Naming Failure
As is the case with other industries, the neuromodulation industry endeavors to select product names that are well thought out and increase the likelihood of patient and clinician acceptance. Medtronic’s AdaptiveStim and Tivic’s ClearUP are two examples that come to mind.
But what neuromodulation vendors don’t often consider—and what they have far less control over—are the names of the neurological disorders that their products treat. Like it or not, patients, or potential patients, can be sensitive to particular nomenclature in a disease or disorder and it’s not in anyone’s interest to discourage them from seeking treatment because of a stigma or other negative connotations associated with an indication’s name.
Such is now the case with failed back surgery syndrome, a pain indication that accounts for a significant portion of annual sales of SCS systems. In 2015, Adnan Al-Kaisy, a pain doctor, argued in the journal Neurochirurgie that the term was too negative. “The initial pejorative connotation of FBSS suggesting failure or blame must now be replaced to direct the patient and therapists towards a temporal concept focusing on the future rather than the past,” he and his coauthors wrote.
Now a cynic might argue that the name serves a purpose if it helps point out the futility of ortho/spine interventions vis a vis neuromodulation therapies. But a counter-cynic could argue that the term might motivate regulators and payers to eliminate ortho/spine interventions, and thus kill the goose that laid the golden egg. But a more serious consideration is that alluding to failure in the disorder’s name might perpetuate the perception that it is the patient that is to blame for the failure. In a recent radio interview, Eric Grigsby of Neurovations cited a historical example of this with the disorder now known as fibromyalgia—particularly as it applied to female patients.
In a recent article in the Journal of Pain Research, Erika Petersen and her colleagues noted that the International Association for the Study of Pain has proposed the term “chronic pain after spinal surgery” as a replacement for FBSS in the International Classification of Disease. But the authors prefer the term “persistent spinal pain syndrome” to CPSS and would divide it into two types, Type 2, post-surgery and Type 1, no surgery performed. “The shift in medical culture required for the transition in terminology related to chronic pain will require time, and there are many issues as identified in the IASP article,” they write. “By changing terminology, we better describe the clinical circumstance of the patient and his/her appropriateness for a specific treatment.”
The alternative term PSPS is preferred by the American Society of Pain and Neuroscience, whose chairman, Tim Deer, and president, Dawood Sayed, are coauthors of the paper.
James Cavuoto
Editor and Publisher
