Dear Dr. Roach: My wife is suffering from a failed back surgery that was caused by a neurosurgeon. The operation was four years ago, and she also had a spine stimulator that was implanted three years ago. Her pain management doctor said that she’ll get progressively worse as current medical care hasn’t improved for this condition. She’s currently consuming the maximum dose of pain medication. To your knowledge, is there any “light at the end of the tunnel” for patients with chronic arachnoiditis? — B.B.

Answer: Persistent spinal pain after surgery (PSPS), which was formerly called “failed back surgery syndrome,” is a difficult diagnosis for patients as the treatments aren’t optimal. Although infections are a common cause of arachnoiditis (inflammation in the arachnoid, which is one of the coverings of the spinal cord), spinal fusion surgery is another common cause. The major symptoms are pain, abnormal sensations and sometimes weakness — most commonly in the lower back and legs. An MRI scan usually confirms the diagnosis.

Sometimes surgery is attempted, but it can make symptoms worse. So, it’s only suggested for some individuals. Pain medications are routinely used — often at very high doses, as seems to be the case for your wife. Spinal cord stimulators and epidural injections can also be beneficial for some people. Physical therapy can be of great benefit.

I wouldn’t say that it’s definite that people with PSPS and arachnoiditis are destined to get progressively worse. Long-term studies (up to 21 years) have shown that most people have a stable course, although symptoms can fluctuate with some days being better and others being worse.

I’m very sorry for both you and your wife, but I don’t know of any dramatic improvements that are on the horizon for this difficult-to-treat condition. Her story is an important reminder for my readers that back surgery can have bad outcomes. Many people don’t know about this syndrome.