Back to Basics: Persistent Spinal Pain Syndrome

Spine & Nerve

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves go back to Basics with a twist - the doctors discuss Persistent Spinal Pain Syndrome (PSPS). PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Previously, certain diagnoses were utilized to describe these pathologies including but not limited to Failed Back Surgery Syndrome and Post-laminectomy syndrome. These terms are not without their limitations: terms such as failed back surgery Syndrome can carry a very negative connotation, and also patients can have the clinical presentation consistent with this diagnosis without having a history of spine surgery (for example a chronic disc herniation can lead to the development of fibrosis around a nerve root ). The aforementioned group of experts published an article in Pain Medicine in April of 2021 proposing the adoption of PSPS with the goal of continuing to optimize the most accurate diagnosis for all appropriate patients, advancement of research in this field, and communication between healthcare providers. PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease processes of spinal origin linked to the predisposition of the human spine to develop painful pathology over time. The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical and thoracic spine can be the site of pathology. Importantly, spinal surgery may or may not have occurred, and may or many not be the primary contributor to the clinical presentation. Listen as the doctors discuss the article regarding this important new nomenclature, as well as review some important pathophysiology for PSPS including epidural fibrosis and adjacent level syndrome. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Nick Christelis, MD, Brian Simpson, MD, Marc Russo, MD, Michael Stanton-Hicks, MD, Giancarlo Barolat, MD, Simon Thomson, MD, Stephan Schug, MD, Ralf Baron, MD, Eric Buchser, MD, Daniel B Carr, MD, Timothy R Deer, MD, Ivano Dones, MD, Sam Eldabe, MD, Rollin Gallagher, MD, Frank Huygen, MD, David Kloth, MD, Robert Levy, MD, Richard North, MD, Christophe Perruchoud, MD, Erika Petersen, MD, Philippe Rigoard, MD, Konstantin Slavin, MD, Dennis Turk, PhD, Todd Wetzel, MD, John Loeser, MD, Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11, Pain Medicine, Volume 22, Issue 4, April 2021, Pages 807–818. 2. Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011 Apr;12(4):577-606. doi: 10.1111/j.1526-4637.2011.01089.x. Epub 2011 Apr 4. PMID: 21463472. 3. Bosscher, H.A. and Heavner, J.E. (2010), Incidence and Severity of Epidural Fibrosis after Back Surgery: An Endoscopic Study. Pain Practice, 10: 18-24.