Back Pain is a widespread public health problem, which affects around 80% of Americans at some point of time in their lives. Each year, an estimated one out of every 14 people will seek some sort of medical care for their back or neck pain, which amounts to 14 million visits on an annual basis. The estimated annual costs for both direct and indirect treatment range from $20 billion to $60 billion. Back and/or neck pain is cited as the second most common reason for physician visits. Most back pain is acute or sub acute,
with 90% of patients recovering within three to four months. However, other estimates suggest less than 30% of patients are completely improved within 3 months of treatment, according to a report to the Clinical Standards Advisory Group of the Department of Health.
Failed Back Surgery Syndrome
Failed back surgery syndrome is a condition present in patients which is characterized by persistent pain after undergoing back surgeries. Multiple factors are responsible for the onset or development of failed back surgery syndrome. One very important factor is smoking. Recent studies in Denmark have shown back surgeries performed on smokers to be highly likely to fail, particularly if the surgeries are performed with the goal of reducing pain in the back.
Failed Back Surgery Syndrome can only occur in two ways – when the initial surgery performed was the incorrect choice for the patient’s needs, meaning it would not fix the underlying issue, or when the surgery was performed that was incomplete or inadequate.
CT scans have made the identification of the underlying cause for failed back surgery syndrome much easier and more specific. Persistent disc herniation, spinal stenosis, infection, post-operative fibrosis, adhesive arachnoiditis and injury to nerves have been shown to be the mechanisms most likely to be involved in failed surgeries.
Treatment of FBSS
Pain Doctors take an interdisciplinary approach is assumed to be appropriate for the treatment of patients suffering from FBSS. As with the majority of other kind of chronic pain conditions, conservative treatments should always be tried first. Such conservative management techniques include physical therapy, psychiatric treatment, medication, and non-invasive options.
If conservative therapy is not deemed to be effective, the patient should then be selected for some mildly invasive procedures, such as injections. If these injections are inadequate and pain is unmanageable, neuroablative and neuroaugmentative pain procedures may then be used.
For many patients with severe FBSS, some form of electrical simulation is used by pain doctors. This can be done through either a transcutaneous electrical nerve stimulation device placed on skin over the back or by implanting a nerve stimulator into the back which directly touches the spinal cord. Success rates for implanted neurostimulation have been reported to be 25% to 55%.
For some patients, treatment of FBSS involves conducting more surgery. Franklin et al., in ‘Outcome of Lumbar Fusion in Washington State Worker’s Compensation’ mentioned that 23% of patients who had lumbar fusion surgery also had an additional surgery within a period of 2 years.
Also Read: 7 Ways To Avoid Lower Back Pain