Still in Pain After Back Surgery?

Published March 4, 2026 · 8 min read

By Tauri Urbanik, Pain Science Researcher

You did the hardest thing. It didn't work.

Surgery is a big deal. You weighed the risks. You went through the prep, the procedure, the recovery. Weeks or months of careful rehabilitation. You expected to come out the other side without pain.

And then the pain came back. Or it never fully left. Or it got worse.

Nobody wants to hear this after surgery. But you deserve to understand what actually happened and, more importantly, what you can do about it now.

You're not the only one. This happens a lot.

That's not a small number. Up to 4 out of every 10 people who have back surgery continue to hurt afterward. Doctors call it Failed Back Surgery Syndrome, or FBSS. It's common enough to have its own diagnosis code.

But the name is misleading. In many cases, the surgery didn't fail. It successfully addressed the structural finding. The disc got trimmed. The spine got fused. The procedure did what it was supposed to do.

The problem? The structural finding wasn't causing the pain.

Surgery targets structure. But your pain might not be structural.

Here's something most people aren't told before surgery. MRI scans of over 3,000 pain-free people found that disc bulges, degeneration, and herniations are incredibly common in people who feel perfectly fine (Brinjikji et al., AJNR, 2015↗). At age 50, nearly 60% of pain-free people have disc bulges. At 80, 96% have degeneration.

So the thing your surgeon removed or fused? Millions of people have the exact same finding and feel nothing.

This doesn't mean your surgeon was wrong to try. Surgery is the standard of care when imaging shows structural issues. But research increasingly shows that chronic back pain is often neuroplastic. Your brain learned a pain pattern and got stuck in it. Surgery can't fix a neural pathway.

Brain research explains why surgery misses

Brain connectivity, not injury severity, is the best predictor of who develops chronic pain. A study in Nature Neuroscience showed that the structure of certain brain circuits determines whether acute pain becomes chronic (Hashmi et al., Brain, 2013↗).

That means two people can have the exact same disc herniation. One recovers fully. The other develops chronic pain. The difference isn't in their spines. It's in their brains.

If your brain was generating the pain before surgery, it'll keep generating it after. Because the operation never touched the actual source.

Signs your post-surgical pain is neuroplastic

Think about your pain since surgery. Does it move around? Is it worse on stressful days? Does it not match the exact surgical site? Does it change with your mood or sleep? Do you have pain in areas that weren't even operated on?

These patterns suggest neuroplastic pain. And they explain why surgery didn't work. It wasn't the wrong surgery. It was the wrong target.

T

Tom, 55

back pain for 3 years post-surgery

Tom had a spinal fusion at L5-S1. The surgery went perfectly. His surgeon was satisfied. But six months later, the pain was back. Different location. More diffuse. Worse during stressful periods at work. Better on vacations. His surgeon couldn't explain it. When Tom learned about neuroplastic pain, he realized the pattern had been there all along. His original pain had started during a divorce. It moved around. It changed with his emotions. Eight weeks into brain retraining, he felt better than he had in years.

Composite story based on common patient patterns. Not a specific individual.

What to do now

You haven't failed at recovery. The approach just targeted the wrong thing. Brain retraining works by teaching your nervous system that the danger signals are false alarms. It doesn't matter whether you've had surgery or not.

A clinical trial published in JAMA Psychiatry showed that 66% of chronic back pain patients became pain-free or nearly pain-free with Pain Reprocessing Therapy in just 4 weeks (Ashar et al., JAMA Psychiatry, 2022↗). Results held at one year. No more surgery. No more injections. Just a different understanding of where the pain actually comes from.

Frequently asked questions

Why do I still have back pain after surgery?

Surgery fixes structural problems. But 10-40% of back surgery patients develop ongoing pain because the real cause was neuroplastic, not structural. Your brain learned a pain pattern that surgery can't address.

What is failed back surgery syndrome?

Failed back surgery syndrome (FBSS) is chronic pain that continues or worsens after spinal surgery. It affects 10-40% of surgical patients. Research suggests many of these cases involve neuroplastic pain that was misattributed to structural damage.

Can brain retraining help after failed back surgery?

Yes. Research shows 66% of chronic back pain patients became pain-free with Pain Reprocessing Therapy. Brain retraining targets the actual pain source, the nervous system, regardless of surgical history.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.DOI: 10.1001/jamapsychiatry.2021.2669
2. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.DOI: 10.3174/ajnr.A4173
3. Hashmi JA, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.DOI: 10.1093/brain/awt211