The Implementation of Persistent Spinal Pain Syndrome (PSPS): Mechanism-Based Recommendations

Abstract

Background: In 2021, the term persistent spinal pain syndrome (PSPS) was introduced. PSPS type 2 (PSPS-T2) replaced the unsatisfactory term failed back surgery syndrome (FBSS). PSPS type 1 (PSPS-T1) is a clinical picture of signs and symptoms of FBSS but without prior surgery. PSPS applies to any spinal level. There are multiple underlying mechanisms and treatments within PSPS. Therapeutic choices are not based on a common nomenclature. One consequence is that the desired outcomes of interventions are not reliably achieved. There is a need to redefine diagnostic clusters of PSPS based on the pain mechanism rather than just anatomic factors or a history of previous surgery. This manuscript provides mechanism-based recommendations to improve treatment selection through the use of the PSPS concept. Methods: An international task force of pain and neurosurgical specialists was established and met at the International Neuromodulation Society Congress 2024, at the North American Neuromodulation Society Congress 2024, and online. Results: An overview of classification systems (i.e., PSPS; P), anatomical structure (A), neural mechanism (M), and degree of certainty (C), is discussed and combined to generate a novel categorization approach to assist with PSPS classification and diagnosis. The PAMC scale was developed to assist with the diagnosis clustering and consequently to improve treatment selection. Conclusion: The proposed recommendations should support future research by better defining study populations and by assisting the clinician to select the appropriate therapy.