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de Andrés Ares J, Eldabe S, Helsen N, Baranidharan G, Barat JL, Bhaskar A, Cassini F, Gillner S, Kallewaard JW, Klessinger S, Mavrocordatos P, Occhigrossi F, Van Zundert J, Huygen F, Stoevelaar H. Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method. Pain Pract 2024. [PMID: 38597223 DOI: 10.1111/papr.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain. METHODS The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios. RESULTS For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region. CONCLUSIONS A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.
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Affiliation(s)
- Javier de Andrés Ares
- Department of Anesthesiology-Pain Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Nicky Helsen
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
| | | | - Jean-Luc Barat
- Service de Neurochirurgie, Hôpital privé Clairval - Ramsay santé, Marseille, France
| | - Arun Bhaskar
- Pain Management Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fabrizio Cassini
- SS. Antonio e Biagio e C. Arrigo Hospital, Allesandria, Piedmont, Italy
| | - Sebastian Gillner
- Department of Neurosurgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Willem Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands
- Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Huygen
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
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3
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Raymaekers V, Meeuws S, Goudman L, der Steen GV, Moens M, Vanloon M, Ridder DD, Menovsky T, Vesper J, Plazier M. Patient profiling and outcome assessment in spinal cord stimulation for chronic back and/or leg pain (the PROSTIM study): a study protocol. Pain Manag 2023; 13:677-687. [PMID: 38054386 DOI: 10.2217/pmt-2023-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Spinal cord stimulation (SCS) is a well-established treatment option in the multidisciplinary approach to chronic back and leg pain. Nevertheless, careful patient selection remains crucial to provide the most optimal treatment and prevent treatment failure. We report the protocol for the PROSTIM study, an ongoing prospective, multicentric and observational clinical study (NCT05349695) that aims to identify different patient clusters and their outcomes after SCS. Patients are recruited in different centers in Europe. Analysis focuses on identifying significant patient clusters based on different health domains and the changes in biopsychosocial variables 6 weeks, 3 and 12 months after implantation. This study is the first to include a biopsychosocial cluster analysis to identify significant patient groups and their response to treatment with SCS.
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Affiliation(s)
- Vincent Raymaekers
- Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, 2650, Belgium
- Faculty of Medicine & Life Science, Hasselt University, Hasselt, 3500, Belgium
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, 2650, Belgium
| | - Sacha Meeuws
- Department of Neurosurgery Jessa Hospital, Hasselt, 3500, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels, 1090, Belgium
- STIMULUS consortium (reSearch & TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology & Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Research Foundation-Flanders (FWO), Brussels, 1090, Belgium
| | | | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels, 1090, Belgium
- STIMULUS consortium (reSearch & TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology & Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels, 1090, Belgium
| | - Maarten Vanloon
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211, The Netherlands
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tomas Menovsky
- Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, 2650, Belgium
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, 2650, Belgium
| | - Jan Vesper
- Department of Stereotactic & Functional Neurosurgery, University Hospital Düsseldorf, Düsseldorf, 40204, Germany
| | - Mark Plazier
- Faculty of Medicine & Life Science, Hasselt University, Hasselt, 3500, Belgium
- Department of Neurosurgery Jessa Hospital, Hasselt, 3500, Belgium
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4
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Rauck RL, Loudermilk E, Thomson SJ, Paz-Solis JF, Bojrab L, Noles J, Vesper J, Atallah J, Roth D, Hegarty J, Prud'Homme M, Phillips GM, Smith SG, Ibrahim M, Willoughby CD, Obray JB, Gupta M, Paez J, Berg AP, Harrison NJ, Maino P, Mambalam P, McCarty M, Towlerton G, Love-Jones S, Ahmed S, Lee A, Shah B, Goor-Aryeh I, Russo MA, Varela N, Phelps JB, Cid J, Fernandez T, Pérez-Hernández C, Keehn D, Rosenow JM, Haider N, Parrent AG, Lawrence MM, Georgius P, Demartini L, Mendiola A, Mehta V, Thoma R, Israel AF, Carolis GD, Bhatia S, Green M, Villarreal A, Crooks MT, Gwinn RP, Pilitsis JG, Sato H, Vega SM, Hillegass MG, Carnes P, Scherer C, Brill S, Yu J, Brennan JJ, Gatzinsky K, Navani A, Snook LT, Bujedo BM, Andrés Ares JD, Murillo A, Trobridge AT, Assil K, Shah J, McLeod C, Buwembo J, Coster OD, Miller N, Sanapati M, Mikhael M, Przkora R, Sukenaga N, Raso LJ, Calodney AK, Cáceres Jerez LE, Uchiyama T, Kallewaard JW, Chandler B, Piedimonte F, Candido KD, Weaver TE, Agari T, Holthouse D, Woon R, Patel N, Lechleiter K, Jain R. Long-term safety of spinal cord stimulation systems in a prospective, global registry of patients with chronic pain. Pain Manag 2023; 13:115-127. [PMID: 36691862 DOI: 10.2217/pmt-2022-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: The availability of long-term (>2 years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3 years after device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant (1776 completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3 years was 7.6% (n = 98). Of these, 32 subjects (2.5%) indicated inadequate pain relief as cause for removal. Implant site infection (11 events) was the most common device-related serious adverse event (<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).
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Affiliation(s)
- Richard L Rauck
- Carolinas Pain Institute & The Center for Clinical Research LLC, Winston-Salem, NC 27103, USA
| | | | - Simon J Thomson
- Mid & South Essex University Hospitals, Basildon, Essex, SS16 5NL, United Kingdom
| | | | - Louis Bojrab
- Forest Health Medical Center, Ypsilanti, MI 48198, USA
| | - John Noles
- Spine & Pain Specialists, Shreveport, LA 71105, USA
| | - Jan Vesper
- University Hospital Düsseldorf, Düsseldorf, 40225, Germany
| | | | - Daniel Roth
- Summit Pain Management, Fort Wayne, IN 46804, USA
| | - Joseph Hegarty
- Optim Health System - Tattnall Hospital, Reidsville, GA 30453, USA
| | | | | | - Stephen G Smith
- Ramos Center for Interventional & Functional Pain Medicine, Englewood, FL 34205, USA
| | - Mohab Ibrahim
- University of Arizona, Banner Health - University Medical Center, Tucson, AZ 85719, USA
| | | | - Jon B Obray
- Southwest Spine & Pain Center, St George, UT 84790, USA
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, LLC, Overland Park, KS 66210, USA
| | - Julio Paez
- Southlake Pain Institute, Clermont, FL 34711, USA
| | | | | | - Paolo Maino
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, 6900, Switzerland
| | | | | | - Glyn Towlerton
- Chelsea & Westminster Hospitals, London, SW10 9NH, United Kingdom
| | | | - Shakil Ahmed
- Weill Cornell Medicine, Center for Comprehensive Spine Care, New York City, NY 10022, USA
| | - Albert Lee
- Tallahassee Neurological Clinic, Tallahassee, FL 32308, USA
| | - Binit Shah
- Carolinas Pain Center, Charlotte, NC 28262, USA
| | - Itay Goor-Aryeh
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, 52621, Israel
| | - Marc A Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, 2292, Australia
| | | | | | - José Cid
- Toledo University Hospital Complex, Toledo, 45004, Spain
| | - Tacson Fernandez
- Royal National Orthopaedic Hospital, NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | | | - Douglas Keehn
- Pain Centers of Wisconsin, Fort Atkinson, WI 53220, USA
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nameer Haider
- APMR Spinal & Skeletal Pain Medicine, Utica, NY 13502, USA
| | - Andrew G Parrent
- London Health Sciences Centre, Western University, London, ON, N6A 5W9, Canada
| | | | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, Queensland, 4567, Australia
| | | | - Agustin Mendiola
- Puerta de Hierro University Hospital, Boadilla del Monte, 28222, Spain
| | - Vivek Mehta
- St. Bartholomew's Hospital, London, EC1A 7BE, United Kingdom
| | | | - Atef F Israel
- Pain Management Associates, Lee's Summit, MO 64086, USA
| | | | - Sanjay Bhatia
- West Virginia University Neurosurgery, Morgantown, WV 26506, USA
| | - Matthew Green
- Pain Medicine of South Australia, Wayville, South Australia, 5034, Australia
| | | | | | - Ryder P Gwinn
- EvergreenHealth Neurosurgery, Kirkland, WA 98034, USA
| | - Julie G Pilitsis
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Hitoaki Sato
- Kobe University Hospital, Kobe City, Hyōgo, 650-0017, Japan
| | | | | | - Paul Carnes
- Raleigh Neurology Associates, Raleigh NC 27607, USA
| | | | - Silviu Brill
- Sourasky Medical Center, Tel Aviv, 6423914, Israel
| | - James Yu
- Sydney Spine & Pain, Hurstville, NSW, 2220, Australia
| | - James J Brennan
- Sentara Neurosurgery Specialists, Virginia Beach, VA 23454, USA
| | | | - Annu Navani
- Comprehensive Spine & Sports Center, Campbell, CA 95008, USA
| | - Lee T Snook
- Metropolitan Pain Management Consultants, Sacramento, CA 95821, USA
| | | | | | - Abel Murillo
- AMPM Research Clinic, Miami Gardens, FL 33169, USA
| | | | - Kamyar Assil
- Conejo Pain Specialists Medical Group, Thousand Oaks, CA 91360, USA
| | - Jawad Shah
- Insight Neurosurgery, Dearborn Heights, MI 48091, USA
| | - Carroll McLeod
- Mississippi Sports Medicine & Orthopaedic Center, Jackson, MS 39110, USA
| | - Joseph Buwembo
- University of Saskatchewan College of Medicine, Saskatoon, SK, S7N 5E5, Canada
| | | | - Nathan Miller
- Coastal Pain & Spinal Diagnostics, Carlsbad, CA 92009, USA
| | | | | | - Rene Przkora
- University of Florida Health, Gainesville, FL 32610, USA
| | - Norihiko Sukenaga
- Hyōgo College of Medicine Hospital, Nishinomiya, Hyōgo, 663-8501, Japan
| | | | | | | | - Takuya Uchiyama
- Kindai University, Faculty of Medicine, Osaka-sayama, Osaka, 577-8502, Japan
| | | | | | | | | | - Tristan E Weaver
- The Ohio State University Medical Center, Columbus, OH 43210, USA
| | - Takashi Agari
- Tokyo Metropolitan Neurological Hospital, Tokyo, 150-0013, Japan
| | - David Holthouse
- Green Lizard Science, Claremont, Western Australia, 6010, Australia
| | - Rex Woon
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
| | | | | | - Roshini Jain
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
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6
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Thomson S, Helsen N, Prangnell S, Paroli M, Baranidharan G, Belaïd H, Billet B, Eldabe S, De Carolis G, Demartini L, Gatzinsky K, Kallewaard JW, Winkelmüller M, Huygen F, Stoevelaar H. Patient selection for spinal cord stimulation: The importance of an integrated assessment of clinical and psychosocial factors. Eur J Pain 2022; 26:1873-1881. [PMID: 35856311 DOI: 10.1002/ejp.2009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND A previously developed educational e-health tool considers both clinical and psychosocial factors when selecting patients with chronic pain for spinal cord stimulation (SCS). The validity of the composite recommendations was evaluated in a retrospective study, demonstrating a strong relationship with patient outcomes after SCS. METHODS An additional retrospective analysis was performed to determine the added value of a psychosocial evaluation as part of the decision-making process on SCS. Data concerned 482 patients who were considered for SCS in 2018-2019. Analysis focused on the relationship between the different layers of the tool recommendations (clinical, psychosocial, composite) with trial results and patient outcomes at 6 months after SCS. Of the initial study population, 381 patients underwent SCS and had follow-up data on at least one of three pain-related outcome measures. RESULTS Pain improvement was observed in 76% of the patients for whom SCS was strongly recommended based on merely the clinical aspects. This percentage varied by the level of psychosocial problems and ranged from 86% in patients without any compromising psychosocial factors to 60% in those with severe problems. Similarly, the severity of psychosocial problems affected trial results in patients for whom SCS was either recommended or strongly recommended. CONCLUSIONS The strong relationship between psychosocial factors embedded in the SCS e-health tool and patient outcomes supports an integrated and multidisciplinary approach in the selection of patients for SCS. The educational e-health tool, combining both clinical and psychosocial aspects, is believed to be helpful for further education and implementation of this approach.
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Affiliation(s)
- Simon Thomson
- Mid and South Essex University Hospitals, Basildon, United Kingdom
| | - Nicky Helsen
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
| | - Simon Prangnell
- Clinical Neuropsychology Service, Oxford University Hospitals, Oxford, United Kingdom
| | - Mery Paroli
- Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy
| | - Ganesan Baranidharan
- Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Hayat Belaïd
- Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Bart Billet
- Department of Anaesthesiology, AZ Delta, Roeselare, Belgium
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Giuliano De Carolis
- FederDolore-SICD; Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy
| | | | - Kliment Gatzinsky
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Willem Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands.,Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Frank Huygen
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
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