Chua Richelle Huey Bing, Loo Guo Hou, Hl Nani, Muthkumaran Guhan, Ritza Kosai Nik
Upper GI and Metabolic Surgery Unit, Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS.
Upper GI and Metabolic Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.
Cureus. 2025 Feb 19;17(2):e79331. doi: 10.7759/cureus.79331. eCollection 2025 Feb.
Failed back surgery syndrome (FBSS) poses a significant challenge in chronic pain management, particularly in patients with obesity, where excess weight exacerbates spinal strain and pain. Bariatric surgery has been explored as a potential adjunctive treatment for pain relief by reducing mechanical stress and systemic inflammation. We report the case of a 42-year-old woman with a history of FBSS, chronic back pain, narcolepsy, rheumatoid arthritis, and obesity, who underwent laparoscopic sleeve gastrectomy as part of a multidisciplinary pain management strategy. Despite having a spinal cord stimulator for pain control, she remained dependent on opioids, gabapentin, and amitriptyline. Following an uneventful surgery, postoperative pain was effectively managed with a ketamine infusion, leading to significant pain score reduction. The patient was discharged with an optimized pain regimen and demonstrated early improvements in mobility and overall well-being. This report highlights the potential role of bariatric surgery in managing chronic pain in patients with FBSS and obesity. It underscores the importance of a multidisciplinary approach, preoperative planning, and tailored postoperative pain management in optimizing outcomes. Further research is warranted to evaluate the long-term impact of bariatric surgery on chronic pain management and functional recovery in this patient population.
失败的脊柱手术综合征（FBSS）在慢性疼痛管理中构成了重大挑战，尤其是在肥胖患者中，超重会加剧脊柱劳损和疼痛。减肥手术已被探索作为一种潜在的辅助治疗方法，通过减轻机械应力和全身炎症来缓解疼痛。我们报告了一例42岁女性患者，她有FBSS、慢性背痛、发作性睡病、类风湿性关节炎和肥胖病史，作为多学科疼痛管理策略的一部分，她接受了腹腔镜袖状胃切除术。尽管她有脊髓刺激器用于控制疼痛，但她仍然依赖阿片类药物、加巴喷丁和阿米替林。手术顺利完成后，通过静脉输注氯胺酮有效控制了术后疼痛，使疼痛评分显著降低。患者出院时采用了优化的疼痛治疗方案，其活动能力和整体健康状况有了早期改善。本报告强调了减肥手术在管理FBSS和肥胖患者慢性疼痛方面的潜在作用。它强调了多学科方法、术前规划和量身定制的术后疼痛管理在优化治疗效果方面的重要性。有必要进行进一步研究，以评估减肥手术对该患者群体慢性疼痛管理和功能恢复的长期影响。
