I’ve Had Surgery for my Back Problem: Why do I Still Have Chronic Pain?
Raj N. Sureja, MD
In my last blog, I listed some of the factors that may play a role in causing surgeries not to be successful, when their purpose was to facilitate the reduction of pain. Here, I will discuss the theories about why Failed Back Surgery Syndrome occurs and what pre-existing conditions can make a patient more likely to develop this syndrome.
As physicians, we are not sure why Failed Surgery Syndrome develops. We know that there are pain “pathways” in the body, that once established, are sometimes quite difficult to turn off or block. That could be because the person suffered a specific pain for a length of time and that their nervous system became used-to or was “trained” to send pain signals through a specific set of nerves to the brain, where pain is recognized and translated to the affected areas. Even when the problem, such as a herniated disk in the spine, is repaired, the nerves still send these same pain signals to the brain.
There are many theories as to why this happens, but we are not sure of the cause. Some studies indicate that nerve fibers which are injured or severed during surgery, will grow back abnormally and form neuromas, which are thickened, inflamed areas of nerve fibers. These can cause chronic pain. Arachnoiditis may develop after spinal surgery. This is inflammation of the lining of the spinal cord which causes a constant irritation, scarring, and binding of spinal nerves leading to chronic spine and extremity pain. Other studies show that post-operative scar tissue forms and presses on nerves in the operated area, causing pain.
We know that certain pre-existing conditions can cause the efficacy of surgery to diminish and to increase the level of complications, such as diabetes. Smoking is a known impediment to healing, but yet many continue to smoke before and after their surgery. Depression has been shown to negatively impact healing and recovery after a surgical procedure.
When I see a patient who I suspect to have Failed Back Surgery Syndrome, I notice these characteristics hold true for most of them:
- They are frustrated
- They are tired of seeing doctors
- They just want some relief from their pain
- They are depressed
- They are physically de-conditioned
- They are tired of taking pain medications