What is it about?
Spinal Cord Stimulation is a proven therapy for chronic neuropathic pain. This article describes the fate of 321 patients treated with SCS at a single well established UK centre using a single manufacturers' devices. Data is presented on long term clinical outcomes, patient related outcome measures and healthcare utility. Comparison is also made with a similar cohort from USA. Differences in SCS fate and possible reasons are of interest.
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Why is it important?
SCS is cost effective and sustainable within U.K. NHS public healthcare system. Cost effectiveness is enhanced with low complications and long device survival. Rechargeability, although a higher initial cost reduces long term need for device replacement and revision complications. Measures of changes in Health related quality of life and patient satisfaction appear more sustainable than questions solely about pain intensity, where a simple linear analogue scale is unlikely to capture the therapeutic gain of treating long term neuropathic pain. Further efficiencies in SCS therapy can be gained by attention to the delivery of SCS such as questioning the requirement for a duplicating trial procedure when trial/implant ratios of 92% can be achieved.
Perspectives
Randomised controlled trials are vital to demonstrate the efficacy and effectiveness of a chosen therapy. Well conducted longitudinal observational studies are useful to record sustainability of effect and complications over a much longer time horizon. I believe that trial of SCS will become obsolete for the majority of patients. All SCS services should be aiming to achieve trial to implant ratios of > 90% and only trailing those where there is doubt of success in the mind of the patient and/or SCS team.
Dr Simon Thomson
Basildon & Thurrock University Hospitals NHS FT
Read the Original
This page is a summary of: A Spinal Cord Stimulation Service Review From a Single Centre Using a Single Manufacturer Over a 7.5 Year Follow-Up Period, Neuromodulation Technology at the Neural Interface, February 2017, Wiley,
DOI: 10.1111/ner.12587.
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