Neurostimulation for chronic neuropathic back pain in failed back surgery syndrome

Failed back surgery syndrome (FBSS) is defined as persistent or recurrent pain, mainly in the lower back and/or legs, even after previous anatomically successful spinal surgery. Treatment of such patients is difficult, with conservative therapy and repeated back surgery often proving unsuccessful at providing adequate pain relief. Spinal cord stimulation (SCS) is a minimally invasive procedure that allows physicians and patients to inexpensively evaluate the response to therapy before permanent implantation. Both trial stimulation and permanent implantation are fully reversible. Early treatment with SCS has been shown to be very effective in well-selected FBSS patients and should be considered instead of reoperation. Clinical studies have demonstrated that SCS provides a sustained, long-term, 50% or more reduction in pain in over 60% of patients and allows concomitant pain medication to be reduced. The substantial improvements in quality of life and functional status permit many patients to return to work. Patients express great satisfaction with SCS and minimal side effects are observed. Moreover, SCS has been shown to be a cost-effective alternative to conventional therapies. Thus, SCS is the treatment of choice in medically refractory FBSS patients where recurrent neuropathic pain persists after surgery and analgesics are no longer effective or accompanied by intolerable side effects.