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I am on round six of possible treatments for failed back surgery syndrome. The pain clinic where I'm getting treated has suggested trying a spinal cord stimulator. Is it really worth the effort and cost to go this route?
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Chronic back and/or leg pain following spinal surgery is called failed back surgery syndrome (FBSS). Most people return to normal function and work quickly after back surgery. But in the case of FBSS, pain continues even with conservative care (pain relieving medications, physical therapy). It sounds like you've made the rounds of possible nonoperative care for this problem.
Finding an effective treatment for this condition has been a problem. Comparing the results of one treatment to another looking for the answer is ongoing. But we can report the results of a recent study that might help you. The study was done by Dr. Deyo (and associates), a well-known and often quoted researcher on the subject of back pain.
The topic was the cost-effectiveness of spinal cord stimulation for failed back surgery syndrome (FBSS) as compared to two other treatment methods. The group included 158 worker compensation patients diagnosed with FBSS.
This report is actually the second published paper based on data gathered and reported on earlier. The first study reported on the results of three separate treatment approaches. The three treatment groups included: 1) spinal cord stimulation, 2) pain clinic, and 3) usual care. This second look compares the costs associated with each treatment method. The most cost-effective treatment is discussed.
In the first study, the authors measured outcomes over a two-year period of time based on pain, disability, and use of opioid (narcotic) medications. They found that five per cent of the spinal cord group reached the treatment goals in these three areas. Only three per cent of the patients treated at the pain clinic met the outlined treatment goals. And 10 per cent of the group receiving usual care had a successful final outcome. Success was defined as at least a 50 per cent improvement in pain, less than daily use of opioids, and a two-point improvement on the disability score using the Roland Disability Questionnaire.
Now taking a look at the costs of each approach, it turns out that the spinal cord stimulation was the most expensive. And the added costs were not offset by better results or fewer visits to the doctor than the usual care approach.
The conclusion of this study was that usual care for failed back surgery syndrome is the most successful and least expensive course of treatment. Spinal cord stimulation was not a cost-effective approach to this problem. That being said, there are other studies that show patients who are helped by this treatment approach. The technique is always tried first before making it a permanent implant. So you may want to consider spinal cord stimulation on a trial basis and see what kind of results you get.
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