Sustainability of Pain Reduction from Trial Stimulation to Long-Term Follow-Up in Chronic Pain Patients with Spinal Cord Stimulation: A Retrospective Analysis
- 1Clinical Division of Pain Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- 2Center for Medical Data Science, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
Abstract
Background/Objectives: Before permanent implantation of a Spinal Cord Stimulation (SCS) system for treatment of chronic pain conditions a trial phase is standard, though its utility is increasingly disputed. Comparisons of long-term to trial-phase pain levels are sparse, and whether trial pain scores predict system explantation risk is unclear. We compare long-term and trial-phase pain levels in SCS treatment and investigate association between trial numeric rating scale (NRS) pain score and explantation. Methods: This retrospective, single-centre study analysed patients who underwent SCS implantation with long-term follow-up. Patients were included if baseline and trial NRS diaries were available and trial phase was successful. Missing follow-up NRS values were extracted from patient files, multiple imputation addressing remaining gaps. ROC analysis, log-rank test, logistic regression, and Cox proportional hazards models evaluated association between trial-phase NRS and explantation. Results: 71 patients (49.3% female, mean age 53.1 ± 13.0 SD years) were included. NRS reduction during trial was −3.52 from baseline [95% CI: −2.94, −4.09] (p < 0.0001). NRS reduction from baseline to long-term follow-up was −1.94 [95% CI: −1.1, −2.74] (p < 0.0001). NRS increased by 1.58 [95% CI: 0.78, 2.38] from trial to follow-up (mean follow-up at 4.42 years [95% CI: 3.53, 5.30]) (p < 0.0002). Higher trial NRS was associated with higher odds of explantation. (Odds Ratio: 1.38 per one-point NRS increase (95% CI: 1.01–2.04, p = 0.0458). Conclusions: In SCS there is significant attrition of pain reduction from trial to long-term follow-up. Higher trial NRS showed a possible association with higher odds of explantation. Therefore, pain reduction during trial phase does not necessarily reflect long-term results and utility of trial-phase pain levels for estimation of explantation risk warrants further investigation.
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BibTeX
@article{pramhas2026sustainability,
title = {{Sustainability of Pain Reduction from Trial Stimulation to Long-Term Follow-Up in Chronic Pain Patients with Spinal Cord Stimulation: A Retrospective Analysis}},
author = {Sibylle Pramhas and Daniela Boryshchuk and Zoltan Micskei and Radoslaw Monte and Sebastian Terner and Andrea Michalek-Sauberer and Sabine Sator},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218294},
url = {https://www.mdpi.com/2077-0383/15/21/8294},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sustainability of Pain Reduction from Trial Stimulation to Long-Term Follow-Up in Chronic Pain Patients with Spinal Cord Stimulation: A Retrospective Analysis
AU - Sibylle Pramhas
AU - Daniela Boryshchuk
AU - Zoltan Micskei
AU - Radoslaw Monte
AU - Sebastian Terner
AU - Andrea Michalek-Sauberer
AU - Sabine Sator
PY - 2026
DA - 2026/10/24
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218294
UR - https://www.mdpi.com/2077-0383/15/21/8294
AB - Background/Objectives: Before permanent implantation of a Spinal Cord Stimulation (SCS) system for treatment of chronic pain conditions a trial phase is standard, though its utility is increasingly disputed. Comparisons of long-term to trial-phase pain levels are sparse, and whether trial pain scores predict system explantation risk is unclear. We compare long-term and trial-phase pain levels in SCS treatment and investigate association between trial numeric rating scale (NRS) pain score and explantation. Methods: This retrospective, single-centre study analysed patients who underwent SCS implantation with long-term follow-up. Patients were included if baseline and trial NRS diaries were available and trial phase was successful. Missing follow-up NRS values were extracted from patient files, multiple imputation addressing remaining gaps. ROC analysis, log-rank test, logistic regression, and Cox proportional hazards models evaluated association between trial-phase NRS and explantation. Results: 71 patients (49.3% female, mean age 53.1 ± 13.0 SD years) were included. NRS reduction during trial was −3.52 from baseline [95% CI: −2.94, −4.09] (p < 0.0001). NRS reduction from baseline to long-term follow-up was −1.94 [95% CI: −1.1, −2.74] (p < 0.0001). NRS increased by 1.58 [95% CI: 0.78, 2.38] from trial to follow-up (mean follow-up at 4.42 years [95% CI: 3.53, 5.30]) (p < 0.0002). Higher trial NRS was associated with higher odds of explantation. (Odds Ratio: 1.38 per one-point NRS increase (95% CI: 1.01–2.04, p = 0.0458). Conclusions: In SCS there is significant attrition of pain reduction from trial to long-term follow-up. Higher trial NRS showed a possible association with higher odds of explantation. Therefore, pain reduction during trial phase does not necessarily reflect long-term results and utility of trial-phase pain levels for estimation of explantation risk warrants further investigation.
SN - 2077-0383
ER -