help reduce pain levels over time.
- Medication – Your doctor may prescribe pain medications as part of your treatment plan for FBSS, including non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or opioid medications such as oxycodone or hydrocodone. Your doctor will determine which medication(s) best suits your individual needs.
- Psychological Therapy – Cognitive behavioral therapy (CBT) is beneficial in treating chronic pain conditions such as FBSS. CBT helps patients develop healthy coping skills to deal with their pain more effectively and learn how to better manage stress levels.
- Spinal Cord Stimulation – Spinal cord stimulation (SCS) involves using electrical signals delivered through implanted electrodes placed near nerves within the spinal cord that have been identified as being involved with the patient’s chronic pain condition. SCS works by blocking or decreasing nerve signals associated with pain from reaching the brain.
- Alternative Treatments: In addition to traditional treatments such as medications and physical therapy, alternative treatments may be useful in treating FBSS symptoms. These include acupuncture, chiropractic care, yoga/meditation techniques, biofeedback training (a technique used to teach the body how to control its responses), and hypnosis techniques (which may help patients learn how to better cope with their chronic pain). While these alternative treatments cannot completely cure FBSS, they may provide additional relief when combined with traditional treatments like medications or physical therapy.
Get the Help you Need!
Failed back surgery syndrome (FBSS) is a very real phenomenon that can happen to anyone who has had spine surgery. FBSS often leads to chronic pain and can be extremely difficult to manage. If you or someone you love is struggling with FBSS, know that help is available. At Progressive Pain Management, we specialize in treating patients with FBSS and other complex cases of chronic pain.
We offer a wide range of treatments, from medication management to interventional procedures, and our team will work with you to create a customized treatment plan that fits your needs. Please fill out the form below to contact us today to learn more about how we can help you find relief from your chronic pain.
Failed back surgery syndrome (FBSS) is the term for a patient’s continued pain after an unsuccessful back surgery. The patient is usually referred to a pain management specialist to treat pain.
The goal of spinal surgery is to decompress a nerve root or to stabilize a painful joint. FBSS occurs when surgery is unsuccessful or negatively affects a structure near the problem area.
Spinal surgery is complicated because it can be hard to diagnose the cause of the pain. X-Rays and MRIs limit what doctors can see because the pain often occurs when the patient is moving and active. Imaging only provides still images.
Failed Back Surgery Syndrome: Signs, Symptoms, and Treatment
Signs & Symptoms of FBSS
One common complaint physicians hear from patients is chronic back pain. However, not everyone experiences the same pain, and the type of pain they experience can vary, based on their spinal disorder, their previous procedure, or underlying cause of FBSS.
Other types of pain that can be associated with FBSS are:
- Nociceptive Pain – Localized pain that may be dull or sharp.
- Neuropathic Pain – Nerve-related pain is caused by nerve or spinal cord damage.
- Radicular Pain – Radicular pain radiates from one area to another
Other common symptoms of Failed Back Surgery Syndrome include:
- Return of original symptoms & pain – When the symptoms return that the original procedure was intended to correct, it may be a sign of FBSS.
- Reduced mobility – Recovering from back surgery is a process. However, if mobility is reduced or limitations arise that are different than predicted by your physician, it could be a sign of FBSS.
- New problems arise – While the surgery may correct the original symptoms, new pain in a different part of the spine should be discussed with your doctor.
- Onset of Headaches – If headaches were not a part of your medical history prior to having surgery, this may be a sign of nerve damage after a spinal procedure.
Diagnosing Failed Back Surgery Syndrome
The first step to diagnosing FBSS pain is to see a doctor for a physical exam. Motion, sensitivity, and strength help doctors decide the next steps to correctly diagnose the pain. Your medical history, pain levels, and previous treatments are discussed with your doctor to help them define the pain and decide on a treatment method.
Having tests like CT scans, MRIs, and X-Rays help doctors take an inside look at your pain. The images don’t always show the root cause of the pain, making FBSS hard to diagnose.
Since imaging is not always reliable, doctors may use another form of testing to diagnose your pain. This is called an aware state surgical examination. A doctor uses a small probe and stimulates the spinal cord, mimicking the pain, and triggering a response from the patient. This informs the doctor what type of pain the patient has and how it is caused.
Back pain patients are referred to pain management specialists who treat their pain and help improve their quality of life through short-term techniques.
Conservative Treatments for Failed Back Surgery Syndrome
There are many conservative treatments for FBSS.Besides the physical therapy and pharmacological therapy with over the counter or prescription medications, doctors use minimally invasive interventional modalities such as epidural steroid injections and injections of the lumbar facet joints or associated medial branches, with or without radiofrequency ablation rhizotomy (RFA).What makes these a consrvative first choice option is the minimally invasive nature of the procedures.These therapeutic interventions are designed to treat the pain and provide temporary symptomatic relief.
Neuromodulation in the Treatment of FBSS
In the treatment of Failed Back Surgery Syndrome, one of the most successful treatment options is Spinal Cord Stimulation. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS.
For patients with unrelenting back pain due to mechanical instability of the spine, degenerative disc disease, spinal injury, or deformity, spinal surgery is a well-accepted treatment option; however, even after surgical intervention, many patients continue to experience chronic back pain that can be notoriously difficult to treat. Clinical evidence suggests that for patients with FBSS, repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management.
SCS has been shown to be a safe and efficacious treatment for this patient population. Recent technological developments in SCS offer even greater pain relief to patients’ refractory to other treatment options, allowing patients to regain functionality and improve their quality of life with significant reductions in pain.
To learn more about FBSS and how the team at Progressive Pain Management can help treat your pain, fill out the form below.