Pain Specialists Australia, Richmond, Victoria, Australia.
Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
Pain Med. 2021 Apr 20;22(4):807-818. doi: 10.1093/pm/pnab015.
For many medical professionals dealing with patients with persistent pain following spine surgery, the term Failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading, and potentially troublesome. It misrepresents causation. Alternative terms have been suggested, but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS.
This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established.
14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option-Persistent spinal pain syndrome-was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification.
This project is important to those in the fields of pain management, spine surgery, and neuromodulation, as well as patients labeled with FBSS. Through a shift in perspective, it could facilitate the application of the new ICD-11 classification and allow clearer discussion among medical professionals, industry, funding organizations, academia, and the legal profession.
对于许多处理脊柱手术后持续性疼痛患者的医疗专业人员来说，术语“失败的脊柱手术综合征（FBSS）”作为诊断标签是不充分的、具有误导性的，并且可能会带来麻烦。它歪曲了因果关系。已经提出了替代术语，但没有一个术语能替代 FBSS。国际疼痛研究协会（IASP）发布了慢性疼痛的修订分类，作为新的《国际疾病分类（ICD-11）》的一部分，该分类已被世界卫生组织（WHO）接受。其中包括“脊柱手术后慢性疼痛（CPSS）”这一术语，建议将其作为 FBSS 的替代术语。
本文提供了替代定义的论据和理由。为了提出一个广泛适用但更精确和更具临床信息的术语，成立了一个国际专家组。
考虑并对 14 个候选替代术语进行了排名。根据商定的标准，这一数字减少到了四个。通过一个结构化的研讨会和德尔菲法，选择了一个首选术语——持续性脊柱疼痛综合征。我们提供了使用持续性脊柱疼痛综合征的理由，并为其纳入 ICD-11 提供了方案。我们建议采用这个术语将增强新的 ICD-11 分类。
对于疼痛管理、脊柱外科和神经调节领域的专业人员以及被贴上 FBSS 标签的患者来说，这是一个重要的项目。通过转变视角，可以促进新的 ICD-11 分类的应用，并允许医疗专业人员、行业、资助组织、学术界和法律界之间进行更清晰的讨论。
