Experiences with Spinal Cord Stimulator in Patients with Chronic Neuropathic Back Pain

Gjesdal, Kine; Furnes, Bodil; Dysvik, Elin

doi:10.1016/j.pmn.2013.06.002

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…First, the value of knowledge and information for SCS patients from a variety of sources was strongly emphasized (contact with other patients, selective internet searching, advice from staff). Similar conclusions are reached by earlier qualitative studies including Sparkes et al (20) highlighting the value of access to expert patients; Gjesdal et al (21) pointing out the important role of the nurse; and Ryan et al (22) incorporating a list of practical information needs for SCS patients. There is clear agreement that reliable information is of crucial value, enabling people to form their own opinions and develop a framework to support their own decision‐making.…”

Section: Discussionsupporting

confidence: 75%

“…Henssen et al (23) refer to the constraints and possible disadvantages of SCS. Gjesdal et al (21) draw attention to the challenges in adaptation to everyday life with SCS; and Turner (24) suggests that psychological intervention in conjunction with SCS may support the process of adjustment, and improve outcomes. A recent systematic review of qualitative research into patients' experiences of neuromodulation concludes that adjuvant psychological therapy should form part of an overall pain management plan, including provision for ongoing emotional and psychosocial support (25).…”

Section: Discussionmentioning

confidence: 99%

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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

McNaughton

Eldabe

et al. 2021

Neuromodulation: Technology at the Neural Interface

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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.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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

McNaughton

Eldabe

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…Spinal cord is of great importance to the production and conduction of pain sensation 55). It is well believed that spinal cord stimulation is helpful to alleviate chronic pain 56,57). Additionally, many studies indicated patients with traumatic spinal cord injury are prone to easily suffer from depression 58).…”

Section: Discussionmentioning

confidence: 99%

Abnormalities in Inflammatory Cytokines Confer Susceptible to Chronic Neuropathic Pain-related Anhedonia in a Rat Model of Spared Nerve Injury

Fang

Zhan

Zhang

et al. 2019

Clin Psychopharmacol Neurosci

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Objective Patients with chronic neuropathic pain (CNP) have a higher incidence to develop depression. However, its pathogenesis has not yet been fully elucidated. Here we aimed to investigate the role of inflammatory cytokines in CNP-related anhedonia, which is a core symptom of depression, and to explore the effects of ketamine and parecoxib on pain and anhedonia. Methods A rat model of spared nerve injury (SNI) was constructed to mimic CNP. Hierarchical cluster analysis of sucrose preference test (SPT) was applied to classify the SNI rats into anhedonia susceptible and unsusceptible. Inflammatory cytokines in medial prefrontal cortex (mPFC) of brain, serum and L2–5 spinal cord were measured. Moreover, effects of ketamine or parecoxib on mechanical withdrawal test (MWT) and SPT in anhedonia susceptible rats were detected. Results Tumor necrosis factor (TNF)-α was increased in mPFC, serum and and spinal cord of anhedonia susceptible rats. Furthermore, anhedonia susceptible and unsusceptible rats both increased the interleukin (IL)-1β level in mPFC, serum and spinal cord. IL-6 was altered in serum and spinal cord, but not in mPFC. IL-10 was significantly altered in mPFC and serum, but not in spinal cord. Additionally, ketamine treatment significantly attenuated the decreased results of MWT and SPT in anhedonia susceptible rats, and that parecoxib significantly improved the MWT score, but failed to alter the result of SPT. Conclusion These findings suggest that abnormalities in inflammatory cytokines confer susceptible to anhedonia in a rat model of SNI. Ketamine, a fast-acting antidepressant, has pharmacological benefits to alleviate pain and anhedonia symptoms.

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“…The intent is to provide this information (despite the low certainty) to be integrated into decision making within clinical practice. Apart from variability in their perceptions on SCS, patients are anxious to know their chances of success (as possible rates), which could influence their understanding and interpretation regarding the utility of SCS therapy in their context 63 64. Qualitative studies on patients’ experiences on SCS treatment report on the importance of accepting and coping of chronic pain state as an important attribute 65 66.…”

Section: Committee Statements and Recommendationsmentioning

confidence: 99%

“…Qualitative interviews indicate that emotions and expectations have a significant influence on how a person can cope with pain. As an example of negative coping and unreasonable expectations, some patients hope that SCS could be a fix or expect a complete pain free state 63 66. Specific to the importance of SCS trials, patients indicate uncertainty on its role, depending on the study design and stage at which patients were interviewed.…”

Section: Committee Statements and Recommendationsmentioning

confidence: 99%

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

Shanthanna

Eldabe

Provenzano³

et al. 2023

Reg Anesth Pain Med

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.

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Experiences with Spinal Cord Stimulator in Patients with Chronic Neuropathic Back Pain

Cited by 5 publications

References 30 publications

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

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

Abnormalities in Inflammatory Cytokines Confer Susceptible to Chronic Neuropathic Pain-related Anhedonia in a Rat Model of Spared Nerve Injury

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain

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