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Should 50% relief on the pain scale be the standard? Maybe not!

BionicWomanBBionicWoman Posts: 619
edited 06/11/2012 - 8:38 AM in Spinal Cord Stimulation
I was doing some reading and ran across some interesting research that was done to examine whether or not using the 50% relief on the pain scale is really the best predictor of long term success with the SCS. I have the full text article in PDF format if anyone wants it. Here's the citation and the abstract, which is all I can post without violating the copyright restrictions. ;)
Oakley J, Krames E, Stamatos J, Foster AM. Successful Long-Term Outcomes of Spinal Cord Stimulation Despite Limited Pain Relief During Temporary Trialing. Neuromodulation. 2008:11,1:67-73


In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long-term benefit. To validate or refute this perception, the long-term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined.

Materials and Methods.
Twelve subjects with intractable pain underwent implantation of trial SCS systems. After a trial period in which they reported less than 50% pain relief, they each received a permanent SCS implant. Pain ratings and complications were tracked for 6–18 months.

At the end of the temporary trial period, the average pain relief was 21%; no subject reported 50% or better pain relief. More favorable outcomes were reported after activation of the permanent system, however. At all follow-up time points, at least a third of the subjects reported better than 50% pain relief, and the average pain relief varied over time between 44% and 83%. All complications were readily resolved and no subjects withdrew from the study.

Although SCS provided limited pain relief during the trial period, efficacy was more satisfactory after permanent implantation. Several subjects went on to experience nearly complete pain relief for up to 18 months (the maximum follow-up visit for study purposes), and no subject chose to discontinue SCS therapy. SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.


  • I agree that there are some serious limitations by using the 50% relief criteria. One of my biggest issues, is that during trials, the leads used are very different from those used in many permanent implants. Also given the fact that the leads are only tacked to the skin and not normally anchored internally seems to cause more confusion than certainty.

    Since most implants are regulated by Pain Management clinics, the concern with complete evaluation of the patient's condition comes into play. Many patients are sent to Pain Management after a singular surgical failure, which may be very premature and preclude someone from getting the correct treatment they require. This can delay proper diagnosis and increase the risk of permanent nerve damage.

    I feel that more stringent patient selection and evaluation criteria needs to be developed. In my opinion, if proper evaluation and selection is done, a trial would not even be necessary and permanent implant could be done without a trial and with a greater percentage of success.

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