Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Development of the Practice Parameters

  • Review publications on the development of practice parameters (and guidelines) as well as publications purporting to present them for SCS.
  • Consult with experts to identify the appropriate clinical practice questions (this will include delineating the points in patient care where the information will be useful for individualizing treatment).
  • Review the literature to identify and grade treatment practices on a continuum from “options” to “recommended.”
  • Determine search strategy (exclusion/inclusion criteria, languages, dates, databases, search terms, and sources, including specialty journals, e.g., Neuromodulation: Technology at the Neural Interface, and additional articles included in reference lists and from expert knowledge).
  • Conduct a literature search using the following strategy:
    • Databases:  MEDLINE, EMBASE
    • Additional publications:  specialty journals (e.g., Neuromodulation: Technology at the Neural Interface), books, articles included in reference lists and gleaned from expert knowledge
    • Inclusion criteria:  All Western European language publications from 1967 through March 2007 (Note: updates will be added to website)
    • Exclusion criteria:  reviews, meta-analyses
    • Search terms (used with appropriate delineators):  spinal cord stimulation, dorsal column stimulation, electrical stimulation
  • Consult with experts about accepted practice based on direct experience or the translation of experience from other disciplines. (Note:  this activity, along with presentation of the reports in the literature, will be considered pre-testing (piloting) of the recommendations and options presented).
  • Identify, summarize, and appraise the evidence supporting each option.
  • Write the first draft - completion date April 1, 2006.
  • Review the first draft (committee) - initial review period April 1-May 1, 2006.
  • Reach consensus and resolve any substantive content differences through frank discussion and debate.  Suggestions for minor changes (e.g. in terminology) will be filtered through the Editor and adopted at his discretion.
  • Identify societies and individuals involved in the development process, including those involved in the external review (include in final draft).
  • Identify any conflicts of interest (actual, potential, or potentially perceived) on the part of any group member and the sources of funding, support or sponsorship for preparation of this document (include in final draft).
  • Integrate comments into second draft (completion date May 31, 2006).
  • Integrate comments into third draft (completion date September 11, 2006).
  • Integrate comments into fourth draft (completion date November 15, 2006).
  • Determine process for external review. Chose and contact external reviewers.
  • Send final draft to committee and external reviewers for comment.
  • Create three versions of the final document:  1) a complete version that includes findings as well as details about the document development process, the evidence, the bibliography, and the recommendation continuum; 2) a version that can be read quickly and includes only the recommendation continuum; and 3) a version written in language suitable for the public.
  • Gain final approval.
  • Determine the review/update timing and process because guidelines are “never complete, always imperfect, and continually challenged . . . by new scientific investigation,” (Haines SJ, 2002).
  • Disseminate to target publication, e.g., Pain Medicine and comprehensive guideline sites, such as
  • Reconfigure print version as appropriate to publish on a stand-alone website.

Haines, SJ Comments [editorial]. Neurosurgery 50(3):Siv-Sv, 2002.