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

Harsha Shanthanna, Sam Eldabe, David Anthony Provenzano, Benedicte Bouche, Eric Buchser, Raymond Chadwick, Tina L. Doshi, Rui Duarte, Christine Hunt, Frank J.P.M. Huygen, Judy Knight, Lynn Kohan, Richard North, Joshua Rosenow, Christopher J. Winfree, Samer Narouze

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)273-287
Number of pages15
JournalRegional anesthesia and pain medicine
Volume48
Issue number6
DOIs
StatePublished - Jun 1 2023

Keywords

  • back pain
  • chronic pain
  • pain management
  • spinal cord stimulation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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