A group of researchers and leaders in the field of pain management led by Dr. Harsha Shanthanna have published evidence-based guidelines aimed at improving patient selection to improve outcomes and efficacy of spinal cord stimulation used for pain management.
Spinal cord stimulation (SCS) is an established treatment for chronic pain, contributing to nearly 40 percent of the neuromodulation devices used worldwide. These devices involve the use of an electric current to modulate nerve activity within the spinal column, often used in place of a pharmacological approach to pain management. The market for neuromodulation devices is valued at $1.9 billion USD with a projected estimate of $4 billion by 2027.
Despite their widespread use, not everyone is an ideal candidate for SCS. One of the major challenges for the use of SCS for chronic pain is the long-term failure in patients after one to two years of therapy.
Like most chronic pain therapies, appropriate patient selection is crucial. Medical regulators such as the US Food and Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS), and healthcare organizations such as the National Health Service (NHS) in England, have emphasized the need for better patient selection and the use of a temporary trial before a final implant, although some of the recent literature and practices seem to question such practices.
To help physicians and other stakeholders make evidence-based decisions, the first ever multi-society guidelines, led by the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM) and supported by other organizations, have been recently published.
“Our guidelines fulfil an important necessity and much-needed direction and guidance for health providers in the field of neuromodulation for chronic spinal pain to improve patient selection and long-term outcomes,” said Dr. Shanthanna, a staff anesthesiologist at St. Joseph’s Healthcare Hamilton and associate professor of medicine at McMaster University.
The newly developed guidelines reinforce the recommendation to perform a trial before offering patients a definitive implant. They also recommend using an individualized approach to set realistic expectations for pain management, to consider a 50 percent pain reduction as a threshold for a successful trial, and other evidence-based recommendations.
The group was comprised of 15 members representing anesthesiology, physical medicine and rehabilitation, neurosurgery, psychology, epidemiology, as well as a patient partner, and was chaired by Dr. Shanthanna.
The guidelines were recently reported in the journal Regional Anesthesia & Pain Medicine, published by the BMJ.