• Wuilker Knoner Campos, Marcelo Neves Linhares, Jamir Sarda, Santos Adair Roberto Soares ARS Laboratory of Neurobiology of Pain and Inflammation, Department of Physiology, UFSC, Florianópolis, SC, Brazil., Júlio Licinio, João Quevedo, Kátia Lin, and Roger Walz.
• Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, SC, Brazil.
• Neuromodulation. 2019 Apr 1; 22 (3): 280-289.

ObjectivesPrevious studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS.Materials And MethodsThirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean). Patient-centered MCI of the VAS and SF-36 domain scores were determined based on the MacNab criteria of surgical global effectiveness. Independent presurgical predictors for MCI in the VAS and SF-36 domains were analyzed using multiple binary logistic regression.ResultsThere was significant improvement of pain and QOL after the SCS (p < 0.00001). Twenty-three patients (67.6%) reached an MCI of pain, and 16 (47.7%)-23 (67.7%) reported an MCI of QOL. Predictors of MCI included ≥80% paresthesia coverage of the painful area, lower levels of anxiety and catastrophizing symptoms, shorter pain duration, female gender and no use of opioids before surgery. MCI of pain and QOL was observed in 50%-70% of patients with chronic pain after SCS.ConclusionsThe identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.© 2018 International Neuromodulation Society.

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