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Mar 2016

ASK THE EXPERTS - March 2016


Non-Drug Therapy Relieves Pain After Failed Back Surgery
By Deepali Gupta, MD, DABA


Over 300,000 back surgeries are performed in the U.S. per year. Unfortunately, 1 out of every 10 patients continues to experience back or leg pain even after surgery. Failed back surgery syndrome (FBSS), also known as post-laminectomy syndrome, occurs in a number of patients who have undergone back surgeries such as laminectomy, discectomy, or lumbosacral fusion.  It can be a severely disabling, long-lasting complication of back surgery.  

At Garden State Medical Center, we usually begin treatment with conservative measures such as non-steroidal anti-inflammatory medications, opioids, and physical therapy. If these do not work, patients are offered minimally invasive techniques such as epidural injections to provide pain relief. These injections offer temporary relief that can last anywhere from a few days, to a few months. When performed a few times a year, these injections can sometimes be enough to help patients manage their chronic pain long-term.


However, some patients do not find relief with any of these techniques and are often left with chronic lower back pain that can severely impact their daily lives. They are unable to continue working, cannot perform daily activities, and eventually do not want to leave their house due to severe pain.  These patients are candidates for a spinal cord stimulator (SCS) therapy that may provide substantial pain relief and change the way they live their lives. SCS therapy is covered by most insurance, including Medicare.


SCS is a therapy that is FDA approved to treat neuropathic pain syndromes including failed back surgery syndrome, chronic regional pain syndrome, diabetic and vascular neuropathic pain. SCS therapy has been used since 1967 to treat lower back pain refractory to other modalities of treatment. Failed back surgery syndrome is currently the most common use for SCS in the United States.


SCS is an implantable device, comprised of a small transmitter and two soft wire leads. The leads have electrodes at the tips which transmit a pulsed electrical energy near the spinal column. This pulsed energy is known to block painful signals that are being transmitted from the back. Long term follow-up studies have determined a 50-75% success rate at 5 years for SCS therapy use for FBSS. It has been shown to provide significant long-term pain relief along with reducing the need for opioid pain medications.


The SCS procedure starts with a trial period to see if the device will work for you. The leads are placed near the nerves through a needle – there is no incision and you go home within an hour following the procedure. If the device proves successful at reducing pain, the patient returns to have a permanent device implanted.

The procedure for the permanent implant is very similar to the trial, except a small incision is made to insert the device under the skin. There is no hospital stay involved for either the trial or the permanent placement.
The procedure is 100% reversible if the patient does not get relief or wishes to have it removed.

For more information about Dr. Gupta and GSMC, visit: or call 732-202-3000

About the doctor
Deepali Gupta, MD is a board certified Anesthesiologist and fellowship trained pain management specialist. She specializes in the evaluation and management of complex spine-related pain stemming from disorders such as spinal stenosis, degenerative disc disease, disc herniation, failed back/neck surgeries, as well as joint diseases. She employs the use of a multidisciplinary approach to pain including medication, procedures aimed at treating neck, back, and joint pain, SCS, as well as physical therapy. She has a particular interest in neuromodulation (SCS) as well as minimally invasive pain interventions.


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