Q: I had surgery to alleviate back pain, but my back still hurts. What can I do?

Answer: The answer to this question involves a more complete understanding of the facts and common causes of post-surgical pain.

Actually 10 to 30 percent of patients who undergo spine surgery each year still have some degree of persistent back or leg pain afterwards.

This condition of persistent pain is often referred to as either Post-Laminectomy Syndrome (PLS) or Failed Back Syndrome (FBS). Unfortunately, these terms can be misleading, as persistent post-surgical pain may not necessarily indicate literal failure as the names imply, but rather simply unresolved pain.

There may be a host of potential reasons as to why pain persists. In many cases, PLS is the result of a previously severely damaged spinal nerve root prior to surgery that fails to fully recover despite adequate surgical decompression. In other instances, nerve roots can be enveloped by scar tissue that gives rise to a chronic pain state.

Other relatively common causes are the recurrence of disc herniation at the surgery site, further structural changes above or below the initial site of surgery, post-operative spinal or pelvic ligament instability (such as SI joint dysfunction), and myofascial pain.

As with any painful condition, your pain management doctor should begin with a precise diagnosis and follow steps such as:

• Careful review and evaluation of your recent surgery to eliminate the possibility of surgical complications such as infection or hardware migration
• Imaging or neurodiagnostic studies may include X-ray, MRI, CT scan, EMG or myelogram may be of value depending on the symptoms
• If no secondary surgical procedures are needed or feasible, there may still be sophisticated non-surgical options that may improve the painful symptoms

It’s key to understand that each patient is unique and an individualized approach to resolving your post-surgical pain is critical for success.

Our pain management physicians at National Spine & Pain Centers offer a comprehensive plan typically including a tailored combination of conservative measures and sophisticated techniques.

Examples include: physical therapy, spinal stabilization exercises and treatments, anti-inflammatory and other medications, trigger point injections, epidural nerve blocks, radiofrequency denervation, lysis of adhesions, or spinal cord stimulation. Advanced regenerative treatments, such as prolotherapy and platelet rich plasma therapy, may also be recommended.