Back pain sucks! Chronic lower back pain affects almost every American at some point in their lives. The pain can be so severe that patients may desperately seek surgical options. Unfortunately, some patients do worse after back surgery. Failed back surgery syndrome (FBSS) is a problem that affects between 20% to 40% of patients. The causes of FBSS can vary and there are perioperative options that can improve outcomes. There are also treatment options for FBSS. We will discuss FBSS in detail and explore options to prevent, mitigate, and treat FBSS.