{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:37:17Z","timestamp":1786361837953,"version":"build-2736575974"},"reference-count":43,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,7,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study evaluated the predictive value of pain outcomes reported during spinal cord stimulation (SCS) trialing for short-term, intermediate-term, and long-term post-implantation pain relief, and whether baseline patient characteristics modify these relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review identified 124 patients who underwent SCS trial and implantation between 2015 and 2022 with a minimum of 6-months follow-up. Pain outcomes included numeric rating scale pain score (NRS), patient-reported percent pain relief (PR-PPR), and calculated percent pain relief (C-PPR) post-trial and at short-term (ST) 1\u20136 months (&gt;1 to \u22646 months), intermediate term (IT) 6\u201315 months (&gt;6 to \u226415 months), long-term (LT) 15\u201324 months (&gt;15 to \u226424 months), and extended long-term (ELT) 24\u201336 months (&gt;24 to \u226436 months) post-implantation. Univariable linear and logistic regression assessed predictive value, while Bland-Altman analysis and Lin\u2019s concordance correlation coefficient (CCC) evaluated agreement between PR-PPR and C-PPR. Interaction modeling assessed effect modification of baseline covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients experienced significant pain reduction following trial (\u2206NRS 4.7; 95%\u2009CI 4.3 to 5.2), with sustained, but attenuating, benefit through 36 months. \u2206NRS demonstrated the strongest predictive value (peak R\u00b2=0.32 at 15\u201324 months), though overall explanatory power was modest. In adjusted models, post-trial NRS was the strongest predictor of achieving \u226550% long-term pain relief (OR 0.70, p=0.002). Bland-Altman analysis showed a mean difference of 10\u2009percentage points between PR-PPR and C-PPR (95% limits of agreement \u221236% to +56%) with poor overall agreement (CCC=0.36). Greater than 50% PR-PPR was maintained in 81.5% at 1\u20136 months and 70.2% at 24\u201336 months, with no significant differences between high and moderate trial responders. Covariate interaction modeling did not identify any consistent patient-specific modifiers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Trial-phase pain metrics demonstrated limited utility in explaining short, intermediate, and long-term pain relief. NRS-based measures showed the most consistent predictive value, while disagreement between PR-PPR and C-PPR raises concerns regarding the reproducibility of percentage-based metrics. These findings emphasize the need for refinement of reliable SCS trial predictors for post-implant pain relief outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-108028","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:25:11Z","timestamp":1786361111000},"page":"rapm-2026-108028","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Limited predictive utility of spinal cord stimulation trial pain metrics for post-implant outcomes"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1410-7605","authenticated-orcid":false,"given":"Alexander David","family":"Keith","sequence":"first","affiliation":[{"name":"College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA"},{"name":"Department of Biology, Washington & Jefferson College, Washington, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S","family":"Kilgore","sequence":"additional","affiliation":[{"name":"Department of Biology, Washington & Jefferson College, Washington, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2147-3523","authenticated-orcid":false,"given":"David Anthony","family":"Provenzano","sequence":"additional","affiliation":[{"name":"Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"2026081004250584000_rapm-2026-108028v1.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34347"},{"key":"2026081004250584000_rapm-2026-108028v1.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"2026081004250584000_rapm-2026-108028v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2014.08.031"},{"key":"2026081004250584000_rapm-2026-108028v1.4","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12024"},{"key":"2026081004250584000_rapm-2026-108028v1.5","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1093\/pm\/pnz185","article-title":"Spinal cord stimulation vs conventional therapies for the treatment of chronic low back and leg pain: A systematic review of health care resource utilization and outcomes in the last decade","volume":"20","author":"Odonkor","year":"2019","journal-title":"Pain Med"},{"key":"2026081004250584000_rapm-2026-108028v1.6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1001\/jamaneurol.2022.4166","article-title":"Long-term outcomes in use of opioids, nonpharmacologic pain interventions, and total costs of spinal cord stimulators compared with conventional medical therapy for chronic pain","volume":"80","author":"Dhruva","year":"2023","journal-title":"JAMA Neurol"},{"key":"2026081004250584000_rapm-2026-108028v1.7","first-page":"293","article-title":"Spinal cord stimulation trends of utilization and expenditures in fee-for-service (FFS) Medicare population from 2009 to 2018","volume":"24","author":"Manchikanti","year":"2021","journal-title":"Pain Physician"},{"key":"2026081004250584000_rapm-2026-108028v1.8","unstructured":"Centers for Medicare & Medicaid Services . 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