Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11

Abstract

Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading and potentially troublesome. It misrepresents causation. Alternative terms have been suggested but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option – Persistent spinal pain syndrome – was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery and neuromodulation, as well as patients labelled with FBSS. Through a shift in perspective it could facilitate the application of the new ICD-11 classification and allow clearer discussion amongst medical professionals, industry, funding organisations, academia, and the legal profession.

Reply to the Letter: Failed back surgery syndrome, a term overdue for replacement

“…We concur with Christelis and colleagues that "persistent spinal pain syndrome (PSPS)," supplemented by the "type 2" designation, would be a much better term to start with -prior to further breakdown of diagnostic entities. It would also be preferable to the term "chronic pain after spinal surgery (CPSS)" which -as nicely outlined by Christelis and colleagues -would not be as precise and possibly misleading [1]. This debate is important because defining diagnoses more precisely will increase the validity of therapeutic studies in the future and along this way will benefit patient's care.…”

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), a Social Pain? Advocacy for a Social Gradient of Health Approach to Chronic Pain

“…Between 10% and 50% of patients who have undergone lumbar spinal surgery still experience the intense persistent pain and impaired function known as Failed Back Surgery Syndrome (FBSS), which has recently been proposed as Persistent Spinal Pain Syndrome type 2 (PSPS-T2) [1][2][3]. PSPS-T2 diagnosis is related to an illness trajectory.…”

Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study

“…Failed back surgery syndrome (FBSS), now known as Persistent Spinal Pain Syndrome type 2 (PSPS-T2), is characterized by persisting back and/or leg pain despite one or several spinal surgical procedures [1][2][3][4]. PSPS-T2 incidence remains devastating, affecting 10 to 40% of operated spine patients [5,6].…”