title: Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy.
abstract: BACKGROUND
  Spinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach.
  
  
  METHODS
  We reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care.
  
  
  CONCLUSIONS
  Based on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.
authors: Department of Anesthesiology, University of California San Francisco, San Francisco, CA, USA.
authors: Lawrence
authors: L
authors: Poree
authors: Elliot
authors: E
authors: Krames
authors: Jason
authors: J
authors: Pope
authors: Timothy R
authors: TR
authors: Deer
authors: Robert
authors: R
authors: Levy
authors: Louise
authors: L
authors: Schultz
mesh_terms: D000465:Algorithms; D020918:Complex Regional Pain Syndromes / Q000191:economics / Q000453:epidemiology / Q000266:history / Q000628:therapy*; D003362:Cost-Benefit Analysis; D006294:Health Resorts / Q000191:economics; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D062187:Spinal Cord Stimulation / Q000191:economics / Q000266:history / Q000379:methods*