What are the options for chronic pain due to failed back surgery syndrome?

Patients with failed back surgery syndrome are typically treated with conventional medical management, which mostly includes medicines for pain and depression, physical therapy, and psychosocial therapy. Other treatments may include epidural injections, nerve blocks, and home based electrical stimulation units (TENS). If these usual courses of treatment continue to fail, the last options are either to perform another back surgery or to implant a spinal cord simulator. According to a recent report by Shivanand et al, repeat back surgery has poor outcomes ranging from only twenty-two to forty percent success rate. Repeat surgery also increases the risk for complications and is very expensive. Spinal cord simulator implantation has been shown in several studies as a viable option and Shivanand et al have shown it to have less than half the complications, shorter hospital stay and similar total cost over the first two years compared to repeat back surgery.