The Spinal Cord Stimulation Trial Success Score (STSS): A Narrative Review and Evidence-Informed Conceptual Framework...

Area of Science:

• Neuromodulation
• Pain Management
• Clinical Decision Support

Background:

• Spinal cord stimulation (SCS) is a recognized treatment for chronic neuropathic pain.
• Patient response to SCS trials and long-term outcomes are variable.
• Clinicians require tools to systematically evaluate patient selection for SCS.

Purpose of the Study:

• To develop a bedside-oriented framework for assessing spinal cord stimulation (SCS) trial candidacy.
• To organize clinically relevant patient-selection domains discussed in neuromodulation literature.
• To create a practical tool for documenting discussions on SCS trial eligibility.

Main Methods:

• Conducted a narrative synthesis of diverse study types (RCTs, cohort studies, reviews, consensus).
• Focused on SCS outcomes and candidate selection criteria.
• Objective was to build a framework, not a predictive model.

Main Results:

• Introduced the Spinal Cord Stimulation Trial Success Score (STSS), a 0-12 point scale.
• The STSS incorporates six domains: primary indication, psychological status, smoking, opioid use, BMI, and pain duration.
• Proposed three categories: more favorable, optimization-sensitive, and less favorable profiles for documentation and decision-making.

Conclusions:

• The STSS serves as an evidence-informed clinical profile, pending prospective validation.
• Interim use as a checklist supports structured assessment, identification of modifiable factors, and shared decision-making.
• The STSS should not replace multidisciplinary judgment or be used as a standalone rule to deny treatment.