In this article, Richard Deyo, MD presents us with new information about worker compensation patients who have chronic back and/or leg pain following spinal surgery. This condition is often 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).
Failed back surgery syndrome (FBSS), is also known as post-laminectomy syndrome but the condition can occur after any back surgery, not just removal of the lamina (pillar of bone that is removed to take pressure off a protruding disc).
The pain is often described as dull, aching, and diffuse. Diffuse pain means the patient cannot point to one spot where the pain is located. Instead, the pain is present over a general area. There may be some abnormal sensations with sharp, pricking, and/or stabbing pain.
Dr. Deyo is a well-known and often quoted researcher on the subject of back pain. The topic this time is 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. Many other studies of worker compensation patients have consistently shown that this group has worse outcomes than other non-worker compensation patients with the same diagnosis and same (or similar) treatment.
This report is actually the second published paper based on data gathered and reported on earlier.The focus on worker compensation patients makes it a unique study. 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 differences in results could not be attributed by differences among the patients because they were evenly matched by age, sex (male versus female), and other personal characteristics. It was observed that the spinal cord stimulation group had more intense leg pain that had been present longer than in the other two groups.The worker compensation group was also more likely to have a lawyer representing their case.
To give you some idea of the costs involved in treating this patient population, the combined costs of total productivity loss and medical costs for each group was as follows:
The conclusion of this study is that usual care for failed back surgery syndrome is the most successful and least expensive course of treatment. Spinal cord stimulation is not a cost-effective approach to this problem. This information will be of interest to state worker compensation programs when deciding what services to cover for injured workers. This particular study was done in Washington state where the use of spinal cord stimulation for this patient population group was approved by the Department of Labor and Industries back in 2004.