Chronic Pain After Back Surgery: Why Pain Can Persist and What the Latest Research Reveals

Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.

Chronic Pain After Back Surgery: Why Pain Can Persist and What the Latest Research Reveals

If you've had back surgery but continue to experience ongoing pain, you're not alone. A growing body of research shows that persistent pain following spinal surgery affects a significant number of people and requires a more comprehensive approach than simply focusing on the spine itself.

At Health Wise Chiropractic, we regularly support patients from Sunbury, Melton and surrounding communities who continue to experience pain, stiffness, reduced mobility and functional limitations following spinal surgery. New research provides important insights into why this happens and what treatments may help improve quality of life.

What Is Persistent Spinal Pain Syndrome (PSPS-T2)?

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), previously known as "Failed Back Surgery Syndrome" (FBSS), refers to ongoing pain that continues after spinal surgery.

Historically, the term "failed back surgery syndrome" implied that the surgery itself had failed. However, modern research recognises that persistent pain is often driven by complex neurological, inflammatory, physical and psychological factors rather than a single surgical issue.

Researchers now view PSPS-T2 as a chronic pain condition involving:

• Ongoing inflammation

• Nerve sensitisation

• Reduced physical conditioning

• Scar tissue formation

• Psychological stress

• Altered pain processing within the nervous system

• 
  

How Common Is Chronic Pain After Back Surgery?

The latest systematic review published in 2026 analysed 100 studies and found:

📊 10–40% of patients continue to experience significant pain following lumbar decompression or spinal fusion surgery.

This means thousands of Australians each year may undergo surgery expecting pain relief but continue to experience:

• Lower back pain

• Leg pain (sciatica)

• Numbness and tingling

• Reduced mobility

• Difficulty exercising

• Dependence on pain medications

• 
  

Why Does Pain Persist After Surgery?

Research identified several common contributors.

1. Scar Tissue Formation

Epidural fibrosis (scar tissue around spinal nerves) was identified in up to:

📊 36% of persistent pain cases

Scar tissue can create ongoing irritation, inflammation and nerve tension.

2. Adjacent Segment Degeneration

Following spinal fusion, neighbouring spinal joints often experience increased stress.

Research found:

📊 Up to 30% of fusion patients develop adjacent segment degeneration within 10 years.

3. Persistent Nerve Sensitisation

Even when the original spinal problem has been corrected, the nervous system can remain highly sensitive and continue generating pain signals.

4. Physical Deconditioning

Reduced activity often leads to:

• Weak spinal muscles

• Loss of endurance

• Reduced balance

• Increased disability

The research repeatedly highlighted the concept of the "deconditioned back" as a major contributor to long-term disability.

The Hidden Health Risks of Ongoing Back Pain

One of the most concerning findings from the review was the broader impact chronic pain can have on overall health.

Researchers found strong associations between PSPS-T2 and:

• Depression

• Anxiety

• Sleep disturbances

• Reduced physical activity

• Social isolation

• Increased healthcare utilisation

Long-term observational studies also identified associations with:

• Cognitive decline

• Increased all-cause mortality

Importantly, these outcomes appear to be largely driven by inactivity, medication dependence and reduced participation in life rather than the spinal condition itself.

Does Spinal Cord Stimulation Work?

Spinal cord stimulation (SCS) is often considered the gold-standard intervention for severe persistent pain after spinal surgery.

The review found:

📊 Patients receiving spinal cord stimulation were over 10 times more likely to achieve at least 50% pain reduction compared with conventional medical management.

However, there was a major limitation.

The "Opioid Paradox"

Researchers analysed outcomes from:

📊 12,632 patients

Despite achieving pain reduction, spinal cord stimulation did not significantly reduce long-term opioid use.

This finding highlights that pain relief alone does not automatically change long-standing medication dependence or pain behaviours.

What Conservative Treatments Showed Benefits?

While advanced medical interventions can help some patients, the review found encouraging evidence for conservative rehabilitation approaches.

Spinal Manipulative Therapy

Researchers found that carefully applied spinal manipulative therapy improved functional outcomes and disability scores compared with standard physiotherapy in some patients.

Importantly, treatment was directed to non-fused spinal regions and adjacent joints rather than surgically fused segments.

High-Intensity Laser Therapy

High-intensity laser therapy (HILT) demonstrated improvements in:

• Functional disability

• Movement tolerance

• Muscle conditioning

Researchers noted that laser therapy works best as an adjunct to active rehabilitation rather than a standalone treatment.

Why Functional Recovery Matters More Than Pain Scores

One of the strongest messages from the research was that successful recovery is not simply about reducing pain.

Instead, long-term success depends on restoring:

✅ Walking capacity

✅ Strength

✅ Mobility

✅ Confidence in movement

✅ Participation in work and hobbies

✅ Physical independence

Researchers concluded that focusing exclusively on pain reduction may overlook the most important outcomes for long-term health.

Exercises Commonly Recommended for Persistent Back Pain

While every patient requires an individual assessment, research supports programs that improve spinal stability and physical conditioning.

Walking Program

Start with:

• 10–15 minutes daily

• Gradually increase duration

• Maintain comfortable pace

Walking improves circulation, spinal nutrition and overall conditioning.

Bird Dog

1. Begin on hands and knees.

2. Extend one arm and opposite leg.

3. Hold for 5–10 seconds.

4. Alternate sides.

Perform 8–10 repetitions each side.

Glute Bridge

1. Lie on your back with knees bent.

2. Lift hips toward the ceiling.

3. Squeeze glutes at the top.

4. Lower slowly.

Perform 10–15 repetitions.

Modified McGill Curl-Up

1. One knee bent, one leg straight.

2. Gently raise shoulders from the floor.

3. Hold for 5–10 seconds.

4. Lower slowly.

Repeat 8–10 times.

Side Plank (Modified)

1. Support body on forearm and knees.

2. Lift hips off floor.

3. Hold 10–20 seconds.

Repeat 3–5 times each side.

Always seek professional advice before commencing exercises after spinal surgery.

How Health Wise Chiropractic Can Help

At Health Wise Chiropractic, we understand that persistent pain after surgery is often influenced by multiple factors beyond the spine itself.

Our evidence-informed approach focuses on:

• Comprehensive movement assessment

• Gentle chiropractic care where appropriate

• Exercise rehabilitation

• Mobility restoration

• Postural advice

• Strength and conditioning strategies

• Laser therapy

• Functional recovery programs

We work with patients throughout Sunbury, Melton, Diggers Rest, Gisborne, Bacchus Marsh and surrounding areas to help improve movement, confidence and quality of life.

Key Takeaways

✔ Between 10–40% of patients experience persistent pain after spinal surgery.

✔ Scar tissue may contribute to ongoing symptoms in up to 36% of cases.

✔ Adjacent segment degeneration affects up to 30% of fusion patients within a decade.

✔ Spinal cord stimulation can significantly reduce pain but may not reduce long-term opioid use.

✔ Research strongly supports multidisciplinary care focused on function, exercise and rehabilitation.

✔ Long-term success is measured not just by pain reduction, but by improved mobility, strength and participation in everyday life.

How Chiropractic Care May Help

At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.

Treatment may include:

• Chiropractic adjustments

• Postural assessment

• Soft tissue therapy

• Corrective exercises

• Ergonomic advice

• Laser therapy

• Shockwave therapy

• Spinal decompression therapy

We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.

About the Author

Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.

He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.

His treatment focus includes:

• Chiropractic adjustments

• Sports chiropractic

• Massage therapy

• Shockwave therapy

• Laser therapy

• Non-surgical spinal decompression

Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.

https://youtube.com/shorts/BJN50uapngk

Belgaumkar AG, Gaidhankar NT, N V P. Treatment Options for Chronic Pain After Spine Surgery: A Systematic Review and Meta-Analysis of Interventional, Pharmacological, and Rehabilitative Strategies. Cureus. 2026 May 1;18(5):e108122. doi: 10.7759/cureus.108122. PMID: 42231986; PMCID: PMC13223383.