Patient selection for spinal cord stimulation: The importance of an integrated assessment of clinical and psychosocial factors

Simon Thomson, Nicky Helsen, Simon Prangnell, Mery Paroli, Ganesan Baranidharan, Hayat Belaïd, Bart Billet, Sam Eldabe, Giuliano De Carolis, Laura Demartini, Kliment Gatzinsky, Jan Willem Kallewaard, Matthias Winkelmüller, Frank Huygen, Herman Stoevelaar*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: A previously developed educational e-health tool considers both clinical and psychosocial factors when selecting patients with chronic pain for spinal cord stimulation (SCS). The validity of the composite recommendations was evaluated in a retrospective study, demonstrating a strong relationship with patient outcomes after SCS. Methods: An additional retrospective analysis was performed to determine the added value of a psychosocial evaluation as part of the decision-making process on SCS. Data concerned 482 patients who were considered for SCS in 2018–2019. The analysis focused on the relationship between the different layers of the tool recommendations (clinical, psychosocial, composite) with trial results and patient outcomes at 6 months after SCS. Of the initial study population, 381 patients underwent SCS and had follow-up data on at least one of three pain-related outcome measures. Results: Pain improvement was observed in 76% of the patients for whom SCS was strongly recommended based on merely the clinical aspects. This percentage varied by the level of psychosocial problems and ranged from 86% in patients without any compromising psychosocial factors to 60% in those with severe problems. Similarly, the severity of psychosocial problems affected trial results in patients for whom SCS was either recommended or strongly recommended. Conclusions: The strong relationship between psychosocial factors embedded in the SCS e-health tool and patient outcomes supports an integrated and multidisciplinary approach in the selection of patients for SCS. The educational e-health tool, combining both clinical and psychosocial aspects, is believed to be helpful for further education and implementation of this approach. Significance statement: This study confirms the relevance of the psychosocial factors embedded in the educational SCS e-health tool ( The strong relationship between the severity of psychosocial factors with patient outcomes supports conducting a comprehensive psychological and behavioural assessment when determining the eligibility of patients for SCS.

Original languageEnglish
Pages (from-to)1873-1881
Number of pages9
JournalEuropean Journal of Pain (United Kingdom)
Issue number9
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
This study was funded by Boston Scientific. The funder was not involved in the design, set‐up and conduct of this study, nor the preparation of this manuscript. The manuscript has been shared with the funder after submission.

Publisher Copyright:
© 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.


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