Utility of an e-Health Tool in the Selection of Patients to Be Treated With Spinal Cord Stimulation: Experience of an Italian Pain Unit

Neuromodulation. 2026 Apr 18:S1094-7159(26)00058-9. doi: 10.1016/j.neurom.2026.02.007. Online ahead of print.

ABSTRACT

OBJECTIVES: Spinal cord stimulation (SCS) is a surgical therapy for chronic neuropathic and mixed-origin pain refractory to conventional treatments. Patient selection considering both clinical and psycho-social factors is essential. This study prospectively validated an online e-health tool for SCS candidate selection and compared its recommendations with expert physician judgment.

MATERIALS AND METHODS: A total of 80 patients (aged 18-85 years) with persistent spinal pain syndrome, complex regional pain syndrome, neuropathic pain syndromes, or ischemic pain syndromes were enrolled at a single pain unit (December 2020-May 2024). Clinical, demographic, and psycho-social variables were collected and entered into the SCS e-health tool, which provided implantation recommendations. Physicians blinded to the tool output rated the probability of trial success. The patients underwent a 45-day SCS trial, followed by implantation in responders. Agreement between tool recommendations and expert judgment was assessed using Fisher exact test and Cohen's κ.

RESULTS: Overall, 69 patients (86.3%) showed positive trial results and were implanted. Success rates corresponded to tool recommendations: 100% for "strongly recommended," 86.2% for "recommended," and 57.1% for "rarely recommended" (p = 0.0214). One-year follow-up confirmed sustained benefits in the strongly recommended group. Agreement between the tool and physician judgment was moderate for clinical variables (unweighted κ = 0.51, weighted κ = 0.54) and fair/moderate when including psycho-social variables (unweighted κ = 0.38, weighted κ = 0.44). Pain intensity and disability were relieved over time.

CONCLUSIONS: The SCS e-health tool is a reliable aid for selecting candidates, integrating clinical and psycho-social factors reflecting trial and long-term outcomes. It can guide clinicians in identifying patients most likely to benefit from SCS and support preimplant decision-making.

PMID:42001326 | DOI:10.1016/j.neurom.2026.02.007