Patients with neuropathic pain secondary to failed back surgery syndrome (FBSS) typically experience persistent pain, disability, and reduced quality of life. We hypothesised that spinal cord stimulation (SCS) is an effective therapy in addition to conventional medical management (CMM) in this patient population. We randomised 100 FBSS patients with predominant leg pain of neuropathic radicular origin to receive spinal cord stimulation plus conventional medical management (SCS group) or conventional medical management alone (CMM group) for at least 6 months. The primary outcome was the proportion of patients achieving 50% or more pain relief in the legs. Secondary outcomes were improvement in back and leg pain, health-related quality of life, functional capacity, use of pain medication and non-drug pain treatment, level of patient satisfaction, and incidence of complications and adverse effects. Crossover after the 6-months visit was permitted, and all patients were followed up to 1 year. In the intention-to-treat analysis at 6 months, 24 SCS patients (48%) and 4 CMM patients (9%) (p<0.001) achieved the primary outcome. Compared with the CMM group, the SCS group experienced improved leg and back pain relief, quality of life, and functional capacity, as well as greater treatment satisfaction (p

Paravertebral nerve block produces ipsilateral analgesia through injection of local anaesthetic alongside the vertebral column. It is advocated predominantly for unilateral surgery, for example, thoracotomy, chest wall trauma, breast surgery, cholecystectomy, herniorrhaphy or renal surgery, although it can be used as a bilateral technique. In chronic pain, it is used for the treatment of benign or malignant neuralgia. There is confusion over the indications for this block and it is apparent that much ignorance surrounds this subject. Its place alongside extradural, intercostal and interpleural analgesia requires elucidation. The aim of this review is to describe the anatomy, techniques, analgesia, side effects and complications of paravertebral nerve blocks so that a more considered use of this form of analgesia can be undertaken.

At 24 months of SCS treatment, selected failed back surgery syndrome patients reported sustained pain relief, clinically important improvements in functional capacity and health-related quality of life, and satisfaction with treatment.