ID: 204233 Patient Centered Neuromodulation Trial: Shared Decision Making in the Era of Multiple Neuromodulation Paradigms

Abstract

Spinal cord stimulation (SCS) has a well-established role for chronic, intractable neuropathic low back and leg pain. There are a wide variety of SCS stimulation paradigms, broadly categorized into paresthesia-based (i.e., conventional) and paresthesia-free (i.e., high-frequency) systems. However, the current literature remains unclear as to which system is the most effective and lacks evidence-based standards to optimize matching to a given patient. While less than two thirds of patients receiving trials undergo permanent SCS implantation, nearly half of patients with SCS implantation experience eventual loss of pain relief without clear etiology despite initial screening trials.1-5 This relatively poor translation of pain relief reveals the limited sensitivity of current trials. Crossover trials, allowing patients to experience both paresthesia-based and paresthesia-free SCS systems, may serve as a patient-centered alternative strategy to identify the most effective mode of stimulation for individual patients.