Failed Back Syndrome

Pain expert Dr. Scott Fishman answers questions about back pain:

Q: My doctor says I have failed back syndrome. What does that mean?


A: Failed back syndrome is not a single disease but a collection of conditions that emerge after any number of surgeries or other treatments.

The sensations that crop up after surgery can include diffuse, dull, and achy pain, pain that radiates into the hips, buttocks, and thighs, or sharp stabs of pain in the back and legs. The surgery accidentally may have cut nerves that became damaged and were causing neuropathic pain.

The pain may result from scarring on nerves emanating from the spinal cord. This would be categorized as a radiculopathy, meaning that the pain radiates from an overactive nerve root.

A failed back may result from a joint that has become irritated and inflamed because surgery altered the person's posture, gait, and way of moving. Another possibility is that the surgery has disrupted the usual way muscles are positioned or function and has triggered myofascial pain related to sore areas within muscles.

A host of things can go wrong with back surgery, either due to the surgery or from the healing that follows. For example, scar tissue always forms following surgery and may be a source of pain. Any surgery is going to change the back's configuration, which always raises the possibility of new problems. This is why no surgeon can give an ironclad guarantee of long-term success.

Medicine's recent understanding that spinal discs and structural weaknesses are not always the cause of low back pain has changed significantly the way that doctors view back pain and back surgery. This is one of the lessons of failed back syndrome and another compelling reason for initially approaching back pain by looking to less invasive therapies. For example, treatments that change the way the back is used, rather than changing the back itself, should be looked at first.

When I see a patient whose back pain has persisted despite a smorgasbord of treatments, including surgery, the underlying problem often has become undeterminable while pain and dysfunction usually have become the prominent features of the disease. I try to look at this condition with a fresh eye and make few assumptions based on earlier experiences.

I do a complete evaluation and search for obvious or subtle neurological or other physiological causes. I also study my patients' postures and the way they move or sit. I look at how the years of pain have affected their health and changed the way they live.

Patients with failed back syndrome need a comprehensive evaluation from multiple perspectives, often requiring a team of medical professionals. This team is the core of the multidisciplinary approach to pain management.