Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Optimizing Cost Effectiveness

How can the cost effectiveness of SCS be optimized?

  • Adjusting stimulation parameters to optimize battery life (the impact of rechargeable batteries on cost effectiveness remains to be studied).
  • Minimizing the incidence of complications, especially those that require removal and replacement of an implanted system
  • Improving equipment design
  • Careful patient selection and improving patient selection criteria
  • Offering SCS before ablative therapies, such as sympathectomy, dorsal root gangliectomy, or repeat operation.
Strength of recommendation Evidence source(s)/rationale
N/A -- information only N/A -- see Bibliography for relevant literature

Optimizing battery life

North RB, Brigham DD, Khalessi A, Calkins S, Piantadosi S, Campbell DS, Daly MJ, Dey B, Barolat G, Taylor R. Spinal cord stimulator adjustment to maximize implanted battery longevity: a randomized, controlled trial using a computerized, patient-interactive programmer. Neuromodulation 7(1):13-25, 2004.
Abstract | Wikistim Entry

Khalessi AA, Taylor RS, Brigham D, North RB Automated vs. manual spinal cord stimulator adjustment: A sensitivity analysis of lifetime cost data from a randomized controlled trial. Neuromodulation 11(3):182-186, 2008.
Abstract | Wikistim Entry

Minimizing complications

Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, North R Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation 14:412-422, 2011.
Abstract | Wikistim Entry

Kumar K, Buchser E, Linderoth B, Meglio M, Van Buyten J-P. Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts. Neuromodulation 10(1):24-33, 2007.

Kumar K, Wilson JR, Taylor RS, Gupta S. Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact. J Neurosurg Spine 5(3):191-203, 2006.
Abstract | Wikistim Entry