Best practice recommendations for implantable neuromodulation therapies for pain: Spinal cord stimulation

Abstract

Chronic pain has a huge global prevalence of 20% and in a country like India which has been labeled by the UN as the most populous country in April 2023, the problem is likely to explode and pose a huge challenge to Indian Practitioners. An addition to this can also be due to an expected doubling of individuals over 65 years of age by rises in the aging population. Pharmacotherapy which is the mainstay for conservative medical management (CMM) often seems to be inadequate and/or has a potential for a range of side effects. The patients who are refractory to all forms of CMM move up on the treatment algorithm for pain interventions. Implantable neuromodulation therapies can be of considerable help in patients who have significantly impaired quality of life due to unremitting severe pain, despite CMM and simpler pain interventions. These implanted devices provide ongoing satisfactory pain relief in select patients. This is for the 1st time that practice recommendations are published to guide practitioners offering this treatment in India. This can also be a reference for selecting the most appropriate patients to optimize outcomes. This can also provide motivation to start collecting information in their local database and also to convince our reimbursement agencies about incorporating this useful modality in the gamut of approved therapies.

Keywords

• efficacy
• intrathecal drug delivery system
• neuromodulation
• peripheral nerve stimulation
• recommendation
• sacral stimulation
• safety
• spinal cord stimulation