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Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
Published on: June 26, 2018
A Multicenter Analysis of Baseline Patient-Reported Outcome Measures as Predictors of Progression From Spinal Cord
Sebastian Encalada1, Matthew A Cascio1, Eva Kubrova1
1Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA.
Background And Objectives:
Spinal cord stimulation (SCS) constitutes an established therapy for refractory chronic pain conditions. Although not standardized, most clinical algorithms define trial success as ≥50% pain reduction, usually accompanied by some degree of functional improvement. This study evaluated Patient-Reported Outcomes Measurement Information System (PROMIS) scores as potential predictors of progression from temporary trial to permanent implant.
Materials And Methods:
A multicenter retrospective analysis was conducted using data from patients who underwent SCS trials across the Mayo Clinic Enterprise between November 20, 2017 and January 20, 2025. Baseline PROMIS scores, including pain interference, fatigue, global pain, and other functional domains, were assessed for their association with progression from SCS trial to permanent implantation. Logistic regression was used to identify positive and negative predictors of trial-to-implant progression, with statistical significance set at p < 0.05.
Results:
A total of 1009 patient records were analyzed, with 766 (76%) proceeding from SCS trial to permanent implantation. Predictive analyses were performed in the subset of 248 patients with complete PROMIS data. Pain interference was the strongest predictor of progression to permanent implantation (adjusted odds ratio [OR] 1.07; 95% CI, 1.02-1.13; p = 0.0007), with fatigue (OR 1.05, p = 0.016) and sleep disturbance (OR 1.04, p = 0.03) also showing statistically significant associations. No significant associations were observed between trial-to-implant progression and other PROMIS domains, such as anxiety, depression, and physical function.
Conclusion:
Higher pain interference, fatigue, and sleep disturbance scores were associated with progression from SCS trial to permanent implantation, which may provide clinical insight when considering patient selection for SCS therapy. However, given the retrospective nature of the study, the small sample size, and the relatively low OR, the utility of PROMIS as a clinical predictor remains unclear.
