Delphi Consensus Revealing the Thoughts of Pain Management and Referral Specialties on the Use of SCS for Chronic Back Pain Patients Not Suitable for Spine Surgery.

Introduction: Chronic back pain is a significant global healthcare challenge, with a lifetime incidence affecting approximately 80% of people worldwide. Most patients respond positively to nonsurgical management, while a substantial proportion of the remainder obtain relief from surgical therapy. For the minority of patients with chronic back pain who do not respond to conventional medical management (CMM) and are not candidates for spine surgery, spinal cord stimulation (SCS) may be a viable treatment option. This Delphi consensus focused on identifying the thoughts and opinions of pain management and referral specialties on the use of SCS in patients with chronic back pain who are not suitable for spine surgery.

Methods: A steering group of US healthcare professionals specialized in spine surgery and chronic back pain management generated 35 statements across six main domains. Using a four-point Likert scale, the survey was created and shared with a wider panel of specialists. Results were analyzed to produce an aggregated agreement level for each statement. The consensus threshold was set at 75% agreement, which is defined as strong consensus, and ≥ 90% agreement was considered powerful consensus.

Results: A total of 211 responses were received from the following specialties: pain physician (18%; n = 38), physical therapist (18%; n = 38), orthopedic surgeon (18%; n = 37), neurosurgeon (17%; n = 36), primary care physician (15%; n = 32), and musculoskeletal radiologist (14%; n = 30). Of the 35 consensus statements developed for broader testing, 30/35 (86%) achieved consensus; 18 (51%) of which achieved ≥ 90% agreement. The remaining five (15%) statements failed to achieve consensus among the wider panel.

Conclusion: Based on the agreement scores, the steering group agreed on seven key findings to consider for pain management in patients with chronic back pain who are not candidates for spine surgery. These findings are opinion-based and are meant to be a starting point to help identify appropriate patients who may benefit from SCS therapy and when an evaluation for SCS candidacy should be considered.