Patient selection for spinal cord stimulation: The importance of an integrated assessment of clinical and psychosocial factors.

Autor: Thomson S; Mid and South Essex University Hospitals, Basildon, UK., Helsen N; Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium., Prangnell S; Clinical Neuropsychology Service, Oxford University Hospitals, Oxford, UK., Paroli M; Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy., Baranidharan G; Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals, Leeds, UK., Belaïd H; Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France., Billet B; Department of Anaesthesiology, AZ Delta, Roeselare, Belgium., Eldabe S; Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK., De Carolis G; FederDolore-SICD, Anaesthesiology & Pain Therapy Unit, Santa Chiara University Hospital, Pisa, Italy., Demartini L; Pain Unit, ICS Maugeri, Pavia, Italy., Gatzinsky K; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden., Kallewaard JW; Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands.; Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands., Winkelmüller M; Department of Neurosurgery, Friederikenstift Hannover, Hannover, Germany., Huygen F; Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands., Stoevelaar H; Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium.
Jazyk: angličtina
Zdroj: European journal of pain (London, England) [Eur J Pain] 2022 Oct; Vol. 26 (9), pp. 1873-1881. Date of Electronic Publication: 2022 Aug 02.
DOI: 10.1002/ejp.2009
Abstrakt: Background: A previously developed educational e-health tool considers both clinical and psychosocial factors when selecting patients with chronic pain for spinal cord stimulation (SCS). The validity of the composite recommendations was evaluated in a retrospective study, demonstrating a strong relationship with patient outcomes after SCS.
Methods: An additional retrospective analysis was performed to determine the added value of a psychosocial evaluation as part of the decision-making process on SCS. Data concerned 482 patients who were considered for SCS in 2018-2019. The analysis focused on the relationship between the different layers of the tool recommendations (clinical, psychosocial, composite) with trial results and patient outcomes at 6 months after SCS. Of the initial study population, 381 patients underwent SCS and had follow-up data on at least one of three pain-related outcome measures.
Results: Pain improvement was observed in 76% of the patients for whom SCS was strongly recommended based on merely the clinical aspects. This percentage varied by the level of psychosocial problems and ranged from 86% in patients without any compromising psychosocial factors to 60% in those with severe problems. Similarly, the severity of psychosocial problems affected trial results in patients for whom SCS was either recommended or strongly recommended.
Conclusions: The strong relationship between psychosocial factors embedded in the SCS e-health tool and patient outcomes supports an integrated and multidisciplinary approach in the selection of patients for SCS. The educational e-health tool, combining both clinical and psychosocial aspects, is believed to be helpful for further education and implementation of this approach.
Significance Statement: This study confirms the relevance of the psychosocial factors embedded in the educational SCS e-health tool (https://scstool.org/). The strong relationship between the severity of psychosocial factors with patient outcomes supports conducting a comprehensive psychological and behavioural assessment when determining the eligibility of patients for SCS.
(© 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.)
Databáze: MEDLINE
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