Neuromodulation : journal of the International Neuromodulation Society
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Randomized Controlled Trial Multicenter Study
Cost-Effectiveness Analysis of Peripheral Nerve Field Stimulation as Add-On Therapy to Spinal Cord Stimulation in the Treatment of Chronic Low Back Pain in Failed Back Surgery Syndrome Patients.
Presently, there is only limited evidence about the cost-effectiveness of peripheral nerve field stimulation (PNFS) and no evidence to date on the cost-effectiveness of PNFS as an add-on therapy to spinal cord stimulation (SCS). In a multicenter randomized controlled trial, PNFS as add-on therapy to SCS demonstrated clinical effectiveness in treating chronic low back pain in failed back surgery syndrome (FBSS) patients. We report here the cost-effectiveness of PNFS as additional therapy. ⋯ From a Dutch national health-care context, when the willingness to pay threshold is up to 60.000 Euros per QALY, PNFS as an add-on therapy to SCS for the treatment of low back pain in FBSS patients has a high probability of being cost-effective.
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To identify relationships between clinical assessments of chronic pain to enable the generation of a multivariate model to predict patient satisfaction with spinal cord stimulation (SCS) treatment. ⋯ Patient-centered outcomes are desirable when evaluating complex multidimensional health impairments but accurately predicting patient satisfaction with treatment remains a challenge. Understanding the variables that predict (either by causation or association) satisfaction would be useful for clinicians. The results of this study suggest that a composite measure of activity tolerance (i.e., walking tolerance) and pain intensity can predict patient satisfaction with SCS therapy. This study highlights the utility of composite outcomes metrics in evaluating the benefits of SCS for chronic low back and leg pain.
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Spinal cord stimulation (SCS) is a well-established procedure for chronic neuropathic pain. Research has established patients with personal psychiatric history do not fare as well as their correspondents following SCS surgery. We explored whether a documented psychiatric family history (PFH) correlated with worse outcomes following SCS surgery. ⋯ Subjects with PFH may experience less improvement in disability following SCS as compared to subjects without PFH. They may take longer to achieve the same outcomes, including pain relief and decrease in pain rumination. Our findings show that improvements in the PFH cohort are equivalent to that of the no PFH cohort on all measures except ODI at 12-month follow-up. Thus obtaining a detailed PFH prior to performing SCS is important in order to implement pre-operative coping training for PFH patients, rather than exclusion from SCS.
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Determining reduction in pain score during spinal cord stimulation (SCS) trial is important prior to permanent SCS implantation. However, this association remains elusive. We investigate the association between post-SCS pain scores and successful permanent SCS implants. ⋯ Low pain scores after SCS trial are predictive of successful SCS implants with high sensitivity. Males and surgical patients with higher pain scores had a lower probability of successful SCS implant than their counterparts. Larger studies are needed to further elucidate this relationship.
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Observational Study
Cervical Spinal Cord Stimulation Using Monophasic Burst Waveform for Axial Neck and Upper Extremity Radicular Pain: A Preliminary Observational Study.
Cervical spinal cord stimulation (cSCS) is an accepted therapeutic option for radicular upper extremity pain and less commonly for cervical axial pain despite less available literature in comparison with lumbar and lower extremity applications. ⋯ This preliminary study suggests that the use of the burst waveform applied to cSCS results in improved function and decreased pain scores in subjects with axial neck pain with and without radicular symptomatology and cervicogenic headache.