Discrepancy Between Reported and Calculated Pain Reduction in Patients With Spinal Cord Stimulation Therapy and Lack of Agreement Between Patient Satisfaction and Degree of Pain Relief

Warren Southerland; Nasir Hussain; Ruan Qing; Puja Shankar; Sindhuja Surapaneni; James Burns; Syed Mahmood; Cyrus Yazdi; Mahmoud Abdel-Rasoul; Thomas T Simopoulos; Jatinder S Gill

doi:10.1016/j.neurom.2023.11.008

Discrepancy Between Reported and Calculated Pain Reduction in Patients With Spinal Cord Stimulation Therapy and Lack of Agreement Between Patient Satisfaction and Degree of Pain Relief

Neuromodulation. 2023 Dec 27:S1094-7159(23)00994-7. doi: 10.1016/j.neurom.2023.11.008. Online ahead of print.

Affiliations

¹ Minimally Invasive Pain and Orthopedics, Houston, TX, USA.
² Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
³ Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA.
⁴ Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
⁵ Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard, Boston, MA, USA. Electronic address: jsgill@bidmc.harvard.edu.

PMID: 38159100
DOI: 10.1016/j.neurom.2023.11.008

Abstract

Objectives: This study aimed to determine agreement between reported percentage pain reduction (RPPR) and calculated percentage pain reduction (CPPR) in patients with percutaneous spinal cord stimulation (SCS) implants, and to correlate RPPR and CPPR with patient satisfaction. We also sought to determine which patient-reported outcome measures are most improved in patients with SCS.

Materials and methods: Fifty patients with percutaneous spinal cord stimulator implants with a mean follow-up of 51.1 months were interviewed and surveyed to assess their pain level, impression of degree of pain relief, satisfaction with the therapy, and desire to have the device again. Baseline pain level was obtained from their preimplant records.

Results: Overall, RPPR was found to be 53.3%, whereas CPPR was 44.4%. Of all patients, 21 reported <50% pain reduction; however, most of these (12/21, 57%) were satisfied with the outcome of therapy. In terms of individual improvement in outcomes, activities of daily life was the most improved measure at 82%, followed by mood, sleep, medication use, and health care utilization at 74%, 62%, 50%, and 48%, respectively.

Conclusions: RPPR appears to be a complex outcome measure that may not agree with CPPR. Overall RPPR is greater than the CPPR. On the basis of our data, these independently valid measures should not be used interchangeably. A 50% pain reduction threshold is not a requisite for patient satisfaction and desire to have the device again. Activities of daily living was the most improved measure in this cohort, followed by mood, sleep, medication usage, and decrease in health care utilization.

Keywords: Activities of daily living; outcomes; pain scores; patient satisfaction; spinal cord stimulator.