PDF(Pubmed)
Abstract：
Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences.
摘要：
脊髓刺激（SCS）已证明对神经性疼痛有效。不幸的是,一些患者报告长期疼痛缓解不足。该疗法强调患者选择；然而，现有选择技术的预后能力和部署策略，包括一项SCS试验,已经被质疑了。经美国区域麻醉和疼痛医学学会董事会批准，我们成立了一个指导委员会,为患者选择和SCS试验的作用制定循证指南.具有临床经验的专业组织代表被邀请作为委员会成员参加。指导委员会进行了全面的文献综述，并将结果整理成叙述性报告，分发给所有委员会成员。指导委员会在七个部分中的每个部分中制定了单独的声明和建议，并分发给成员投票。我们使用了改良的Delphi方法，其中以盲法将草稿分发给每个成员进行投票。评论被纳入随后的修订，为达成共识而进行表决。共有39项建议的七个部分获得了所有成员的100％共识。章节包括SCS试验的定义和术语；SCS试验的益处；社会心理特征筛查；患者对SCS治疗和试验使用的看法；SCS治疗的其他患者预测因素；SCS试验的进行；以及SCS试验的评估，包括成功的最低标准。建议包括除心绞痛（B级）外，应在明确的SCS植入前进行SCS试验。所有患者都必须使用客观有效的社会心理因素工具进行筛查，这必须包括抑郁症（B级）。尽管有一些限制,试验有助于患者选择,并为患者提供体验治疗的机会.这些建议有望指导执业医师和其他利益相关者，不应被误认为是实践标准。医师应继续根据患者的个人考虑和偏好做出最佳判断。
