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Guzzi G, Della Torre A, Bruni A, Lavano A, Bosco V, Garofalo E, La Torre D, Longhini F. Anatomo-physiological basis and applied techniques of electrical neuromodulation in chronic pain. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:29. [PMID: 38698460 PMCID: PMC11064427 DOI: 10.1186/s44158-024-00167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
Chronic pain, a complex and debilitating condition, poses a significant challenge to both patients and healthcare providers worldwide. Conventional pharmacological interventions often prove inadequate in delivering satisfactory relief while carrying the risks of addiction and adverse reactions. In recent years, electric neuromodulation emerged as a promising alternative in chronic pain management. This method entails the precise administration of electrical stimulation to specific nerves or regions within the central nervous system to regulate pain signals. Through mechanisms that include the alteration of neural activity and the release of endogenous pain-relieving substances, electric neuromodulation can effectively alleviate pain and improve patients' quality of life. Several modalities of electric neuromodulation, with a different grade of invasiveness, provide tailored strategies to tackle various forms and origins of chronic pain. Through an exploration of the anatomical and physiological pathways of chronic pain, encompassing neurotransmitter involvement, this narrative review offers insights into electrical therapies' mechanisms of action, clinical utility, and future perspectives in chronic pain management.
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Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Attilio Della Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Angelo Lavano
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Bosco
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Domenico La Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy.
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Tieppo Francio V, Alm J, Leavitt L, Mok D, Yoon BV, Nazir N, Lam C, Latif U, Sowder T, Braun E, Sack A, Khan T, Sayed D. Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation. Pain Pract 2024; 24:584-599. [PMID: 38078593 DOI: 10.1111/papr.13328] [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: 04/09/2024]
Abstract
INTRODUCTION The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. MATERIALS AND METHODS This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. RESULTS The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. CONCLUSION Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Alm
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Logan Leavitt
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Mok
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - B Victor Yoon
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy Sowder
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward Braun
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Talal Khan
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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D’Souza RS, Abd-Elsayed A. Perioperative management and best practices. SPINAL FUSION TECHNIQUES 2024:46-49. [DOI: 10.1016/b978-0-323-88223-1.00013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Ali R, Schwalb JM. History and Future of Spinal Cord Stimulation. Neurosurgery 2024; 94:20-28. [PMID: 37681953 DOI: 10.1227/neu.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/27/2023] [Indexed: 09/09/2023] Open
Abstract
Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to medical management. An SCS system comprised one or more leads implanted in the epidural space, typically connected to an implantable pulse generator. This review discusses the history, indications, surgical technique, technological advances, and future directions of SCS.
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Affiliation(s)
- Rushna Ali
- Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Medical Group, West Bloomfield , Michigan , USA
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Du T, Ni B, Shu W, Ren Z, Guo S, Zhang X, Zhu H, Hu Y. Dorsal Root Entry Zone Lesioning Following Unresponsive Spinal Cord Stimulation for Post-Traumatic Neuropathic Pain. World Neurosurg 2023; 178:e300-e306. [PMID: 37473865 DOI: 10.1016/j.wneu.2023.07.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) and dorsal root entry zone (DREZ) lesioning are important therapeutic options for intractable post-traumatic neuropathic pain (PNP). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. This study aims to retrospectively analyze the effect and complications of DREZ lesioning for patients with PNP who were unresponsive to SCS and provide a surgical reference. METHODS Demographic data and surgical characteristics of patients with PNP who underwent DREZ lesioning after an unresponsive SCS were reviewed. Long-term outcomes including numeric rating scale, global impression of change, and long-term complications were assessed. Kaplan-Meier analysis was used to evaluate pain-free survival. RESULTS Of 19 patients with PNP, 8 had brachial plexus injury (BPI), 7 had spinal cord injury, 2 had cauda equina injury, 1 had intercostal nerve injury, and 1 had lumbosacral plexus injury. All patients were unresponsive or had a recurrence of pain after SCS, with an average pain-relief rate of 9.3%. After DREZ lesioning, the mean numeric rating scale scores significantly decreased from 7.6 ± 1.5 to 1.8 ± 1.7, with an average pain-relief rate of 75.3%. Seven patients (36.8%) experienced worsened neurologic dysfunction at the last follow-up. Patients with BPI had a significantly better outcome than other pathologies (P < 0.001) after DREZ lesioning. CONCLUSIONS DREZ lesioning is an effective alternative procedure to SCS for patients with PNP who have lost limb function. Particularly for those with BPI, DREZ lesioning has shown good efficacy and can be considered a preferred surgical option.
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Affiliation(s)
- Tao Du
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bing Ni
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Shu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Ren
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Song Guo
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongwei Zhu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongsheng Hu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Shanthanna H, Eldabe S, Provenzano DA, Bouche B, Buchser E, Chadwick R, Doshi TL, Duarte R, Hunt C, Huygen FJPM, Knight J, Kohan L, North R, Rosenow J, Winfree CJ, Narouze S. Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain. Reg Anesth Pain Med 2023; 48:273-287. [PMID: 37001888 PMCID: PMC10370290 DOI: 10.1136/rapm-2022-104097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/18/2023] [Indexed: 04/03/2023]
Abstract
Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.
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Affiliation(s)
| | - Sam Eldabe
- James Cook University Hospital, Middlesbrough, UK
| | | | | | - Eric Buchser
- Pain Management and Neuromodulation Centre, EHC, Morges, Switzerland
- Pain, EHC, Morges, Switzerland
| | | | - Tina L Doshi
- Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rui Duarte
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Christine Hunt
- Anesthesiology - Pain Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | | | - Judy Knight
- Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Richard North
- Neurosurgery, Anesthesiology and Critical Care Medicine (ret.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Wallace MS, North JM, Phillips GM, Calodney AK, Scowcroft JA, Popat-Lewis BU, Lee JM, Washabaugh EP, Paez J, Bolash RB, Noles J, Atallah J, Shah B, Ahadian FM, Trainor DM, Chen L, Jain R. Combination therapy with simultaneous delivery of spinal cord stimulation modalities: COMBO randomized controlled trial. Pain Manag 2023; 13:171-184. [PMID: 36866658 DOI: 10.2217/pmt-2022-0101] [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: 03/04/2023] Open
Abstract
Aim: The Combining Mechanisms for Better Outcomes randomized controlled trial assessed the effectiveness of various spinal cord stimulation (SCS) modalities for chronic pain. Specifically, combination therapy (simultaneous use of customized sub-perception field and paresthesia-based SCS) versus monotherapy (paresthesia-based SCS) was evaluated. Methods: Participants were prospectively enrolled (key inclusion criterion: chronic pain for ≥6 months). Primary end point was the proportion with ≥50% pain reduction without increased opioids at the 3-month follow-up. Patients were followed for 2 years. Results: The primary end point was met (n = 89; p < 0.0001) in 88% of patients in the combination-therapy arm (n = 36/41) and 71% in the monotherapy arm (n = 34/48). Responder rates at 1 and 2 years (with available SCS modalities) were 84% and 85%, respectively. Sustained functional outcomes improvement was observed out to 2 years. Conclusion: SCS-based combination therapy can improve outcomes in patients with chronic pain. Clinical Trial Registration: NCT03689920 (ClinicalTrials.gov), Combining Mechanisms for Better Outcomes (COMBO).
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Affiliation(s)
- Mark S Wallace
- University of California, San Diego, San Diego, CA, 92093, USA
| | - James M North
- Carolinas Pain Institute & the Center for Clinical Research, Winston-Salem, NC, 27103, USA
| | | | | | | | | | - Jennifer M Lee
- Evergreen Health Medical Group, Kirkland, WA, 98034, USA
| | | | - Julio Paez
- South Lake Pain Institute, Clermont, FL, 34711, USA
| | | | - John Noles
- Spine & Pain Specialists, Shreveport, LA, 71105, USA
| | | | - Binit Shah
- Carolinas Pain Center, Huntersville, NC, 28078, USA
| | | | - Drew M Trainor
- The Denver Spine & Pain Institute, Denver, CO, 80033, USA
| | - Lilly Chen
- Boston Scientific Neuromodulation, Valencia, CA, 91355, USA
| | - Roshini Jain
- Boston Scientific Neuromodulation, Valencia, CA, 91355, USA
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Review of the Treatments for Central Neuropathic Pain. Brain Sci 2022; 12:brainsci12121727. [PMID: 36552186 PMCID: PMC9775950 DOI: 10.3390/brainsci12121727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Central neuropathic pain (CNP) affects millions worldwide, with an estimated prevalence of around 10% globally. Although there are a wide variety of treatment options available, due to the complex and multidimensional nature in which CNP arises and presents symptomatically, many patients still experience painful symptoms. Pharmaceutical, surgical, non-invasive, cognitive and combination treatment options offer a generalized starting point for alleviating symptoms; however, a more customized approach may provide greater benefit. Here, we comment on the current treatment options that exist for CNP and further suggest the need for additional research regarding the use of biomarkers to help individualize treatment options for patients.
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Spinal Cord Stimulation in Chronic Low Back Pain Syndrome: Mechanisms of Modulation, Technical Features and Clinical Application. Healthcare (Basel) 2022; 10:healthcare10101953. [PMID: 36292400 PMCID: PMC9601444 DOI: 10.3390/healthcare10101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
Chronic low-back pain (CLBP) is a common disease with several negative consequences on the quality of life, work and activity ability and increased costs to the health-care system. When pharmacological, psychological, physical and occupational therapies or surgery fail to reduce CLBP, patients may be a candidate for Spinal Cord Stimulation (SCS). SCS consists of the transcutaneous or surgical implantation of different types of electrodes in the epidural space; electrodes are then connected to an Implanted Pulse Generator (IPG) that generates stimulating currents. Through spinal and supraspinal mechanisms based on the “gate control theory for pain transmission”, SCS reduces symptoms of CLBP in the almost totality of well-selected patients and its effect lasts up to eight years in around 75% of patients. However, the evidence in favor of SCS still remains weak, mainly due to poor trial methodology and design. This narrative review is mainly addressed to those professionals that may encounter patients with CLBP failing conventional treatments. For this reason, we report the mechanisms of pain relief during SCS, the technical features and some clinical considerations about the application of SCS in patients with CLBP.
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Brill S, Defrin R, Aryeh IG, Zusman AM, Benyamini Y. Short- and long-term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial. Eur J Pain 2022; 26:1849-1862. [PMID: 35761769 PMCID: PMC9543320 DOI: 10.1002/ejp.2002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/03/2022] [Accepted: 06/25/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The effectiveness and long-term outcomes of spinal cord stimulation (SCS) are not fully established, especially considering that data from patients who withdrew from the trial are rarely analysed, which may lead to overestimation of SCS efficacy. We evaluated short- and long-term effects of SCS on chronic pain and perceived health, beyond natural variability in these outcomes. METHODS In a prospective design, 176 chronic pain patients referred to SCS were evaluated five times (baseline; retest ~6 weeks later; post-SCS trial; 8 and 28 weeks post-permanent implantation). Patients whose SCS trial failed (Temp group) were followed up and compared to those who underwent permanent SCS (Perm group). RESULTS Analyses revealed a non-linear (U-shaped) trend significantly different between the two groups. In the Perm group, a significant improvement occurred post-SCS implantation in pain severity, pain interference, health-related quality of life and self-rated health, which was followed by gradual worsening and return to baseline values at end of follow-up. In the Temp group, only minor changes occurred in these outcomes over time. On average, baseline and end of follow-up values in the Perm and Temp groups were similar: ~40% in each group exhibited an increase in pain severity over time and 38% and 33%, respectively, exhibited reductions in pain severity over time. CONCLUSIONS Since the greatest improvement in the outcome measures occurred from baseline to post-SCS trial (T1-T3) followed by a gradual decline in the effect, it appears that SCS may not be effective for the majority of chronic pain patients. SIGNIFICANCE This longitudinal study evaluated short and long term effects of spinal cord stimulation (SCS) on chronic pain outcome measures, beyond their natural variation in time. Despite significant short term improvements, by the end of the seven months' follow-up, the outcomes in the treatment group (people who received the permanent implantation) were similar to those of the control group (people whose SCS trial failed and did not continue to permanent implantation) suggesting SCS may not be cost-effective for chronic pain patients.
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Affiliation(s)
- Silviu Brill
- Department of Anesthesia and Critical Care Medicine, Institute of Pain MedicineTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Ruth Defrin
- Department of Physical Therapy, Sagol School of Neuroscience, School of Health Professions, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Itay Goor Aryeh
- Pain Medicine Institute, Sheba Medical CenterTel HashomerRamat GanIsrael
| | | | - Yael Benyamini
- Bob Shapell School of Social WorkTel Aviv UniversityTel AvivIsrael
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11
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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: 5] [Impact Index Per Article: 2.5] [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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Alizadeh R, Sharifzadeh SR. Pathogenesis, etiology and treatment of failed back surgery syndrome. Neurochirurgie 2021; 68:426-431. [PMID: 34543614 DOI: 10.1016/j.neuchi.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/22/2021] [Accepted: 09/04/2021] [Indexed: 12/19/2022]
Abstract
Failed back surgery syndrome (FBSS) is associated with persistent lower back pain after and despite one or more surgical interventions. A number of factors underlie and maintain FBSS and successful management of pain chiefly depends on identifying them. Pharmacological, surgical, and non-surgical therapeutic measures are taken to treat the pain. Spinal cord stimulation and nerve stimulation have been widely practiced in this regard and enhanced pain reduction and patient satisfaction. In hernia and recurrent disc degeneration and sagittal imbalance, discectomy and/or fusion are indicated. The present review focuses on FBSS and its underlying components and on available treatment options.
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Affiliation(s)
- R Alizadeh
- Department of Anesthesiology and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - S R Sharifzadeh
- Department of Orthopedic Surgery, School of Medicine, AJA University of Medical Science, Tehran, Iran.
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McClure JJ, Desai BD, Ampie L, You W, Smith JS, Buchholz AL. A Systematic Review of the Cost-Utility of Spinal Cord Stimulation for Persistent Low Back Pain in Patients With Failed Back Surgery Syndrome. Global Spine J 2021; 11:66S-72S. [PMID: 33890806 PMCID: PMC8076810 DOI: 10.1177/2192568220970163] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To review the literature surrounding the cost-effectiveness of implanting spinal cord stimulators for failed back surgery syndrome. METHODS A systematic review was conducted inclusive of all publications in the Medline database and Cochrane CENTRAL trials register within the last 10 years (English language only) assessing the cost-effectiveness of Spinal Cord Stimulator device implantation (SCSdi) in patients with previous lumbar fusion surgery. RESULTS The majority of reviewed publications that analyzed cost-effectiveness of SCSdi compared to conventional medical management (CMM) or re-operation in patients with failed back surgery syndrome (FBSS) showed an overall increase in direct medical costs; these increased costs were found in nearly all cases to be offset by significant improvements in patient quality of life. The cost required to achieve these increases in quality adjusted life years (QALY) falls well below $25 000/QALY, a conservative estimate of willingness to pay. CONCLUSIONS The data suggest that SCSdi provides both superior outcomes and a lower incremental cost: effectiveness ratio (ICER) compared to CMM and/or re-operation in patients with FBSS. These findings are in spite of the fact that the majority of studies reviewed were agnostic to the type of device or innervation utilized in SCSdi. Newer devices utilizing burst or higher frequency stimulation have demonstrated their superiority over traditional SCSdi via randomized clinical trials and may provide lower ICERs.
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Affiliation(s)
- Jesse J. McClure
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Bhargav D. Desai
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Leonel Ampie
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Wen You
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Justin S. Smith
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Avery L. Buchholz
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA,Avery L. Buchholz, Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA.
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14
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Schwarm FP, Ott M, Nagl J, Leweke F, Stein M, Uhl E, Maxeiner H, Kolodziej MA. Preoperative Elevated Levels for Depression, Anxiety, and Subjective Mental Stress Have No Influence on Outcome Measures of Peripheral Nerve Field Stimulation for Chronic Low Back Pain-A Prospective Study. Neuromodulation 2021; 24:1042-1050. [PMID: 33522693 DOI: 10.1111/ner.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. The treatment of low back pain strongly depends on psychological factors like anxiety, depression, and mental stress. The aim of this study was to evaluate the impact of such factors on outcome measures after lead- and implantable pulse generator-implantation. MATERIALS AND METHODS Between 2014 and 2019, a prospective cohort study of 39 patients with chronic lumbar pain was conducted. Hospital Anxiety and Depression Scale (HADS) score was assessed at baseline to measure symptoms of anxiety and depression. Symptom checklist-90 (SCL-90) was used to measure subjective psychopathology. Pain intensity (numeric pain rating scale [NRS]), SF12v2 with Physical Component Summary and Mental Component Summary (MCS) scores, and Oswestry Disability Index (ODI) were assessed pre- and postoperatively as well as three and six months after PNFS implantation. Outcome values were compared to baseline data. Statistical analysis was performed using depending t-test and analysis of variance (ANOVA). A p value <0.05 was considered significant. RESULTS The cohort consisted of 39 patients (18 females, 21 males) with a median age of 61 years (IQR25-75 = 52-67 years). NRS, ODI, and SF12v2 showed significant improvement in the whole follow-up period compared to baseline values (p < 0.05). Elevated HADS scores for anxiety were seen in 64.1%, for depression in 76.9% of the patients at baseline. SCL-90 was pathologic in 71.8% of the cases. A one-way ANOVA revealed no differences between elevated HADS- and SCL-90 values and all outcome measures after PNFS implantation in the whole follow-up period (p > 0.05). CONCLUSION Chronic low back pain is often associated with psychological distress. Our study showed highly elevated levels for anxiety and depression as well as subjective mental stress in patients with chronic low back pain without negative impact on NRS, ODI, and SF12v2 in the whole follow-up after PNFS implantation.
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Affiliation(s)
- Frank P Schwarm
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marc Ott
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jasmin Nagl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hagen Maxeiner
- Department of Anesthesiology, Intensive Care and Pain Therapy, Justus-Liebig-University Giessen, Giessen, Germany
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15
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Hagedorn JM, McArdle I, D'Souza RS, Yadav A, Engle AM, Deer TR. Effect of Patient Characteristics on Clinical Outcomes More Than 12 Months Following Dorsal Root Ganglion Stimulation Implantation: A Retrospective Review. Neuromodulation 2021; 24:695-699. [PMID: 33508161 DOI: 10.1111/ner.13326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Dorsal root ganglion (DRG) stimulation is an effective treatment option for lower extremity complex regional pain syndrome and other focal pain conditions. However, the patient characteristics that may predict long-term outcomes have not been defined. MATERIALS AND METHODS This was a retrospective observational study that included 93 patients who were implanted with a DRG stimulator at a single private practice institution. A variety of demographic data was collected. Follow-up results were reviewed from multiple time points more than 12 months. Patients were classified as either "responder" or "nonresponder" status using two different thresholds, "greater than or equal to 50% pain relief" and "greater than or equal to 80% pain relief." RESULTS A history of prior chronic opioid use was associated with significantly lower rates of responder status based on both a 50% pain relief threshold and 80% pain relief threshold at the one week to one month, three months, and 12-months visits. CONCLUSIONS This single-center retrospective study found patients prescribed chronic opioids at the time of DRG stimulator implantation had a higher likelihood of less than 50% pain relief and 80% pain relief at one month, three months, and 12 months follow-up visits.
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Affiliation(s)
- Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ian McArdle
- West Virginia University School of Medicine, Charleston, WV, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhishek Yadav
- Department of Anesthesiology, Brown University, Providence, RI, USA
| | - Alyson M Engle
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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16
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Predicting the Response of High Frequency Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome: A Retrospective Study with Machine Learning Techniques. J Clin Med 2020; 9:jcm9124131. [PMID: 33371497 PMCID: PMC7767526 DOI: 10.3390/jcm9124131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Despite the proven clinical value of spinal cord stimulation (SCS) for patients with failed back surgery syndrome (FBSS), factors related to a successful SCS outcome are not yet clearly understood. This study aimed to predict responders for high frequency SCS at 10 kHz (HF-10). Data before implantation and the last available data was extracted for 119 FBSS patients treated with HF-10 SCS. Correlations, logistic regression, linear discriminant analysis, classification and regression trees, random forest, bagging, and boosting were applied. Based on feature selection, trial pain relief, predominant pain location, and the number of previous surgeries were relevant factors for predicting pain relief. To predict responders with 50% pain relief, 58.33% accuracy was obtained with boosting, random forest and bagging. For predicting responders with 30% pain relief, 70.83% accuracy was obtained using logistic regression, linear discriminant analysis, boosting, and classification trees. For predicting pain medication decrease, accuracies above 80% were obtained using logistic regression and linear discriminant analysis. Several machine learning techniques were able to predict responders to HF-10 SCS with an acceptable accuracy. However, none of the techniques revealed a high accuracy. The inconsistent results regarding predictive factors in literature, combined with acceptable accuracy of the currently obtained models, might suggest that routinely collected baseline parameters from clinical practice are not sufficient to consistently predict the SCS response with a high accuracy in the long-term.
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17
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Gould HM, D'Eon MS, Grinberg AM, Chakravarthy KV, Castellanos J, Rutledge T. Psychosocial characteristics of candidates for implantable pain devices: validation of an assessment model. Pain Manag 2020; 11:159-172. [PMID: 33183132 DOI: 10.2217/pmt-2020-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: To provide a detailed profile of Veteran and community patients with chronic pain who completed preprocedural psychological evaluations for implantable pain devices. Patients & methods: A total of 157 candidates completed a preimplantable pain device evaluation between June 2018 and October 2019 with a pain psychologist that included a structured interview, elicitation of patient-centered goals for the implantable device, and psychometric testing. Results: Candidates demonstrated moderate to high rates of sleep impairment (73%), depressive symptoms (62%), anxiety symptoms (61%), pain catastrophizing (37%), cognitive impairment screen (30%) and somatic symptoms (24%). Conclusion: Candidates for implantable pain devices report high rates of mood, sleep and cognitive impairment, reinforcing the value of preprocedural psychological evaluations.
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Affiliation(s)
- Hilary M Gould
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Maya S D'Eon
- Department of Psychiatry, University of California, San Diego, CA 92093, USA.,Department of Anesthesiology, University of California, San Diego, Health Sciences, San Diego, CA 92093, USA
| | - Austin M Grinberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.,David Geffen School of Medicine at The University of California, Los Angeles, CA 90095, USA
| | - Krishnan V Chakravarthy
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Anesthesiology, University of California, San Diego, Health Sciences, San Diego, CA 92093, USA
| | - Joel Castellanos
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Anesthesiology, University of California, San Diego, Health Sciences, San Diego, CA 92093, USA
| | - Thomas Rutledge
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92093, USA
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18
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Poulsen DM, Sørensen JCH, Blichfeldt-Eckhardt MR, Gulisano HA, Knudsen ALH, Nikolajsen L, Meier K. Pain Catastrophizing Does Not Predict Spinal Cord Stimulation Outcomes: A Cohort Study of 259 Patients With Long-Term Follow-Up. Neuromodulation 2020; 24:76-85. [PMID: 32929834 DOI: 10.1111/ner.13213] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/19/2020] [Accepted: 05/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) is an important treatment modality used to treat chronic neuropathic pain. However, reported success rates of 26%-70% entail an increased focus on patient selection. An area of core interest is psychological evaluation, often using scales such as the Pain Catastrophizing Scale (PCS). The aim of this study was to assess the relation between baseline PCS scores obtained before implantation and SCS outcomes defined as (1) Rating on Patients' Global Impression of Change scale (PGIC), (2) Pain relief on the Numeric Rating Scale (NRS), (3) Cessation of pain medication, and (4) Risk of permanent explantation. MATERIALS AND METHODS Using records from the Neurizon Neuromodulation Database, we performed a multicenter open cohort study of 259 permanently implanted SCS patients. Follow-up ranged from six months to nine years (median = three years). For each of the defined SCS outcomes, patients were grouped according to their latest follow-up registration. Subsequently, we used a one-way ANOVA and exact t-tests to compare mean baseline PCS scores between groups. RESULTS No difference in mean baseline PCS scores was found between PGIC groups. Baseline PCS scores was not associated with the probability of obtaining 30% or 50% pain relief on latest registration. Baseline PCS scores of patients able to cease all usage of tricyclic antidepressants, antiepileptics, or opioids during SCS treatment did not differ from baseline scores of continuous users. We found no association between baseline PCS scores and risk of permanent explantation. CONCLUSION This study did not demonstrate any associations between baseline PCS scores and SCS outcomes.
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Affiliation(s)
- Dennis Møgeltoft Poulsen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Experimental Neuroscience (CENSE), Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Experimental Neuroscience (CENSE), Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Rune Blichfeldt-Eckhardt
- ESES Unit, Department of Neurosurgery, Odense University Hospital, Odense, Denmark.,Department of Anesthesiology and Critical Care, Odense University Hospital, Odense, Denmark
| | | | | | - Lone Nikolajsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kaare Meier
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Experimental Neuroscience (CENSE), Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
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19
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Abd-Elsayed A, Abdallah R, Falowski S, Chaiban G, Burkey A, Slavin K, Guirguis M, Raslan AM. Development of an Educational Curriculum for Spinal Cord Stimulation. Neuromodulation 2020; 23:555-561. [PMID: 32282109 DOI: 10.1111/ner.13142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal cord stimulators (SCSs) are used for treating chronic pain. The number of SCSs implanted each year is on the increase. The North American Neuromodulation Society (NANS) education committee aimed to develop a SCS curriculum as a tool to guide physicians at different training levels, based on the most recent evidence. MATERIAL AND METHODS A multidisciplinary (anesthesiology, physical medicine, neurosurgery, and neurology), taskforce representing the education committee of the NANS met to develop a SCS curriculum following the Accreditation Council for Graduate Medical Education (ACGME) milestones. The task force used the best available evidence and knowledge to develop the curriculum. Once developed, the SCS curriculum was then approved by the NANS board. RESULTS The task force developed a SCS training curriculum. Milestones included patient care and procedural skills, system-based practice, medical knowledge, interpersonal communication, practice based learning and professionalism. Each milestone was defined for three categories, early learner, advanced learner, and practitioner. CONCLUSION A multidisciplinary task force of the NANS education committee developed a SCS training curriculum that defines ACGME milestones for basic learners, advanced learners, and practitioners.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rany Abdallah
- Department of Anesthesiology, Temple University, Philadelphia, PA, USA
| | | | - Gassan Chaiban
- Department of Anesthesiology, the Ochsner Medical Center, New Orleans, LA, USA
| | - Adam Burkey
- Department of Anesthesia, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois Hospital, Chicago, IL, USA
| | - Maged Guirguis
- Department of Anesthesiology, the Ochsner Medical Center, New Orleans, LA, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
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20
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Thomson S, Huygen F, Prangnell S, De Andrés J, Baranidharan G, Belaïd H, Berry N, Billet B, Cooil J, De Carolis G, Demartini L, Eldabe S, Gatzinsky K, Kallewaard JW, Meier K, Paroli M, Stark A, Winkelmüller M, Stoevelaar H. Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool. Eur J Pain 2020; 24:1169-1181. [PMID: 32187774 PMCID: PMC7318692 DOI: 10.1002/ejp.1562] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022]
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/).
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Affiliation(s)
- Simon Thomson
- Department of Anaesthesiology, Basildon and Thurrock University Hospitals, Basildon, UK
| | - Frank Huygen
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simon Prangnell
- Clinical Neuropsychology Service, Oxford University Hospitals, Oxford, UK
| | - José De Andrés
- Valencia University Medical School Anesthesia Unit - Surgical Specialties Department, Department of Anaesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain
| | | | - Hayat Belaïd
- Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Neil Berry
- Neuromodulation Team, Wessex Neurological Centre, Southampton, UK
| | - Bart Billet
- Department of Anaesthesiology, AZ Delta, Roeselare, Belgium
| | - Jan Cooil
- Department of Physiotherapy, Basildon and Thurrock University Hospitals, Basildon, UK
| | - Giuliano De Carolis
- Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy
| | - Laura Demartini
- Pain Unit, Clinical Scientific Institutes Maugeri, Pavia, Italy
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Kliment Gatzinsky
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan W Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands
| | - Kaare Meier
- Department of Neurosurgery and Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mery Paroli
- Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy
| | - Angela Stark
- Pain Management Service, Basildon and Thurrock University Hospitals, Basildon, UK
| | | | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
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21
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Määttä J, Martikainen A, Ikäheimo TM, Nissen M, Viinamäki H, von Und Zu Fraunberg M, Huttunen J. Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients. Neuromodulation 2019; 23:646-652. [PMID: 31508883 DOI: 10.1111/ner.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study is to investigate whether benzodiazepine use differs between patients with favorable and unfavorable spinal cord stimulation (SCS) treatment outcome. We hypothesize that the patients with unfavorable SCS outcome would exhibit a higher level of benzodiazepine use. MATERIALS AND METHODS Using a case-control study setting, we examined benzodiazepine use in SCS patients and in matched population controls as a potential risk factor poor SCS outcome. A total of 373 consecutive SCS patients treated in Kuopio University Hospital between 1997 and 2014 and their 1117 matched population controls were followed until patient death or the end of March 2016. RESULTS Benzodiazepines were used during the 24-month period before or after SCS implantation by 42.3% of the SCS patients who had the device explanted, 39.5% who had an unsuccessful trial stimulation, 28.0% who still had the device at the end of the follow-up period, and 8.0% of the controls. Diazepam use before SCS increased the odds for explanting of SCS by 2.4-fold (95% Cl: 1.0-5.4). Starting clonazepam use after SCS was associated with a 5.2-fold (95% CI: 1.5-18.9) increase in the odds of unsuccessful trial stimulation. CONCLUSION The benzodiazepine use in patients with poor SCS outcome illustrates the role of anxiety in SCS outcomes and the need for multidisciplinary treatment of pain.
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Affiliation(s)
- Jaakko Määttä
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Antti Martikainen
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tiina-Mari Ikäheimo
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mette Nissen
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heimo Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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22
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Simopoulos T, Sharma S, Wootton RJ, Orhurhu V, Aner M, Gill JS. Discontinuation of Chronic Opiate Therapy After Successful Spinal Cord Stimulation Is Highly Dependent Upon the Daily Opioid Dose. Pain Pract 2019; 19:794-799. [PMID: 31199551 DOI: 10.1111/papr.12807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to determine if any of the factors recorded on a standard clinical history of a patient considered for spinal cord stimulation (SCS) would be associated with reduction or cessation of opioids following implantation. DESIGN Retrospective, single academic center. METHODS Patients included in the chart analysis underwent implantation of percutaneous SCS devices from 1999 to 2015 with follow-up until the end of September 2018. Patients who achieved at least an average of 50% pain reduction were included for analysis of daily opioid intake. Patients were then divided into 4 groups that included no opioid use, stable opioid daily dose, weaned opioid dose, and complete cessation of opioids. Statistical methods were used to analyze for associations between opioid intake after SCS insertion and usual elements of a clinical history, including adjuvant medications, numeric pain rating, past medical history, psychiatric illness, substance abuse, employment, and smoking history. RESULTS In a group of 261 patients who had undergone implantation, 214 met the criteria for analysis and had a median age of 50 years, with majority having the diagnoses of failed back surgery syndrome and complex regional pain syndrome. The only factor that was associated with complete cessation of opioid use was a median dose of 30 mg of morphine per day (P < 0.01) and was observed in 15% of subjects who used opioids preoperatively. CONCLUSION The elimination of opioid dependence following initiation of SCS therapy is highly dependent on the daily dose.
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Affiliation(s)
- Thomas Simopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sanjiv Sharma
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Raymond Joshua Wootton
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Vwaire Orhurhu
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Moris Aner
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jatinder S Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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23
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Paroli M, Bernini O, De Carolis G, Tollapi L, Bondi F, Martini A, Dario A, Paolicchi A. Are Multidimensional Pain Inventory Coping Strategy Profiles Associated with Long-Term Spinal Cord Stimulation Effectiveness? PAIN MEDICINE 2019; 19:1023-1032. [PMID: 28549170 DOI: 10.1093/pm/pnx106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction It is acknowledged that the way patients cope with pain may influence treatment outcome. In particular, psychological factors are deemed important when considering patients for suitability for spinal cord stimulation (SCS). Objective The aim of the study is to observe how pre-implantation psychological characteristics impact the effectiveness of SCS for chronic pain. Methods The analysis comprised data from 137 patients who underwent an SCS implant. Screening evaluation included a coping strategies profile (Multidimensional Pain Inventory) and psychiatric disorders (Mini-International Neuropsychiatric Interview). Based on SCS implant outcome collected during follow-up visits, patients were divided into three groups: subjects with long-term pain relief (long-term group), subjects who failed the SCS treatment and decided to explant trial device (trial explanter group [TE]), and those who chose a permanent device (permanent explanter group [PE]). Results Results showed that most of the patients who failed with the SCS (TE and PE groups) demonstrated a dysfunctional coping profile and showed a higher presence of psychiatric disorders, which significantly influenced the experience and perception of pain. Conclusions The findings of this study support the value of a multidisciplinary screening. Addressing psychological issues before SCS implantation can reduce the failure rate of SCS.
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Affiliation(s)
- Mery Paroli
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Olivia Bernini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Giuliano De Carolis
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lara Tollapi
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Franca Bondi
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Antonella Martini
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alessandro Dario
- Department of Neurosurgery, Macchi Foundation Hospital, Varese, Italy
| | - Adriana Paolicchi
- Anesthesiology and Pain Therapy UnitAzienda Ospedaliera Universitaria Pisana, Pisa, Italy
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The Use of Spinal Cord Stimulation/Neuromodulation in the Management of Chronic Pain. J Am Acad Orthop Surg 2019; 27:e401-e407. [PMID: 30358637 DOI: 10.5435/jaaos-d-17-00829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Chronic pain causes a tremendous burden on the society in terms of economic factors and social costs. Rates of spinal surgery, especially spinal fusion, have increased exponentially over the past decade. The opioid epidemic in the United States has been one response to the management of pain, but it has been fraught with numerous catastrophic-related adverse effects. Clinically, spinal cord stimulation (SCS)/neuromodulation has been used in the management of chronic pain (especially spine-related pain) for more than two decades. More recent advances in this field have led to new theories and approaches in which SCS can be used in the management of chronic spine-related pain with precision and efficacy while minimizing adverse effects commonly seen with other forms of chronic pain treatment (eg, narcotics, injections, ablations). Narcotic medications have adverse effects of habituation, nausea, constipation, and the like. Injections sometimes lack efficacy and can have only limited duration of efficacy. Also, they can have adverse effects of cerebrospinal fluid leak, infection, and so on. Ablations can be associated with burning discomfort, lack of efficacy, recurrent symptoms, and infection. High-frequency stimulation, burst stimulation, tonic stimulation with broader paddles, and new stimulation targets such as the dorsal root ganglion hold promise for improved pain management via neuromodulation moving forward. Although a significant rate of complications with SCS technology are well described, this can be a useful tool in the management of chronic spine-related pain.
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Abstract
Spinal cord stimulation (SCS) has been well established as a safe and effective treatment of pain derived from a wide variety of etiologies. Careful patient selection including a rigorous trial period and psychological evaluation are essential. When patients proceed to permanent implantation, various considerations should be made, such as the type of lead, type of anesthesia, and waveform patterns for SCS. This article discusses the common indications for SCS, patient selection criteria, and pertinent outcomes from randomized clinical trials related to common indications treated with SCS. Technical considerations, such as type of implant, anesthesia, and programming, are also discussed.
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Affiliation(s)
- Andrew K Rock
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Huy Truong
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Yunseo Linda Park
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
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Duarte RV, Thomson S. Trial Versus No Trial of Spinal Cord Stimulation for Chronic Neuropathic Pain: Cost Analysis in United Kingdom National Health Service. Neuromodulation 2019; 22:208-214. [PMID: 30536992 PMCID: PMC6590634 DOI: 10.1111/ner.12898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the current project was to evaluate the spinal cord stimulation (SCS) screening trial success rate threshold to obtain the same cost impact across two identical sets of patients following either a prolonged screening trial prior to implantation strategy or a full implant without a screening trial. MATERIALS AND METHODS A cost impact analysis was carried out from a health care perspective and considered trial to implant rates reported in the literature. Items of resource use were costed using national averages obtained from the National Health Service (NHS) reference cost data base. Cost components were added up to derive total patient level costs for the NHS. Only the costs associated with the screening trial procedures and devices were considered. RESULTS The most conservative of our estimates suggest that a failure rate of less than 15% is cost saving to the NHS. A failure rate as high as 45% can also be cost saving if the less expensive nonrechargeable SCS devices are used. All the thresholds observed represent a considerably higher screening failure rate than that reported in the latest randomized controlled trials (RCTs) of SCS. A trial to implant ratio of 91.6% could represent savings between £16,715 (upper bound 95% CI of rechargeable implantable pulse generator [IPG] cost) and £246,661 (lower bound 95% CI of nonrechargeable IPG cost) per each 100 patients by adopting an implantation only strategy. CONCLUSIONS Considerable savings could be obtained by adopting an implantation strategy without a screening trial. It is plausible that accounting for other factors, such as complications that can occur with a screening trial, additional savings could be achieved by choosing a straight to implant treatment strategy. Nevertheless, additional evidence is warranted to support this claim.
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Affiliation(s)
- Rui V. Duarte
- Liverpool Reviews and Implementation GroupUniversity of LiverpoolLiverpoolUK
| | - Simon Thomson
- Basildon and Thurrock University HospitalsBasildonUK
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Grinberg AM, D'Eon MS, Ellison JK, Rutledge T, Castellanos J, Chakravarthy KV. A revised psychosocial assessment model for implantable pain devices to improve their evidence basis and consensus with updated pain management guidelines. Pain Manag 2019; 9:139-149. [PMID: 30681019 DOI: 10.2217/pmt-2018-0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although psychosocial evaluations for implantable pain devices have been consensus recommendations since the 1990s, there is an inconsistent support regarding their ability to identify suitable pain device candidates or to predict clinical outcomes. With the emergence of evidence-based practices and the recent release of pain management guidelines emphasizing functional improvements and safety, the disparity between the recommendations for implantable pain device psychosocial evaluations and the evidence supporting them has only grown. In this special report, we describe a revised model for conducting psychosocial evaluations among implantable pain device candidates. This model includes changes to increase the evidence-basis of the psychosocial evaluations, incorporate patient-centered care standards and harmonize the evaluation structure with the most current pain management guidelines.
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Affiliation(s)
- Austin M Grinberg
- VA San Diego Healthcare System, Anesthesia Pain Clinic, San Diego, CA, USA 92161
| | - Maya S D'Eon
- University of California, San Diego, Health Sciences, San Diego, CA, USA 92093.,University of California, San Diego, Department of Psychiatry, San Diego, CA, USA 92093
| | - Jenna K Ellison
- VA San Diego Healthcare System, Anesthesia Pain Clinic, San Diego, CA, USA 92161
| | - Thomas Rutledge
- VA San Diego Healthcare System, Anesthesia Pain Clinic, San Diego, CA, USA 92161.,University of California, San Diego, Health Sciences, San Diego, CA, USA 92093
| | - Joel Castellanos
- VA San Diego Healthcare System, Anesthesia Pain Clinic, San Diego, CA, USA 92161.,University of California, San Diego, Health Sciences, San Diego, CA, USA 92093
| | - Krishnan V Chakravarthy
- VA San Diego Healthcare System, Anesthesia Pain Clinic, San Diego, CA, USA 92161.,University of California, San Diego, Health Sciences, San Diego, CA, USA 92093
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Prabhala T, Kumar V, Gruenthal E, Collison C, Prusik J, Owusu S, Hobson E, McCallum SE, Pilitsis JG. Use of a Psychological Evaluation Tool as a Predictor of Spinal Cord Stimulation Outcomes. Neuromodulation 2018; 22:194-199. [DOI: 10.1111/ner.12884] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/30/2018] [Accepted: 09/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Tarun Prabhala
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Vignessh Kumar
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Eric Gruenthal
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Claire Collison
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Julia Prusik
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Stephanie Owusu
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Ellie Hobson
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Sarah E. McCallum
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
| | - Julie G. Pilitsis
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical College; Albany NY USA
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Shimizu T, Hosomi K, Maruo T, Goto Y, Shimokawa T, Haruhiko K, Saitoh Y. Repetitive transcranial magnetic stimulation accuracy as a spinal cord stimulation outcome predictor in patients with neuropathic pain. J Clin Neurosci 2018; 53:100-105. [PMID: 29699887 DOI: 10.1016/j.jocn.2018.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECT Spinal cord stimulation (SCS) is an effective albeit invasive and relatively expensive treatment of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) is a non-invasive treatment of neuropathic pain. The aim of the current study was to investigate whether rTMS can predict the successful outcome of SCS. METHODS The study population consisted of 22 patients with neuropathic pain who had undergone SCS and rTMS. We conducted statistical analyses to identify the factors that predict pain reduction following SCS. RESULTS Multiple regression analyses showed that only degree of pain relief following rTMS was statistically correlated with success in SCS; on the other hand, age, sex, lesion location, pain duration and laterality, and targeted extremities were not correlated. Using receiver-operating characteristic (ROC) curve analyses of the pain relief following rTMS, the diagnostic sensitivity for successful SCS was 0.60 and the specificity was 0.83. CONCLUSIONS The degree of pain relief following rTMS over M1 is a significant prognostic factor of SCS outcome in patients with intractable neuropathic pain. SIGNIFICANCE The current study provides evidence showing that rTMS, a non-invasive and relatively easy to administer procedure, may aid in the selection of suitable candidates for SCS treatment.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Otemae Hospital, 1-5-34 Otemae, Osaka, Osaka 540-0008, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Koichi Hosomi
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Tomoyuki Maruo
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Otemae Hospital, 1-5-34 Otemae, Osaka, Osaka 540-0008, Japan.
| | - Yuko Goto
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Toshio Shimokawa
- Clinical Research Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
| | - Kishima Haruhiko
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Youichi Saitoh
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. http://www.neuromod.med.osaka-u.ac.jp/eng/access.html
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30
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Shirvalkar P, Poree LR, Krames ES. The Development of Algorithms for Pain Care Including Neuromodulation Therapies. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Khan H, Pilitsis JG, Prusik J, Smith H, McCallum SE. Pain Remission at One-Year Follow-Up With Spinal Cord Stimulation. Neuromodulation 2017; 21:101-105. [PMID: 29058361 DOI: 10.1111/ner.12711] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Spinal Cord Stimulation (SCS) is an effective treatment for chronic pain. How often pain remission follows SCS has not been evaluated. This is a retrospective analysis of patients who underwent an implantation of spinal cord stimulators for various chronic pain conditions. The objective of the study was to elucidate characteristics and features of patients with pain relief greater than 80% after one year of treatment. METHODS A total of 86 patients with thoracic SCS and 12-month follow-up data were identified. Patients were divided into a remission group (>80% improvement in Numeric Pain Rating Scale [NRS] pain scale), average responders (20-80% improvement) and a non-responder group (less than 20% improvement). These patient groups were compared via the following outcome measures: NRS, Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), McGill Pain Questionnaire (MPQ), and Insomnia Severity Index (ISI). Correlations with age, body mass index (BMI), tobacco and alcohol usage, patient satisfaction with SCS, disability status, and opioid usage were assessed. RESULTS Nineteen of 86 patients (22%) were remitters at one year follow-up, including 17 patients who had an NRS = 0 at that time. Upon analyzing the three patient groups (non-responders, average responders, and remitters), remitter patients showed the greatest change over the one-year post-operative period in ODI (F(2) = 8.101, p < 0.01) and PCS (F(2) = 7.607, p < 0.01). Moreover, remission was less likely when the patients were on disability prior to implant (χ2 (2) = 6.469, p < 0.05) and on opioids pre-operatively (χ2 (2) = 17.688, p < 0.01). CONCLUSIONS Our study demonstrates a remission rate of 22% with SCS at one-year follow with a total of 19.8% of our total patient cohort having an NRS of 0. Greater decreases in PCS and ODI correlate with remission. Further, pre-operative disability and opioid use correlate with lower likelihood of remission.
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Affiliation(s)
- Hirah Khan
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA.,Department of Neuroscience Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julia Prusik
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA.,Department of Neuroscience Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurology, Albany Medical College, Albany, NY, USA
| | - Heather Smith
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Sarah E McCallum
- Department of Neuroscience Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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Henssen DJ, Scheepers N, Kurt E, Arnts I, Steegers M, Vissers K, van Dongen R, Engels Y. Patients’ Expectations on Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Qualitative Exploration. Pain Pract 2017; 18:452-462. [DOI: 10.1111/papr.12617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Dylan J.H.A. Henssen
- Department of Anatomy; Donders Institute for Brain, Cognition & Behavior; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Neurosurgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Nicole Scheepers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Inge Arnts
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Monique Steegers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Robert van Dongen
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Pain Management and Palliative Care; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Medical Center; Nijmegen The Netherlands
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Abstract
STUDY DESIGN A review of clinical best practices for spinal cord stimulation (SCS). OBJECTIVE The aim of this study is to summarize published and evidence based guidelines with regards to utilizing SCS, including patient selection, disease indication, perioperative management, complication mitigation strategies, and device selection. Additional focus has been provided on quality care to individual patients by acknowledging the importance of durable outcomes and care delivery costs. SUMMARY OF BACKGROUND DATA For more than 30 years, SCS has successfully alleviated patient suffering and enhanced the lives of patients with refractory pain conditions. Prospective studies of SCS have consistently demonstrated benefits through reduction of pain, improvement in function, and reduced healthcare expenditures in select patient diagnosis groups. Although the benefits of SCS are well-supported, the clinical application of this therapy varies widely based on physician training and experience, regional clinical practice variations, and insurance coverage. METHODS This article provides a summary of published studies, case reports, evidence-based guidelines and expert consensus, with the intent of increasing physician competency and enhancing patient care through improved clinical outcomes. RESULTS A guide to SCS implantation, appropriate patient selection, ranked recommendations for diseases that may most benefit for SCS treatment, complication mitigation strategies, and finally, indications for choosing the most efficacious modality of SCS therapy for specific patients and pain conditions. CONCLUSION Although SCS has been shown to be safe and effective for a number of pain conditions, emerging SCS modalities promise even greater efficacy over traditional SCS. To achieve this promise, physicians must carefully select and manage their patients and the SCS device. LEVEL OF EVIDENCE N\A.
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Rosenberg J, Fabi A, Candido K, Knezevic N, Creamer M, Carayannopoulos A, Ghodsi A, Nelson C, Bennett M. Spinal Cord Stimulation Provides Pain Relief with Improved Psychosocial Function: Results from EMP3OWER. PAIN MEDICINE 2016; 17:2311-2325. [PMID: 28025365 DOI: 10.1093/pm/pnw152] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The EMP3OWER™ study evaluated spinal cord stimulation (SCS) safety and efficacy and the associated changes in psychosocial and functional outcomes. METHODS Upon informed consent and IRB approval, 620 eligible subjects were enrolled prior to SCS trial evaluation and were assessed at baseline, 3, 6 and 12 months post-implant. Patient-reported pain relief (PRP), numerical rating scale (NRS), satisfaction, quality of life (QOL), and pain disability index (PDI) were assessed at all follow-up visits while the pain catastrophizing scale (PCS), short form-36 (SF-36), short form-McGill pain questionnaire version 2 (SF-MPQ-2), and the state-trait anxiety inventory (STAI) were assessed at the 6- and 12-month follow-up visits. Device and/or procedure-related adverse events were also recorded and reported. Subjects reporting a PRP ≥ 50% were considered responders. Repeated measures analysis of variance (RMANOVA) examined the changes across time for all continuous measures. RESULTS A total of 401 (71%) subjects received a permanent implant. Mean (±SD) patient-reported pain relief was 59.3% (±26.2), 59.2% (±28.9), and 58.2% (±32.0) at 3, 6, and 12 months, respectively. A majority of enrolled subjects were responders at 3 (75.5%), 6 (74.7%), and 12 months (69.7%). RMANOVA revealed a statistically significant change for NRS, PCS, PDI, SF-36, SF-MPQ-2, and STAI scores. At 3 months, the majority of subjects (85.7%) were either very satisfied or satisfied with their device, with similar results at 6 and 12 months. At 3 months, the majority of subjects (73.3%) reported greatly improved or improved QOL with similar results at 6 and 12 months. CONCLUSIONS Spinal cord stimulation provided pain relief and significant improvement of patient psychological and functional outcome measures.
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Affiliation(s)
- Jason Rosenberg
- *SC Pain and Spine Specialists LLC, Murrells Inlet, South Carolina
| | - Alain Fabi
- Bronson Neuroscience Center, Kalamazoo, Mississippi
| | | | - Nick Knezevic
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | | | | | - Abdi Ghodsi
- PARS Neurosurgical Associates, Parkersburg, West Virginia
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Marola O, Cherala R, Prusik J, Kumar V, Fama C, Wilock M, Crimmins J, Pilitsis JG. BMI as a Predictor of Spinal Cord Stimulation Success in Chronic Pain Patients. Neuromodulation 2016; 20:269-273. [DOI: 10.1111/ner.12482] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Olivia Marola
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical Center; Albany NY USA
| | - Rasan Cherala
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Julia Prusik
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Vignessh Kumar
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Chris Fama
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Meghan Wilock
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Jordan Crimmins
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
| | - Julie G. Pilitsis
- Department of Neurosurgery; Albany Medical Center; Albany NY USA
- Department of Neuroscience and Experimental Therapeutics; Albany Medical Center; Albany NY USA
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