British journal of anaesthesia
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Spinal cord stimulation (SCS) is widely accepted as a useful treatment for patients with intractable chronic pain. However, its effectiveness varies between individuals. Therefore, a tool for evaluating its effectiveness in advance is eagerly awaited. We examined whether resting-state functional magnetic resonance imaging as a diagnostic and prognostic tool can predict responsiveness to SCS. ⋯ For patients with intractable chronic pain, functional connectivity between the middle anterior cingulate cortex and precuneus/posterior cingulate cortex is a promising candidate biomarker to estimate responsiveness to spinal cord stimulation before treatment.
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Optimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. ⋯ Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.