![]() Spinal cord stimulation delivers electricity to spinal nerves to suppress pain signals. Spinal cord stimulation can be used independently or delivered as a component of a multimodal pain management program. As well, people would not be considered for SCS if they were candidates for surgery to correct spinal pathology. In such cases, SCS is used as a last resort or “rescue” option. 17– 19 Spinal cord stimulation is typically recommended after medical management and/or physical and behavioral interventions have been unsuccessful. ![]() Nonsurgical interventions are used to manage chronic pain, including physical and behavioural interventions (e.g., mindfulness-based stress reduction) and medications (called medical management e.g., anti-inflammatories, muscle relaxants, gabapentinoids, antidepressants, and opioids). 5– 7 Chronic pain also negatively affects people's physical, emotional, social, and mental health. Chronic pain is a costly disease for patients and the health care system it has a great impact on the lives of patients and their families, including on their relationships, lifestyles, and occupations. 4Ĭhronic pain may result from injury, infection, disease, or surgery-and some chronic pain may have no apparent cause. 3 However, prevalence estimates are greatly affected by sampling methods, measurement, and definitions. 1 Incidence rates for chronic pain based on the Canadian National Population Health Survey results for chronic pain were 6.0% to 8.7% for women and 4.8% to 6.1% for men. 2 Chronic pain is highly prevalent: 11% to 44% of Canadian adults experience it. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” 1 Pain is considered to be chronic when episodes last over prolonged periods, usually longer than 3 or 6 months after an initial episode. Their direct knowledge of different pain therapies allowed them to provide context and comparisons when they discussed the impact of SCS on their chronic pain. The people we spoke with who had chronic noncancer pain reported that their pain had a substantial negative impact on their activities and emotional well-being. ![]() However, if the province outsourced this therapy using the Senza HF10 SCS system, the total 5-year budget impact would be about $8.76 million. Publicly funding 10-kHz high-frequency SCS (using the Freedom SCS system) in Ontario over the next 5 years would lead to a total net cost savings of $0.73 million (ranging from about $0.10 million in year 1 to about $0.21 million in year 5). Owing to limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who have first tried and failed SCS at lower frequencies (up to 1.2 kHz), we did not conduct a cost-effectiveness analysis comparing this pathway of care and 10-kHz high-frequency SCS for Ontario. ![]() The two included economic evaluations found that 10-kHz high-frequency SCS was cost-saving compared with conventional SCS, but neither was applicable to the Ontario context. ![]() As well, patients may reduce their opioid consumption with 10-kHz high-frequency SCS (GRADE: Low). Overall, 10-kHz high-frequency SCS likely provides reductions in pain intensity and functional disability, and improvements in quality of life in people with chronic noncancer pain (GRADE: Moderate). We included 5 studies (7 publications) in the clinical evidence review. ![]()
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