A more holistic and personalised approach for patients with chronic (back) pain
Accurate and individual predictions of the effectiveness of spinal cord stimulation for the treatment of chronic back pain are now possible
9 December 2020
One out of three patients still suffers from Failed Back Surgery Syndrome (FBSS) after the procedure. An implanted spinal cord stimulator can relieve their pain. Approximately 1,000 patients undergo spinal cord implants each year. To date, it was quite difficult to evaluate the effectiveness for patients of this neurosimulator. A study by the DISCOVER consortium, led by Professor Maarten Moens and Dr Lisa Goudman of UZ Brussel has now mapped this effectiveness for the first time, developing a model to predict the effectiveness for individual patients one year after the procedure. The results of this study were recently published in the prestigious scientific journal “Pain”.
Living with chronic pain is very difficult and has a serious impact on patients’ everyday lives. Pain intensity (which the current therapeutic treatments tend to focus on) in addition to the impact on various aspects of their lives is meaningful for these patients.
Since the eighties, an implantable pacemaker-like spinal cord stimulator is used to treat this pain. Pain doctors in Belgium pioneered this treatment, which was considered revolutionary at the time.
Both low back and leg pain significantly decreased 12 months after implantation
Patients with Failed Back Surgery Syndrome are eligible for a spinal cord implant. The study of the DISCOVER consortium aimed to determine the impact on pain intensity, sleep quality, disability, health-related quality of life, and medication use one year after the procedure.
Pain treatments often tend to solely focus on pain intensity, lacking a holistic approach to the patient. The researchers defined a “holistic responder” or a broad set of elements that are important for evaluating the effectiveness of a therapeutic treatment in patients with FBSS. “Holistic responders’” thus are patients with spinal cord stimulation who achieved an improvement for every element. The combination of pain relief, a decrease in pain medication, and an improvement in functionality and quality of life are the cornerstones of success.
Professor Maarten Moens, neurosurgeon at UZ Brussel: “The impact of the spinal cord stimulation treatment on these four elements can now be predicted with an accuracy of 90%. The outcomes revealed clinically significant and sustained pain relief over a 12-month period in patients with FBSS. The neurostimulator also achieved an improvement in sleep quality, functionality and a decrease in pain medication.”
The outcome of pain treatment can now be predicted for specific patients
Based on the data of the study’s respondents, Dr Lisa Goudman, a clinical researcher at UZ Brussel, developed a prediction model based that is tailored to the patient and the attending physician, with an extremely high accuracy, sensitivity and specificity. The model uses a number of specific outcome variables, obtained during pre-surgery consultations, to predict pre-implantation of the spinal cord stimulator whether individual patients can expect to see an excellent holistic response one year after the procedure.
Dr Goudman: “Chronic pain can now have a realistic idea of what to expect over a period of 12 months after implantation of a spinal cord stimulator. Moreover, the attending physician is able to develop a more personalised approach, with positive outcomes for the patient.”
About the study
DISCOVER, a consortium of 19 pain clinics in Belgium, led by Professor Maarten Moens and his team at UZ Brussel, was set up four years ago. This multidisciplinary project, a collaboration between neurosurgeons and anaesthesiologists, consisted of a registry of various parameters of patients who were potentially eligible for the implant of a spinal cord stimulator for at least 12 months after the procedure.
What made this project so unique was the excellent collaboration between the various implantation teams in Belgium and the constructive relationship between neurosurgeons and anaesthesiologists.
Karolien De Prez