Management of FBSS
Pharmacological
While prescribed to reduce pain, medications should facilitate exercise therapy and enable improvements in functional status. Antineuropathic agents such as the gabapentinoids are frequently prescribed if there is a radicular or neuropathic component to chronic pain.
Exercise Therapy
FBSS causes muscle deconditioning, leading to weakness of the musculature (e.g., transverses abdominis, paraspinal muscles) responsible for maintaining spinal stability. Though different approaches exist, the general aim of exercise therapy is to decrease pain, improve posture, stabilize the hypermobile segments, improve fitness, and reduce mechanical stress on spinal structures. An additional benefit is that patients are taught active coping mechanisms with pain, giving them a sense of control over their predicament. Exercise programmes that are individualised and supervised and composed of stretching and strengthening are associated with superior outcomes. More recent evidence suggests benefits of core muscle strengthening to improve stability of the spine and reduce pain.
Cognitive and behavioural therapy (CBT)
Considering the influence of psychological factors on chronic low back pain, it is not surprising that psychological therapy is an important component of treatment for failed back surgery syndrome. CBT is broadly defined as interventions that apply psychological principles to change the overt behavior, thoughts, or feelings of persons with chronic pain to help them experience less distress and enjoy more satisfying and productive daily lives. The common components of CBT include teaching and maintenance of relaxation skills, behavioural activation such as goal setting and pacing strategies, interventions to change perception such as visual imagery, desensitization, or hypnosis, and promotion of self-management perspective.
Download our Brochure