Persistent Spinal Pain Syndrome: New Terminology for a New Era

Petersen, Erika; Schatman, Michael E; Sayed, Dawood; Deer, Timothy R

doi:10.2147/jpr.s320923

Cited by 18 publications

(10 citation statements)

References 25 publications

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“…In the absence of an anatomical correlate, these patients are defined as having a 'failed back surgery syndrome' or persistent spine pain syndrome type 2 (PSPS2). [2][3][4] For patients with PSPS2 and predominant back pain, the optimal treatment modality remains controversial.…”

Section: Introductionmentioning

confidence: 99%

sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

et al. 2023

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IntroductionPersistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive behavioural therapy. Nevertheless, structured treatment algorithms are missing as high-level evidence on the various treatments is sparse. The aim of this study is to compare higher frequency neuromodulation with instrumentation surgery in patients suffering from PSPS2.Methods and analysisThe sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE) trial is a prospective randomised rater blinded multicentre study. Patients suffering from PSPS2 with a functional burden of Oswestry Disability Index (ODI) >20 points are randomised to treatment via spinal cord stimulation or spinal instrumentation. Primary outcome is back-related functional outcome according to the ODI 12 months after treatment. Secondary outcomes include pain perception (visual analogue scale), Short Form-36, EuroQOL5D, the amount of analgesics, the length of periprocedural hospitalisation and adverse events. Follow-up visits are planned at 3 and 12 months after treatment. Patients with previous lumbar instrumentation, symptomatic spinal stenosis, radiographical apparent spinal instability or severe psychiatric or systemic comorbidities are excluded from the study. In order to detect a significant difference of ≥10 points (ODI) with a power of 80%, n=72 patients need to be included. The recruitment period will be 24 months with a subsequent 12 months follow-up. The beginning of enrolment is planned for October 2022.Ethics and disseminationThe PROMISE trial is the first randomised rater blinded multicentre study comparing the functional effectiveness of spinal instrumentation versus neuromodulation in patients with PSPS2 in order to achieve high-level evidence for these commonly used treatment options in this severely disabling condition. Patient recruitment will be performed at regular outpatient clinic visits. No further (print, social media) publicity is planned. The study is approved by the local ethics committee (LMU Munich, Germany) and will be conducted according to the Declaration of Helsinki.Trial registration numberNCT05466110.

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Section: Introductionmentioning

confidence: 99%

sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

et al. 2023

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“… 10 , 11 While the elimination of the FBSS terminology may be welcome, the new framework does not fully account for all patients with chronic spinal pain. 12 …”

Section: Introductionmentioning

confidence: 99%

“…Spinal surgery may or may not have occurred and may or may not be relevant in particular cases. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Is There a Difference in Fear-Avoidance, Beliefs, Anxiety and Depression Between Post-Surgery and Non-Surgical Persistent Spinal Pain Syndrome Patients?

Rodrigues¹,

Oliveira²,

Costa³

et al. 2022

JPR

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Introduction Patients with post-surgery persistent spinal pain syndrome (PSPS) or non-surgical PSPS might be affected by sustained fear-avoidance beliefs (FAB), anxiety and depression. In this scenario, this study aimed to describe those aspects in patients with post-surgery PSPS and non-surgical PSPS. Methods This study included patients with PSPS, and non-surgical PSPS, over 18 years, with quarterly evaluations at the Chronic Pain Clinic. After evaluation, demographic and clinical characteristics were obtained. The Beck Depression Inventory-II, Beck Anxiety Inventory, Douleur neuropathique 4 questions, Visual Analog Pain Scale, and Fear-Avoidance Beliefs Questionnaire–Brazilian Version (FABQ-Brazil) were used to evaluate psychological aspects. Results Forty-six patients were included, 23 patients with post-surgery PSPS and 23 with non-surgical PSPS. Both groups had high scores in the physical and work domains of the FABQ, high rates of absenteeism and most patients in these groups had moderate-to-severe neuropathic pain and some degree of anxiety and/or depression. The groups showed no statistically significant difference (p > 0.05) when comparing all questionnaires. Discussion This is one of the first studies to evaluate FAB and other associated psychological factors, such as anxiety and depression, in patients with post-surgery PSPS in a follow-up several years after surgery and compare with patients diagnosed with non-surgical PSPS. In this study, most patients in both groups had high scores in the FABQ domains, not having statistically relevant difference between groups. Conclusion Even though there was no statistically relevant difference between the PSPS patient with or without surgical history in terms of the assessed outcome measures, the described scores for fear-avoidance beliefs, pain, anxiety and depression were high, showing an interference in the daily life activities of those patients.

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“…As a consequence, more surgery for (chronic) low back pain is performed (Rajaee et al, 2012), which in some cases might fail to provide sufficient pain relief. It is estimated that approximately 20% of the patients will suffer from a so-called 'persistent spinal pain syndrome' (PSPS) (Petersen et al, 2021;Thomson, 2013). Painful sensations resulting from PSPS, previously called 'failed back surgery syndrome' (Chan & Peng, 2011), are either localized in the back where the surgery was performed or radiate down to one or both lower limbs.…”

Section: Introductionmentioning

confidence: 99%

Changes in quantitative sensory testing and patient perspectives following spinal cord stimulation for persistent spinal pain syndrome: An observational study with long‐term follow‐up

Plantaz

Dongen

Witkam

et al. 2022

European Journal of Pain

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Background Spinal cord stimulation (SCS) can impact sensory, pain and tolerance thresholds in various ways, which can be accessed via quantitative sensory testing (QST). The objectives of this study were to (1) assess the subjective sensory responses using QST in patients following SCS therapy for PSPS and (2) to get a clinical impression of the results of SCS during an interview of these patients with PSPS and SCS during long term follow‐up. Methods Forty patients with PSPS who received SCS treatment underwent QST via electrical and mechanical pressure stimuli. QST was performed at four different moments (1) pre‐implantation SCS, (2) two weeks postoperatively, (3) three months after permanent SCS implantation and (4) six months after permanent SCS implantation. Patients’ perspectives on pain, use of drugs and quality of life were assessed via semi‐structured interviews during a follow‐up between 5 and 11 years. Results We found statistical significant differences in the changes of sensory, pain and tolerance thresholds. A decrease in pain complaints and analgesics use were reported by the patients during follow‐up. The quality of life in patients increased from three to eight (NRS 0 [worst QoL imaginable] ‐10 [best QoL imaginable]) after receiving SCS. Conclusions The increased thresholds on areas without pain or being covered by the SCS induced paresthesias may indicate that there are central changes contributing to these deviations in thresholds. The overall QoL in patients improved greatly after receiving SCS. Significance This study provides an overview of the effect of SCS on sensory, pain and tolerance thresholds in patients with PSPS throughout the SCS treatment process. In addition, this study presents data from 40 patients with PSPS treated with SCS, analysing several long‐term patient‐reported outcome measures. The results serve to give more insight into the mechanism of SCS and document SCS as a possible treatment for PSPS.

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Persistent Spinal Pain Syndrome: New Terminology for a New Era

Cited by 18 publications

References 25 publications

sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

Is There a Difference in Fear-Avoidance, Beliefs, Anxiety and Depression Between Post-Surgery and Non-Surgical Persistent Spinal Pain Syndrome Patients?

Changes in quantitative sensory testing and patient perspectives following spinal cord stimulation for persistent spinal pain syndrome: An observational study with long‐term follow‐up

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