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- Elliot S Krames, Sayed Monis, Lawrence Poree, Timothy Deer, and Robert Levy.
- Pacific Pain Treatment Centers, San Francisco, California, USA. krames118@gmail.com
- Neuromodulation. 2011 Jul 1;14(4):299-311; discussion 311.
ObjectiveIn this paper we review the literature on failed back surgery syndrome (FBSS) and use principles of Safety, Appropriateness, Fiscal Neutrality, and Effectiveness (SAFE) to determine the appropriate place for spinal cord stimulation (SCS) for the treatment of FBSS.Methods And ResultsWe analyzed the most recent literature regarding treatments of pain due to FBSS and used the SAFE principles to reprioritize pain treatments, particularly electrical stimulation therapies, for FBSS in a more appropriate, relevant, and up to date continuum of care.ConclusionsBased on this review and analysis of the safety, appropriateness, cost-effectiveness, and efficacy of treatments for the pain of FBSS, relegating SCS to a last resort therapy is no longer justifiable. SCS should be considered before submitting a patient to either long-term systemic opioid therapy or repeat spinal surgery for chronic pain resulting from FBSS.© 2011 International Neuromodulation Society.
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