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failed back surgery syndrome

Neuromodulation for the Management of Chronic Pain After Spinal Surgery

Teaser: 

Vishal Varshney MD FRCPC,1 Jill Osborn PhD, MD, FRCPC,2 Philippe Magown PhD, MD, FRCSC,3 Scott Paquette MEd, MD, FRCSC,4 Ramesh Sahjpaul MD, MSc, FRCSC,5

1Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
2Department of Anesthesia, Providence Healthcare, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
3Department of Surgery, Section of Neurosurgery, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada.
4Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
5Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia,  Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

CLINICAL TOOLS

Abstract: Chronic neuropathic pain is associated with substantial disability and societal economic impact. Formerly called Failed Back Surgery Syndrome, and now labelled as Chronic Pain after Spinal Surgery by the ICD-11, this entity represents persistent neuropathic leg pain following structurally corrective spinal surgery, often refractory to pharmacological and interventional management,. In appropriately selected patients where medical management has been unsuccessful, the minimally invasive surgical technique of spinal cord stimulation can reduce disability and pain. Technological advances continue to improve this approach with greater success, lessened morbidity, and expanding indications.
Key Words: chronic pain after spinal surgery, failed back surgery syndrome, neuropathic pain, spinal cord stimulation, neuromodulation.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Managing chronic pain after spinal surgery is a challenging and requires combined pharmacological and interventional options.
2. Spinal cord stimulation is a modality with strong evidence to supports its efficacy in the management of patients with chronic pain after spinal surgery.
3. The workup of patients with chronic pain after spinal surgery must include multi-tier pharmacological approaches, psychological optimization, and structural spinal assessment from a multidisciplinary group of clinicians.
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system1. Spontaneous features include burning pain and tightness with unpredictable lancinating features.
The mechanism of spinal cord stimulation involves multiple sites within the central and peripheral nervous system. SCS can influence levels of cerebrospinal fluid neurotransmitters including increases in GABA, serotonin, Substance-P, norepinephrine, acetylcholine, and adenosine, and decreases in glutamate and aspartate.
The differential target multiplexed (paresthesia-free) spinal cord stimulation programs appear superior to the older standard paresthesia-based approach.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, failed back surgery syndrome, neuropathic pain, spinal cord stimulation, neuromodulation, chronic pain after spinal surgery

Refractory Back Pain after Surgery: an Overview of the Failed Back Surgery Syndrome (FBSS)

Teaser: 

1Zhi Wang BSc, MSc MD FRCSC, 2Ali Ghoul MD, 3Jesse Shen MD, PhD Candidate, 4Amer Sebaaly MSc, MD,

1Associate Professor, Montreal University (CHUM), Montreal, Quebec. 2PGY 3 Orthopaedic Resident, Saint Joseph University, Beirut Lebanon. 3PGY 5 Montreal University, Montreal Quebec. 4Orthopedic Lecturer, Saint Joseph University, Beirut, Lebanon.

CLINICAL TOOLS

Abstract: “Lumbar spinal pain of unknown origin, either persisting despite surgical intervention or appearing after surgical intervention for spinal pain, originating in the same topographical location” is a description widely used to describe Failed Back Surgery Syndrome (FBSS). In reality, the syndrome is more often a mismatch between the patient’s expectations and the surgical results. This review will describe the possible causes and presentation of FBSS and highlight the role of the multidisciplinary team approach in its management involving non-operative and surgical interventions. The most important objective is correct patient selection for surgery before the first operation.
Key Words: Failed Back Surgery Syndrome, multi-disciplinary approach, spine surgery, low back pain, patient expectations.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Fusing even a short segment of the spine can have significant, possibly deleterious effects, on the complex spinal functions.
2. The Failed Back Syndrome is often a mismatch between the patient's expectations and the final result rather than a failure of surgical technique.
3. The poor result may be the result of preoperative, intraoperative or postoperative factors. All three areas must be assessed.
4. Correct patient selection is as important or even more important than the surgical approach.
The incidence of Failed Back Surgery Syndrome ranges from 10-40% after a major spinal operation.
Setting the preoperative expectations with a full discussion between the patient, referring physician and operating surgeon plays a key role.
There are three periods – pre-operative, intra-operative, post-operative–in which FBSS can arise.
Proper patient selection and pre-operative optimization of all modifiable factors improve outcomes and decrease the possibility of FBSS.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, failed back surgery syndrome, low back pain, multidisciplinary approach, spine surgery, patient expectations
Disclaimer: 
Disclaimer at the end of each page

Chronic Neuropathic Pain in Primary Care—The Role of Neuromodulation

Teaser: 

Philippe Magown, MD CM, PhD, FRCSC,

Caleo Health, Calgary, Alberta.

CLINICAL TOOLS

Abstract: Neuropathic pain is a severe pain condition characterized by burning, tingling, or lancinating pain in the distribution of a nerve, dermatome, or sclerotome and affects patient function, quality of life, mood, and employment. Neuropathic pain is generally refractory to pain medications but amenable to gabapentinoids and antidepressants. When neuropathic pain is refractory to conservative medical management, neuromodulation is the next strategy. Neuromodulation is the modulation of neural signals, most commonly performed with electrical stimulation, such as spinal cord stimulation. Spinal cord stimulation can provide clinically significant pain relief, improve quality of life and function for neuropathic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, and refractory angina.
Key Words: Spinal cord stimulation, failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, refractory angina.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Neuromodulation outcomes for neuropathic pain are best if performed early upon confirmation of pain refractoriness to multimodal and multi-pharmacological management.
2. Level 1 and 2 evidences support the use of neuromodulation for neuropathic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, and refractory angina.
3. Neuromodulation can provide 50% or more pain relief in a significant proportion of patients with neuropathic pain conditions refractory to pharmacotherapy.
1. Neuropathic pain is a severe pain condition along a nerve, dermatome, or sclerotome that is characterized by burning, lancinating, prickling, or shocking-like pain generally refractory to pain medications.
2. Neuropathic pain refractory to four or more pharmacological agents among TCAs, SNRIs, gabapentinoids, and tramadol can benefit from neuromodulation, even more so if performed within two years of onset.
3. Neuromodulation can provide 50% or more pain relief in a significant proportion of patients with failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, and refractory angina.
A successful back school educates the patient about the benign nature of back pain and provides the tools to transfer knowledge about back hygiene into practice in the patient's life.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, spinal cord stimulation, failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, refractory angina
Disclaimer: 
Disclaimer at the end of each page