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Observational Study
. 2024 Nov 4;49(11):793-799.
doi: 10.1136/rapm-2023-104962.

Impact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain

Johnathan H Goree  1 , Nalin Payakachat  2 , Lauren Byers  3 , G Lawson Smith  1 , Jarna R Shah  1 , Kimberly E Stephens  4   5
Affiliations
Observational Study

Impact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain

Johnathan H Goree et al. Reg Anesth Pain Med. .

Abstract

Introduction: Significant interindividual variability in spinal cord stimulation (SCS) outcomes exists. Due to its high cost and risks of complications, criteria to guide patient selection for SCS trials and their outcomes would be helpful. With increased focus on the use of patient-reported outcomes to improve care, we aim to evaluate the National Institute of Health Patient Reported Outcome Measurement Information System measures for an association with successful SCS trials in patients with persistent pain.

Methods: Our prospective, observational study enrolled 60 patients with persistent pain who underwent an SCS trial. Patients completed demographic and Patient Reported Outcome Measurement Information System computer adaptive test (PROMIS CAT) assessments to measure self-reported pain interference, depression, anxiety, physical functioning, and sleep disturbance at the time they presented for placement of their trial device.

Results: Of the 58 patients who underwent successful electrode placement, 11 had an unsuccessful trial. There were no differences in patient demographics between patients with a successful and an unsuccessful trial. Patients who had a successful SCS trial reported lower pre-trial levels of anxiety, depression, and sleep disturbance and decreased post-trial levels of depression, sleep disturbance, and pain interference.

Conclusions: We found that patients with high levels of depression, anxiety, and sleep disturbance using the PROMIS CAT were predictive of unsuccessful trials. In addition, we found that patients with successful SCS trials reported lower levels of these domains on PROMIS CAT administered at the end of the trial.

Keywords: CHRONIC PAIN; OUTCOMES; Spinal Cord Stimulation; Treatment Outcome.

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Conflict of interest statement

Competing interests: LB, GLS, JS, and KS have no conflicts to disclose. JHG is a consultant for Saluda Medical, Abbott, and Stratus Medical and the recipient of research support paid to the institution by SPR Therapeutics and Mainstay Medical. NP is an employee of Eli Lilly and Company.

Figures

Figure 1
Figure 1. CONSORT (Consolidated Standards of Reporting Trials) flow diagram showing the acquisition of study participants.
Figure 2
Figure 2. PROMIS CAT (Patient Reported Outcome Measurement Information System computer adaptive test) scores by trial success. Box and whisker plots with individual patient T-scores for the preprocedure PROMIS CAT for anxiety (A), depression (B), sleep disturbance (C), pain interference (D), and physical functioning (E). Individual scores are normalized to a T-score of 50 (dashed line) with an SD of 10 (shaded region). Higher scores indicated increased levels of the outcome assessed.
Figure 3
Figure 3. Change in PROMIS CAT (Patient Reported Outcome Measurement Information System computer adaptive test) scores in patients with a successful trial. Matched pre-trial and post-trial PROMIS CAT scores of patients with successful SCS trials for anxiety (A), depression (B), sleep disturbance (C), pain interference (D), and physical functioning (E). Individual scores are normalized to a T-score of 50 (dashed line) with an SD of 10 (shaded region). Higher scores indicated increased levels of the outcome assessed.
See this image and copyright information in PMC

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