When Back Pain Treatments Fail

Back pain is a vexing problem for many patients and their doctors trying to treat them. Often, the problem just comes on without cause, and the symptoms continue even after treatments were prescribed to cure what was thought to be the cause of the problem. Back pain symptoms may even continue after several treatment trials that included medications, physical therapy, epidural injections, narcotic pain medications, and even back surgery. In some cases, the prescribed treatments for back pain create other medical problems rather than solve them, such as narcotic pain addiction and the painful effects of infection and scar tissue adhesions - as could be the case with surgery. When back pain treatments fail, many patients must either find a way to manage their pain symptoms, or try other less conventional therapies such as alternative therapies. There is cause for not giving up, and for you continuing trying new options. All of the treatments mentioned on this website have worked for some people, and there will always continue to be new technologies and pain management tools which aim to provide more pain relief, with fewer complication rates.

Let's take a look at some of the reasons why back surgery fails: Failed Back Surgery Syndrome (FBSS): When conservative back pain treatments fail to stabilize the spine or significantly decrease the effects of arthritis or nerve pain, back surgery may be considered. Though the risks of spine surgery are relatively high, patients may make the decision to undergo surgery if they have been suffering for too long, and nothing else has worked. If successful, spine surgery should accomplish one or more of these things:
  • Stabilize a painful joint
  • Decompress a pinched nerve root
In many cases, both of these goals are accomplished, and based on the radiologic images, the patient should begin feeling better after a given period of recovery and physical rehabilitation. In many cases, the surgery is considered a success, and indeed the patient does feel better and is able to resume a normal life. In other cases, the structural abnormality is fixed, but the patient continues to suffer the same symptoms. This condition may be labeled as Failed Back Surgery Syndrome (FBSS) when the patient doesn't get better.

Why does this happen, when so many state of the art resources are available during the diagnostic process and the surgery itself. Are the radiologic images, such as MRIs and discograms just not accurate enough to really see what is going on inside the body? Do the surgeons make mistakes in most surgeries that don't result in successful outcomes? Are too many patients failing to perform the post-surgery rehabilitation recommended to heal the affected anatomy?

Here is one thing that is believed about FBSS. The primary reason why back surgeries are not effective is that the lesion that was operated was not the cause of the patient's pain. This would seem like an unlikely mistake to make, but consider that most people out there have bulging and prolapsed discs in their back, whether they experience back pain or not. The body has an amazing way to adapt to changes in the human body, and often many of us continue to lead comfortable lives even when arthritis develops. In many back pain cases, a patient experiences pain at a particular level in their back. The pain may be isolated to a given location in their lower back or radiate outward and down their hip and leg. When a spotlight is put on the that painful area of the back, using X-rays, MRIs, and other radiologic images, an anatomical abnormality, such as a lesion, may appear to confirm a cause of pain. The doctor may then surgically fix the lesion, after other less invasive treatments have been exhausted. Unfortunately, the lesion that was not the cause of pain was removed, but the cause of the pain remains.

Back Surgery Prognosis: Some back surgeries are more likely than others to provide patients with a more successful outcome:
  • A discectomy or microdiscectomy is two procedures that are performed for lumbar herniated discs when the degenerated discs are causing either lower back pain or leg pain. These two procedures are much more likely to produce successful outcomes when the patient's symptom is leg pain than low back pain.
  • A spine fusion may be performed to treat either spondylolisthesis or lumbar degenerative disc disease. The surgery is less likely to be a success when multi-level lumbar fusions are done.
Treatment Options When Back Pain Treatments Fail: Back surgery mail fail if it does not address the main pain generator, or if multiple pain generators were the cause of the pain. In such cases, the surgery may have fixed one of the pain generators, but left one or more others to affect the patient. Some pain generators may not be obvious on radiologic images.

Complications: Adjacent Segment Disease is one complication of spinal fusion surgeries in which the remaining motion segments of the spine generate pain signals related to the increased loads they are required to bear as a result of the reduced number of motion segments.