What Is Persistent Spinal Pain Syndrome?

Chronic back or neck pain can be frustrating, especially when symptoms continue after treatment or even after spine surgery. For some patients, the problem is not simply a slow recovery or a single untreated injury. Persistent pain may develop into a complex condition now known as Persistent Spinal Pain Syndrome, or PSPS.

Persistent Spinal Pain Syndrome is a term used to describe ongoing spinal pain that continues despite previous treatment and may occur with or without a history of spine surgery. Understanding what PSPS is, why it develops, and how it can be treated can help patients move toward a more accurate diagnosis and a more personalized pain management plan.

What Is Persistent Spinal Pain Syndrome?

Persistent Spinal Pain Syndrome is a condition characterized by ongoing pain associated with the spine that persists despite treatment or continues after spinal surgery.

The term PSPS has increasingly been used in place of the older term Failed Back Surgery Syndrome. While the older terminology focused on whether surgery was considered a “failure,” Persistent Spinal Pain Syndrome provides a more accurate description of what patients experience: persistent or recurrent spinal pain that may have multiple causes.

Importantly, ongoing pain after treatment does not necessarily mean that a surgical procedure was performed incorrectly or that treatment was unsuccessful. Spine pain is often complex, and more than one structure may contribute to a patient’s symptoms.

PSPS is commonly divided into two categories:

PSPS Type 1: Persistent Spinal Pain Without Previous Spine Surgery

PSPS Type 1 describes persistent spinal pain in patients who have not undergone spinal surgery.

A patient may continue to experience significant back, neck, or radiating pain despite conservative treatments such as physical therapy, activity modification, injections, or other nonsurgical approaches.

The pain may be related to conditions involving the spinal discs, facet joints, sacroiliac joints, nerves, spinal stenosis, or other structures. In some cases, multiple pain generators may be present at the same time.

PSPS Type 2: Persistent Spinal Pain After Spine Surgery

PSPS Type 2 refers to persistent or recurrent spinal pain following one or more spinal procedures.

This category is similar to what was historically described as Failed Back Surgery Syndrome. However, Persistent Spinal Pain Syndrome recognizes that continued symptoms after surgery can occur for many reasons.

For example, surgery may successfully address one source of pain while another pain generator remains. New spinal changes may also develop over time, or nerve-related pain may continue even after pressure on a nerve has been relieved.

What Causes Persistent Spinal Pain Syndrome?

Persistent Spinal Pain Syndrome can develop when one or more pain-generating structures continue to cause symptoms despite previous treatment.

Potential causes can include:

• Recurrent or persistent disc problems
• Degenerative disc disease
• Facet joint pain
• Sacroiliac joint dysfunction
• Spinal stenosis
• Scar tissue around spinal nerves
• Persistent nerve irritation or nerve damage
• Recurrent disc herniation
• Adjacent segment degeneration after spinal fusion
• Hardware-related problems in some patients
• Incomplete identification of the original pain source
• Multiple pain generators occurring at the same time

The exact cause of persistent spinal pain can vary significantly from one patient to another. This is why a careful evaluation is important before deciding on additional treatment.

What Are the Symptoms of Persistent Spinal Pain Syndrome?

The symptoms of Persistent Spinal Pain Syndrome depend on the underlying cause and the specific nerves, joints, discs, or other structures involved.

Common symptoms may include:

• Chronic low back or neck pain
• Pain that returns after previous treatment
• Pain that radiates into the buttocks, hips, arms, or legs
• Burning, tingling, numbness, or electric shock-like sensations
• Muscle weakness
• Difficulty sitting, standing, walking, or sleeping
• Pain that interferes with work and daily activities

Some patients experience primarily localized spinal pain, while others have significant nerve-related symptoms. Pain may also change over time, making ongoing evaluation important.

Why Can Pain Continue After Spine Surgery?

Pain can continue after spine surgery because spinal surgery may address one specific problem while other sources of pain remain or develop later.

For example, a procedure may successfully relieve pressure on a nerve, but the patient may also have facet joint arthritis, sacroiliac joint dysfunction, disc-related pain, or nerve damage contributing to symptoms.

In other cases, structural changes can occur after surgery. A spinal fusion may alter how forces are distributed through nearby spinal segments, potentially contributing to degeneration at adjacent levels over time.

Scar tissue can also form around nerves following surgery. While scar tissue is a normal part of healing, it may contribute to ongoing symptoms in certain situations.

The nervous system itself can also play a role. When pain signals continue for an extended period, nerves may become increasingly sensitive, allowing pain to persist even after the original injury or structural problem has improved.

How Is Persistent Spinal Pain Syndrome Diagnosed?

Diagnosing Persistent Spinal Pain Syndrome involves identifying the specific source or sources contributing to a patient’s ongoing symptoms.

A comprehensive evaluation may include a review of:

• Previous surgeries and treatments
• Current symptoms and pain patterns
• Medical history
• Physical examination findings
• Imaging studies such as X-rays, MRI, or CT scans
• Previous procedure reports
• Nerve testing when appropriate

In some cases, diagnostic injections or nerve blocks may be used to help determine whether a specific joint, nerve, or other structure is responsible for the pain.

Because PSPS may involve more than one pain generator, identifying the exact cause is often more complicated than simply finding an abnormality on an imaging study. Imaging findings must be considered alongside the patient’s symptoms and physical examination.

What Treatments Are Available for Persistent Spinal Pain Syndrome?

Treatment for Persistent Spinal Pain Syndrome depends on the underlying cause, the location of the pain, and the patient’s individual symptoms and treatment history.

A personalized treatment plan may include one or more approaches.

Interventional Pain Procedures

Targeted procedures may help address specific sources of pain. Depending on the diagnosis, options may include:

• Epidural injections
• Facet joint injections or medial branch blocks
• Radiofrequency ablation
• Sacroiliac joint injections
• Selective nerve root blocks
• Other image-guided diagnostic or therapeutic procedures

These treatments are designed to target specific pain generators rather than treating spinal pain as a single condition.

Spinal Cord Stimulation

Spinal cord stimulation may be considered for certain patients with persistent nerve-related pain, particularly when other treatments have not provided adequate relief.

A spinal cord stimulator uses electrical signals to modify the way pain signals are processed before they reach the brain. Modern systems can offer different stimulation options, and patients typically undergo a temporary trial before permanent implantation is considered.

Dorsal Root Ganglion Stimulation

For certain types of focal or difficult-to-treat nerve pain, dorsal root ganglion stimulation may be another neuromodulation option. This approach targets specific nerve structures involved in transmitting pain signals.

Physical Rehabilitation and Functional Restoration

Movement and rehabilitation may remain an important part of treatment, even when pain has persisted for months or years. A carefully designed program may focus on improving mobility, strength, stability, and function while helping patients gradually return to daily activities.

Additional Treatments Based on the Diagnosis

Some patients may benefit from other therapies depending on the cause of their symptoms. The most appropriate treatment should be based on a thorough evaluation rather than a one-size-fits-all approach.

Can Persistent Spinal Pain Syndrome Be Treated Without Another Surgery?

Yes, many patients with Persistent Spinal Pain Syndrome may have nonsurgical treatment options depending on the cause of their pain.

Additional surgery is not always the most appropriate next step for persistent spinal pain. In some cases, further surgery may be necessary when there is a correctable structural problem. However, when another operation is unlikely to address the true source of pain, interventional pain management and other targeted treatments may offer alternative options.

The key is determining what is causing the ongoing symptoms before moving forward with treatment.

Why Is an Accurate Diagnosis So Important?

An accurate diagnosis is important because Persistent Spinal Pain Syndrome can involve several different pain generators, and each may require a different treatment approach.

Treating the wrong structure may provide little or no improvement. For example, pain caused by a sacroiliac joint problem may not respond to treatment directed at a spinal disc, while nerve-related pain may require a different approach than pain originating from the facet joints.

A detailed diagnostic process can help physicians develop a more targeted treatment strategy based on the patient’s individual condition.

When Should You Seek Evaluation for Persistent Spinal Pain?

You should consider seeking medical evaluation when back or neck pain continues despite treatment, returns after a procedure, or significantly interferes with daily activities.

Persistent pain should not automatically be viewed as something a patient simply has to live with. Advances in diagnostic techniques, interventional pain management, and neuromodulation have expanded the options available for patients with complex spinal pain.

The Bottom Line

Persistent Spinal Pain Syndrome is a complex condition involving ongoing or recurrent spinal pain that may occur with or without previous spine surgery. Because multiple structures and mechanisms can contribute to symptoms, successful treatment often begins with identifying the specific source of pain.

For patients living with persistent back, neck, or nerve-related pain, a comprehensive evaluation can help determine whether targeted, nonsurgical, interventional, or neuromodulation-based treatments may be appropriate.

This article is intended for educational purposes only and should not be considered medical advice. Persistent or worsening spinal pain should be evaluated by a qualified healthcare professional.