Pain after back surgeries
Learn more about common pain disorders, their development, and pain mechanisms.
Classification
Persistent, chronic pain after back surgeries is common, affecting up to 60-70% of patients, and can occur even after a carefully planned and surgically correctly performed back operation. These back pains are often accompanied by radiating pain in the limbs. Pain after back surgeries is referred to as PSPS Type 2 – Persistent Spinal Pain Syndrome, formerly known as Failed Back Surgery Syndrome (FBSS).
The number of back surgeries performed annually has been increasing significantly for many years. The reasons for this development are diverse and cannot be attributed solely to medical advancements.
With each additional back surgery, the likelihood of a pain-free life decreases. After one surgery, 60 to 90% of patients are pain-free or experience minimal discomfort. After the second back surgery, only 30% benefit, and after the fourth surgery, only 5% are pain-free.
Causes
A variety of factors can be responsible for an unfavorable outcome. Despite careful medical examination and the latest radiological methods (MRI), it is often difficult or even impossible to identify the anatomical cause of a back pain problem with certainty. Due to the high level of suffering of the affected patients, surgeries are sometimes performed even under these circumstances. This can result in not choosing the optimal spinal surgical strategy, leading to chronic back pain in the form of PSPS Type 2.
Treatment
The treatment of chronic pain after back surgeries is challenging and is best managed in an interdisciplinary setting.
Essential for successful treatment is the training of the back muscles. Well-trained back muscles relieve the spine and thus reduce pain. Additionally, medications are used, but they often provide only limited relief.
Thermoablation
Degenerative changes in the facet joints (connecting joints) often play a significant role in the pain development process. Especially after spinal fusion surgeries, known as spondylodesis, there is increased wear of the facet joints of the adjacent vertebrae, referred to as adjacent segment degeneration. In these cases, radiofrequency treatment is an important option. The goal of radiofrequency treatment is the thermal ablation of small nerves (medial branch nerves) that transmit pain signals from the facet joints to the brain. Successful thermal ablation of these medial branch nerves leads to improved pain control. Improved pain control enables more efficient training of the back muscles.
Spinal Neurostimulation
If conservative treatment measures and radiofrequency treatment of the medial branches (MB) fail, and if there is back-leg pain after surgery, spinal neuromodulation treatment, known as neuromodulation, can be considered. PSPS Type 2, neuropathic pain, and CRPS are three good indications for an SCS. A spinal cord stimulator delivers electrical impulses directly to the spinal cord, covering the pain signals. This influences/modulates the perception, processing, and transmission of pain at the spinal cord level.
