To trial or not to trial before Spinal Cord Stimulation for chronic neuropathic pain: the patients’ view from the TRIAL-STIM randomised controlled trial

Raymond Chadwick, Rebekah McNaughton, Sam Eldabe, Ganesan Baranidharan, Jill Bell, Morag Brooks, Rui V. Duarte, Jenny Earle, Ashish P. Gulve, Rachel Houten, Susan Jowett, Anu Kansal, Shelley Rhodes, Jennifer Robinson, Sara Griffiths, Rod Taylor, Simon Thomson, Harbinder Sandhu

Research output: Contribution to journalArticlepeer-review

Abstract


Objectives

Spinal cord stimulation (SCS) is an established treatment of chronic neuropathic pain. Although a temporary SCS screening trial is widely used to determine suitability for a permanent implant, its evidence base is limited. The recent TRIAL‐STIM study (a randomized controlled trial at three centers in the United Kingdom) found no evidence that an SCS screening trial strategy provides superior patient outcomes as compared with a no trial approach. As part of the TRIAL‐STIM study, we undertook a nested qualitative study to ascertain patients' preferences in relation to undergoing a screening trial or not.
Materials and Methods

We interviewed 31 patients sampled from all three centers and both study arms (screening trial/no trial) prior to SCS implantation, and 23 of these patients again following implantation (eight patients were lost to follow‐up). Interviews were undertaken by telephone and audio‐recorded, then transcripts were subject to thematic analysis. In addition, participants were asked to state their overall preference for a one‐stage (no screening trial) versus two‐stage (screening trial) implant procedure on a five‐point Likert scale, before and after implantation.
Results

Emergent themes favoured the option for a one‐stage SCS procedure. Themes identified include: saving time (off work, in hospital, attending appointments), avoiding the worry about having “loose wires” in the two‐stage procedure, having only one period of recovery, and saving NHS resources. Participants' rated preferences show similar support for a one‐stage procedure without a screening trial.
Conclusions

Our findings indicate an overwhelming preference among participants for a one‐stage SCS procedure both before and after the implant, regardless of which procedure they had undergone. The qualitative study findings further support the TRIAL‐STIM RCT results.
Original languageEnglish
Number of pages12
JournalNeuromodulation
DOIs
Publication statusPublished - 1 Dec 2020

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