I like to think differently about the future of spinal cord stimulation: Challenging the status quo

The International Neuromodulation Society has over 2000 members worldwide and is growing. The INS is made up of national chapters of neuromodulation specialists, such as NSUKI (Neuromodulation Society of UK and Ireland), Benelux Neuromodulation Society (Belgium, Netherlands and Luxembourg), Italy, Germany, Spain etc.

This year we had the first INS European Chapters meeting in Nijmegen, 20 to 22 September 2018

I was invited to chair a session and speak about the PROCO study and its context. I chose to speak generally about the state of our science in this field and tried to position PROCO as not only a really good study designed to answer important scientific questions about the role of frequency in sub-perception SCS programming but also as an innovative trial design in our field. This was the first double blind randomised SCS study using multiple comparator groups, with each subject acting as their own control.

I also presented new work, which has been submitted for publication in Neuromodulation. It is a health economic model that looks at the relative health acquisition costs of 100 patients treated with the usual trial and if successful implantation of SCS with a 100 patients treated with full implantation without a trial period. The idea is to see at what trial/permanent ratio does a trial and subsequent implant become more cost effective than a straight to implant strategy. Surprisingly the base case figure is 65%. In a practice like mine with over 91% trial/permanent ratio it shows that the trial prior to implant strategy is not cost effective.

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