Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Regional Anesthesia & Pain Medicine, Journal Year: 2023, Volume and Issue: 48(6), P. 273 - 287

Published: March 30, 2023

Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized this therapy; however, the prognostic capabilities and deployment strategies of existing techniques, including an SCS trial, have been questioned. After approval by Board Directors American Society Regional Anesthesia Pain Medicine, a steering committee was formed to develop evidence-based guidelines patient role trial. Representatives professional organizations with clinical expertize were invited participate as members. A comprehensive literature review carried out committee, results organized into narrative reports, which circulated all Individual statements recommendations within each seven sections formulated members voting. We used modified Delphi method wherein drafts member in blinded fashion Comments incorporated subsequent revisions, recirculated voting achieve consensus. Seven total 39 approved 100% consensus from Sections included definitions terminology trial; benefits screening psychosocial characteristics; perceptions on therapy use other predictors conduct trials; evaluation trials minimum criteria success. Recommendations that trial should be performed before definitive implant except anginal (grade B). All must screened objective validated instrument factors, include depression Despite limitations, helps provides opportunity experience therapy. These are expected guide practicing physicians stakeholders not mistaken practice standards. Physicians continue make their best judgment based individual considerations preferences.

Language: Английский

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Patient Satisfaction With Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation for Chronic Intractable Pain: A Systematic Review and Meta-Analysis

Neuromodulation Technology at the Neural Interface, Journal Year: 2022, Volume and Issue: 25(7), P. 947 - 955

Published: June 8, 2022

Language: Английский

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Objective wearable measures correlate with self-reported chronic pain levels in people with spinal cord stimulation systems

npj Digital Medicine, Journal Year: 2023, Volume and Issue: 6(1)

Published: Aug. 15, 2023

Spinal Cord Stimulation (SCS) is a well-established therapy for treating chronic pain. However, perceived treatment response to SCS may vary among people with pain due diverse needs and backgrounds. Patient Reported Outcomes (PROs) from standard survey questions do not provide the full picture of what has happened patient since their last visit, digital PROs require patients visit an app or otherwise regularly engage software. This study aims assess feasibility using biomarkers collected wearables during predict PRO outcomes. Twenty participants were recruited implanted SCS. During six months study, activity physiological metrics data 15 was used develop machine learning pipeline objectively levels categories measures. The model reached accuracy 0.768 ± 0.012 in predicting intensity mild, moderate, severe. Feature importance analysis showed that smartwatch such as heart rate, rate variability, step count, stand time can contribute modeling different aspects results suggest wearable be outcomes pain, enabling continuous, real-time monitoring use therapies.

Language: Английский

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Identifying SCS Trial Responders Immediately After Postoperative Programming with ECAP Dose-Controlled Closed-Loop Therapy

Pain and Therapy, Journal Year: 2024, Volume and Issue: 13(5), P. 1173 - 1185

Published: July 9, 2024

Drawbacks of fixed-output spinal cord stimulation (SCS) screening trials may lead to compromised trial outcomes and poor predictability long-term success. Evoked compound action potential (ECAP) dose-controlled closed-loop (CL) SCS allows objective confirmation therapeutic neural activation pulse-to-pulse adjustment. We report on the immediate patient-reported neurophysiologic treatment response post-physiologic CL-SCS feasibility early responder prediction.

Language: Английский

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Paresthesia-Based Versus High-Frequency Spinal Cord Stimulation: A Retrospective, Real-World, Single-Center Comparison

Neuromodulation Technology at the Neural Interface, Journal Year: 2021, Volume and Issue: 25(5), P. 710 - 718

Published: July 17, 2021

Language: Английский

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Burst spinal cord stimulation can attenuate pain and its affective components in chronic pain patients with high psychological distress: results from the prospective, international TRIUMPH study

The Spine Journal, Journal Year: 2021, Volume and Issue: 22(3), P. 379 - 388

Published: Aug. 20, 2021

Language: Английский

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Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Regional Anesthesia & Pain Medicine, Journal Year: 2023, Volume and Issue: 48(6), P. 251 - 272

Published: March 30, 2023

Background/importance Patient selection for spinal cord stimulation (SCS) therapy is crucial and traditionally performed with clinical followed by a screening trial. The factors influencing patient the importance of trialing have not been systematically evaluated. Objective We report narrative review conducted to synthesize evidence regarding role SCS trials. Evidence Medline, EMBASE Cochrane databases were searched reports (any design) in adult patients, from their inception until March 30, 2022. Study data extraction carried out using DistillerSR. Data organized into tables summaries, categorized study design. Importance variables was considered looking at influence on long-term success. Findings Among 7321 citations, 201 consisting 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registry-based reports, 13 case complications during included. Based RCTs OSs, median trial success rate 72% 82%, 65% 61% 12 months, respectively. Although several psychological non-psychological determinants investigated, do consistent approach selection. factors, untreated depression associated poor outcomes, but effect others inconsistent. Most except chronic angina involved only one RCT compared or without (range) duration 10 (0–30) 7 (0–56) days among Conclusions Due lack identify responders therapy, complements exclude patients who find helpful and/or intolerant system. However, more rigorous large are necessary better evaluate its role.

Language: Английский

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Passive Recharge Burst Spinal Cord Stimulation Provides Sustainable Improvements in Pain and Psychosocial Function: 2-year Results From the TRIUMPH Study

Spine, Journal Year: 2021, Volume and Issue: 47(7), P. 548 - 556

Published: Nov. 22, 2021

Study Design. Prospective, international, multicenter, single-arm, post-market study. Objective. The aim of this study was to assess long-term safety and effectiveness spinal cord stimulation using a passive recharge burst design for chronic intractable pain in the trunk and/or limbs. Herein we present 24-month outcomes from TRIUMPH (NCT03082261). Summary Background Data. Passive (B-SCS) uniquely mimics neuronal firing patterns nervous system has been shown modulate affective attentional components processing. Methods. After successful trial period, subjects received permanent SCS implant returned follow-up at 6, 12, 18, 24 months. Results. Significant improvements physical, mental, emotional functioning observed after 6 months treatment were maintained 2 years. Pain catastrophizing scale (PCS) scores dropped below population norm. Health-related quality life on EQ-5D improved across all domains mean index score within one standard deviation reduction (on NRS) statistically significant ( P < 0.001) timepoints. Patient reported relief, stated percentage improvement pain, consistent timepoints 60%. Patients measures including activity levels impact daily life. At months, 84% satisfied 90% would recommend procedure. Subjects decreased their medication intake categories; 38% reduced psychotropic muscle relaxants, 46% analgesic, anti-convulsant NSAIDs, 48% opioid medication. Adverse events occurred low rates without unanticipated events. Conclusion. Early positive results with B-SCS long term. Evidence multiple assessment tools show that can alleviate intensity, psychological distress, improve physical function health-related Level Evidence: 3

Language: Английский

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Comparison of Spinal Cord Stimulation Trial Reporting Protocols and Long-Term Pain Relief Outcomes Following Implantation

Neuromodulation Technology at the Neural Interface, Journal Year: 2022, Volume and Issue: 26(5), P. 1047 - 1050

Published: March 10, 2022

Language: Английский

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The Discrepancy and Agreement between Patient-Reported Percentage Pain Reduction and Calculated Percentage Pain Reduction in Chronic Pain Patients

Neurology International, Journal Year: 2023, Volume and Issue: 15(2), P. 560 - 568

Published: April 4, 2023

Two derivatives of the numeric rating scale (NRS) and visual analog (VAS), namely patient-reported percentage pain reduction (PRPPR) calculated (CPPR), are commonly used when evaluating reduction. A small number studies have attempted to assess agreement between PRPPR CPPR. However, they been limited in their scope by a focus on specific types pain, or treatment modalities. As far as authors this article aware, is first study CPPR chronic patients, well how duration affects correlations The aim retrospective analysis was determine whether PRPPR, discrepancy two. Additionally, assessed individual modalities, lack there of, impacted correlation mean for entire patient population were 59.98 40.71, respectively. two parameters 19.27. CPPR, measured concordance coefficient, 0.984 (95% C.I., 0.982-0.986).

Language: Английский

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