Appropriate referral and selection of patients with chronic pain for neuromodulation

  • Nevenka Krcevski Skvarc

    Assistant Professor, Anesthesiology, Pain Medicine and Palliative Care, Faculty of Medicine of University Maribor, Slovenia
  • Frank Huygen

    Anaesthesiologist, University Hospital, Erasmus Medical Centre, Professor in Anaesthesiology, Erasmus University Rotterdam, The Netherlands

Chair: Nevenka Krcevski Skvarc, Slovenia
Speaker: Frank Huygen, Netherlands
Introduction: Spinal cord stimulation (SCS) is a well-established and accepted treatment for chronic neuropathic, nociplastic (neuropathic-like) and ischemic pain. The heterogeneity of patients in clinical practice makes it sometimes challenging to determine which patients are eligible for SCS. We conducted a study in which we aimed to establish patient-specific recommendations for referral and selection of SCS in chronic pain.

Methods: A multidisciplinary European panel used the RAND / UCLA Appropriateness Method (RUAM) to assess the appropriateness of referral and / or implantation for SCS in 4 pain areas: chronic low back pain and / or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischemic pain syndromes. In addition, the panel identified psychosocial factors relevant to the decision for SCS treatment.

RESULTS: The suitability of SCS was strongly determined by the neuropathic or nociplastic (neuropathic-like) pain component, location and distribution of pain, anatomical abnormalities and previous response to pain processing therapies. Psychosocial factors considered relevant were: lack of commitment, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and reluctance. An e-health tool has been developed which combines clinical and psychosocial factors into advice on referral / selection for SCS.
Conclusions: The RUAM was useful in reaching consensus on patient-specific criteria for referral / selection for SCS in chronic pain 1 . The e-health tool is free available (https://scstool.org) and can help physicians learn to apply an integrated approach to clinical and psychosocial factors.

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