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

Area of Science:

• Pain Medicine
• Neurosurgery
• Neurology

Background:

• Persistent Spinal Pain Syndrome (PSPS) is a new term encompassing conditions previously known as Failed Back Surgery Syndrome (FBSS).
• Current PSPS classification lacks mechanism-based specificity, leading to inconsistent treatment outcomes.
• There is a critical need for diagnostic criteria that focus on underlying pain mechanisms rather than solely anatomical factors or surgical history.

Purpose of the Study:

• To propose mechanism-based recommendations for improved treatment selection in Persistent Spinal Pain Syndrome (PSPS).
• To introduce a novel categorization approach for PSPS diagnosis and classification.
• To enhance the reliability of achieving desired outcomes from interventions for spinal pain.

Main Methods:

• An international task force of pain and neurosurgical specialists convened at major neuromodulation society congresses and online.
• Reviewed existing classification systems for Persistent Spinal Pain Syndrome (PSPS).
• Developed a novel categorization approach combining P (PSPS), A (anatomical structure), M (neural mechanism), and C (degree of certainty) - the PAMC scale.

Main Results:

• The study discusses an overview of classification systems, anatomical structure, neural mechanism, and degree of certainty.
• A novel categorization approach, the PAMC scale, was developed to aid PSPS classification and diagnosis.
• The PAMC scale is designed to assist in diagnosis clustering and improve the selection of appropriate treatments for PSPS.

Conclusions:

• The proposed recommendations aim to refine study populations for future research in PSPS.
• The PAMC scale is expected to assist clinicians in selecting the most appropriate therapies for patients with PSPS.
• Implementing mechanism-based classification should lead to more effective and targeted treatments for persistent spinal pain.