Biopsychosocial assessment of neuromodulation analgetic treatment of patients with failed back surgery syndrome (first part)
Abstract
Introduction: Failed back surgery syndrome (FBSS) refers to patients who continue to suffer from chronic back and leg pain following spinal surgery or surgeries. The patients experience mixed pain, disability, reduced functionality and quality of life.
Many methods of various treatment are used, often with poor results. Neuromodulation analgesic methods (spinal cord stimulation and intrathecal delivery of morphine with sophisticated systems) have become a well-established treatment for FBSS over the past twenty years.
We have introduced these methods in our clinical practice for FBSS patients since 2000. Methods: We have used both neuromodulation analgesic methods for the treatment in thirty-six carefully selected FBSS patients who failed in conventional medical management and successfully fulfilled the trial period.
These patients, who suffered from intractable pain, tended to have greater psychological distress, depression, disability, catastrophize and feelings of helplessness. We evaluated pain relief changes in back and leg pain and changes in the functional capacity, in the use of pain medication, in the quality of pain and other parameters through the administration of any bio-psycho-social instruments before and after the implantation of a neuromodulation system.
We used VAS I-1V, SF-36 medicai outcomes questionnaire, Beck depression inventory, Oswestry disability Index anda Selforeport symptom inventory (SCL 90). A paired-samples t-test has been used for statistical evaluation.
We also presented the complications after implantation. Results: When comparing the patients before and after implantation we recognized better pain control and decreased use of pain killers, mainly strong opioids (33 opioid users before implantation, only 3 after implantation).
The average pain reduction in our patients was about 50% according to the VAS scale (0-10). Statistically significant changes were found in functional capacity and in higher quality of life, e.g.
VAS I-IV and somatization, anxiety and unfiled items (e.g. sleep and appetite). We should resolve some complications during neuromodulation treatment.
The main complications were found with electrodes in neurostimulators. Due to serious infectious complication we had to remove two systems.
Conclusions: In accordance with other international trials we showed that both neuromodulation treatments provide pain relief, reduce the consumption of pain killers and improve the functional capacity and quality of life in selected FBSS patients. Psychological and social assessment of FBSS patients with the use of suitable instruments before implantation could be an important part of an indication for neuromodulation analgesic treatment and will prevent the choice of unsuitable patients.
We should stress the patients' satisfaction with neuromodulation treatment, better patient selection and the cost-effectiveness of neuromodulation treatment in future studies.