Chronic back pain after spine surgery for herniated discs and stenosis

Dear Ask The Doctor: I have had surgery for bulging disks and spinal stenosis. I am still in chronic pain and don'tknow what to do. Can you please help?

Dear Debbie: Sometimes the damaged produced by the compression on the spinal nerves before the surgery is so severe that even after the decompression the back pain may persist. Usually a nerve root compression can cause acute or chronic  back pain and is associated with radiculopathy (nerve damage due to the sustained compression). However, radiculopathy is not a cause of back pain; rather, nerve root impingement, muscle spasm (related to the pain), disc herniation, facet arthropathy, and other conditions are the  causes of back pain. Lumbosacral radiculopathy, like other forms of radiculopathy, results from nerve root impingement and/or inflammation that has progressed enough to cause neurologic symptoms in the areas that are supplied by the affected or compressed nerve. During the acute phase of the pain, the physical therapy is very important and involves the use of ultrasound, TENS, heat to control pain, teaching you back-protection techniques (e.g., proper lifting, posture awareness). A lumbar stabilization program is also useful in  instructing you in various techniques to control  back pain, and you also can work on strengthening the stabilizing muscles of the lumbar spine. If after follow a physical therapy program, and try every conservative measure the pain and the neurological symptoms do not improve, then the orthopedic surgeon has to re evaluate you to discuss other treatment  possibilities to control pain.