Journal of Pain Research (Apr 2022)
Patient Selection for Spinal Cord Stimulation in Treatment of Pain: Sequential Decision-Making Model — A Narrative Review
Abstract
Lisa Goudman,1– 5 Philippe Rigoard,6– 8 Maxime Billot,6 Rui V Duarte,9 Sam Eldabe,10 Maarten Moens1– 4,11 1Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium; 2STIMULUS Consortium (Research and Teaching Neuromodulation VUB/UZ Brussel), Vrije Universiteit Brussel, Brussels, 1090, Belgium; 3Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 1090, Belgium; 4Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, 1090, Belgium; 5Research Foundation — Flanders (FWO), Brussels, 1090, Belgium; 6PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 86021, France; 7Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, 86021, France; 8Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, 86360, France; 9Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, L69 3BX, UK; 10Pain Clinic, James Cook University Hospital, Middlesbrough, TS4 3BW, UK; 11Department of Radiology, Universitair Ziekenhuis Brussel, Jette, 1090, BelgiumCorrespondence: Lisa Goudman, Department of Neurosurgery, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, Jette 1090, Belgium, Tel +32-2-477-5514, Fax +32-2-477-5570, Email [email protected]: 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.Keywords: patient selection, decision-making, neuromodulation, experience-based medicine
