title: Diagnosis and treatment of failed back surgery syndrome in the UK: mapping of practice using a cross-sectional survey.
abstract: BACKGROUND
  Chronic back pain is a serious public health issue, associated with poor quality of life and disability. There is a specific group of chronic back pain sufferers whose pain persists despite their having undergone anatomically successful lumbosacral spine surgery. These patients are known as having failed back surgery syndrome (FBSS) and are frequently seen in pain clinics. It is currently unclear what constitutes routine practice in terms of diagnosis and treatment of FBSS in the UK.
  
  
  OBJECTIVE
  To map the diagnosis of and provision of care for patients with FBSS.
  
  
  METHODS
  A cross-sectional survey of specialist pain clinics in the UK.
  
  
  RESULTS
  This first attempt to survey 241 pain clinics in the UK achieved a response rate of 52%. The results of this survey suggest that patients at UK pain clinics were often diagnosed with FBSS between 6 and 12 months after surgery. Treatment is often initiated when patients report a level of pain between 3 and 5 cm (on a 10-cm visual analogue scale) and a range of therapeutic options are pursued in the hope of addressing the range of presenting symptoms.
  
  
  CONCLUSIONS
  It is evident from the findings of this survey that, though there is some variation, pain specialists in the UK identify and handle patients with FBSS as a separate clinical entity. Direct, randomised comparisons of interventions should be the focus of research into appropriate treatment regimens going forward. Also, evidence of clinical effectiveness will need to incorporate elements of patient acceptance of interventions.
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Puvan
authors.initials: P
authors.lastname: Tharmanathan
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Joy
authors.initials: J
authors.lastname: Adamson
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ashby
authors.affiliation: Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
keywords: Low back pain; back surgery; chronic pain; pain clinic; primary care