Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway

Figure 2

The proposed standardized multidisciplinary team’s failed back surgery syndrome care pathway, as recommended by the Chronic Back and Leg Pain Network. FBSS, failed back surgery syndrome; IDD, intrathecal drug delivery; MDT, multidisciplinary team; SCS, spinal cord stimulation; SIJ, sacroiliac joint; TENS, transcutaneous electrical nerve stimulation; WHO, World Health Organization. Note. In cases of new pain and/or exacerbation of original pain at any stage of this flow, reimaging and spine expertise is required. ¹Best practice is for the psychosocial evaluation to be performed by a psychologist or psychiatrist with specific experience in the field of pain. Assessments may include the relevant tests and questionnaires aiming to identify patients with major psychological or psychiatric contraindications [23]. ²Best practice is to avoid long-term use of WHO Step III analgesics and review ineffective long-term use of antineuropathic pain medication [28–30]. ³There is limited evidence supporting a prolonged effect of epidural injections, selective nerve root blocks, and radiofrequency denervation in an FBSS population [20, 25, 31, 32]. Despite this lack of clinical evidence, these therapies may be tried/reserved for the management of acute exacerbation in pain.