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

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.