Case of the Month #16: Persistent Pain Following Spinal Surgery by Dr Lorraine de Gray

Published: 01/06/2022

Questions and points for discussion

1.    Pain that persists following spinal surgery is frequently alluded to as Failed Back Surgery Syndrome – what is your view on this nomenclature?

2.    An ethical dilemma – is it right that a patient should be “coerced” into going to a pain clinic because of being threatened to have her medication withdrawn?

3.    How do you engage with this patient?

4.    How can we prevent patients ending up in this situation? 

5.    Think how different members of a multidisciplinary pain team can potentially help her – how will you convince her of this?

6.    How will you manage her medication? How do you convince her that coming down on her medication is unlikely to see any escalation in her pain levels?  What is the likely impact of her current medication on her levels of fatigue and iron deficiency anaemia?

7.    How do you reduce opioids, gabapentinoids and benzodiazepines is a safe and acceptable way?

8.    What would your overall management plan be?