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Implementing the SAFE Principles for the Development of Pain Medicine Therapeutic Algorithms That Include
Elliot Krames1, Lawrence Poree, Timothy Deer
1Pacific Pain Treatment Centers, San Francisco, CA, USA; Pain Clinic of Monterey Bay, Aptos, CA, USA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Center for Pain Relief Inc., Charleston, WV, USA; West Virginia University School of Medicine, Morgantown, WV, USA; Departments of Neurologic Surgery and Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Abstract:
Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include "safety,""appropriateness,""fiscal neutrality," and "efficacy."

