Understanding the Role of Patient Preference in the Treatment Algorithm for Chronic Low Back Pain: Results from a Survey-Based Study

Abstract

Aims: Interventional pain treatments range from injections to established radiofrequency ablation techniques and finally neuromodulation. In addition to safety, efficacy and cost dominance, patient preference for type of treatment is important. Methods: Chronic pain patients (n = 129) completed a preference scale to determine which interventional pain management procedures they would prefer from among radiofrequency ablation, temporary (60-day) peripheral nerve stimulation (PNS), conventional PNS and spinal cord stimulation/dorsal root ganglion stimulation. A second survey (n = 347) specific to assessing the preference for radiofrequency ablation or temporary PNS treatment was completed by patients with low back pain. Results: On the basis of mean rank, temporary PNS percutaneously implanted for up to 60 days was the most preferred treatment compared with the other options presented (p = 0.002). Conclusions: Patient preference should be unbiased and considered as an independent variable for physician discussion in treatment options and future research.

Lay abstract

Patient preference is an important variable for physicians to consider when discussing treatment options for low back pain. A consumer survey study was completed discussing patient preference among various invasive treatments for low back pain. When given scenarios discussing risks and benefits of each procedure (temporary peripheral nerve stimulation for 60 days, heat ablation of small back nerves and permanently implanted back pain devices) temporary peripheral nerve stimulation was considered the preferred option.

Keywords::

• back pain
• chronic back pain
• low back pain
• patient preference
• peripheral nerve stimulation
• radiofrequency ablation
• spinal cord stimulation

Author contributions

P Staats and A Gulati had primary responsibility for writing this manuscript. E Ottestad, D Spinner and M Erdek had significant contributions in editing and interpreting the data in the manuscript. T Deer designed, executed and analyzed the data for the study

Financial & competing interests disclosure

This work was conducted at SPR Therapeutics, OH, USA, and this study was supported by a grant from SPR Therapeutics. This study was funded by SPR Therapeutics, Inc. P Staats serves as a consultant to electroCore, Medtronic, Nalu, Saluda and SPR Therapeutics. A Gulati is a consultant for Flowonix, Medtronic, Nalu, SPR Therapeutics and Bausch Health and serves on the advisory board for AIS. E Ottestad serves as a consultant to Bioness, Ipsen, Nine Continents, SPR Therapeutics and Tulavi. T Deer serves as consultant to Abbott, Axonics, Boston Scientific, Cornerloc, Medtronic, Nalu, Nevro, Saluda and SPR Therapeutics. Funded research: Abbott, Avanos, Boston Scientific, Saluda and SPR Therapeutics. D Spinner is a consultant for Bioness, SPR Therapeutics and Nalu Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Institutional review board disclosure

This study was determined to be exempt from institutional review board approval per 45 CFR 46.101(b) (Categories of Exempt Human Subjects Research) based on its use of anonymized survey procedures [22]. A medical ethicist reviewed and constructed the questions to minimize the internal bias in the questions that were presented to the participants.

Additional information

Funding

This work was conducted at SPR Therapeutics, OH, USA, and this study was supported by a grant from SPR Therapeutics. This study was funded by SPR Therapeutics, Inc. P Staats serves as a consultant to electroCore, Medtronic, Nalu, Saluda and SPR Therapeutics. A Gulati is a consultant for Flowonix, Medtronic, Nalu, SPR Therapeutics and Bausch Health and serves on the advisory board for AIS. E Ottestad serves as a consultant to Bioness, Ipsen, Nine Continents, SPR Therapeutics and Tulavi. T Deer serves as consultant to Abbott, Axonics, Boston Scientific, Cornerloc, Medtronic, Nalu, Nevro, Saluda and SPR Therapeutics. Funded research: Abbott, Avanos, Boston Scientific, Saluda and SPR Therapeutics. D Spinner is a consultant for Bioness, SPR Therapeutics and Nalu Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.