Aims
Persistent spinal pain syndrome (PSPS) has been proposed to replace failed back surgery syndrome (FBSS) and provide a broader framework for chronic or recurrent spinal pain. This guideline aimed to develop evidence-based recommendations for the diagnosis, assessment, and whole-course management of PSPS, with particular emphasis on type II PSPS after spinal surgery.
Methods
The guideline was initiated by the Osteoporosis Prevention and Rehabilitation Committee of the Chinese Association of Rehabilitation Medicine. A multidisciplinary working group of experts in spine surgery, pain medicine, rehabilitation medicine, psychiatry/psychology, and evidence-based medicine identified clinical questions and refined 70 preliminary questions into 12 PICO-formatted questions. PubMed, Embase, CNKI, Wanfang Data, and other databases were searched for systematic reviews, randomized controlled trials, observational studies, and other relevant evidence through 31 October 2025. Study quality and evidence levels were assessed using established tools, and recommendations were finalized through evidence synthesis, nominal group technique, and two face-to-face expert panel meetings.
Results
Twelve recommendations were developed. PSPS was classified as type I (non-surgical) or type II (surgical). The guideline proposes a multidisciplinary, stepwise pathway incorporating history taking, red- and yellow-flag screening, physical examination, indicated imaging/laboratory assessments, and multidimensional pain and functional evaluation. Treatment is individualized by pain mechanism, severity, and functional impairment. Recommendations address mechanism-based pharmacotherapy; differential etiologies of type II PSPS; neuropathic, osteoporotic, ischemic, fibromyalgia-related, and psychosocial/functional pain; interventional therapies including epidural steroid injection, spinal cord stimulation, and radiofrequency ablation; rehabilitation; health education; and self-management.
Conclusions
This Chinese clinical practice guideline provides a structured, mechanism-based framework for multidisciplinary diagnosis and treatment of PSPS. It supports individualized, stepwise, whole-course care and highlights the need for standardized diagnostic criteria and higher-quality evidence to optimize outcomes.