Continued Pain After Neck and Back Surgery
In the first decade of his career as an anesthesiologist, Dr. Urban spent many days in the operating room during 6-12 hour spine operations. With many patients undergoing repeat operations and continuing pain despite potent chronic opioid treatment he realized that surgery didn’t always fix everybody and some patients continued to have increasing pain. This was some of the stimulus for Dr. Urban to continue his career with an intervention pain fellowship and establish Urban Pain Institute in 2012. Not to knock his surgeon colleagues, as Dr. Urban has a good working relationship with many, but some patients may not have surgery as their best option. In other patients Dr. Urban encourage patients to think about surgery and let others know when it is really urgent or an emergency.
Continuing Pain in the First Couple Months After Spine Surgery
Patients are followed by their surgeon postoperatively and healing seems to be progressing well but they may have continued pain that may not be dealt with by the surgeon.
- There may be some continued inflammation or aggravation of the nerve roots after surgery
- Optimize treatment with medications that quiet the excitation of nerves and promote healing.
- Sometimes a simple transforaminal injection of corticosteroid may be all that is need to quiet things down and promote healing.
- Patients may have been on significant opioids prior to surgery and their body still needs these medications beyond what the surgical team is accustomed.
- Customize sustainable plan for opioids in extended postoperative period.
Continuing Pain Four to Six Months After Spine Surgery (Up to One Year After Fusion)
- The surgeon may have perfectly fixed intended source of pain for which surgery was planned but there may be other generators of pain not expected to be fixed by that operation. Some examples:
- Facet (Zygapophyseal) Joint Pain is not alleviated by microdiscectomy, laminectomy or decompressive surgery.
- Sacroiliac (SI) Joint pain.
Long Term Persistent After Spine Surgery/Failed Back Surgery Syndrome
- The surgeon may have perfectly fixed intended source of pain for which surgery was planned but there may be other generators of pain not expected to be fixed by that operation.
- Look at other causes of pain.
- There may be permanent nerve damage from surgery or preexisting damage tht was permanent and not reversible.
- Further surgery may not be indicated.
- Further operations have increased risk of complications.
- Success goes down with further operations.
- Pain may increase with further operations.
A Temporary Trial of Minimally Invasive, Completely Reversible, Neuromodulation (Spinal Cord Stimulator) may be the Best Next Step.
Contact URBAN PAIN INSTITUTE for help, a neck, back and spine specialist in Alaska! Referral from surgeon or primary care provider frequently not needed.
