Persistent Spinal Pain Syndrome — Timoteo Almeida, MD, PhD

Persistent Spinal Pain Syndrome

Also known as "Failed Back Surgery Syndrome" (FBSS)

When pain persists after spine surgery, it doesn't mean nothing can be done. Spinal cord stimulation offers a well-established path to relief for patients whose pain hasn't responded to other treatments.

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Pain after spine surgery

Persistent or recurrent back pain, leg pain, or both after a spine operation. It's more common than many people realize.

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Spinal cord stimulation

SCS is a well-established option for chronic neuropathic pain after surgery when other treatments haven't provided enough relief.

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Trial before commitment

Most programs use a trial period first — temporary leads let you experience relief before deciding on a permanent implant.

Understanding your condition

What is persistent spinal pain syndrome?

After a spine operation, some patients continue to have pain — persistent nerve pain radiating into the leg, scar-related nerve irritation, recurrent stenosis, or other pain generators. "Failed back surgery syndrome" is not a single diagnosis — it's a description that signals the need for careful re-evaluation and a stepwise plan.

The name can feel discouraging, but it doesn't mean your original surgery failed or that nothing more can be done. It means the current pain needs a fresh look, a clear understanding of what's driving it, and the right next step.

Am I a candidate?

Who may benefit from spinal cord stimulation?

You may be a candidate if:

SCS works best for a specific pain profile — careful evaluation helps determine if it's the right fit for you.

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Pain has lasted months after surgery and remains significant despite reasonable trials of medications, physical therapy, and/or injections.
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Your symptoms suggest a neuropathic component — burning, shooting, or electric pain, especially in the legs. Some modern SCS approaches also target back pain.
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Imaging and clinical evaluation do not show a clear structural problem that would be better treated with another operation.
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You can participate in a trial and follow-up, and have appropriate psychosocial screening as part of standard best practices.

Your option

Spinal Cord Stimulation (SCS)

SCS changes how pain signals are processed by the spinal cord. Rather than masking pain with medication, it works at the neural level to reduce the pain signals reaching your brain.

⚙ Implant-based neuromodulation

How Spinal Cord Stimulation Works

One or more leads are placed in the epidural space near the spinal cord. A small generator implanted under the skin sends electrical signals that modulate pain processing.

Mechanism Electrical signals from the leads change how the spinal cord processes pain — reducing the intensity of pain signals before they reach the brain.

Programming The device is programmable and adjustable. Settings can be refined over time to optimize your pain relief as your needs change.

Evidence Evidence syntheses support SCS as an option for chronic pain conditions including FBSS, with outcomes depending on patient selection and device/programming type.

Reversibility SCS is reversible — the system can be turned off, reprogrammed, or removed if needed (removal requires a procedure).

Adjustable Reversible Trial first Programmable Outpatient implant

Your journey

What to Expect

The SCS pathway is designed around a "try before you commit" approach — you experience the therapy before making a permanent decision.

Evaluation

Updated evaluation of your pain pattern, review of prior surgery and imaging, discussion of goals, and standard screening — including psychosocial factors that can affect outcomes.

Trial Period

Temporary leads are placed for several days. You track pain relief and function in your daily life to determine whether a permanent implant is worthwhile for you.

Permanent Implant

If the trial is successful, leads and generator are implanted — usually outpatient. The device is programmed and refined over subsequent visits for optimal relief.

Weighing your decision

Benefits and Risks

Potential Benefits

✦ Improved pain control and daily function
✦ Better sleep quality
✦ Reduced reliance on pain medications for some patients
✦ Reversible — can be turned off or removed

Possible Risks

△ Common: Temporary soreness, bruising, need for reprogramming
△ Uncommon: Infection, bleeding, spinal fluid leak, neurologic injury
△ Device-related: Lead migration is a commonly reported reason for revision if benefit decreases; hardware malfunction can also occur

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Recovery and activity restrictions

Restrictions are typically strictest for the first weeks to reduce lead movement risk — no heavy lifting, bending/twisting, or overhead reaching depending on lead location and your team's protocol. For detailed instructions, please see our Post-operative Instructions page.

Common questions

Patient FAQs

What counts as a "successful" SCS trial?

Many teams look for meaningful improvement in pain — often greater than 50% reduction — and improved function that matches your goals. The goal is meaningful benefit, not perfection.

Will I feel tingling?

Some stimulation systems produce a tingling sensation (paresthesia), while others are designed to minimize or eliminate it. Your team can explain the available options and help you choose the approach that best fits your preferences.

Can the device be removed?

Yes — SCS is reversible. The system can be turned off, reprogrammed, or removed entirely, though removal does require a procedure.

Why do I need psychological screening?

Psychosocial factors can significantly affect pain treatment outcomes. Screening is a standard best-practice step — not a barrier — that helps your team optimize your chances of a good result.

When to Seek Urgent Care

Go to the ER or call urgently for: fever with worsening incision redness or drainage, new leg weakness or numbness, new bowel or bladder dysfunction, severe back pain with neurologic changes, or severe headache after a procedure.