To Trial or Not to Trial Before Spinal Cord Stimulation for Chronic Neuropathic Pain: The Patients' View From the TRIAL-STIM Randomized Controlled Trial



Chadwick, Raymond, McNaughton, Rebekah, Eldabe, Sam, Baranidharan, Ganesan, Bell, Jill, Brookes, Morag, Duarte, Rui V, Earle, Jenny, Gulve, Ashish, Houten, Rachel ORCID: 0000-0002-4315-7732
et al (show 8 more authors) (2021) To Trial or Not to Trial Before Spinal Cord Stimulation for Chronic Neuropathic Pain: The Patients' View From the TRIAL-STIM Randomized Controlled Trial. NEUROMODULATION, 24 (3). pp. 459-470.

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Abstract

Objectives Spinal cord stimulation (SCS) is an established treatment of chronic neuropathic pain. Although a temporary SCS screening trial is widely used to determine suitability for a permanent implant, its evidence base is limited. The recent TRIAL-STIM study (a randomized controlled trial at three centers in the United Kingdom) found no evidence that an SCS screening trial strategy provides superior patient outcomes as compared with a no trial approach. As part of the TRIAL-STIM study, we undertook a nested qualitative study to ascertain patients' preferences in relation to undergoing a screening trial or not. Materials and Methods We interviewed 31 patients sampled from all three centers and both study arms (screening trial/no trial) prior to SCS implantation, and 23 of these patients again following implantation (eight patients were lost to follow-up). Interviews were undertaken by telephone and audio-recorded, then transcripts were subject to thematic analysis. In addition, participants were asked to state their overall preference for a one-stage (no screening trial) versus two-stage (screening trial) implant procedure on a five-point Likert scale, before and after implantation. Results Emergent themes favoured the option for a one-stage SCS procedure. Themes identified include: saving time (off work, in hospital, attending appointments), avoiding the worry about having "loose wires" in the two-stage procedure, having only one period of recovery, and saving NHS resources. Participants' rated preferences show similar support for a one-stage procedure without a screening trial. Conclusions Our findings indicate an overwhelming preference among participants for a one-stage SCS procedure both before and after the implant, regardless of which procedure they had undergone. The qualitative study findings further support the TRIAL-STIM RCT results.

Item Type: Article
Uncontrolled Keywords: Neuropathic pain, patient choice, screening trial, spinal cord stimulation, thematic analysis
Depositing User: Symplectic Admin
Date Deposited: 12 Jan 2021 11:26
Last Modified: 18 Jan 2023 23:05
DOI: 10.1111/ner.13316
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3111010