Financial Support: None received.
A Multi-Center Analysis Evaluating Factors Associated with Spinal Cord Stimulation Outcome in Chronic Pain Patients
Version of Record online: 12 JUL 2011
Wiley Periodicals, Inc.
Volume 12, Issue 8, pages 1142–1153, August 2011
How to Cite
Williams, K. A., Gonzalez-Fernandez, M., Hamzehzadeh, S., Wilkinson, I., Erdek, M. A., Plunkett, A., Griffith, S., Crooks, M., Larkin, T. and Cohen, S. P. (2011), A Multi-Center Analysis Evaluating Factors Associated with Spinal Cord Stimulation Outcome in Chronic Pain Patients. Pain Medicine, 12: 1142–1153. doi: 10.1111/j.1526-4637.2011.01184.x
Conflict of Interest: None of the authors has any conflict of interest with regards to the manufacturers of any of the devices used in this manuscript.
- Issue online: 16 AUG 2011
- Version of Record online: 12 JUL 2011
- Outcome Assessment;
- Chronic Pain;
- Pain Management
Background. In addition to its conventional use as a treatment for refractory neuropathic extremity pain, spinal cord stimulation (SCS) has recently emerged as a possible treatment for visceral and arthritic pain. But concurrent with the expansion of possible conditions amenable to SCS, other studies have questioned the long-term efficacy of SCS for traditional indications. These disparate findings argue strongly for the refinement of selection criteria. The purpose of this study is to identify correlates of outcome for SCS.
Methods. Data were retrospectively collected on 244 patients who underwent a SCS trial at two academic medical centers. Success was predefined as ≥50% pain relief sustained for ≥6 months. Variables analyzed for their association with outcome included demographics, location of pain, diagnosis, presence of coexisting diseases, pain descriptors, opioid and adjuvant medication use, duration and pain relief during trial, and complications.
Results. The presence of allodynia and/or hyperalgesia correlated with both a positive SCS trial (P = 0.01) and long-term implantation outcome (P = 0.05). History of substance abuse was associated with a negative permanent SCS outcome (P = 0.05) but bore no relationship to trial results. The variable most strongly associated with an SCS outcome was experiencing <50% pain relief during the trial, which strongly presaged a negative result (P < 0.001).
Conclusions. Although weak associations with outcome were noted for several clinical variables, none was strongly associated with trial and permanent implantation results. The strongest predictor of a negative SCS outcome was obtaining <50% pain relief during the trial period.