Aspects of the failed back syndrome: role of litigation

Abstract

Objective: A review that attempts to identify the mechanism and causation of persistent or recurring low back pain. Design: A personal assessment of clinical features with a selective review of the literature. Results: Thirty to forty per cent of our population aged 10 ± 65 years report that back trouble occurs on a monthly basis and in 1% to 8% this interferes with work. A de®nite patho-anatomical cause for the pain is demonstrable in only a minority. It can be deduced that psychosocial factors, including insurance bene®ts are of importance for this variation. Conclusions: Neither non-operative nor surgical procedures have a major impact on the capacity for work in this substantial minority of backache su erers. The main risk factors identi®ed are: Wrong diagnosis, repeated medical certi®cates for sickness bene®ts, failed surgery, symptoms incongruous with signs or imaging, multiple spinal procedures, poor social support and poor motivation, psychological illness, clinical depression before or after injury or operation. Pending compensation and delays in settlement are important additional features in claimants for compensation. For patients with unproven diagnostic labels such as`painbehaviour', no evidence exists that any type of surgery is cost e ective.

A preclinical post laminectomy rat model mimics the human post laminectomy syndrome

“…Clinical experience supports the view that the size of the failed post laminectomy patient group is not a small number (Atlas et al, 1996;Chiball et al, 2000;Devulder et al, 1995;Elimimian et al, 1999;Nachemson et al, 2004;Pearce, 2000;Revel et al, 1996). The socioeconomic costs in the US alone for back related injuries are calculated in the tens of billions of dollars annually (AAOS, 1999).…”

Pain behaviour in young immigrants having chronic pain: an exploratory study in primary care

“…One weakness in this study is that we failed to analyse secondary gains. For instance, ongoing litigation may affect the outcome of rehabilitation (Main and Spanswick, 1995; Pearce, 2000; Hoejsted et al ., 1999; Walsh and Dumitru, 1988). Another drawback may be the lack of a Swedish control group, but this might have proved impossible to obtain, because few Swedes in this age group have been on sick leave for long periods.…”

Failed back surgery syndrome—terminology, etiology, prevention, evaluation, and management: a narrative review

“…Patients receiving workers’ compensation often experience less favorable results after spinal surgery, characterized by increased pain, increased opioid use, decreased functional capacity, and reduced overall emotional well-being [ 16 ]. The influence of litigation must be considered as a significant variable that can intensify claims related to the severity and duration of symptoms, regardless of the medical or surgical treatment administered, underscoring the critical need to understand how legal processes affect symptom perception and reporting [ 17 ].…”