Persistent Spinal Pain Syndrome: a proposal for Failed Back Surgery Syndrome and ICD-11


The term “Failed Back Surgery Syndrome” (FBSS) is used as a diagnostic label for patients who have remaining or even worse pain or symptoms after spine surgery. Despite the term FBSS being problematic and unhelpful, it is commonly used in place of more descriptive and helpful labels. The term FBSS is misleading, and fails to identify if the surgery was unable to relieve the symptoms, or if the surgery caused or worsened symptoms. It provides no useful information about the potential cause(s) of the patient’s pain and symptoms and therefore does nothing to guide further appropriate diagnosis and treatment. It can leave patients feeling disappointed, depressed, and may lead to continuing or worsening symptoms.

In an attempt to address these issues, a panel of international medical experts was established. The panel critically evaluated the term FBSS and considered a list of candidate replacement terms. The panel selected and proposed a more appropriate and clinically meaningful replacement term: “Persistent Spinal Pain Syndrome” (PSPS). The term PSPS comprises two types, depending on whether the pain/symptoms are associated with surgery (Type 2) or not associated with surgery (Type 1).

Find the complete manuscript here.

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