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Incidence and etiology of impediments to spinal cord stimulator trial progression
Erin E Alpaugh1, Esha A Vaidya2, Jason S Kilgore3
1Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
Background:
Spinal cord stimulator (SCS) trials are used to assess therapy efficacy before permanent implantation. Despite initial candidacy, not all patients proceed to SCS trial. Comprehending potential barriers to SCS therapy could offer strategies to enhance patient access.
Objective:
The purpose of this study is to evaluate the incidence and etiology of impediments to SCS trial progression unrelated to preoperative MRI findings.
Methods:
A retrospective chart review of a single center identified patients who were under consideration for SCS trial from September 2013 to July 2023. Impediments to trial progression were classified from electronic health records. Demographic variables and time intervals were analyzed using logistic regression and a non-parametric test.
Results:
This retrospective study identified 358 patients considered for an SCS trial of which 84 (23.5%) did not progress. Relevant impediment classifications included: medical reasons (39.8%), patient-directed decisions (25.8%), insurance or financial responsibilities (16.1%), MRI-documented contraindications (10.8%), and psychiatric concerns (7.5%). In the multivariable logistic regression, complex regional pain syndrome (CRPS; b = -0.82, p = 0.04) was the only demographic variable significantly associated with non-progression to trial.
Conclusion:
Across all SCS trial candidates, 20.7% did not progress for reasons unrelated to MRI findings. SCS trial progression was hindered by medical, personal, and financial challenges during the preoperative period. These findings highlight a need for enhancing patient access and optimizing preprocedural processes.
Insights
Many spinal cord stimulator (SCS) candidates face barriers to trial progression, including medical, personal, and financial issues. Addressing these impediments is crucial for improving patient access to SCS therapy.
Area of Science:
- Pain management and neuromodulation.
- Surgical candidacy assessment.
Background:
- Spinal cord stimulator (SCS) trials precede permanent implantation to assess efficacy.
- Not all patients initially considered for SCS proceed to trial.
- Identifying barriers to SCS trial progression can improve patient access.
Purpose of the Study:
- To determine the incidence and causes of impediments to SCS trial progression.
- To investigate barriers unrelated to preoperative MRI findings.
Main Methods:
- Retrospective chart review of patients considered for SCS trial (September 2013 - July 2023).
- Classification of impediments from electronic health records.
- Analysis of demographic variables and time intervals using logistic regression and non-parametric tests.
Main Results:
- 84 out of 358 (23.5%) patients did not progress to SCS trial.
- Key impediments included medical reasons (39.8%), patient decisions (25.8%), financial issues (16.1%), MRI contraindications (10.8%), and psychiatric concerns (7.5%).
- Complex regional pain syndrome (CRPS) was significantly associated with non-progression (p=0.04).
Conclusions:
- 20.7% of SCS trial candidates did not progress for non-MRI related reasons.
- Medical, personal, and financial challenges impede SCS trial progression.
- Optimizing preprocedural processes is needed to enhance patient access to SCS therapy.
