What is Spine Surgery Pain

Despite advances in technology and surgical techniques, not all surgeries are successful in alleviating back pain. Some patients will still experience chronic spine pain after surgery. Examining the outcomes and potential causes of continued pain after spine surgery will help to understand who is susceptible and what treatment options may reduce this aggravating condition.

Low back pain is common in the general adult population. Almost 85% of adults will suffer from back pain at some point during their lifetime. The incidence of surgery for back pain is increasing. In one recent 10-year period, there was a 220% increase in spinal fusion surgeries. Statistics have also revealed that approximately 200,000 lumbar laminectomies and discectomies are performed every year in the United States.

Researchers have learned that the success rate for laminectomies and discectomies is higher than that of fusions. According to research published in a recent edition ofPain Medicine, the success rate of lumbar spinal fusions is approximately 10% to 40%, while 75% to 80% of laminectomies and discectomies result in success. Research has also shown that after the initial surgery, success rates are progressively reduced.
Failed back surgery resulting in pain is defined by the International Association for the Study of Pain as “lumbar/cervical pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain.” Symptoms associated with this pain include:
  • Dull/aching pain in back and/or legs
  • Sharp pain in extremities
  • Abnormal sensation in extremities
  • Stabbing pain in back and/or extremities

Causes of Spine Surgery Pain

Spine surgery pain results from surgical intervention to treat a variety of conditions that affect the back. Factors that contribute toward spine pain after surgery include the following causes:

  • Recurrent disc herniation: This is a common cause of spine pain after back surgery. Removal of part of a disc at one level can lead to weakness and eventual herniation of a disc at another level of the spine. The typical clinical presentation is initial pain relief after surgery followed by a sudden return of leg pain upon the occurrence of a disc herniation.
  • Scar tissue (fibrosis): Epidural scarring following back surgery is common. Both preclinical and clinical research indicates that fibrosis is responsible for causing approximately 20% to 36% of cases of chronic pain after back surgery. This scar tissue can inhibit the ability of the spinal structure to cope with degenerative changes, which causes pain.
  • Spinal muscular deconditioining: Every surgery has the potential of altering weight among the various structures of the spine. Changes in the biomechanics of the spine can lead to muscular instability. Weakened muscles around the spine can exacerbate pain. A comprehensive physical therapy program can help reduce the likelihood of muscular deconditioning

Along with the changes in the pathology of the spine, other potential causes of pain after surgery include infection, technical errors during surgery, spinal stenosis, and smoking.

Treatment for Spine Surgery Pain

Once physicians evaluate the potential causes of spinal pain after surgery through imaging studies and patient examination, they must institute an effective care plan. Management of spine surgery pain includes the following modalities:
  • Medication: Pharmacological options for patients with recurrent pain include nonsteroidal anti-inflammatory drugs, acetaminophen (Tylenol), muscle relaxants, tramadol, opioids, anti-convulsant medications, and anti-depressant.
  • Physical Therapy: Research has shown that physical therapy can decrease pain and improve function in patients suffering from pain after spine surgery. Physical therapists will educate patients on the proper body mechanics to help reduce pain. They will also prescribe an exercise regimen to help strengthen muscles along with other pain-relieving modalities such as electrical stimulation, ice, and stretching.
To treat chronic pain after spine surgery, physicians also rely on specialized interventional techniques, such as selective nerve blocks,epidural injections, vertebroplasty, and radiofrequency ablation. These minimally invasive procedures can be highly effective in treating pain. Other complementary treatments are also considered, such as, biofeedback, and acupuncture.

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Once the physician and the patient realize that back surgery has failed to alleviate chronic pain, it is time to assess the potential causes and employ management options. Pain after spine surgery can be frustrating to treat; however, traditional and interventional methods remain important options to consider.

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