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Pain After Spine Surgery: Why It Happens and What Can Help

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By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 9 min read

🎧 Listen to this guideAudio version coming soon. Narrated in Mr Sadek’s voice using AI voice technology, from a script he has reviewed.

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Key points

  • Some pain after spine surgery is normal. It usually eases over the following weeks, and most people are back to their usual activities within about three months.
  • Pain that carries on beyond normal healing is now called persistent spinal pain syndrome type 2, a term that replaces “failed back surgery syndrome”.
  • It is common: studies suggest it affects somewhere between about 1 in 10 and 4 in 10 people after lumbar surgery.
  • There are many possible causes. Finding the most likely one guides what will help.
  • Help usually combines activity, physiotherapy and psychological support. Repeat surgery is only for a clear cause that can be corrected.

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After spine surgery, contact your surgical team or NHS 111 straight away, or go to A&E, if you have:

  • a wound that is hot, red, swollen, oozing or opening up;
  • a high temperature, or you feel shivery and generally very unwell;
  • new or worsening pain, weakness or numbness in your legs;
  • new numbness around your bottom or genitals, or new problems controlling your bladder or bowels (go to A&E or call 999).

Numbness in the saddle area with bladder or bowel changes can be a sign of cauda equina syndrome, which is an emergency.[1]

What is normal after spine surgery?

An operation on the spine involves a cut in the skin and work on the muscles, bone and other tissues. Pain from this healing is expected. The NHS advises that after lumbar decompression you may need painkillers for several weeks, many people return to work after 4 to 6 weeks, and it can take up to 12 weeks to get back to all your usual activities.[1]

Recovery is rarely a straight line. Good days and bad days are normal, especially as you become more active. Leg symptoms from a nerve that was squeezed for a long time can take a while to settle. Physiotherapy is often arranged to help you move well again.[1] If you are unsure whether your progress is normal, ask your surgical team.

When pain persists: a new name

Pain that continues or comes back after spine surgery used to be called “failed back surgery syndrome”. Many specialists felt this label was unhelpful and misleading. It suggests that the operation, or even the patient, has failed, and it says nothing about the cause.[2]

In 2021, an international expert group proposed a new term, persistent spinal pain syndrome (PSPS), designed to fit the World Health Organization’s latest disease classification (ICD-11). It has two types:[2]

  • Type 1: persistent spinal pain where no relevant spinal surgery has been done.
  • Type 2: persistent spinal pain after spinal surgery.

The same group describes pain by where it is felt (mainly back, mainly leg, or both) and by its nature: from irritated tissues, from nerves, from changes in how the nervous system handles pain, or a mix.[2] NICE defines chronic pain as pain that lasts or keeps coming back for more than three months.[3]

How common is it?

Figures vary because studies use different definitions and follow people for different lengths of time. A 2018 review describes a generally accepted range of 10% to 40% after lumbar surgery.[4] A UK study of more than 10,000 adults in England found that 20.8% met criteria for persistent pain after lumbar surgery.[5] A 2023 analysis pooling 16 studies after lumbar discectomy found about 15%.[6]

So you are not alone, and persistent pain does not mean anyone did something wrong. It does mean the pain deserves a careful look.

Why does pain persist?

There is often more than one reason. Doctors find it useful to think about factors before, during and after the operation.[4]

A disc prolapse coming back

After a discectomy, more disc material can bulge out again, at the same level or a nearby one. Reported rates range from 2% to 25% in one review,[7] and 6% to 23% in another.[4] Smoking, diabetes and obesity may raise the risk.[7]

Wear at the next level (adjacent segment disease)

After a spinal fusion, the levels above and below take more strain and can wear. In one study of 215 people, the predicted need for further surgery at a neighbouring level was 16.5% at five years and 36.1% at ten years.[8] A review puts the rate of symptoms from this at about 27%.[4]

Scar tissue and nerve irritation

Healing always forms some scar tissue. Scar around a nerve root is thought to contribute to pain in 20% to 36% of people with persistent pain after surgery. A nerve can also be irritated or damaged by being handled during the operation.[4] The NHS lists nerve damage as an uncommon but serious complication.[1] Nerve pain often feels burning, shooting or electric.

Instability or problems with a fusion

Removing bone and joint to free the nerves can occasionally leave a segment unstable, so that one bone slips on another.[4][1] After a fusion, a screw may sit poorly, or the bones may not join fully.[4]

Infection

Infection is uncommon. Warning signs include a fever, feeling unwell, and a wound that is red, leaking or opening.[4][1]

The original problem or plan

Sometimes the scan showed a real problem, but it was not the main source of pain. Examples include mainly back pain treated with an operation designed for leg pain, a nerve not freed fully, or pain coming from the hip or sacroiliac joint.

A more sensitive nervous system

When pain goes on for months, the nervous system can become more sensitive, so that signals are amplified. This is sometimes called central sensitisation, or nociplastic pain.[2] Stress, low mood, poor sleep and worry can make pain harder to bear and are linked with poorer results from surgery.[4] This does not mean the pain is imagined. It is real pain, and it can be treated.

How is it assessed?

NICE advises a person-centred assessment that looks at the causes of pain and at how it affects your sleep, mood, work and relationships.[3] Your specialist will take a careful history, checking for warning signs, and examine you, including your hips and sacroiliac joints. Tests are chosen to answer specific questions:[4]

  • MRI with contrast (an injected dye) can help tell scar tissue from a new disc prolapse, because scar takes up the dye and disc material does not.
  • CT scanning shows bone in detail, for example whether a fusion has healed and where screws sit.
  • X-rays, including bending views, show alignment and any abnormal movement.
  • Blood tests, such as a blood count and markers of inflammation, are used if infection is suspected.

These tests are listed in a 2018 review of persistent pain after surgery.[4] Not everyone needs every test. Sometimes no single cause is found, and NICE recognises that this can happen.[3]

What can help?

Staying active, exercise and physiotherapy

NICE advises information and support to help you manage your own pain, encouragement to keep up normal activities, and help to return to work. It suggests group exercise programmes, with manual therapy such as manipulation or massage only as part of a package that includes exercise.[9] For chronic pain without a clear cause, NICE recommends a supervised group exercise programme and staying physically active.[3]

Psychological support and pain management programmes

NICE suggests considering cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) for chronic pain without a clear cause. These help you change how pain affects your life, not just how much it hurts.[3] Many NHS pain services also run pain management programmes, which combine exercise, education and psychological approaches. NICE reviewed these and found small benefits in quality of life for mixed types of chronic pain, mostly from studies in low back pain, but it did not make a recommendation for or against them.[3] NICE also removed its back pain recommendation on combined physical and psychological programmes in July 2026, after a review found it might be out of date.[9]

Medicines

Medicines usually play a supporting role. NICE advises against several commonly used painkillers for long-term back pain and sciatica, and advises doctors not to start strong painkillers for long-term pain that has no clear cause.[9][3] Your GP, surgeon or pain team can talk through which options are suitable for you.

If you already take regular painkillers, do not stop them suddenly. NICE advises reviewing them with your prescriber, including how to reduce them safely.[9][3]

Spinal cord stimulation

A spinal cord stimulator is a small implanted device that sends mild electrical signals to the spinal cord to change how pain is felt. NICE recommends it as an option for adults with nerve pain that has lasted at least six months despite usual treatment, scoring at least 50 out of 100 for severity, after a successful trial of stimulation and assessment by a specialist pain team.[10]

The evidence depends on the type of pain. In the PROCESS trial of 100 people with mainly leg nerve pain after surgery, 48% with a stimulator had at least half their leg pain relieved at six months, compared with 9% on medical care alone. By 12 months, 32% of people with a stimulator had device-related complications.[11] A smaller trial found stimulation more successful than repeat surgery for persistent leg pain (9 of 19 people compared with 3 of 26).[12] By contrast, a 2023 Cochrane review of stimulation for low back pain concluded that it probably does not give lasting benefit that outweighs its costs and risks.[13]

Repeat surgery

Another operation is only advised when there is a clear cause that matches your symptoms and can be corrected, such as a new disc prolapse pressing on a nerve, an unstable segment or a fusion that has not healed. Results tend to be poorer with each repeat operation.[4] NICE also advises against spinal injections for low back pain.[9]

Coping day to day

  • Pace yourself. Spread activity through the day and build up gradually, rather than doing a lot on a good day and paying for it later.
  • Expect flare-ups. NICE notes that chronic pain often fluctuates and that life can improve even when the pain does not.[3]
  • Set goals that matter to you, such as walking to the shops, returning to work or a hobby.
  • Look after your sleep and mood, and tell your GP if you feel low or anxious.
  • If you smoke, stopping can help healing and may lower the risk of another disc prolapse.[7]

When to seek help

See your GP or contact your surgical team if your pain is not improving as expected, if it is still significant after about three months, or if it is affecting your sleep, mood or work. Use the urgent list at the top of this page for warning signs. The NHS advises contacting the hospital or NHS 111 if you develop new leg pain, weakness or numbness, bladder or bowel problems, or a hot, red or oozing wound.[1]

Frequently asked questions

Is it normal to still have pain 6 weeks after back surgery?

Often, yes. After lumbar decompression the NHS says you may need painkillers for several weeks, many people return to work after 4 to 6 weeks, and it can take up to 12 weeks to get back to all your usual activities.[1] NICE only describes pain as chronic once it has lasted more than three months.[3] If your pain is getting worse rather than better, or you have new leg pain, weakness or numbness, contact your surgical team or NHS 111.[1]

Why do I still have sciatica after a discectomy?

There are several possible reasons. More disc material can bulge out again, which reviews report in 2% to 25%[7] and 6% to 23%[4] of people after discectomy. Scar tissue around the nerve root, a nerve that was not fully freed, or a nerve that was irritated during surgery can also play a part.[4] An MRI with contrast can help tell a new disc prolapse from scar tissue.[4] Your surgical team can advise whether a scan is needed.

Can scar tissue cause pain after back surgery?

It can contribute, but it is rarely the whole story. Some scarring is a normal part of healing. Scar around a nerve root is thought to contribute to pain in 20% to 36% of people with persistent pain after surgery.[4] On an MRI with contrast, scar tissue takes up the dye while disc material does not, which helps doctors tell them apart.[4] Persistent pain usually has more than one cause, so treatment is based on the whole picture rather than the scar alone.[4]

Will another operation fix my pain?

Only if there is a clear cause that can be corrected. Results tend to be less good with each repeat operation.[4] In a small trial of people with persistent leg pain who were candidates for repeat surgery, spinal cord stimulation was more successful than another operation.[12] Your specialist will explain whether surgery is likely to help you.

Can I get spinal cord stimulation on the NHS?

Yes, for some people. NICE recommends it as an option for adults with long-term nerve pain that has lasted at least six months despite usual treatment, after assessment by a specialist pain team and a successful trial of stimulation.[10] It has the best evidence for leg nerve pain after surgery, where a trial found 48% had at least half their leg pain relieved at six months, compared with 9% on medical care alone.[11] For low back pain, a 2023 Cochrane review found it probably gives no lasting benefit.[13]

Should I take stronger painkillers if my pain does not go away?

Usually not. NICE advises against opioids for chronic low back pain and chronic sciatica.[9] For chronic pain without a clear cause, it advises against starting opioids and several other medicines.[3] If you already take strong painkillers, do not stop suddenly. NICE advises a shared review with your prescriber, including a discussion of withdrawal effects.[9][3] Your GP or pharmacist can help you plan this safely.

Is it safe to exercise with ongoing pain after spine surgery?

In most cases, yes, once your surgical team is happy with your healing. Follow their advice on activities to avoid in the early weeks.[1] After that, NICE encourages keeping up normal activities and suggests group exercise programmes for back pain.[9] For long-term pain, it recommends a supervised group exercise programme and staying physically active.[3] A physiotherapist can help you build up gradually.

When should I get urgent help after spine surgery?

The NHS advises contacting the hospital or NHS 111 if, after lumbar decompression, you get new pain, weakness or numbness in your legs, problems controlling your bladder or bowels, or a wound that is hot, red, itchy or oozing.[1] A fever or feeling very unwell can be signs of infection.[4] New numbness around your bottom or genitals with bladder or bowel changes can mean cauda equina syndrome: go to A&E or call 999 straight away.

Further reading

References

  1. NHS. Lumbar decompression surgery. NHS website, page last reviewed 10 March 2026. Link
  2. Christelis N, et al. Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11. Pain Med. 2021;22(4):807-18. Link
  3. National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). Published 7 April 2021. Link
  4. Sebaaly A, et al. Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian Spine J. 2018;12(3):574-85. Link
  5. Weir S, et al. The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). BMJ Open. 2017;7(9):e017585. Link
  6. Alshammari HS, et al. Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis. Cureus. 2023;15(7):e41841. Link
  7. Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine J. 2019;9(2):202-9. Link
  8. Ghiselli G, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004;86(7):1497-503. Link
  9. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Last updated 29 July 2026. Link
  10. National Institute for Health and Care Excellence. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin (TA159). Published 22 October 2008. Link
  11. Kumar K, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1-2):179-88. Link
  12. North RB, et al. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98-106. Link
  13. Traeger AC, et al. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023;3(3):CD014789. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026