Failed Back Surgery Syndrome: What's the Next Step?Severe back and/or leg pain after spinal surgery is referred to as failed back surgery syndrome (FBSS). This type of neuropathic (nerve) pain doesn't respond to pain relievers or conventional treatment.
Decreased quality of life and disability is common with FBSS. The cost of treatment is three times the amount for back pain patients who don't have neuropathic pain. In this study, the use of spinal cord stimulation (SCS) in addition to conventional medical management (CMM) is compared with just CMM.
Two groups of patients with neuropathic pain were followed for 12 months. The SCS group had a neurostimulation device implanted. The CMM group received medications for pain relief and to reduce inflammation. Some patients tried nerve blocks and epidural injections. Physical therapy, chiropractic care, and psychologic help were also included.
Success of treatment was defined as 50 per cent improvement in leg pain after six months. Other outcome measures included improved back pain, increased function, and decreased usage of drugs. Measures of patient satisfaction and improved quality of life were also recorded.
Patients with the SCS had much better results than the CMM group. Pain relief and decreased use of analgesic drugs was significantly improved in the SCS group. Rates of return to work were the same between the two groups.
The authors concluded that SCS provides pain relief and improves quality of life and function in patients with neuropathic pain from FBSS. In the SCS group 48 per cent met the goal of pain reduction by 50 per cent. This compares favorably to the nine per cent reported in the CMM group.
Krishna Kumar, et al. Spinal Cord Stimulation Versus Conventional Medical Management for Neuropathic Pain: A Multicentre Randomised Controlled Trial in Patients with Failed Back Surgery Syndrome. In Pain. November 2007. Vol. 132. No. 1-2. Pp. 179-188.
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