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Kapural L, Mekhail NA, Costandi S, Gilmore C, Pope JE, Li S, Hunter CW, Poree L, Staats PS, Taylor RS, Eldabe S, Kallewaard JW, Thomson S, Petersen EA, Sayed D, Deer TR, Antony A, Budwany R, Leitner A, Soliday N, Duarte RV, Levy RM. Durable multimodal and holistic response for physiologic closed-loop spinal cord stimulation supported by objective evidence from the EVOKE double-blind randomized controlled trial. Reg Anesth Pain Med 2024; 49:233-240. [PMID: 37491149 DOI: 10.1136/rapm-2023-104639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Chronic pain patients may experience impairments in multiple health-related domains. The design and interpretation of clinical trials of chronic pain interventions, however, remains primarily focused on treatment effects on pain intensity. This study investigates a novel, multidimensional holistic treatment response to evoked compound action potential-controlled closed-loop versus open-loop spinal cord stimulation as well as the degree of neural activation that produced that treatment response. METHODS Outcome data for pain intensity, physical function, health-related quality of life, sleep quality and emotional function were derived from individual patient level data from the EVOKE multicenter, participant, investigator, and outcome assessor-blinded, parallel-arm randomized controlled trial with 24 month follow-up. Evaluation of holistic treatment response considered whether the baseline score was worse than normative values and whether minimal clinical important differences were reached in each of the domains that were impaired at baseline. A cumulative responder score was calculated to reflect the total minimal clinical important differences accumulated across all domains. Objective neurophysiological data, including spinal cord activation were measured. RESULTS Patients were randomized to closed-loop (n=67) or open-loop (n=67). A greater proportion of patients with closed-loop spinal cord stimulation (49.3% vs 26.9%) were holistic responders at 24-month follow-up, with at least one minimal clinical important difference in all impaired domains (absolute risk difference: 22.4%, 95% CI 6.4% to 38.4%, p=0.012). The cumulative responder score was significantly greater for closed-loop patients at all time points and resulted in the achievement of more than three additional minimal clinical important differences at 24-month follow-up (mean difference 3.4, 95% CI 1.3 to 5.5, p=0.002). Neural activation was three times more accurate in closed-loop spinal cord stimulation (p<0.001 at all time points). CONCLUSION The results of this study suggest that closed-loop spinal cord stimulation can provide sustained clinically meaningful improvements in multiple domains and provide holistic improvement in the long-term for patients with chronic refractory pain. TRIAL REGISTRATION NUMBER NCT02924129.
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Affiliation(s)
- Leonardo Kapural
- Carolinas Pain Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, California, USA
| | - Sean Li
- Premier Pain Centers, Shrewsbury, New Jersey, USA
| | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, New York, USA
| | - Lawrence Poree
- University of California at San Francisco, San Francisco, California, USA
| | | | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Sam Eldabe
- Pain Medicine, James Cook Univesity Hospital, Middlesbrough, UK
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Simon Thomson
- Pain Medicine and Neuromodulation, Mid & South Essex University Hospitals, Essex, UK
| | - Erika A Petersen
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy R Deer
- Spine and Nerve Center of the Virginias, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, Florida, USA
| | - Ryan Budwany
- West Virginia University, Morgantown, West Virginia, USA
| | - Angela Leitner
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
| | - Nicole Soliday
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
| | - Rui V Duarte
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Robert M Levy
- Anesthesia Pain Care Consultants, Boca Raton, Florida, USA
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Ueno K, Tachibana K, Masunaga N, Shinoda Y, Minamisaka T, Inui H, Amiya R, Inoue S, Murakami A, Hoshida S. Clinical outcomes of spinal cord stimulation in patients with intractable leg pain in Japan. Pain Pract 2024. [PMID: 38459710 DOI: 10.1111/papr.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/14/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Neuromodulation through spinal cord stimulation (SCS) is a therapeutic option for relieving leg pain and improving the chances of limb salvage in patients with intractable chronic limb-threatening ischemia (CLTI); however, there is no consensus on its indications. OBJECTIVE The aim of this study was to assess the clinical outcomes of SCS in patients with intractable leg pain caused by various diseases treated in the department of cardiovascular medicine in Japan. METHODS This was a retrospective study of patients who underwent SCS for pain management. Patients were considered eligible for the therapy if they met the following criteria: (1) intractable leg pain (numerical rating scale [NRS] score of 10), (2) no revascularization option, and (3) no septicemia. RESULTS Twenty patients (mean age: 77 years; men/women: 11/9) were included in this study. The NRS score of the patients significantly reduced from 10 ± 0 before procedure to 4 ± 3 at discharge (p < 0.001). The clinical response rate of the entire cohort was 65% (13/20) at 17 ± 14 months after implantation; however, patients with intractable CLTI showed a low response rate (45%), whereas those with subacute limb ischemia showed a high response rate (100%). A multivariable regression analysis showed that hemoglobin level was significantly associated with treatment response, even after adjusting for age and sex (p = 0.026). The area under the receiver operating characteristic curve for the correlation between hemoglobin level (cutoff, 11.4 g/dL) and clinical response to SCS was 0.824 (0.619-1). CONCLUSIONS SCS can reduce clinical symptoms in majority of patients with intractable leg pain. Although implantation of an SCS device has been shown to improve microvascular perfusion insufficiency, the correlation between hemoglobin level and the clinical effect of SCS indicates that a preserved microcirculatory vascular bed is essential for the therapy to be effective.
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Affiliation(s)
- Keisuke Ueno
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Koichi Tachibana
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Nobutaka Masunaga
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Hirooki Inui
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Ryohei Amiya
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Soki Inoue
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Arisa Murakami
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
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Goudman L, De Smedt A, Billot M, Roulaud M, Rigoard P, Moens M. Opinions of Health Care Providers About Neuromodulation for Pain: Results of an Online Survey at the 2nd Joint Congress of the International Neuromodulation Society European Chapters. Neuromodulation 2023; 26:1887-1892. [PMID: 35551866 DOI: 10.1016/j.neurom.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/23/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Neuromodulation for pain has been successfully applied for decades, in that the goals and expectations that patients aim to achieve are clearly described. Nevertheless, the point of view of health care providers is less clear. Therefore, this study aimed to explore the goals, expectations, and definition of success for neuromodulation for pain according to health care providers. MATERIALS AND METHODS An online survey was developed and spread at the 2nd Joint Congress of the International Neuromodulation Society (INS) European Chapters in September 2021 in Paris. Respondents were asked 1) to select the goals to treat patients with neuromodulation for pain, 2) to indicate factors that they expect to change according to neuromodulation for pain, and 3) to provide their definition of success of neuromodulation for pain. RESULTS We approached 101 respondents, of whom 88 health care providers at least partly completed the survey. Increasing mobility/functionality (26.7%), decreasing pain intensity (24.5%), and decreasing medication use (16.6%) were the most frequently reported goals of neuromodulation. The same top three variables were selected as factors that health care providers expected to change. For the definition of success, quality of life of patients outranked other definitions. Other highly ranked definitions, in descending order, were obtaining pain relief, increasing functionality, and increasing patient satisfaction. DISCUSSION Goals and expectations of health care providers are not completely in line with previously explored goals of patients that are related to pain relief and improving walking abilities. Health care providers seem to put a high emphasis on the quality of life of the patient when evaluating the success of neuromodulation, which is not completely aligned with the currently used reimbursement rules that are mainly focusing on pain relief instead of incorporating health-related quality of life. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT05013840.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium.
| | - Ann De Smedt
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Saleki M, Khabbass M, Bretherton B, Baranidharan G. Exploring Patient Satisfaction and Other Outcome Measures With Pain Relief in Spinal Cord Stimulation: A Single-Site, Cohort Audit. Cureus 2023; 15:e51339. [PMID: 38288220 PMCID: PMC10824466 DOI: 10.7759/cureus.51339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Context Spinal cord stimulation (SCS) is an approved treatment for chronic pain of neuropathic origin. Initial research suggests a close relationship between pain relief and patient satisfaction with SCS. Objectives To see whether similar patterns were observed in our center and to identify areas of improvement, this single-site, cohort audit explored the association between pain relief and satisfaction as well as specific factors that influence satisfaction at follow-up in patients with fully implanted SCS. Methods Age, gender, pain condition, SCS system, average pain (numerical rating scale, NRS), and worst pain (NRS) scores at baseline and the most recent follow-up visit were collected. Percentage change in average pain was calculated, and the patients were allocated to one of three pain improvement groups: <30%, 30%-50%, or >50%. A telephone survey explored patient outcomes including patient satisfaction, sleep, fatigue, quality of life (QoL), walking ability, and medication use. Chi-square tests of independence were performed. Results The final sample comprised 87 patients (<30%: n = 26; 30%-50%: n = 29; >50%: n = 32). The pain improvement group was significantly associated with satisfaction (p = 0.010): all patients in the >50% improvement group reported being either very satisfied or somewhat satisfied with SCS. The pain improvement group was also significantly associated with change in sleep (p < 0.001), fatigue (p = 0.001), QoL (p = 0.003), and opioid consumption (p = 0.010). Improvements were most frequently reported in the >50% improvement group. Conclusion Findings point to an association between pain relief and patient satisfaction with SCS. Other factors, including sleep, fatigue, QoL, and opioid consumption, may influence this association and deserve further exploration.
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Deer T, Gilligan C, Falowski S, Desai M, Pilitsis J, Jameson J, Moeschler S, Heros R, Tavel E, Christopher A, Patterson D, Wahezi S, Weisbein J, Antony A, Funk R, Ibrahim M, Lim C, Wilson D, Fishell M, Scarfo K, Dickerson D, Braun E, Buchanan P, Levy RM, Miller N, Duncan J, Xu J, Candido K, Kreiner S, Fahey ME, Yue J. Treatment of Refractory Low Back Pain Using Passive Recharge Burst in Patients Without Options for Corrective Surgery: Findings and Results From the DISTINCT Study, a Prospective Randomized Multicenter Controlled Trial. Neuromodulation 2023; 26:1387-1399. [PMID: 37642628 PMCID: PMC10801705 DOI: 10.1016/j.neurom.2023.07.009] [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] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) is effective for relieving chronic intractable pain conditions. The Dorsal spInal cord STImulatioN vs mediCal management for the Treatment of low back pain study evaluates the effectiveness of SCS compared with conventional medical management (CMM) in the treatment of chronic low back pain in patients who had not undergone and were not candidates for lumbar spine surgery. METHODS AND MATERIALS Patients were randomized to passive recharge burst therapy (n = 162) or CMM (n = 107). They reported severe pain and disability for more than a decade and had failed a multitude of therapies. Common diagnoses included degenerative disc disease, spondylosis, stenosis, and scoliosis-yet not to a degree amenable to surgery. The six-month primary end point compared responder rates, defined by a 50% reduction in pain. Hierarchical analyses of seven secondary end points were performed in the following order: composite responder rate (numerical rating scale [NRS] or Oswestry Disability Index [ODI]), NRS, ODI, Pain Catastrophizing Scale responder rate, Patient Global Impression of Change (PGIC) responder rate, and Patient-Reported Outcome Measure Information System-29 in pain interference and physical function. RESULTS Intention-to-treat analysis showed a significant difference in pain responders on NRS between SCS (72.6%) and CMM (7.1%) arms (p < 0.0001). Of note, 85.2% of those who received six months of therapy responded on NRS compared with 6.2% of those with CMM (p < 0.0001). All secondary end points indicated the superiority of burst therapy over CMM. A composite measure on function or pain relief showed 91% of subjects with SCS improved, compared with 16% of subjects with CMM. A substantial improvement of 30 points was observed on ODI compared with a CONCLUSIONS This study found substantial improvement at six months in back pain, back pain-related disability, pain-related emotional suffering, PGIC, pain interference, and physical function in a population with severe, debilitating back pain for more than a decade. These improvements were reported in conjunction with reduced opioid use, injection, and ablation therapy. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT04479787.
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Affiliation(s)
- Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Mehul Desai
- International Spine, Pain & Performance Center, Washington, DC, USA
| | | | | | | | | | - Edward Tavel
- Clinical Trials of South Carolina, Charleston, SC, USA
| | | | | | - Sayed Wahezi
- Montefiore Medical Center-Waters Place, New York, NY, USA
| | | | | | | | - Mohab Ibrahim
- Banner University Medical Center Tucson Campus, Tucson, AZ, USA
| | - Chi Lim
- Carolina Orthopaedic & Neurosurgical Associates, SC, USA
| | | | | | | | | | | | - Patrick Buchanan
- Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA
| | | | - Nathan Miller
- Coastal Pain & Spinal Diagnostics Medical Group, Carlsbad, CA, USA
| | - Jonathan Duncan
- Burkhart Research Institute for Orthopaedics, San Antonio, TX, USA
| | - Jijun Xu
- The Cleveland Clinic Foundation, OH, USA
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Levy RM, Mekhail N, Abd-Elsayed A, Abejón D, Anitescu M, Deer TR, Eldabe S, Goudman L, Kallewaard JW, Moens M, Petersen EA, Pilitsis JG, Pope JE, Poree L, Raslan AM, Russo M, Sayed D, Staats PS, Taylor RS, Thomson S, Verrills P, Duarte RV. Holistic Treatment Response: An International Expert Panel Definition and Criteria for a New Paradigm in the Assessment of Clinical Outcomes of Spinal Cord Stimulation. Neuromodulation 2023; 26:1015-1022. [PMID: 36604242 DOI: 10.1016/j.neurom.2022.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment response to spinal cord stimulation (SCS) is focused on the magnitude of effects on pain intensity. However, chronic pain is a multidimensional condition that may affect individuals in different ways and as such it seems reductionist to evaluate treatment response based solely on a unidimensional measure such as pain intensity. AIM The aim of this article is to add to a framework started by IMMPACT for assessing the wider health impact of treatment with SCS for people with chronic pain, a "holistic treatment response". DISCUSSION Several aspects need consideration in the assessment of a holistic treatment response. SCS device data and how it relates to patient outcomes, is essential to improve the understanding of the different types of SCS, improve patient selection, long-term clinical outcomes, and reproducibility of findings. The outcomes to include in the evaluation of a holistic treatment response need to consider clinical relevance for patients and clinicians. Assessment of the holistic response combines two key concepts of patient assessment: (1) patients level of baseline (pre-treatment) unmet need across a range of health domains; (2) demonstration of patient-relevant improvements in these health domains with treatment. The minimal clinical important difference (MCID) is an established approach to reflect changes after a clinical intervention that are meaningful for the patient and can be used to identify treatment response to each individual domain. A holistic treatment response needs to account for MCIDs in all domains of importance for which the patient presents dysfunctional scores pre-treatment. The number of domains included in a holistic treatment response may vary and should be considered on an individual basis. Physiologic confirmation of therapy delivery and utilisation should be included as part of the evaluation of a holistic treatment response and is essential to advance the field of SCS and increase transparency and reproducibility of the findings.
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Affiliation(s)
- Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
| | - Nagy Mekhail
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology and Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Abejón
- Multidisciplinary Pain Management Unit, Hospital Universitario Quirónsalud, Madrid, Spain
| | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Jan W Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, the Netherlands; Department of Anesthesiology and Pain Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Lawrence Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Marc Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, Australia
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Rod S Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK; MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Simon Thomson
- Department of Pain Medicine and Neuromodulation, Mid & South Essex University Hospitals, Essex, UK
| | - Paul Verrills
- Metro Pain Group, Melbourne, New South Wales, Australia
| | - Rui V Duarte
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia; Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, UK.
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Goudman L, Pilitsis JG, Russo M, Slavin KV, Hayek SM, Billot M, Roulaud M, Rigoard P, Moens M. From pain intensity to a holistic composite measure for spinal cord stimulation outcomes. Br J Anaesth 2023:S0007-0912(23)00252-0. [PMID: 37328304 DOI: 10.1016/j.bja.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Lisa Goudman
- STIMULUS Research Group (reSearch and TeachIng NeuroModULation Uz BruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (Fonds voor Wetenschappelijk Onderzoek - FWO), Brussels, Belgium; Florida Atlantic University, Boca Raton, USA.
| | | | - Marc Russo
- Hunter Pain Specialists, Broadmeadow, Australia
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois Chicago, Chicago, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, USA
| | - Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France; Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France; Prime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- STIMULUS Research Group (reSearch and TeachIng NeuroModULation Uz BruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Goudman L, Billot M, Duarte RV, Eldabe S, Rigoard P, Moens M. Gradation of Clinical Holistic Response as New Composite Outcome to Evaluate Success in Spinal Cord Stimulation Studies for Pain. Neuromodulation 2023; 26:139-146. [PMID: 35088757 DOI: 10.1016/j.neurom.2021.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The most prominent outcome measurement in the field of neuromodulation is pain relief. Nevertheless, the number of studies that rely on composite outcomes has increased. The aims of this study are twofold: (1) to evaluate which measures are important to include in a composite outcome and (2) to develop this new composite outcome to evaluate the degree of being a clinical holistic responder with a corresponding minimal clinical important difference (MCID). MATERIALS AND METHODS Data from patients with persistent spinal pain syndrome type 2 treated with High-Dose Spinal Cord Stimulation (HD-SCS) were used. Pain intensity for low back and leg pain, disability, health-related quality of life, medication use, and patient satisfaction were measured at baseline and after 12 months of HD-SCS. Exploratory and Confirmatory Factor Analyses were used to evaluate which measures should be included in the composite outcome. Anchor-based and distribution-based methods were applied to determine the MCID of the newly developed outcome measurement. RESULTS A three-factor model was the most appropriate for this data set, in which leg pain intensity, EQ5D VAS, and disability had the largest loading on these factors. A clinical holistic outcome was created with a total score ranging from 0 (=better [no pain, no disability, and perfect health status]) to 300 (=worse [maximal pain, maximal disability, and worst health status]). The MCID value based on an absolute change score from baseline up to 12 months of HD-SCS was 87.97. When calculating with percentage changes, a MCID value of 48.4% was revealed. CONCLUSIONS This new composite outcome evaluating the degree of deviation from being a holistic responder is a step toward a meaningful, overall outcome assessment for patients who are treated with SCS. Further studies to evaluate the psychometric properties and the generalizability toward other patient populations still need to be performed.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan, Brussels, Belgium; STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sam Eldabe
- Pain Clinic, The James Cook University Hospital, Middlesbrough, UK
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan, Brussels, Belgium; STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan, Brussels, Belgium.
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Harland T, Hadanny A, Pilitsis JG. Machine Learning and Pain Outcomes. Neurosurg Clin N Am 2022; 33:351-358. [DOI: 10.1016/j.nec.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Taylor RS, Soliday N, Leitner A, Hunter CW, Staats PS, Li S, Thomson S, Kallewaard JW, Russo M, Duarte RV. Association Between Levels of Functional Disability and Health-Related Quality of Life With Spinal Cord Stimulation for Chronic Pain. Neuromodulation 2022:S1094-7159(22)00650-X. [DOI: 10.1016/j.neurom.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
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Goudman L, Rigoard P, Billot M, Duarte RV, Eldabe S, Moens M. Patient Selection for Spinal Cord Stimulation in Treatment of Pain: Sequential Decision-Making Model - A Narrative Review. J Pain Res 2022; 15:1163-1171. [PMID: 35478997 PMCID: PMC9035681 DOI: 10.2147/jpr.s250455] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023] Open
Abstract
Despite the well-known efficacy of spinal cord stimulation (SCS) in chronic pain management, patient selection in clinical practice remains challenging. The aim of this review is to provide an overview of the factors that can influence the process of patient selection for SCS treatment. A sequential decision-making model is presented within a tier system that operates in clinical practice. The first level incorporates the underlying disease as a primary indication for SCS, country-related reimbursement rules, and SCS screening-trial criteria in combination with underlying psychological factors as initial selection criteria in evaluating patient eligibility for SCS. The second tier is aligned with the individualized approach within precision pain medicine, whereby individual goals and expectations and the potential need for preoperative optimizations are emphasized. Additionally, this tier relies on results from prediction models to provide an estimate of the efficacy of SCS in the long term. In the third tier, selection bias, MRI compatibility, and ethical beliefs are included, together with recent technological innovations, superiority of specific stimulation paradigms, and new feedback systems that could indirectly influence the decision-making of the physician. Both patients and physicians should be aware of the different aspects that influence patient selection in relation to SCS for pain management to make an independent decision on whether or not to initiate a treatment trajectory with SCS.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium,STIMULUS Consortium (Research and Teaching Neuromodulation VUB/UZ Brussel), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, 1090, Belgium,Research Foundation — Flanders (FWO), Brussels, 1090, Belgium,Correspondence: Lisa Goudman, Department of Neurosurgery, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, Jette1090, Belgium, Tel +32-2-477-5514, Fax +32-2-477-5570, Email
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 86021, France,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, 86021, France,Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, 86360, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 86021, France
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, L69 3BX, UK
| | - Sam Eldabe
- Pain Clinic, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium,STIMULUS Consortium (Research and Teaching Neuromodulation VUB/UZ Brussel), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, 1090, Belgium,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium
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High-dose spinal cord stimulation for patients with failed back surgery syndrome: a multicenter effectiveness and prediction study. Pain 2021; 162:582-590. [PMID: 32910099 DOI: 10.1097/j.pain.0000000000002035] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
ABSTRACT The use of high-dose spinal cord stimulation (HD-SCS) has increased drastically during the past few years, with positive results. However, there remains a deficit of real-world data of the effectiveness of HD-SCS. Therefore, the primary aim was to evaluate the effectiveness of HD-SCS in patients with failed back surgery syndrome (FBSS). The second aim was to develop a prediction model for a holistic responder. One hundred ninety-four patients were recruited to a multicenter real-world registry. Self-reporting outcome variables were evaluated at baseline (before SCS) and at 1, 3, and 12 months of HD-SCS implant. Outcome measures were the mean pain intensity over time, sleep quality, disability, health-related quality of life, and medication use. Besides the effectiveness, logistic regression and decision tree analysis were performed to define a holistic responder (pain intensity reduction, medication reduction, Oswestry disability index reduction, and EQ5D improvement) after 12 months of HD-SCS. Of 185 FBSS patients who underwent a baseline visit, 75.13% had a successful HD trial. At 12 months, 92 patients were still receiving HD-SCS. Both low back and leg pain significantly decreased at 12 months. All outcome measures revealed a significant time-dependent effect from baseline to 12 months. Holistic responders could be predicted with a sensitivity and specificity of 90%. Clinically significant and sustained pain relief over a period of 12 months was achieved with HD-SCS in patients with FBSS. In addition, HD-SCS also achieved an improvement in sleep quality, functionality, and a decrease in pain medication.
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