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Updated: Apr 29, 2026
04:42
Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
Published on: June 26, 2018
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A 50-year-old man with chronic low back pain
1Center for Pain Medicine, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jrathmell@partners.org
JAMA
|April 3, 2008
Summary
This case study explores long-term low back pain management, reviewing treatments from medications to interventional procedures. It offers clinicians an evidence-based approach for persistent lumbosacral and radicular pain.
Area of Science:
- Pain Management
- Neurosurgery
- Physical Medicine and Rehabilitation
Background:
- Low back pain (LBP) is a prevalent condition with significant disability.
- Chronic LBP, often stemming from lumbar disk herniation, poses complex management challenges.
- This case illustrates the multifaceted nature of persistent LBP despite surgical intervention.
Observation:
- The patient experienced chronic disabling low back pain for over 20 years post-lumbar disk herniation and diskectomy.
- Numerous treatments were administered without achieving sustained pain relief or functional recovery.
- The patient's trajectory highlights the limitations of conventional treatments for refractory LBP.
Findings:
- A comprehensive review of treatment modalities for lumbosacral and radicular pain is presented.
- Evidence-based efficacy of neuropathic pain medications, chronic opioid therapy, physical therapy, and spinal manipulation is discussed.
- Interventional pain treatments, including epidural injections, nerve blocks, spinal cord stimulation, and intrathecal drug delivery, are evaluated for their indications and outcomes.
Implications:
- Provides clinicians with an evidence-based framework for selecting treatments for chronic low back pain.
- Emphasizes the importance of multidisciplinary pain management programs for complex cases.
- Highlights the role of interventional procedures in managing refractory neuropathic and radicular pain.
- Informs clinical decision-making for patients with long-standing, disabling low back pain.
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