Wuilker Knoner Campos1,2,3,4, Marcelo Neves Linhares1,2,3,4,5, Jamir Sarda6, Adair Roberto Soares Santos7, Júlio Licinio8, João Quevedo9, Kátia Lin4,10, Roger Walz4,10. 1. Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, SC, Brazil. 2. Neuron Institute, Baia Sul Medical Center, Florianópolis, SC, Brazil. 3. Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil. 4. Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, SC, Brazil. 5. Department of Surgery, Neurosurgery Division, HU, UFSC, Florianópolis, SC, Brazil. 6. Psychology Department, Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil. 7. Laboratory of Neurobiology of Pain and Inflammation, Department of Physiology, UFSC, Florianópolis, SC, Brazil. 8. Department of Psychiatry, College of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA. 9. Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA. 10. Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, SC, Brazil.
Abstract
OBJECTIVES: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. MATERIALS AND METHODS: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean). Patient-centered MCI of the VAS and SF-36 domain scores were determined based on the MacNab criteria of surgical global effectiveness. Independent presurgical predictors for MCI in the VAS and SF-36 domains were analyzed using multiple binary logistic regression. RESULTS: There was significant improvement of pain and QOL after the SCS (p < 0.00001). Twenty-three patients (67.6%) reached an MCI of pain, and 16 (47.7%)-23 (67.7%) reported an MCI of QOL. Predictors of MCI included ≥80% paresthesia coverage of the painful area, lower levels of anxiety and catastrophizing symptoms, shorter pain duration, female gender and no use of opioids before surgery. MCI of pain and QOL was observed in 50%-70% of patients with chronic pain after SCS. CONCLUSIONS: The identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.
OBJECTIVES: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. MATERIALS AND METHODS: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean). Patient-centered MCI of the VAS and SF-36 domain scores were determined based on the MacNab criteria of surgical global effectiveness. Independent presurgical predictors for MCI in the VAS and SF-36 domains were analyzed using multiple binary logistic regression. RESULTS: There was significant improvement of pain and QOL after the SCS (p < 0.00001). Twenty-three patients (67.6%) reached an MCI of pain, and 16 (47.7%)-23 (67.7%) reported an MCI of QOL. Predictors of MCI included ≥80% paresthesia coverage of the painful area, lower levels of anxiety and catastrophizing symptoms, shorter pain duration, female gender and no use of opioids before surgery. MCI of pain and QOL was observed in 50%-70% of patients with chronic pain after SCS. CONCLUSIONS: The identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.
Authors: Lisa Goudman; Nieke Vets; Julie Jansen; Ann De Smedt; Maxime Billot; Philippe Rigoard; Ann Cordenier; Sebastiaan Engelborghs; Aldo Scafoglieri; Maarten Moens Journal: J Clin Med Date: 2021-08-13 Impact factor: 4.964