Patient Selection for Spinal Cord Stimulation in Treatment of Pain: Sequential Decision-Making Model-A Narrative Review

Goudman, Lisa, Rigoard, Philippe, Billot, Maxime, Duarte, Rui V, Eldabe, Sam and Moens, Maarten (2022) Patient Selection for Spinal Cord Stimulation in Treatment of Pain: Sequential Decision-Making Model-A Narrative Review. JOURNAL OF PAIN RESEARCH, 15. pp. 1163-1171.

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Official URL: http://dx.doi.org/10.2147/jpr.s250455

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.

Item Type:	Article
Uncontrolled Keywords:	patient selection, decision-making, neuromodulation, experience-based medicine
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	16 May 2022 11:06
Last Modified:	18 Jan 2023 21:02
DOI:	10.2147/JPR.S250455
Open Access URL:	https://doi.org/10.2147/JPR.S250455
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3154887