Special articleEvidence-based consensus guidelines on patientRegselection and trial stimulation for spinal cordstimulation therapy for chronic non-cancer painHarsha ShanthannaSam Eldabe,2David Anthony Provenzano3Benedicte Bouche,Eric Buchser,Raymond Chadwick,2Tina L DoshiRui DuarteChristine HuntFrankPM Huygen,Judy Knight,Anesth Pain Med:first published asLynn Kohan,12 Richard North,13 Joshua Rosenow,14 Christopher JWinfree,15Samer Narouze 16Additional supplementalABSTRACTBACKGROUNDmaterial is published onlineSpinal cord stimulation (SCS)has demonstratedSpinal cord stimulation (SCS)is an establishedonly.To view,please visit thejoumal online (http://dx.doiorg/effectiveness for neuropathic pain.Unfortunately,sometherapy for the treatment of chronic refractory10.1136apm-2022-104097).patients report inadequate long-term pain relief.Patientpain.Despite refinements in its technology and10.1136-2022-1 10For numbered affiliations seeselection is emphasized for this therapy;however,theexpanding research efforts,long-term challengesend of article.prognostic capabilities and deployment strategies ofremain,with nearly 30%6-40%patients reportingexisting selection techniques,including an SCS trialinadcquate relief beyond 24-36monthsSCS04007Correspondence tohave been questioned.After approval by the Board oftherapy is not effective in all patients and appro-gDr Harsha ShanthannaDirectors of the American Society of Regional Anesthesiapriate patient selection is critical.As SCS involvesAnesthesia,McMasterand Pain Medicine,a steering committee was formedexpensive and invasive spinal procedures and a名University,Hamilton,ON L854L8,Canada;to develop evidence-based guidelines for patientlong-term commitment to living with implantedMarshanthhmcmaster.caselection and the role of an SCS trial.Representativesequipment,treatment failure is associated withof professional organizations with clinical expertizedissatisfaction,need for explant surgery,and undueReceived 28 September 2022costs to the health system and society.Studies2023Accepted 18 January 2023were invited to participate as committee members.indicate that SCS can be cost-effective only in the0A comprehensive literature review was carried outby the steering committee,and the results organizedlong run,as the initial costs outweigh those ofinto narrative reports,which were ciralated to allconventional management.10 Over the years,usethe committee members.Individual statements andof SCS has increased exponentially,with aroundrecommendations within each of seven sections were50,000 SCS devices implanted annually across theformulated by the steering committee and circulated toworld,and an estimated market size valued atloaded frommembers for voting.We used a modified Delphi methodUS$1.88 billion in 2018 that is projected to growwherein drafts were circulated to eac member in ato US$3.58 billion by 2026.12 Patient selection forblinded fashion for voting.Comments were incorporatedSCS needs to consider:(1)appropriate pain
