In many cases there will be no effective treatment for failed back surgery syndrome as the damage to the spinal nerves occurred prior to the surgery and is untreatable. For other patients a regime of physical therapy, narcotic medications, other analgesics and NSAIDs, epidural steroid injections, and further surgery may be recommended. Patients may also make use of pain relief devices such as the TENS unit (transcutaneous electrical nerve stimulation) which blocks pain signals to some degree and both antidepressants and psychological interventions to affect behaviours and attitudes to pain and discomfort. Cognitive Behavioural Therapy (CBT) has been shown in some studies to effectively reduce patients’ fears surrounding their back pain and the degree of self-imposed activity limitation, allowing patients to enjoy improved quality of life without concomitant medication or further surgery.
The Importance of Rehab
It is possible that the patient’s lack of relief from back surgery is actually due to a secondary pain generator incurred through improper physical therapy or separate condition. Second to improper diagnosis and operating on the wrong lesion, postoperative rehabilitation problems are the most common reason for failed back surgery syndrome. It is important that patients appreciate that their recovery period and active management of their healing process is as important as the surgery itself. Failure to allow adequate healing time, or to carry out physical therapy as advised can lead to an unsatisfactory outcome. Patients who have undergone long and invasive procedures will usually have the most protracted recovery and have to work harder at their rehabilitation. Immediate relief from symptoms is unlikely and a regime of stretching and strengthening back exercises is the preferred option to simply waiting until more surgery can be obtained.
Rather than simply assuming back and leg pain are a continuation of the pre-surgical symptoms, a physician should consider the possibility that an entirely different pathology is at work, such as a muscular injury or nervous system condition. For example, a patient treated for sciatica through a discectomy and fusion may consider the surgery to have been a failure as they continue to have sciatic pain. It may be, however, that their nerve compression in the lumbar spine has successfully resolved but that they are continuing to have muscle spasms in the piriformis which are causing similar symptoms. Patients ought not to be complacent and accept their lot as a sufferer of failed back surgery syndrome as it may be that therapies that failed to provide relief previously will actually have benefit for the new symptoms.