Persistent Spinal Pain Syndrome (PSPS), formerly known as Failed Back Surgery Syndrome, refers to persistent or newly onset pain following spinal surgery. This can include both back pain and radiating nerve or leg pain. Surgical wound pain immediately after the operation, as well as discomfort in the first few days and weeks following the procedure, are common and are part of the normal healing process. These are not classified as PSPS. PSPS is diagnosed when pain persists over an extended period or recurs after an initial period of improvement.
What causes PSPS?
Patients who develop Persistent Spinal Pain Syndrome have had one or more back surgeries due to back and/or leg pain. Despite back surgery, 10–40 % of those operated on still suffer pain afterwards. Where the pain comes from is usually unknown.
In the last 20 years, the number of back operations has increased rapidly. With each additional back surgery, the success rate decreases:
- 70–90 % after the first surgery
- 30 % after the second operation
- 15 % after the third operation
- 5 % after the fourth operation
The longer patients suffer from Persistent Spinal Pain Syndrome, the more difficult it is to treat. Complicating the chronic back pain can be stress, decreased self-esteem, unemployment, financial problems, and depression. The level of suffering is comparable to chronic heart failure or cancer.
How can PSPS be treated?
Persistent Spinal Pain Syndrome can be treated conservatively, interventional or with neuromodulation. At our clinic, patients who have a long history of suffering are examined on an interdisciplinary basis in order to be able to offer them a therapy tailored to their needs.
Conservative therapy
The most important therapeutic approach is to train the muscles. Physiotherapy can help with this, combined with painkillers or psychosomatic pain therapy depending on the findings.
Interventional pain therapy
If conservative treatment of the pain is not effective, methods of interventional pain therapy can be used. These include
- targeted infiltration,
- targeted current therapy with radio frequency (radio frequency ablation) or
- thermocoagulation, in which a cannula with a fine wire is guided directly to the pain-conducting nerve structure in a minimally invasive manner and the nerve fiber is specifically obliterated.
Neuromodulation
Neuromodulation affects the transmission of nerve impulses through current or through medication. If conservative therapies for Persistent Spinal Pain Syndrome do not bring improvement, spinal cord stimulation can be performed or a pain pump can be used.