Residual postsurgical back pain.

Residual Postsurgical Back Pain (RPP) is a complex problem, involving considerable etiologic and diagnostic confusion. About two-thirds of all patients enrolled in chronic pain centers in the United States suffer from RPP. More than 50 billion dollars are spent on the diagnosis and treatment of back pain in this country. In most cases, the etiology of the patient's complaints is multifactorial. Treatment is difficult and frequently involves surgical as well as non-surgical modalities. Surgical treatment is of value in a carefully selected group of patients, either those in whom the original procedure failed to correct the underlying abnormality or those who show evidence of compression of neural elements, or instability of vertebral column. Because extensive co-morbidity is often present, discrete operative intervention may not fully arrest the compete etiology of the patient's distress, and, indeed; may sometimes worsen the patient's complaints. Possible coexisting problems like degenerative disease or depression should be addressed in all patients prior to surgical intervention, so that the corrected variable is the preponderant cause of the patient's difficulty.