The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

Volker M. Tronnier; Sam Eldabe; Jörg Franke; Frank Huygen; Philippe Rigoard; Javier de Andres Ares; Richard Assaker; Alejandro Gomez-Rice; Marco La Grua; Maarten Moens; Lieven Moke; Christophe Perruchoud; Nasir A. Quraishi; Dominique A. Rothenfluh; Pedram Tabatabaei; Koen Van Boxem; Carmen Vleggeert-Lankamp; Björn Zoëga; Herman J. Stoevelaar

doi:10.1007/s00586-018-5711-0

The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

Volker M. Tronnier, Sam Eldabe, Jörg Franke, Frank Huygen, Philippe Rigoard, Javier de Andres Ares, Richard Assaker, Alejandro Gomez-Rice, Marco La Grua, Maarten Moens, Lieven Moke, Christophe Perruchoud, Nasir A. Quraishi, Dominique A. Rothenfluh, Pedram Tabatabaei, Koen Van Boxem, Carmen Vleggeert-Lankamp, Björn Zoëga, Herman J. Stoevelaar^*

^*Corresponding author for this work

Clinic of Neurosurgery

7 Citations (Scopus)

Abstract

Purpose: Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS. Methods: Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios. These scenarios were unique combinations of patient characteristics considered relevant to treatment choice. Appropriateness had to be expressed on a 9-point scale (1 = extremely inappropriate, 9 = extremely appropriate). A treatment was considered appropriate if the median score was ≥ 7 in the absence of disagreement (≥ 1/3 of ratings in each of the opposite sections 1–3 and 7–9). Results: Appropriateness outcomes showed clear and specific patterns. In 48% of the scenarios, exclusively one of the 4 treatments was appropriate. Conservative treatment was usually considered appropriate for patients without clear anatomic abnormalities and for those with new pain differing from the original symptoms. Neurostimulation was considered appropriate in the case of (predominant) neuropathic leg pain in the absence of conditions that may require surgical intervention. Re-operation could be considered for patients with recurrent disc, spinal/foraminal stenosis, or spinal instability. Conclusions: Using the RUAM, an international multidisciplinary panel established criteria for appropriate treatment choice in patients with PPSS. These may be helpful to educate physicians and to improve consistency and quality of care. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

Original language	English
Journal	European Spine Journal
Volume	28
Issue number	1
Pages (from-to)	31-45
Number of pages	15
ISSN	0940-6719
DOIs	https://doi.org/10.1007/s00586-018-5711-0
Publication status	Published - 25.01.2019

Funding

Conflict of interest Panellists were financially compensated for their time and reimbursed for travel and hotel costs by the funder. Other COI declarations: VT has received consulting fees from Medtronic and EISAI in the form of honoraria for lectures or attendances at advisory boards/steering committees over the last 5 years. His Department has received research funding from Deutsche Forschungsgemein-schaft, Bundesministerium für Bildung und Forschung, Kreitzstiftung, Medtronic Europe, and Abbott over the last 5 years. SE has received consulting fees from Medtronic, Boston Scientific, Abbott, Mainstay Medical and Saluda Medical in the form of honoraria for lectures or attendances at advisory boards/steering committees over the last 5 years. His Department has received research funding from the National Institute of Health Research UK, Medtronic Europe, and Nevro. JF has received consultancy fees/honoraria from Medronic, Medacta, Relievant, Zimmer, Paradigm, Baxter, Globus medical, EOs Imaging, EItgeistlich and Safe Orthopedics, royalties from Medacta, OHST and Medtronic, and research grants from Medtronic, Relievant, Baxter, Zimmer, Geistlich, Eos Imaging and Paradigm Spine. FH has received honoraria as a consultant for ABBOTT, Medtronic and Grunenthal. PR has received grants and personal fees from Medtronic, Abbott and Boston Sci. RA has received honoraria for lectures/courses from Medtron-ic and DePuy Synthes, royalties from Medtronic, and advisory board honoraria from SpineGuard. AG-R has received honoraria for lectures/ courses from Medtronic and Stryker. MM has received speaker fees and independent research grants from Medtronic and Nevro. LM received consultancy fees from Medtronic. His institute received fellowship grants from Medtronic and Spinevision, research grants from Research Foundation Flanders (FWO), KU Leuven C2 grant and KU Leuven Medtronic Educational Chair. CP is consultant for Medtronic. PT holds consultant agreements with Medtronic and Abbott. HJS has received honoraria from Medtronic for advice to the design of the study and data analysis. MLG, JAA, NQ, DR, KVB, CVL, and BZ declare that they have no other conflict of interest. The study was funded by Medtronic International Trading

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Tronnier, V. M., Eldabe, S., Franke, J., Huygen, F., Rigoard, P., de Andres Ares, J., Assaker, R., Gomez-Rice, A., La Grua, M., Moens, M., Moke, L., Perruchoud, C., Quraishi, N. A., Rothenfluh, D. A., Tabatabaei, P., Van Boxem, K., Vleggeert-Lankamp, C., Zoëga, B., & Stoevelaar, H. J. (2019). The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method. European Spine Journal, 28(1), 31-45. https://doi.org/10.1007/s00586-018-5711-0

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title = "The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method",

abstract = "Purpose: Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS. Methods: Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios. These scenarios were unique combinations of patient characteristics considered relevant to treatment choice. Appropriateness had to be expressed on a 9-point scale (1 = extremely inappropriate, 9 = extremely appropriate). A treatment was considered appropriate if the median score was ≥ 7 in the absence of disagreement (≥ 1/3 of ratings in each of the opposite sections 1–3 and 7–9). Results: Appropriateness outcomes showed clear and specific patterns. In 48\% of the scenarios, exclusively one of the 4 treatments was appropriate. Conservative treatment was usually considered appropriate for patients without clear anatomic abnormalities and for those with new pain differing from the original symptoms. Neurostimulation was considered appropriate in the case of (predominant) neuropathic leg pain in the absence of conditions that may require surgical intervention. Re-operation could be considered for patients with recurrent disc, spinal/foraminal stenosis, or spinal instability. Conclusions: Using the RUAM, an international multidisciplinary panel established criteria for appropriate treatment choice in patients with PPSS. These may be helpful to educate physicians and to improve consistency and quality of care. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].",

author = "Tronnier, \{Volker M.\} and Sam Eldabe and J{\"o}rg Franke and Frank Huygen and Philippe Rigoard and \{de Andres Ares\}, Javier and Richard Assaker and Alejandro Gomez-Rice and \{La Grua\}, Marco and Maarten Moens and Lieven Moke and Christophe Perruchoud and Quraishi, \{Nasir A.\} and Rothenfluh, \{Dominique A.\} and Pedram Tabatabaei and \{Van Boxem\}, Koen and Carmen Vleggeert-Lankamp and Bj{\"o}rn Zo{\"e}ga and Stoevelaar, \{Herman J.\}",

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year = "2019",

month = jan,

day = "25",

doi = "10.1007/s00586-018-5711-0",

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Tronnier, VM, Eldabe, S, Franke, J, Huygen, F, Rigoard, P, de Andres Ares, J, Assaker, R, Gomez-Rice, A, La Grua, M, Moens, M, Moke, L, Perruchoud, C, Quraishi, NA, Rothenfluh, DA, Tabatabaei, P, Van Boxem, K, Vleggeert-Lankamp, C, Zoëga, B & Stoevelaar, HJ 2019, 'The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method', European Spine Journal, vol. 28, no. 1, pp. 31-45. https://doi.org/10.1007/s00586-018-5711-0

TY - JOUR

T1 - The appropriate management of persisting pain after spine surgery

T2 - a European panel study with recommendations based on the RAND/UCLA method

AU - Tronnier, Volker M.

AU - Eldabe, Sam

AU - Franke, Jörg

AU - Huygen, Frank

AU - Rigoard, Philippe

AU - de Andres Ares, Javier

AU - Assaker, Richard

AU - Gomez-Rice, Alejandro

AU - La Grua, Marco

AU - Moens, Maarten

AU - Moke, Lieven

AU - Perruchoud, Christophe

AU - Quraishi, Nasir A.

AU - Rothenfluh, Dominique A.

AU - Tabatabaei, Pedram

AU - Van Boxem, Koen

AU - Vleggeert-Lankamp, Carmen

AU - Zoëga, Björn

AU - Stoevelaar, Herman J.

PY - 2019/1/25

Y1 - 2019/1/25

N2 - Purpose: Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS. Methods: Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios. These scenarios were unique combinations of patient characteristics considered relevant to treatment choice. Appropriateness had to be expressed on a 9-point scale (1 = extremely inappropriate, 9 = extremely appropriate). A treatment was considered appropriate if the median score was ≥ 7 in the absence of disagreement (≥ 1/3 of ratings in each of the opposite sections 1–3 and 7–9). Results: Appropriateness outcomes showed clear and specific patterns. In 48% of the scenarios, exclusively one of the 4 treatments was appropriate. Conservative treatment was usually considered appropriate for patients without clear anatomic abnormalities and for those with new pain differing from the original symptoms. Neurostimulation was considered appropriate in the case of (predominant) neuropathic leg pain in the absence of conditions that may require surgical intervention. Re-operation could be considered for patients with recurrent disc, spinal/foraminal stenosis, or spinal instability. Conclusions: Using the RUAM, an international multidisciplinary panel established criteria for appropriate treatment choice in patients with PPSS. These may be helpful to educate physicians and to improve consistency and quality of care. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

AB - Purpose: Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS. Methods: Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios. These scenarios were unique combinations of patient characteristics considered relevant to treatment choice. Appropriateness had to be expressed on a 9-point scale (1 = extremely inappropriate, 9 = extremely appropriate). A treatment was considered appropriate if the median score was ≥ 7 in the absence of disagreement (≥ 1/3 of ratings in each of the opposite sections 1–3 and 7–9). Results: Appropriateness outcomes showed clear and specific patterns. In 48% of the scenarios, exclusively one of the 4 treatments was appropriate. Conservative treatment was usually considered appropriate for patients without clear anatomic abnormalities and for those with new pain differing from the original symptoms. Neurostimulation was considered appropriate in the case of (predominant) neuropathic leg pain in the absence of conditions that may require surgical intervention. Re-operation could be considered for patients with recurrent disc, spinal/foraminal stenosis, or spinal instability. Conclusions: Using the RUAM, an international multidisciplinary panel established criteria for appropriate treatment choice in patients with PPSS. These may be helpful to educate physicians and to improve consistency and quality of care. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

UR - https://www.scopus.com/pages/publications/85051560254

U2 - 10.1007/s00586-018-5711-0

DO - 10.1007/s00586-018-5711-0

M3 - Journal articles

C2 - 30078053

AN - SCOPUS:85051560254

SN - 0940-6719

VL - 28

SP - 31

EP - 45

JO - European Spine Journal

JF - European Spine Journal

IS - 1

ER -

The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

Abstract

Funding

UN SDGs

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