15
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e‐health tool

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic‐like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient‐specific recommendations for referral and selection of SCS in chronic pain.

          Methods

          A multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in four pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment.

          Results

          Appropriateness of SCS was strongly determined by the neuropathic or neuropathic‐like pain component, location and spread of pain, anatomic abnormalities and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were as follows: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and unwillingness to reduce high‐dose opioids. An educational e‐health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS.

          Conclusions

          The RUAM was useful to establish a consensus on patient‐specific criteria for referral/selection for SCS in chronic pain. The e‐health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors.

          Significance

          Determining the eligibility of SCS in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e‐health tool ( https://www.scstool.org/).

          Related collections

          Most cited references36

          • Record: found
          • Abstract: found
          • Article: not found

          Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial.

          Current treatments for chronic pain have limited effectiveness and commonly known side effects. Given the prevalence and burden of intractable pain, additional therapeutic approaches are desired. Spinal cord stimulation (SCS) delivered at 10 kHz (as in HF10 therapy) may provide pain relief without the paresthesias typical of traditional low-frequency SCS. The objective of this randomized, parallel-arm, noninferiority study was to compare long-term safety and efficacy of SCS therapies in patients with back and leg pain.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial

            A comparative effectiveness trial indicates that dorsal root ganglion stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to spinal cord stimulation.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis.

              In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. The intent of this article is to perform a systematic review to examine the relationship between presurgical predictor variables and treatment outcomes, to review the existing evidence for the benefit of psychological screening prior to lumbar surgery or SCS, and to make treatment recommendations for the use of psychological screening. Out of 753 study titles, 25 studies were identified, of which none were randomized controlled trials and only four SCS studies met inclusion criteria. The methodological quality of the studies varied and some important shortcomings were identified. A positive relationship was found between one or more psychological factors and poor treatment outcome in 92.0% of the studies reviewed. In particular, presurgical somatization, depression, anxiety, and poor coping were most useful in helping to predict poor response (i.e., less treatment-related benefit) to lumbar surgery and SCS. Older age and longer pain duration were also predictive of poorer outcome in some studies, while pretreatment physical findings, activity interference, and presurgical pain intensity were minimally predictive. At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome.
                Bookmark

                Author and article information

                Contributors
                herman.stoevelaar@ismar.com
                Journal
                Eur J Pain
                Eur J Pain
                10.1002/(ISSN)1532-2149
                EJP
                European Journal of Pain (London, England)
                John Wiley and Sons Inc. (Hoboken )
                1090-3801
                1532-2149
                04 April 2020
                July 2020
                : 24
                : 6 ( doiID: 10.1002/ejp.v24.6 )
                : 1169-1181
                Affiliations
                [ 1 ] Department of Anaesthesiology Basildon and Thurrock University Hospitals Basildon UK
                [ 2 ] Department of Anaesthesiology Erasmus University Medical Center Rotterdam The Netherlands
                [ 3 ] Clinical Neuropsychology Service Oxford University Hospitals Oxford UK
                [ 4 ] Valencia University Medical School Anesthesia Unit – Surgical Specialties Department, Department of Anaesthesiology, Critical Care and Pain Management General University Hospital Valencia Spain
                [ 5 ] Leeds Pain and Neuromodulation Centre Leeds Teaching Hospitals Leeds UK
                [ 6 ] Department of Neurosurgery Fondation Ophtalmologique Adolphe de Rothschild Paris France
                [ 7 ] Neuromodulation Team Wessex Neurological Centre Southampton UK
                [ 8 ] Department of Anaesthesiology AZ Delta Roeselare Belgium
                [ 9 ] Department of Physiotherapy Basildon and Thurrock University Hospitals Basildon UK
                [ 10 ] Anaesthesiology & Pain Therapy Unit Santa Chiara University Hospital Pisa Italy
                [ 11 ] Pain Unit Clinical Scientific Institutes Maugeri Pavia Italy
                [ 12 ] Department of Pain Medicine The James Cook University Hospital Middlesbrough UK
                [ 13 ] Department of Neurosurgery Sahlgrenska University Hospital Gothenburg Sweden
                [ 14 ] Department of Anaesthesiology and Pain Management Rijnstate Hospital Velp The Netherlands
                [ 15 ] Department of Neurosurgery and Department of Anaesthesiology Aarhus University Hospital Aarhus Denmark
                [ 16 ] Pain Management Service Basildon and Thurrock University Hospitals Basildon UK
                [ 17 ] Department of Neurosurgery Friederikenstift Hannover Hannover Germany
                [ 18 ] Centre for Decision Analysis and Support Ismar Healthcare Lier Belgium
                Author notes
                [*] [* ] Correspondence

                Herman Stoevelaar, Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium.

                Email: herman.stoevelaar@ 123456ismar.com

                Article
                EJP1562
                10.1002/ejp.1562
                7318692
                32187774
                fa36f7c0-c90d-4653-821e-81b9947bad50
                © 2020 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC®

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 January 2020
                : 10 March 2020
                : 11 March 2020
                Page count
                Figures: 4, Tables: 5, Pages: 13, Words: 8554
                Funding
                Funded by: Boston Scientific , open-funder-registry 10.13039/100008497;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                July 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:26.06.2020

                Anesthesiology & Pain management
                Anesthesiology & Pain management

                Comments

                Comment on this article