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

Area of Science:

• Pain Medicine
• Neurosurgery
• Medical Diagnostics

Background:

• The term Failed Back Surgery Syndrome (FBSS) is considered inadequate and misleading by medical professionals for patients with persistent pain post-spine surgery.
• Existing alternative terms have not supplanted FBSS, highlighting a need for a more precise diagnostic label.

Purpose of the Study:

• To propose and justify a replacement term for Failed Back Surgery Syndrome (FBSS).
• To introduce a more precise and clinically informative diagnostic label for chronic pain after spinal surgery.

Main Methods:

• An international expert group was convened to identify and evaluate potential replacement terms for FBSS.
• A structured workshop and Delphi process were used to rank candidate terms, leading to the selection of Persistent Spinal Pain Syndrome.

Main Results:

• Four terms were shortlisted from 14 candidates based on agreed criteria.
• Persistent Spinal Pain Syndrome (PSPS) was selected as the preferred term.
• A schema for incorporating PSPS into the International Classification of Diseases (ICD-11) was developed.

Conclusions:

• The adoption of Persistent Spinal Pain Syndrome (PSPS) is proposed to enhance the International Classification of Diseases (ICD-11) classification.
• This terminology shift aims to improve clarity in discussions among spine surgeons, pain management specialists, and other stakeholders.
• Implementing PSPS can facilitate the application of the new ICD-11 classification for chronic pain after spinal surgery.