Implementing the SAFE Principles for the Development of Pain Medicine Therapeutic Algorithms That Include Neuromodulation Techniques


Address correspondence and reprint requests to: Elliot Krames, MD, Pacific Pain Treatment Centers, San Francisco, CA 94109, USA. Email:


Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include “safety,”“appropriateness,”“fiscal neutrality,” and “efficacy.”