Trial Stim RCT gets first presentation at NANS 2020

Selecting patients who will benefit long term from spinal cord stimulation has relied upon clinical criteria and severity thresholds, such as neuropathic pain rated > or = to 5/10. The next step is a trial of spinal cord stimulation. However little is known about the clinical utility or diagnostic accuracy of such a trial.

Led by Professor Sam Eldabe, a well respected team of clinical researchers and SCS clinical teams in 3 different UK NHS trusts conducted the Trial Stim Study that reported in public for the first time at NANS (North American Neuromodulation Society) Annual Scientific meeting at Caesars Palace, Las Vegas in January 2020.

I led the Basildon team and each centre contributed about a third of the total of 105 patients recruited.

We wanted to investigate the following

  1. Determine the diagnostic performance of SCS screening trial
  2. Compare the outcomes and cost-effectiveness of an SCS trial strategy to an implantation only strategy
  3. Assess the experiences and preferences of patients.

This pragmatic independently funded RCT found, at 6 month follow up, that while a SCS screening trial may provide diagnostic utility there was no evidence to support that a screening trial strategy provides either better patient outcomes or cost-effectiveness versus an implantation only approach. Patients expressed a strong preference for no screening trial.

It should be noted that each centre is very experienced at SCS selection and, as recommended by NICE, have access to multidisciplinary team assessment and care.

This is a pivotal study that will change the way we apply spinal cord stimulation. The manuscripts have been submitted for publication

In a further project, I led a group of highly experienced European pain anaesthetists, neurosurgeons and multidisciplinary team members to develop a pan European consensus for referral and selection of patients for spinal cord stimulation. This manuscript has also been submitted. A web based E-Tool to help support referrers and SCS selection has been developed and will be made available, dependent upon registration, following publication.

Together I hope that access to SCS will become clearer and more streamlined so that suitable ptients can be treated sooner and more effectively.

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