title: Using the SAFE principles when evaluating electrical stimulation therapies for the pain of failed back surgery syndrome.
abstract: OBJECTIVE
  In this paper we review the literature on failed back surgery syndrome (FBSS) and use principles of Safety, Appropriateness, Fiscal Neutrality, and Effectiveness (SAFE) to determine the appropriate place for spinal cord stimulation (SCS) for the treatment of FBSS.
  
  
  RESULTS
  We analyzed the most recent literature regarding treatments of pain due to FBSS and used the SAFE principles to reprioritize pain treatments, particularly electrical stimulation therapies, for FBSS in a more appropriate, relevant, and up to date continuum of care.
  
  
  CONCLUSIONS
  Based on this review and analysis of the safety, appropriateness, cost-effectiveness, and efficacy of treatments for the pain of FBSS, relegating SCS to a last resort therapy is no longer justifiable. SCS should be considered before submitting a patient to either long-term systemic opioid therapy or repeat spinal surgery for chronic pain resulting from FBSS.
authors: Pacific Pain Treatment Centers, San Francisco, California, USA. krames118@gmail.com
authors: Elliot S
authors: ES
authors: Krames
authors: Sayed
authors: S
authors: Monis
authors: Lawrence
authors: L
authors: Poree
authors: Timothy
authors: T
authors: Deer
authors: Robert
authors: R
authors: Levy
mesh_terms: D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000191:economics; D055111:Failed Back Surgery Syndrome / Q000628:therapy*; D006801:Humans