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

Pain Relief

Pain relief is the primary outcome measure of SCS success, with the arbitrary criterion of a 50% reduction in pain commonly used as the threshold for success.  This may be reported by the patient directly, as a percentage, or it may be calculated from numeric (e.g., 0-10) or visual analog scales.  The results of these different measures might vary in the same patient; in any event, no measure of pain relief has been shown to be an absolute criterion for success or for proceeding to a permanent implant.  Pain relief should be considered along with other outcomes.

Strength of recommendation Evidence source(s)/rationale
N/A -- information only N/A -- see Bibliography for relevant literature

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Scott J, Huskisson EC. Graphic representation of pain. Pain 2:175-184, 1976.

Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144, 1983.

Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45-56, 1983.
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Ohnhaus EE, Adler R. Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain 1:379-384, 1975.
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Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277-299, 1975.
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Kopec JA, Esdaile JM. Functional disability scales for back pain. Spine 20:1943-1949, 1995.
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Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117-126, 1986.
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Holroyd KA, Holm JE, Keefe FJ, Turner JA, Bradley LA, Murphy WD, Johnson P, Anderson K, Hinkle AL, O'Malley WB. A multi-center evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients. Pain 48:301-311, 1992.
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Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149-158, 2001.
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Collins SL, Moore A, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain 72:95-97, 1997.
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Ceran F, Ozcan A. The relationship of the Functional Rating Index with disability, pain, and quality of life in patients with low back pain. Med Sci Monit 12(10):CR435-39, 2006.
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Carlsson AM. Assessment of chronic pain. II. Problems in the selection of relevant questionnaire items for classification of pain and evaluation and prediction of therapeutic effects. Pain 19(2):173-184, 1984.
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Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analog scale. Pain 16:87-101, 1983.
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