Post Surgical Chronic Back Pain

The decision to undergo surgery to resolve chronic back pain issues is a serious decision. This usually happens after a person has lived with pain for months or years. They may have exhausted all other pain management options. When surgery is deemed a success but the patient still has the same or worse pain, it’s very frustrating. This situation is dismal for both the patient and the provider. The goal of medical procedures is to help patients achieve a life without pain. However, sometimes surgery doesn’t deliver these results. The Nevada Advanced Pain Specialists in Reno, Sparks, and Carson City understand how tough this can be. They offer additional and effective treatment options for those living with chronic pain.

What is Post-Surgical Pain?

Post-surgical, also known as postoperative, chronic back pain is any pain that is felt after surgery has been performed successfully. While pain after any surgical treatment is to be expected, what isn’t to be expected is pain that continues to get worse. The goal of all surgery is to improve the patient’s symptoms, prevent continuing damage to the injured/affected body part, and afford the patient with pain-free mobility and function. Even if the surgery is successful, the outcome has the potential to not always be as positive or ideal as expected. 

Post-surgical chronic back pain can happen to anyone who has undergone surgery, regardless of age. In addition to feelings of pain, the most common symptoms of post-surgical pain include: 

• Severe swelling
• Severe pain, regardless of rehabilitative efforts or pain medication
• Vomiting
• Fever/chills
• Chest pain or trouble breathing
• Dizziness or disorientation
• Developing a cough
• Infection/drainage around the incision

Acute pain

Acute pain is common after surgery. Chronic pain, lasting three months or longer, is not. Patients may experience chronic back pain if the surgery didn’t fully address the original issue or if additional damage occurred during the procedure. Surgery involves cutting soft tissues and nerves, triggering the body’s injury response. This response creates inflammation. As tissues and nerves heal, they may do so improperly, leading to chronic pain either at the surgical site or in another area affected by nerve sensations.

What Causes Post-Surgical Chronic Back Pain?

Unfortunately there are a myriad of reasons why a person might experience post-surgical chronic back pain. Pain during the healing process is normal. However, chronic pain that lasts well after the standard period of recovery has ended, or pain that gets worse with time, is not particularly usual.

The main reason why a person might experience post-surgical chronic back pain is that there have been subtle changes to the way the spine moves and functions. These small changes from surgery, coupled with the original reason the surgery was performed (i.e. to treat herniated discs or compressed nerves), can lead to imbalances and stress on certain parts of the spine. So when a person moves or sits or lies down, the body can put pressure on certain muscles, joints, tendons and nerves in and around the spine. This can happen even if the surgery performed was deemed successful and there weren’t any complications during the procedure. 

The feelings of pain can also vary. Some patients can describe pain as burning, aching, shooting, numbness or sensitivity to touch or temperature, or all of the above. This is another reason why post-surgical chronic back pain is difficult to treat because the pain can or cannot be directly associated with the particular surgery itself. If damage was done to any nerves at the surgical site, the person might feel pain in a completely different part of the body. 

General pain is commonplace after a surgery, which is why your healthcare provider will prescribe pain medication. However, there are some additional causes of postoperative pain that require medical attention. If you believe you suffer from or are experiencing any of the below conditions, please reach out to your healthcare provider immediately: 

• Heart attack
• The incision site opening or stitches falling apart
• Infection
• Pneumonia
• External bleeding at the incision site, or internal bleeding
• Change in bowel/bladder functions
• Blood clot
• Hematoma or seroma (a collection of blood or fluid at the incision site)
• Chronic conditions, i.e. lupus or rheumatoid arthritis

Another reason for chronic pain after back surgery is a condition called failed back syndrome or failed back surgery syndrome (FBSS). This refers to surgery that was a success, but that failed to completely resolve the patient’s pain symptoms. 

Even with a successful surgery, there are a few factors that determine the outcome. One reason might be that the surgery only targeted one area of the body, thereby only resolving a part of the total cause of the pain. Other times, the body’s response to the initial injury requires more time to heal. Another option could be the buildup of scar tissue from the original issue or even the surgery itself that presses on nerves, causing residual pain. Any of these reasons could leave a person feeling chronic pain that requires additional treatment.

The best way to continue the path toward a pain-free life is to contact a pain management specialist as soon as chronic pain is felt so that immediate action can be taken, which maximizes the patient’s chance for positive recovery and successful pain management. 

What are the Reasons for Post-Surgical Chronic Back Pain?

Surgery is an invasive option that most medical professionals recommend after conservative treatment has been exhausted. The reason why is because surgery poses risks and complications, as well as a longer period of recovery. Even with a successful surgery, there are medical conditions that can arise from the surgery itself, or from complications as a result of the surgery. These medical conditions could include: 

Epidural Fibrosis:

The development of scar tissue after a surgical procedure is common because it’s how the body attempts to repair a wound. Scar tissue is generally not an issue because there are no nerves in the scar tissue itself. However, there are some cases where the scar tissue pushes against surrounding nerves and pinches them, or the scar tissue can grow together and larger, putting tension on the surrounding tissue, which causes pain. Epidural fibrosis is the excessive production of scar tissue near the root of a nerve, putting pressure on the nerve. This pressure causes post-surgical pain and nerve dysfunction, and often leads to a burning or gnawing pain. Symptoms of epidural fibrosis are generally seen six to 12 weeks after surgery. 

Repeated Spinal Stenosis after Decompression Surgery:

The purpose of decompression surgery is to alleviate the pressure on the spinal nerves caused by a narrowing of one or more spaces within the spinal column, which is referred to as spinal stenosis. One decompression surgery option is a laminectomy, which is when part or all of the vertebral bone is removed. This allows for a release of pressure on the nerves, which might have been caused due to injury, herniated disc, etc. The surgery does have opportunities for complications, such as if the bone grows back and creates another area of stenosis in the spine, there are fragments of bone left from surgery, or there was trauma done to the nerve roots. Another option is a discectomy, which is the surgical removal of the abnormal portion of an intervertebral disc that is bulging out and pressing on the nerve root or spinal cord.

The downside to this procedure is that the disc could re-herniate and once again press on the nerves. The risk with both procedures is that since a part of the spine is being removed, it could lead to greater issues with instability in the long term, which could create additional complications and opportunities for pain. 

Fusion Failure:

Spinal fusion is a surgical procedure that involves linking two vertebrae together with the goal to improve support and stability. The risk with fusion failure is that since two vertebrae are solidly linked together, this could create pain above and below the fusion area, as the surrounding vertebrae in the spine experience restricted movement and stress. This can lead to adjacent segment disease, which can lead to degeneration from wear-and-tear and could require additional surgery to fix. 

How Do I Know if I Have Post-Surgical Chronic Back Pain?

The best and only way to determine if you are suffering from post-surgical chronic back pain is to seek help from a medical professional. In addition to reviewing your medical and health history, and utilizing diagnostic tools such as X-rays/MRI/CT Scan, they will also ask questions about the level of pain you’re experiencing, when the pain is felt, where the pain is felt, and what the pain feels like. 

If your provider believes your pain falls within the normal range of pain that is generally experienced after surgery, they will more than likely recommend at-home treatment methods, such as rest, pain medications, and following proper post-operative wound care. However, if the pain is believed to be directly correlated with recent back surgery, a hospital visit might be required. The final option is that the patient is suffering from chronic back pain, which could happen, as we’ve discussed, for a myriad of reasons. A pain management specialist will then help to provide additional treatments with the goal to manage the pain symptoms as much as possible so the patient can enjoy an ideal quality of life. 

What are the Treatment Options for Post-Surgical Chronic Back Pain?

After back surgery, continued pain can make considering further treatment options overwhelming. However, there are some minimally-invasive treatment options that have been proven to help alleviate pain symptoms and allow the patient to experience an active lifestyle again. 

One of the most common treatment options is an epidural steroid injection (ESI). This outpatient procedure involves an injection of a corticosteroid and an anesthetic into the epidural space in the back. The goal is to quickly reduce inflammation and provide lasting chronic pain relief. Relief can last from weeks to a year, though results vary by person.

Another option:

Another option is a spinal cord stimulator. This two-step procedure involves placing a medical device in the body to treat severe pain. A spinal cord stimulator involves attaching one or more electrical leads into the epidural space in the back. These leads are connected to a pulse generator that delivers a mild electrical current to stimulate the spinal cord. The stimulation replaces pain signals to the brain, reducing the sensation of pain. Instead, the patient will instead feel a light tingling or buzzing sensation. An added benefit is that the patient can control the level of sensation, so can increase it or decrease it as needed. 

Nevada Advanced Pain Specialists

The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas understand just how exhausting living with post-surgical chronic back pain can be. By the time someone chooses surgery, they’ve often tried ineffective at-home treatments for months or years. After surgery and recovery, persistent pain becomes a problematic issue. This is where Nevada Advanced Pain Specialists can help. Our team specializes in pain management, helping patients find relief and improve their quality of life. If you are suffering from post-surgical chronic back pain and would like to know about your treatment options, please schedule an appointment today.