The medical profession is one where the area of consultation is weak. If more surgery does not guarantee some improvement then the goal of management is pain relief, rehabilitation, and the return to as near normal function as possible. Goals and expectations must be realistic. The patient must be told in certain terms what their responsibilities are. Plus, the physician and patient must be held accountable for the goals that are to be achieved.
Many patients do well with appropriate medications and a general rehabilitation program.
However, when the basics fail, more aggressive methods should be considered. The nature of these will depend on the experience and expertise of the pain specialist. The one message that I convey to my patients is that pain relief can be achieved.