Given the substantial socioeconomic impact of Spinal Cord Stimulation (SCS) implantations and given that currently no direct high-quality evidence with a relevant outcome measurement is available to guide the treatment choice between subthreshold SCS versus best medical treatment in patients with Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), we here propose a scientifically well-constructed randomized controlled trial to answer this question. The primary scientific objective is to examine whether subthreshold SCS, compared to best medical treatment, provided to patients with PSPS-T2 results in a higher percentage of clinical holistic responders at 6 months. The secondary objective of the study is to examine if subthreshold SCS compared with BMT is having more efficacy in improving patients' individual competencies for self-management, increasing the likelihood to return to work, work status and healthcare expenditure, improving pain relief, obtaining pain medication reduction, decreasing anxiety and depression, increasing quality of life and decreasing disability.
After filling in the questionnaires at the 6 months follow-up visit, patients could change treatment groups (in both directions). This decision will be a shared decisions between patient and treating physician in case the randomized intervention did not provided enough pain relief.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
114
For each patient who is randomized to BMT, an optimal individual treatment plan will be developed by the treating physician.
SCS will be programmed at subthreshold stimulation.
Jessa Ziekenhuis
Hasselt, Belgium
Universitair Ziekenhuis Brussel
Jette, Belgium
Emmaüs, AZ Sint-Maarten
Mechelen, Belgium
AZ Delta
Roeselare, Belgium
AZ Turnhout
Turnhout, Belgium
Clinical holistic responder status
The clinical holistic responder status as a composite measure represents the global effect of a treatment, based on a combination of questionnaires.
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Overall pain intensity with Visual Analogue Scale (VAS)
Overall pain, defined as a combination of back and leg pain, but not pain from other body parts, measured with the VAS (100mm)
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Pain medication use
Open question regarding the dosage, frequency and type of pain medication
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Functional disability
The functional disabilities will be assessed with the Oswestry Disability Index (ODI)
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Health related quality of life
Health related quality of life, evaluated with the EuroQol with five dimensions and 5 levels
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Patient global impression of change
Patients will be asked to quantify the impression of change after treatment using the Patient Global Impression of Change scale (PGIC).
Time frame: Evaluated at 1 month, 6 months and 12 months.
Work status
Work status is evaluated with a self-designed questionnaire
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Patients' individual competencies for self-management
Patient activation measure-13 (PAM) is a 13-item instrument which assesses self-reported behaviour, knowledge, and confidence for self-management of one's health.
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Healthcare utilisation.
Healthcare expenditure will be investigated by self-reporting methods.
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
Anxiety and Depression.
The hospital Anxiety and Depression Scale (HADS) will measure symptoms of anxiety and depression
Time frame: The change between the baseline screening and the evaluation at 1 month, 6 months and 12 months.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.