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Background: In recent years, delayed elective care and growing waiting lists increasingly resulted in postponed surgeries for patients with chronic back and leg pain., Objective: To develop, implement, and evaluate the feasibility of a triage tool for patients with chronic back and/or leg pain to identify those eligible for referral to spinal cord stimulation (SCS) consultation., Methods: A triage tool was developed, based on Dutch SCS guidelines, literature review and expert panel consultation. The triage process was detected and implemented in collaboration with a multidisciplinary team, prior to first orthopaedic consultation. Feasibility, reliability and predictive accuracy were analysed as part of the evaluation of the triage tool., Results: The triage indicators included: Pain location (leg/mixed), DN4 > 3, pain duration ≥ 3 months, leg pain ≥ back pain and NPRS leg pain ≥ 5. The triage tool was applied on patients on the orthopaedic waiting list, followed by a full orthopaedic review if they were not excluded. A total of 1025 orthopaedic patients with chronic back and leg pain were assessed with the triage tool. The triage tool was evaluated as feasible (mean System Usability Score 74.2 [SD 11.5]), reliable (inter-rater reliability [Fleiss' Kappa 0.79], intra-rater reliability [Cohen's Kappa 0.89]) and accurate (sensitivity [100%], specificity [98.8%], positive predictive value [40%] and negative predictive value [100%])., Conclusion: Early triage of potential SCS candidates potentially supports rapid and appropriate care allocation, shortens waiting list time and improves clinical outcomes. Future research should explore strategies to optimise the tool's performance in identifying patients most likely to benefit from SCS therapy., Significance: A novel triage tool was developed to identify patients with chronic back and leg pain for an early referral to SCS. This tool, evaluated for feasibility, reliability, and predictive accuracy, shows promise in reducing waiting times and improving patient selection. It can be a prelude to the further development of decision support for SCS and an acceleration in the care process for SCS candidates., (© 2025 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background: Virtual reality (VR) is a promising tool in a multimodal analgesic approach; however, evidence regarding virtual reality for postsurgical pain is limited. This study investigates the initial effectiveness and feasibility of self-administered virtual reality in postsurgical pain management., Methods: Patients reporting a postsurgical pain score ≥4 were randomized for control or VR, stratified for 3 interventions with varying levels of immersion and interaction. Subjects were instructed to use virtual reality as add-on treatment at least 3 times a day for 10 minutes on days 2 till 4 postoperatively. Primary outcome was the mean daily pain intensity. Results of pain scores were related to patient and intervention characteristics, to explore which characteristics interact with virtual reality effects. Secondary outcomes were analgesic use, anxiety, stress, and feasibility., Results: One hundred patients were included in the analyses: 37 in the control group and 63 for VR. VR did not demonstrate a significant effect on self-reported pain scores (P = .43), nor were specific patient or intervention characteristics associated with greater VR effects. Analgesic usage did not differ between groups. However, there was a trend toward greater cumulative percentages of patients achieving a 30% pain reduction, and significantly lower daily experienced stress (P = .01) and anxiety (P = .03) levels in VR intervention groups. VR was used less than prescribed, mainly because of illness and pain. Adverse events included disorientation, nausea, and fatigue., Conclusions: This explorative study did not demonstrate initial effectiveness of VR as add-on pain treatment regarding pain and analgesic use; however, VR positively affected stress and anxiety. VR is safe and suitable for a wide target audience, and feasibility differed between interventions. Personalizing and improving VR technology may enhance its effectiveness., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Spinal cord stimulation (SCS) is a recommended therapy to treat failed back surgery syndrome (FBSS). A trial period is practiced to enhance patient selection. However, its fundamental evidence is limited, especially concerning long-term benefit and therapy safety. We compared the long-term (5.3 ± 4.0 years) clinical outcome and therapy safety of a trialed and nontrialed implantation strategy, including multidimensional variables and pain intensity fluctuations over time. A multicenter cohort analysis was performed in 2 comparable groups of FBSS patients. Regarding eligibility, patients had to be treated with SCS for at least 3 months. While the Trial group comprised patients who underwent an SCS implantation after a successful trial, the No-Trial group encompassed patients who underwent complete implantation within 1 session. The primary outcome measures were pain intensity scores and complications. The Trial and No-Trial groups consisted of 194 and 376 patients (N = 570), respectively. A statistically but not clinically significant difference in pain intensity (P = .003; effect = 0.506 (.172-.839)) was found in favor of the Trial group. No interaction between a time dependency effect and pain intensity was noted. Whereas trialed SCS patients were more likely to cease opioid usage (P = .003; OR = .509 (.326-.792)), patients in the No-Trial group endured fewer infections (P = .006; proportion difference = .43 (.007-.083)). Although the clinical relevance of our findings should be proven in future studies, this long-term real-world data study indicates that patient-centered assessments on whether an SCS trial should be performed have to be investigated. According to the current ambiguous evidence, SCS trials should be considered on a case-by-case basis. PERSPECTIVE: The currently available comparative evidence, together with our results, remains ambiguous on which SCS implantation strategy might be deemed superior. An SCS trial should be considered on a case-by-case basis, for which further investigation of its clinical utility in certain patient populations or character traits is warranted., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)