Appropriate referral and selection of patients with chronic pain for neuromodulation

Presented at: EFIC Virtual Pain Education Summit

Speakers

Nevenka Krcevski Skvarc

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

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

Abstract

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.

Q&A