Outcomes of spinal cord stimulation: patient validation

Objective. To identify aspects of daily life that have been most affected by chronic low back pain among spinal cord stimulation (SCS) patients and to determine the relative contribution that improvement in each would make to patients' quality of life (QOL). Materials and Methods. Telephone survey of 44 patients with chronic low back pain who were about to undergo or had been recently implanted with an SCS system. Patients were asked to define, by open-ended response and examiner-read list, those aspects of daily life that had been most affected by pain and to assess the relative importance that improvement in each would make to daily life. Results. Patients identified 13 areas of daily function that were most significantly impacted by chronic low back pain. Most frequently, activities of daily living, decreased ability to work, psychological changes, and limitations to social life and recreation were identified. Functional status change, decreased ability to walk, and ability to perform daily household activities were rated as the most important change from among items included in examiner-read list. Conclusions. Patients with chronic low back pain seek improvement in multiple dimensions of QOL after SCS, particularly increased physical activity, social relations, work status, and mood. It is likely that patients' assessment of SCS "success" correlates highly with functional improvement. As such, an understanding of SCS therapeutic benefit and satisfaction requires that QOL be carefully assessed in future outcome trials.