In my last blog, I discussed the theories about why Failed Back Surgery Syndrome occurs and what pre-existing conditions can make a patient more likely to develop this syndrome. In this entry, I will detail how I diagnose and begin conservative treatment on a patient who suffers from Failed Back Surgery Syndrome.
To start my patient evaluation, I take a detailed medical history and review previous medical notes, X-rays and MRI imaging studies. I perform a comprehensive physical examination. I also ask a lot of questions about quality and nature of a person’s pain, their lifestyle and if they are able to do the activities that they enjoy. I ask them about how they currently treat the pain, if they use narcotics or other medications, if they have had spinal injections, if they have been through a course of physical therapy, and if they have tried alternative methods of controlling pain, including acupuncture, biofeedback or psychological counseling. I try to get a complete picture of the person and to understand all of the factors that could be impacting their recovery. Sometimes it is a simple diagnosis. Other times, I have to play the detective and put the clues together over time.
When I have made a diagnosis of Failed Surgery Syndrome, I begin treating the patient for their pain with a goal of reducing the pain to a tolerable level, improving day to day functioning, and minimizing the use of narcotics. Oftentimes, the person has seen multiple physicians and specialists prior to seeing me for the first time, and they have been on various medications, sometimes narcotics, for long periods of time. Based on their history and previous treatments, their current medication regimen may be changed in order to optimize therapy. Often times, neuropathic pain medications are added to treat nerve pain. Over time, narcotic therapy can lead to an increase in the pain the medication is trying to treat, a phenomenon known as opioid- induced hyperalgesia. The person may need to be slowly weaned off the medication in order to reverse this process. Topical agents, such as gels or dermal patches, may also be introduced in order to manage the pain better.
Dr. Raj N. Sureja is a Board-Certified, Fellowship-Trained Interventional Pain Management Specialist, who currently practices at Orthopaedic & Spine Center in Newport News, VA. For more information on Dr. Sureja or OSC, please go to www.osc-ortho.com. For an appointment, please call 757-596-1900.