British journal of pain
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British journal of pain · Nov 2012
Diagnosis and treatment of failed back surgery syndrome in the UK: mapping of practice using a cross-sectional survey.
Chronic back pain is a serious public health issue, associated with poor quality of life and disability. There is a specific group of chronic back pain sufferers whose pain persists despite their having undergone anatomically successful lumbosacral spine surgery. These patients are known as having failed back surgery syndrome (FBSS) and are frequently seen in pain clinics. It is currently unclear what constitutes routine practice in terms of diagnosis and treatment of FBSS in the UK. ⋯ It is evident from the findings of this survey that, though there is some variation, pain specialists in the UK identify and handle patients with FBSS as a separate clinical entity. Direct, randomised comparisons of interventions should be the focus of research into appropriate treatment regimens going forward. Also, evidence of clinical effectiveness will need to incorporate elements of patient acceptance of interventions.
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Failed back surgery syndrome (FBSS) is a generalised disorder that is characterised by chronic pain in the lower back and/or legs that persists or recurs following anatomically successful spinal surgery. This paper aims to (1) assess the burden of failed back surgery in terms of its epidemiology, impact on health outcomes and costs and (2) summarise the evidence base for the cost-effectiveness of interventions for the management of FBSS. A narrative review based on a search of MEDLINE (PubMed) up to August 2012 was undertaken. ⋯ Intrathecal morphine pumps may also be a potentially cost-effective strategy for FBSS. The findings of this review emphasise the importance of identifying strategies to prevent the development of FBSS and effective guidelines for the management of established FBSS. The continued development and application of new neuromodulation therapies and technological innovations in the field of FBSS need to be accompanied by the collection of clinical and economic data in order to demonstrate to healthcare policy makers and payers that such innovations provide benefit to the patient at good value for money.
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Failed back surgery syndrome (FBSS) is a complex condition which can be very difficult to treat. In this article, we propose a pragmatic algorithm for the management of the syndrome. The management of this condition should include a comprehensive initial assessment to rule out treatable cause, pharmacological optimisation, psychological techniques and neuromodulation. ⋯ Emerging techniques in neuromodulation such as high-frequency spinal cord stimulation, peripheral nerve field stimulation and dorsal root ganglion stimulation hold promise for the future, but long-term outcome regarding efficacy and safety is not yet established. Intrathecal drug delivery systems should also be considered in those who are unsuitable or unresponsive to neuromodulation and still warrant further treatment. However, the long-term outcome may not be as good as with other treatments mentioned above.
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British journal of pain · Nov 2012
Failed back surgery syndrome: whose failure? Time to discard a redundant term.
Failed back surgery syndrome or "failed back syndrome" refers to persistent pain after spinal surgery. This opinion piece will discuss the back ground and scale of failed back surgery syndrome. ⋯ It will be argued that failed back surgery syndrome and failed back syndrome are now redundant terms and are not useful for either patient or healthcare provider, and so should be discarded. Key words Failed back surgery syndrome, failed back syndrome.