title: An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management.
abstract: OBJECTIVE
  Failed back surgery syndrome (FBSS) patients experience pain, functional disability, and reduced health-related quality of life (HRQoL) despite anatomically successful surgery. Examining sub-dimensions of health outcomes measures provides insight into patient well-being.
  
  
  METHODS
  The international multicenter PROCESS trial collected detailed HRQoL (EuroQol-5D; Short-Form 36) and function (Oswestry Disability Index) information on 100 FBSS patients.
  
  
  RESULTS
  At baseline, patients reported moderate-to-severe leg and back pain adversely affecting all dimensions of function and HRQoL. Compared with conventional medical management alone, patients also receiving spinal cord stimulation (SCS) reported superior pain relief, function, and HRQoL at six months on overall and most sub-component scores. The majority of these improvements with SCS were sustained at 24 months. Nonetheless, 36-40% of patients experienced ongoing marked disability (standing, lifting) and HRQoL problems (pain/discomfort).
  
  
  CONCLUSIONS
  Longer-term patient management and research must focus on these refractory FBSS patients with persisting poor function and HRQoL outcomes.
authors: Department of Pain & Anaesthesia, James Cook University Hospital, Middlesbrough, Cleveland, UK;             Department of Neurosurgery, Regina General Hospital, Regina, Saskatchewan, Canada;             Neuromodulation Centre EHC Hospital, Morges, & Anaesthesia Service, CHUV, Lausanne, Vaud, Switzerland; and             Peninsula Medical School, Universities of Exeter and Plymouth, Devon, UK.
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