German National Guidelines for Epidural Spinal Cord Stimulation for the Treatment of Chronic Pain

Epidural spinal cord stimulation (SCS) or dorsal root ganglion stimulation (DRG-S) is a neuromodulatory, reversible interventional procedure for patients with pain who cannot be adequately treated with conservative and less invasive means. This review provides the recently updated German recommendations for SCS and DRG-S, followed by a standardized diagnostic and therapeutic procedure. The purpose of this work is to present the current evidence-based results of SCS, including DRG-S, for various neuropathic and nonneuropathic pain conditions. Moreover, it aims to optimize the treatment of patients with chronic pain for whom neuromodulation can be a component in the treatment concept of multimodal pain therapy. A systematic literature search was conducted based on a Cochrane analysis, followed by search strategies in the common data bases (PubMed, Medline, and Embase). The relevant literature was reviewed and discussed within working groups. Finally, evaluation of evidence and identification of recommendations was performed by members of the guideline commission comprising representatives of relevant medical societies in Germany. The first German guideline on SCS was published in April 2013. Any guideline has only limited validity (eg, in Germany, guidelines are valid for a maximum of five years). Owing to the numerous publications in this field, an update had become mandatory. On the basis of literature from 2013 to 2018, indications were newly identified or reevaluated. In addition, new methods were discussed, and predictors for treatment success were defined as part of the psychologic assessment. Neuromodulation, especially SCS, is based on the systematic study of treatment data. Real-world data are indispensable. Particularly in the current situation, in which fundamental questions about the value of SCS are being publicly discussed, sometimes in nonscientific media, it is essential to publish systematic guidelines, on both a national and international level.