Failed Back Surgery Syndrome (FBSS) in Interventional Pain Medicine


Failed back surgery syndrome (FBSS) is a challenging condition that occurs when individuals continue to experience persistent or recurring pain despite having undergone spinal surgery. Interventional pain medicine offers a range of minimally invasive techniques to diagnose and treat FBSS, aiming to provide relief and improve the patient's quality of life. This information aims to shed light on FBSS within the context of interventional pain medicine.

Causes of Failed Back Surgery Syndrome:

  • Persistent compression: Residual compression on nerves or spinal structures following surgery.
  • Scar tissue formation: Excessive scar tissue around the surgical site leading to nerve irritation.
  • Incomplete decompression: Insufficient removal of the impinging structures during surgery.
  • Adjacent segment disease: Degeneration of spinal segments adjacent to the surgically treated area.
  • Psychosocial factors: Emotional stress, anxiety, or depression impacting the perception of pain.

Interventional Pain Medicine Techniques for FBSS:

  • Epidural steroid injections: Targeted injection of steroids into the epidural space to reduce inflammation and alleviate pain.
  • Facet joint injections: Medications injected into facet joints to address pain originating from these joints.
  • Lumbar sympathetic blocks: Injection to block sympathetic nerves, often used for complex regional pain syndrome (CRPS).
  • Radiofrequency ablation (RFA): Application of heat to nerves responsible for pain signals, providing long-term relief.
  • Spinal cord stimulation: Implantation of a device delivering electrical impulses to interfere with pain signals.
  • Intrathecal drug delivery: Implantation of a pump delivering pain-relieving medications directly to the spinal cord.

Benefits of Interventional Pain Medicine for FBSS:

  • Targeted relief: Procedures focus on specific pain generators, addressing the root cause of pain.
  • Minimally invasive: Many interventions involve small incisions, reducing recovery time and risk of complications.
  • Improved functionality: By targeting the source of pain, patients often experience enhanced mobility and functionality.


  • Multidisciplinary approach: Collaboration with physical therapists, psychologists, and other healthcare professionals for a comprehensive treatment plan.
  • Patient education: Active patient involvement in understanding the condition and participating in the treatment plan.
  • Realistic expectations: Managing expectations regarding the outcomes of interventions and the potential need for a combination of therapies.


Failed back surgery syndrome poses significant challenges, but interventional pain medicine provides a valuable arsenal of minimally invasive techniques to diagnose and treat the condition. By focusing on the specific pain generators and utilising a multidisciplinary approach, interventional pain medicine plays a crucial role in improving the quality of life for individuals grappling with the complexities of FBSS.