A Case of Severe Low Back Pain After Surgery

ABSTRACT

The etiology of chronic back pain is often unknown but can include failed spinal surgery. Pain can often be of mixed type and it is important to evaluate pain mechanisms.

Comorbid factors often contribute to pain chronicity. Multimodal treatment, including opioid rotation where indicated, may offer a successful management approach. Other rehabilitative procedures such as physiotherapy, exercise therapy, and good sleep hygiene may have a profound impact on patient quality of life. Spinal cord stimulation may be an effective option for some patients with failed spinal surgery syndrome. A case of severe low back pain after surgery in a 45-year-old man is presented to illustrate this.

This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

KEYWORDS :

• back
• pain
• physical therapy
• postlaminectomy syndrome
• spinal cord stimulation
• surgery

COMMENTARY FROM GERMANY

Eberhard A. Lux

In many cases, the diagnosis and treatment of patients with chronic pain will only be successful if both the predominant pain mechanism and psychosocial factors are considered. Many patients with chronic pain after spinal surgery experience mixed pain, where nociceptive and neuropathic mechanisms exist side-by-side.

To differentiate between types of pain, we use the painDETECT questionnaire at our clinic, which is available in many languages. In this case, the patient was diagnosed with musculoskeletal pain with comorbid factors, similar to many of our chronic pain patients. More complex pain questionnaires such as the Deutscher Schmerz-Fragebogen can also be very useful for the physician, alongside a detailed history and examination. The Hospital Anxiety and Depression Scale can also illustrate these common comorbidities.

Patients with chronic pain benefit especially from multimodal, multidisciplinary programs, within outpatient or inpatient settings, involving coordination between physicians, psychologists, physiotherapists, nurses, and social workers.¹

Pain reduction and improved function in daily activities should be the aim of these programs. Individual goals should be defined early in the therapeutic process; in this case, it was a return to work. Exercise, weight loss, sleep modulation, reduction of alcohol intake, and a new partner were steps for successful treatment in this case.

COMMENTARY FROM SPAIN

César Margarit Ferri

Patients with low back pain require a global approach to management, including psychological evaluation and an understanding of their work and social history. These comorbid factors can contribute to pain chronicity. Pharmacological treatment is indicated to relieve pain; at the same time, it is advisable to minimize side effects in order to enable better drug compliance and improve quality of life.

According to the biopsychosocial model, treatment of failed spinal surgery syndrome includes addressing both pain and other problems, including depression, mood impairment, sleep disturbance, and changes in social patterns contributing to reduced quality of life, increased of use of health care resources, and work absenteeism.^1–3 The societal impact of pain is particularly important in developed countries. We should tailor multimodal and individualized treatments for chronic pain not only to treat pain, but also to control comorbidities if possible and drive patients to rehabilitate in all aspects of life. Opioid rotation, antineuropathic pain medications, and adjuvant drugs and therapies that can minimize adverse effects may all contribute to better global pain management.

Declaration Of Interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

Notes

Professor Eberhard A. Lux is with the Pain and Palliative Medicine Clinic, Klinikum St. Marien Hospital, Lünen, Germany.

Dr. César Margarit Ferri is Chief of pain unit in the Anesthesiology, Critical Care and Pain Medicine Department, Hospital General de Alicante, Alicante, Spain.