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Antonella Paladini [1] and Giustino Varrassi [2] and Giuseppe Bentivegna [3] and Sandro Carletti [4] and Alba Piroli [1] and Stefano Coaccioli [2; 3]

Academic Editor: Donald A. Simone

1, Department of MESVA, School of Medicine, University of L’Aquila, L’Aquila, Italy, univaq.it

2, Paolo Procacci Foundation, Rome, Italy

3, Department of Internal Medicine, Rheumatology and Medical Pain Therapy, Perugia University School of Medicine, Terni, Italy, unipg.it

4, Department of Neurosurgery, “Santa Maria” General Hospital, Terni, Italy

Received Feb 1, 2017; Revised Apr 7, 2017; Accepted May 16, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Failed back surgery syndrome (FBSS) can be defined as “surgical end stage after one or several operative interventions on the lumbar neuroaxis, indicated to relieve lower back pain, radicular pain, or the combination of both without positive effect” [1]. Clinical presentation is characterized as a chronic pain syndrome which severely impacts the quality of a patient’s professional and personal life. Typically, symptoms associated with FBSS include diffuse, dull, and aching pain, sharp, pricking pain involving the back and legs, and stabbing pain in the extremities due to abnormal sensibility. Several factors can contribute to the onset or development of FBSS including, but not limited to, either residual or recurrent disc herniation, persistent postoperative nerve root pressure, altered joint mobility, axial hypermobility with instability, scar tissue and fibrosis, depression, anxiety, and spinal muscular pain. An individual’s predisposition to the development of FBSS might be due to systemic disorders such as diabetes, autoimmune disease, and peripheral vascular disease [2, 3]. Although the etiology, underlying mechanisms, and pathoanatomic correlations can differ greatly across cases of FBSS, there is a consensus that this syndrome is typically “mixed,” inasmuch as there are both nociceptive and neuropathic mechanisms responsible for pain [2, 4]. Treatment of FBSS includes a wide range of therapeutic options such as pharmacologic agents, physical therapy, behavioral medicine, transcutaneous electrical nerve stimulation, minor nerve blocks, and pulsed electromagnetic therapy [5]. The objectives of management should be directed to restoration of functional ability, improvement of quality of life, coping strategies, and pain self-management [2, 6]. A stereotyped approach is...
 
     
     
 
   

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