A request from an international group of experts in the clinical and scientific aspects of chronic pain of spinal origin has been received by ESJ Editor-in-chef. The aim of the proposal is to discontinue the use of the term "failed back surgery syndrome” (FBSS). This request was made after a three-year process, including a structured Delphi selection procedure, concluding that the term "persistent spinal pain syndrome” (PSPS) would be an appropriate and viable replacement.

The following is the text of the request:

While many replacement terms have been proposed for the misleading, inadequate and pejorative FBSS, PSPS represents a different approach. Based on the principle of a persistent spinal syndrome, it is a broader concept which includes, but is not restricted to, post-surgical pain. Its logical basis should facilitate the diagnosis and therapy of individual patients in a manner that is more physiologically orientated and less emotionally laden and stigmatising.

The latest version of the International Classification of Diseases, ICD-11, was adopted by the WHO in 2019 and is due for international implementation in January 2022. It recognises chronic pain as a disease entity for the first time. Within this, it proposes “chronic pain after spinal surgery (CPSS)” to replace FBSS. However, through its very narrow definition, CPSS does not equate to FBSS. PSPS would encompass CPSS, address the limitations, and render FBSS obsolete. They have demonstrated how PSPS can be integrated into ICD-11, which would further rationalise diagnoses coming under the umbrella of chronic pain of spinal origin.

The International Association for the Study of Pain (IASP) has recently published a revised, more experiential, definition of pain. Calls for more patient-centred care along with more accurate, less judgemental terminology are growing. Persistent use of the term "failed back surgery syndrome" runs counter to these efforts.

The proposals, rationale and process are reported in an open-access article published in Pain Medicine (see below).

The replacement of a widely-used term, no matter how inappropriate that term may be, is inevitably a slow process. 

Please do not hesitate to contact Dr. Christelis (n.christelis@painspecialistsaustralia.com.au) or Dr. Simpson (briansimpson48@btinternet.com) should you wish to receive more information or to discuss the request.


On behalf of the steering group: Nick Christelis, Brian Simpson, Marc Russo, Michael Stanton-Hicks, Giancarlo Barolat, Simon Thomson.


Christelis N, Simpson B, Russo M, Stanton-Hicks M, Barolat G, Thomson S, Schug S, Baron R, Buchser E, Carr DB, Deer TR, Dones I, Eldabe S, Gallagher R, Huygen F, Kloth D, Levy R, North R, Perruchoud C, Petersen E, Rigoard P, Slavin K, Turk D, Wetzel T, Loeser J.Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-1, Pain Medicine 2021; 22(4): 807-818.