医学
神经调节
神经病理性疼痛
脊髓
脊髓刺激
慢性疼痛
斯科普斯
物理疗法
临床试验
随机对照试验
曲马多
麻醉
刺激
物理医学与康复
梅德林
外科
内科学
精神科
止痛药
法学
政治学
作者
Lisa Goudman,Julie G. Pilitsis,Marc Russo,Konstantin V. Slavin,Salim M. Hayek,Maxime Billot,Manuel Roulaud,Philippe Rigoard,Maarten Moens
标识
DOI:10.1016/j.bja.2023.05.016
摘要
Editor—Despite the beneficial effects of spinal cord stimulation in reducing pain intensity, 1 Grider J.S. Manchikanti L. Carayannopoulos A. et al. Effectiveness of spinal cord stimulation in chronic spinal pain: a systematic review. Pain Physician. 2016; 19: E33-E54 Crossref PubMed Google Scholar diminishing pain medication use, 2 Goudman L. Duarte R.V. De Smedt A. Copley S. Eldabe S. Moens M. Cross-country differences in pain medication before and after spinal cord stimulation: a pooled analysis of individual patient data from two prospective studies in the United Kingdom and Belgium. Neuromodulation. 2023; 26: 215-223 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar and improving return to work, 3 Moens M. Goudman L. Brouns R. et al. Return to work of patients treated with spinal cord stimulation for chronic pain: a systematic review and meta-analysis. Neuromodulation. 2019; 22: 253-261 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar the implantation of spinal cord stimulators involves a high cost. Reimbursement for a spinal cord stimulator implant is often conditional on a successful trial period with country-related definitions to determine success of such a trial with varying trial durations (i.e. without a standard, worldwide definition of a successful trial). 4 Eldabe S. Duarte R.V. Gulve A. et al. Does a screening trial for spinal cord stimulation in patients with chronic pain of neuropathic origin have clinical utility and cost-effectiveness (TRIAL-STIM)? A randomised controlled trial. Pain. 2020; 161: 2820-2829 Crossref PubMed Scopus (38) Google Scholar Most reimbursement rules incorporate a 50% reduction in pain intensity, 5 Kumar K. Taylor R.S. Jacques L. et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007; 132: 179-188 Abstract Full Text Full Text PDF PubMed Scopus (824) Google Scholar whether or not combined with other criteria, such as reduction in pain medication use, and at least stable levels of daily activity. Moreover, guidelines for the management of neuropathic pain and number needed to treat have incorporated this threshold. The real meaning of a 50% threshold of improvement has not been subjected to trials that evaluate its validity in practical terms and its relationship to related factors, including psychological improvement, social adjustment, mood evaluation, and return to work. 6 Seres J.L. The fallacy of using 50% pain relief as the standard for satisfactory pain treatment outcome. Pain Forum. 1999; 8: 183-188 Abstract Full Text PDF Google Scholar
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