Post Surgical Chronic Back Pain

The decision to undergo invasive surgical treatment for chronic back pain is a huge decision, and one that isn’t taken lightly for both the patient and the pain management specialist. So when pain is still experienced after surgery, it can lead to a lot of questions as to “Why is the pain still happening?” and “Will I ever experience a pain-free life again?” While there are several reasons why post-surgical chronic back pain can still occur, the good news is that there are also several additional treatment options to consider. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas is highly trained in the best and most effective methods to help their family of patients who are experiencing chronic back pain find relief. 

What is Post-Surgical Chronic Back Pain? 

Post-surgical chronic back pain is persistent pain that occurs after back surgery. While it’s common to experience some form of pain after back surgery, this specific type of chronic pain is felt after the common period of recovery has ended, and can often feel as bad or even worse than the original feeling of pre-surgical pain. This is a frustrating situation for patients because the goal of surgery was to get out of pain, improve mobility and increase their quality of life, not to continue to experience pain. 

While the symptoms of post-surgical chronic back pain can vary from patient to patient, the most common include sleeplessness, lack of an appetite, crying, becoming lethargic, and lack of drinking. However, there are times when the symptoms signal a greater medical issue at hand, and it’s important to seek care immediately. These symptoms include: 

• Severe pain that doesn’t get better with medication or time
• Severe swelling
• Chest pain or difficulty breathing
• Fever/chills
• Vomiting 
• Disorientation or dizziness
• Leakage around the surgical incision(s)
• Trouble breathing or chest pain

Due to the invasive nature of back surgery, most patients can expect to experience discomfort that could last for a few months. The reason for the long recovery time is because the body interprets the surgery as trauma. When this pain lasts longer than expected, or returns after the healing period has ended, this means that the surgery either didn’t correct the entire cause of the chronic pain in the first place, or that, in rare cases, additional complications occurred during the surgery itself or during the recovery period. Additionally, if patients are unable to experience relief after three months, there is a good chance that they might not experience relief from their surgical treatment and might need to continue to explore additional treatment options, both focusing on the back as well as other medical conditions that could be affecting the back and producing chronic feelings of pain. 

What Causes Pain After Back Surgery? 

Unfortunately, there are numerous reasons why a patient will still experience pain after back surgery. The main reason for this is because the back is so intricate! Not only do treatment options target vertebral joints, ligaments, tendons, and nerves for resolving the cause of pain, there are also a myriad of treatments, therapies and surgeries available. So while the goal of all treatment is to help the patient find pain relief, there are instances where surgery may or may not have resolved the issue on a comprehensive level. 

The feeling and duration of post-surgical pain back can also vary. General feelings of discomfort can be expected, which is why your provider will prescribe pain medication and review with you an appropriate period of recovery based on your health and any other medical conditions. In other non-typical recovery cases, some pain can occur quickly and be accompanied by a fever, or there can be pain that is felt not in the back, like when breathing. 

Post-surgical chronic back pain can be caused by any number of the below conditions, which require additional medical attention and treatment:

• Infection at the surgical site
• Blood clot
• Internal or external bleeding
• Chronic medical conditions that the surgery didn’t treat
• Heart attack
• Pneumonia
• Hematoma or seroma (a collection of blood or fluid in the wound)
• Change in bowel habits
• Wound or stitches not healing properly

Another main cause of post-surgical chronic back pain that is either a continuation of pre-surgical conditions and persistent pain is called failed back surgery syndrome or failed back syndrome. This occurs when the surgery, which was successful, did not completely resolve the patient’s pain symptoms. 

There are several factors that work together that can affect, positively and negatively, the outcome of back surgery. For one, the particular area of the back where the surgery was performed was only one part of the problem that is collectively causing the patient pain. Another option could be the fact that the nerves, muscles, ligaments and tendons that were operated on need additional time to heal and operate properly. Or, the development of scar tissue that resulted from the invasive surgery is causing a new form of pain as it impinges on the nerves or muscles around it, creating a form of residual pain. In addition to possibly exploring additional treatment options, some patients will have to live with pain management options as well. 

Why Does Post-Surgical Chronic Back Pain Happen?

Back surgery is an invasive treatment option, meaning there is a lot of healing that occurs in and around the surgical site. This could lead to additional complications that yield pain in the long run. Some notable post-surgical medical conditions that can lead to additional forms of pain include:  

• Epidural Fibrosis: Scar tissue is an expected part of the healing process. While scar tissue, also known as epidural fibrosis, does not have any nerve tissue so it does not have any feeling, the location and amount of scar tissue can lead to pain. If the scar tissue forms on or around structures that do have nerves, or the nerves themselves, this can put pressure or tension on nerves, which results in pain. While pain isn’t felt after surgery, as the body heals and the scar tissue forms, pain can occur around two to three months after surgery. This type of pain is often described as a burning, gnawing and constant pain that can sometimes be lessened with stretching exercises. 
• Recurrent Stenosis After Decompression Surgery: The purpose of decompression surgery is to treat compressed nerves caused by the narrowing of the spinal canal (spinal stenosis) and relieve pressure on nerve roots that are causing pain. Laminectomy is one main decompression surgical operation to remove the back of one or more vertebrae, usually to give access to the spinal cord or to relieve pressure on nerves. It is possible for spinal stenosis to happen again, leading to recurrent pain. There is also the opportunity for issues to happen with the surgery itself, such as fragments on bone left behind or damage to the nerve itself. Another decompression surgical operation is discectomy, a surgical removal of the whole intervertebral disc or only the disc material irritating a nearby nerve, which can lead to reherniation of the disc. The common issues with decompression surgery is that the provider is removing a part of the spine, which can often lead to instability issues in the long term. 
• Fusion failure: Spinal fusion is surgery that connects two or more bones in the spine, with the goal to prevent pain. However, because the spine is fused, this limits the movement of the spine, which can cause stress above and below the fusion. When this happens, adjacent segment disease occurs, which can cause pain from degeneration and wear-and-tear over time. 

How is Post-Surgical Chronic Back Pain Diagnosed? 

The best way to find out what may be causing your post-surgical chronic back pain is to partner with your pain management specialist. In addition to asking the patient when the pain started, what the pain feels like, and when during the day the pain is felt, they will also use diagnostic tools such as X-rays, MRIs and CT scans, as well as take blood and fluid samples and perform a physical examination. 

Treatment will depend on your provider’s diagnosis. If your provider determines that the pain is best remedied by medications and light at-home recovery methods, such as rest, ice packs, etc., then that’s great! If you are diagnosed with post-surgical chronic back pain, then additional treatment options might be needed to provide long-term and consistent pain relief. However, if your provider believes that your pain is chronic back pain that is related to a surgical complication, immediate treatment might be needed. 

What Treatments are Available for Post-Surgical Chronic Back Pain? 

For patients who underwent invasive back surgery with the hopes of finally experiencing pain relief, but are still living with pain, the last thing they want to think about is more back treatments. The process of per-surgical efforts, surgery itself, and the post-operative healing process is a daunting task that consumes months of time. This is made even worse when the feeling of pain still resides, or is even worse. Regardless if patients needed back surgery due to an emergency traumatic event that required immediate care, or they opted for back surgery because they felt it was the best option for them, there are additional options that could still provide relief from unresolved pain. 

One of the most popular options for treating post-surgical chronic back pain is an epidural steroid injection, or ESI. This treatment is a safe and relatively pain-free pain management tool for treating chronic pain, specifically in the back. It is an out-patient procedure that involves a provider injecting a steroid and an anesthetic in the epidural space, targeting the affected nerves believed to be causing pain. The medication both provides immediate pain relief as well as reduces inflammation on the nerve, ultimately stopping pain signals from being sent to the brain. Most patients can expect to feel pain relief for a few weeks or up to a year. 

Another option for treating chronic back pain is spinal cord stimulation. Dubbed the “pacemaker for pain,” spinal cord stimulators work by replacing the feeling of pain with a light tingling sensation. The device, which is about the size of a book of matches, is implanted into the epidural space in the spinal cord, as close as possible to the area where the patient is experiencing pain. The device produces a low electrical current that interrupts the pain sensations from traveling to the brain, so instead of feeling pain the patient feels a tingling feeling. What makes this treatment so effective is that the patient is in control of the amount of sensation felt, so can increase or decrease the strength based on the feeling of pain at any given time. 

Both are great treatment options for patients who are experiencing chronic back pain, even after back surgery has been performed. It’s essential to partner with a trained management specialist who can not only properly diagnose the main source or cause of pain, but who can also recommend and provide the best treatment options possible. The goal is to not only provide pain relief now, but to also fix the source of pain so that pain-relief is felt in the long term. 

If you are still suffering from persistent pain months after your back surgery, please reach out to the California Pain Consultants team today. We know just how debilitating it is to not only have to endure pain after a successful surgery, but to also then have to restart the treatment process all over again. We are committed to working with our family of patients to help them find the best treatment option that provides the greatest results, now and for the future, because we believe that no one should have to endure a lifetime of pain. If you believe you are suffering from post-surgical chronic back pain and would like more information about the available treatment options, please reach out to the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas and schedule an appointment with one of our amazing pain management specialists.