Spinal Cord Stimulation (SCS) has been a therapy in the treatment of chronic pain for 50
years, particularly for patients resistant to conventional pharmacological treatment and
other less complex invasive procedures. Over the years, various versions of guidelines
have been established and drafted for the selection and clinical indications in which SCS
therapy is most likely to be successful. The main clinical indications include:
Chronic pain in the lumbar region and lower limbs, especially in patients who have
undergone spine surgeries (Failed Back Surgery Syndrome, FBSS).
Complex Regional Pain Syndrome (CRPS).
Peripheral neuropathic pain.
Ischemic pain in the limbs. In daily clinical practice, the heterogeneity of
patients often makes it difficult to determine which patients are eligible for this
treatment. A large number of clinical studies suggest that cognitive aspects and
individual coping mechanisms in dealing with pain experiences impact treatment
response. For this reason, international guidelines recommend that individuals
considered for SCS should undergo a comprehensive psychological evaluation.
Recently, an online tool (SCS-e-tool) has been implemented for selecting patients
eligible for SCS implantation. Developed by a team of experts in pain therapy with
various clinical backgrounds, this tool is freely available online and can be used by
healthcare professionals. It is designed to assist in evaluating a patients suitability
for spinal cord stimulation and aid in making informed clinical decisions.
The SCS-e-tool takes into account various factors, including cognitive aspects and the
patient pain management modalities. The goal is to provide a comprehensive and
personalized assessment to identify patients who may benefit most from spinal cord
stimulation therapy. This tool can be a valuable aid for healthcare professionals in the
decision-making process regarding patient selection for SCS therapy.
It is important to note that, despite the utility of assessment tools, the final decision
on a patient candidacy for spinal cord stimulation should be based on a comprehensive
evaluation that includes clinical, psychological, and individual aspects of the patient.
The implementation of tools like the SCS-e-tool represents a step forward in the
personalized approach to chronic pain management and the optimization of patient
selection for specific therapies such as spinal cord stimulation.
Recently, an online tool (SCS-e-tool) has been implemented for the selection of patients
eligible for SCS implantation, developed by a pool of experts in pain therapy with
diverse clinical profiles. This tool, available online for free and built according to
the RUAM method, allows the input of various clinical profiles with diagnostic, clinical,
and psychological information and provides indications on the likelihood of SCS success
and suggestions regarding the need for psycho-social support therapies in conjunction
with neurostimulation.
The e-tool scores range from 1 to 9 and are divided as follows: 1-3 inappropriate
intervention, 4-6 intervention with uncertain outcomes, 7-9 appropriate intervention with
a high probability of success. The e-tool has a dual use for implanters and referrers.
For both groups, the scope is similar, but perspectives differ: Referrers perspective:
appropriateness in terms of referring a patient to consider SCS as the next step in
chronic pain management. Implanter's perspective: appropriateness in terms of selecting a
patient for SCS as the next step in chronic pain management.
