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.