Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes

Khazen, Olga; Rosoklija, Gavril; Custozzo, Amanda; Gillogly, Michael; Bridger, Cheyanne; Hobson, Ellie; Feustel, Paul J.; Lambiase, Laura; DiMarzio, Marisa; Pilitsis, Julie G.

doi:10.1111/ner.13299

Cited by 6 publications

(3 citation statements)

References 54 publications

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“…We identified 51 studies reporting on data from databases or registries (online supplemental file 2), of which the majority focused on efficacy and safety, 10 on infection or adverse events, and 7 on cost-effectiveness. For the focus of this review, six were on predictors,152–157 three on conversion rates of trial to permanent implant,158–160 and five on analysis of SCS explants 161–165. Among studies reporting explants, the rates were between 0% and 23.9% up to 1-year follow-up, between 0% and 31.1% from 1 to 5 years of follow-up, between 1.8% and 33.8% beyond 5 years post-implantation.…”

Section: Resultsmentioning

confidence: 99%

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Background/importancePatient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated.ObjectiveWe report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials.Evidence reviewMedline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success.FindingsAmong 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registry-based reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and non-psychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively.ConclusionsDue to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role.

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Section: Resultsmentioning

confidence: 99%

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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“…These notable improvements are thought to be due, at least in part, to an increase in the positive impression of treatment and overall psychological benefit that patients obtain when they log their progress routinely and reflect on their current health-related state. Mental health and treatment expectations are thought to have at least some effect on outcomes in most patients treated with SCS for chronic pain [ 18 , 29 , 30 ]. Therefore, whether the use of available digital health tools equipped with EMA-based tracking or remote-based communication features is, in turn, correlated with improved clinical outcomes (eg, psychological health measures) is now an important question warranting further investigation.…”

Section: Discussionmentioning

confidence: 99%

User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials

Lee¹,

Woon²,

Ramsum³

et al. 2022

JMIR eHum Factors

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Background Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new “mySCS” mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results When provided the opportunity, the percentage of users who engaged with the tracking app for ≥50% of the time during their trial was found to be 64.43% (n=8589). Among the 13,331 patients who used the app, 58.24% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05%). Of those patients who undertook a 7-day SCS trial, 62.30% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04% (n=11,070) of those who reached trial completion. A trial success rate of 91% was determined for those who used the app (versus 85% success rate for nonusers). Conclusions Data from this initial, real-world examination of a mobile, digital-health–based tracking app (“mySCS”), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success.

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“…In essence, pain is a subjective, conscious perception separable from pure nociception. Depression and even suicide is not uncommon in patients suffering from CNP, and factors of depression, loneliness, and anxiety have been associated with poorer outcomes following SCS [ 75 , 76 , 77 , 78 ]. However, these cognitive components also constitute unique avenues for pain management that can be applied alone or in addition to standard treatments to enhance recovery.…”

Section: Cognitive Affective and Emotional Approachesmentioning

confidence: 99%

Review of the Treatments for Central Neuropathic Pain

et al. 2022

Self Cite

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Central neuropathic pain (CNP) affects millions worldwide, with an estimated prevalence of around 10% globally. Although there are a wide variety of treatment options available, due to the complex and multidimensional nature in which CNP arises and presents symptomatically, many patients still experience painful symptoms. Pharmaceutical, surgical, non-invasive, cognitive and combination treatment options offer a generalized starting point for alleviating symptoms; however, a more customized approach may provide greater benefit. Here, we comment on the current treatment options that exist for CNP and further suggest the need for additional research regarding the use of biomarkers to help individualize treatment options for patients.

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Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes

Cited by 6 publications

References 54 publications

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review

User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials

Review of the Treatments for Central Neuropathic Pain

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